Irisin and Volume Overload are Associated with Protein Energy Wasting in Peritoneal Dialysis Patients.

BACKGROUND/AIMS: Protein energy wasting (PEW) is a common medical phenomenon that is observed in maintenance dialysis patients. PEW also increases morbidity and mortality of these patients. Its pathogenesis is unclear. We hypothesize that serum irisin levels and volume overload may induce PEW in peritoneal dialysis (PD) patients. The aim of this study is to measure serum irisin levels, evaluate volume status of PD patients, and study their correlations with PEW in PD patients. METHODS: This study is a cross-sectional study with 160 PD patients from the PD center of Peking University Third Hospital and 35 healthy control subjects. PD patients were divided into PEW group and non-PEW group according to PEW diagnosis criteria. Serum irisin concentrations were measured by ELISA. Volume overload status (volume overload is defined as overhydration value ≥2 liters) of PD patients was analyzed by bioelectrical impedance. RESULTS: The serum irisin levels were significantly lower in PD patients compared with those of the controls (113.2±11.8 ng/ml vs. 464.2±37.4 ng/ml, P<0.01). The serum irisin levels were lower in PD patients with PEW than those of the patients without PEW (106.5±15.2 ng/ml vs. 117.4±17.6 ng/ml, P<0.01). PEW is more prevalent in patients with volume overload than patients without volume overload (62.5% vs. 43.1%, x2=5.756, P=0.016); however, no direct relationship was found between irisin levels and volume overload status. The independent influencing factors of PEW were serum irisin, serum albumin, and volume overload. CONCLUSION: Our results are the first to provide clinical evidence of the association between serum irisin, volume overload, and PEW in PD patients. PEW may inhibit the release or synthesis of irisin from skeletal muscles, and volume overload may aggravate PEW in PD patients.

[Analysis of clinical state for arteriosclerosis obliterans in lower extremity of diabetic patients on peritoneal dialysis].

OBJECTIVE: To investigate the prevalence of arteriosclerosis obliterans in lower extremity and its influence factors in diabetic patients on peritoneal dialysis. METHOD: In this single center cross-sectional study, 74 with diabetic patients on peritoneal dialysis were recruited. The general information, dialysis program, laboratory examination and dialysis adequacy test results were recorded.Their symptoms and signs of arteriosclerosis obliterans in lower extremities were investigated and ankle brachial index (ABI) was determined. RESULT: In this study,70.3% of the patients had different degrees of symptoms and signs of arteriosclerosis obliterans in lower extremity. With Fortaine classification, 13.5% of the patients were in early lesions phase, 28.8% in local ischemic phase, 51.9% in nutritional disturbance phase, and 5.8% in gangrene phase. The patients were divided into three groups base on Fontaine classification: control group (no symptoms), mild group(early lesions phase and local ischemic phase) and severe group(nutritional disturbance phase and gangrene phase). There was a significant difference between the insulin dose, left foot ABI levels, plasma albumin levels and total Kt/V levels among the three groups (P<0.05). The plasma albumin levels and insulin doses were independent factors associated with arteriosclerosis obliterans in lower extremity (P<0.05). CONCLUSION: In diabetic patients on peritoneal dialysis, there is a high prevalence of arteriosclerosis obliterans in lower extremity, which is related to high insulin dosage and low serum albumin levels.

Implementing continuous quality improvement process in potassium management in peritoneal dialysis patients.

BACKGROUND: Abnormal plasma potassium levels are not uncommon in peritoneal dialysis (PD) patients. Here, we implemented a continuous quality improvement (CQI) approach that mainly focused on dietary management to improve potassium control in PD patients. METHODS: All clinically stable patients who visited the PD clinic monthly were included in this study. A CQI team that included nephrologists, primary nurses, dietician, patients, and their family members was organized, and it monitored patients for 6 months. Patients were asked to provide their dialysis records and 3-day dietary records at each visit. Dialysis adequacy, including potassium and phosphorus removals, was checked before and after the implementation of CQI. Changes in dietary prescription, without altering dialysis prescriptions and potassium supplementation, were made monthly, according to patients' dietary information and blood potassium levels. RESULTS: In total, 84 patients (28 male and 56 female) were included in this study. At baseline, the prevalence of hyperkalemia and hypokalemia was 14.3% each. After the intervention, the prevalence of hyperkalemia dropped to 10.7% and 6% at 3 months and 6 months, respectively. The prevalence of hypokalemia dropped to 8.3% and 7.1% at 3 months and 6 months, respectively. CONCLUSIONS: Our data suggest that implementing CQI, with a focus on dietary intervention, could significantly reduce the prevalence of potassium abnormality in PD patients.

Comparison of quality of life and causes of hospitalization between hemodialysis and peritoneal dialysis patients in China.

BACKGROUND: Hemodialysis (HD) and peritoneal dialysis (PD) are important renal replacement treatment in end stage renal disease (ESRD), but the comparison of quality of life (QOL) and causes of hospitalisation between the two modalities in China is lacking. In the present study, we compared the two modalities in a multi-center study. SUBJECTS AND METHODS: Six hundred and fifty four HD and 408 PD patients were investigated from 10 hospitals in China from Sept, 2004 to Jan, 2005. Among the HD patients, there were 360 males and 294 females with a mean age of 57.22 +/- 12.49 years (18-88 y). Among PD patients, there were 165 males and 243 females, with a mean age of 61.59 +/- 12.65 years (22-89 y). Health related 36 items short form questionnaires (SF-36) were used to assess the quality of life. Hospitalisation data were collected and analyzed. RESULTS: SF-36 domains of Body Pain (BP), General Health (GH), Role-Emotional (RE), Social Functioning (SF), Vitality (VT) and Mental Health (MH) were all significantly higher in the PD patients as compared to the HD patients although there was no significant difference in Physical Functioning (PF) and Role-Physical (RP) between the two groups. The two most common causes of hospitalisation in HD patients were cardiovascular disease (39.8%) and pulmonary infection (21.3%), while they were infectious peritonitis (47.6%) and cardiovascular disease (31.9%) in PD patients. The ever hospitalised patients had lower SF-36 scores in the domains of PF, BP, GH, RE, SF, VT and MH as compared to those of non-hospitalised patients. CONCLUSION: Our study indicated that with the current practice in China, PD patients may enjoy better quality of life than their HD counterparts. Our results also showed that the most common cause of hospitalisation was cardiovascular disease in HD patients and peritonitis in PD patients.