International peritoneal dialysis training practices and the risk of peritonitis.

BACKGROUND: The effects of training practices on outcomes of patients receiving peritoneal dialysis (PD) are poorly understood and there is a lack of evidence informing best training practices. This prospective cohort study aims to describe and compare international PD training practices and their association with peritonitis. METHODS: Adult patients on PD <3 months participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) were included. Training characteristics (including duration, location, nurse affiliation, modality, training of family members, use of individual/group training and use of written/oral competency assessments) were reported at patient and facility levels. The hazard ratio (HR) for time to first peritonitis was estimated using Cox models, adjusted for selected patient and facility case-mix variables. RESULTS: A total of 1376 PD patients from 120 facilities across seven countries were included. Training was most commonly performed at the facility (81%) by facility-affiliated nurses (87%) in a 1:1 setting (79%). In the UK, being trained by both facility and third-party nurses was associated with a reduced peritonitis risk [adjusted HR 0.31 (95% confidence interval 0.15-0.62) versus facility nurses only]. However, this training practice was utilized in only 5 of 14 UK facilities. No other training characteristics were convincingly associated with peritonitis risk. CONCLUSIONS: There was no evidence to support that peritonitis risk was associated with when, where, how or how long PD patients are trained.

Prognostic value of renal function in patients with cardiac resynchronization therapy.

BACKGROUND: Renal insufficiency is prevalent in patients with heart failure and indicates poor prognosis. We examine (i) the relationship between left ventricular (LV) reverse remodeling (RR) and renal function and (ii) the prognostic value of renal function in patients receiving cardiac resynchronization therapy (CRT). METHODS: The relationship between LV-RR, defined as a 10% reduction in LV end-systolic volume, and renal function was examined in 85 consecutive patients receiving CRT. Echocardiographic assessment and renal function tests were performed before and 3 months after CRT. All-cause mortality and the composite of mortality or heart failure hospitalization between those with preserved or deteriorated renal function at 3 months were assessed by Kaplan Meier analysis. RESULTS: There was a slight improvement in glomerular filtration rate (GFR) in those with LV-RR (n=44; 51.7+/-20.4 vs. 54.2+/-19.1 ml/min/1.73 m2; p=0.024) while a significant deterioration (n=41; 61.9+/-17 vs. 48.8+/-13.0 ml/min/1.73 m2; p<0.001) was observed in those without LV-RR. The change (Delta) in GFR was significantly correlated with DeltaLV end-systolic/diastolic volumes and DeltaLV ejection fraction. After follow up of 856.4+/-576.8 days, patients with preserved renal function had significant lower all-cause mortality (log rank chi2=4.82, p=0.029) and the composite endpoints (log rank chi2=5.04, p=0.025). CONCLUSION: Preservation of renal function was observed in patients with systolic heart failure and renal insufficiency responding to CRT and provided prognostic information. A rapid decline in renal function after CRT was associated with worse clinical outcomes.

Prevalence of sleep disturbances in Chinese patients with end stage renal failure on maintenance hemodialysis.

BACKGROUND: Sleep disorders, such as daytime sleepiness, insomnia, restless legs syndrome (RLS) and obstructive sleep apnea syndrome (OSAS) have been reported as prevalent among patients with end stage renal failure(ESRF). MATERIAL/METHODS: As there is little published data from Southeast Asia, a sleep questionnaire was administered to all patients (N=43, 27 males) on chronic hemodialysis (HD) at the Prince of Wales Hospital, Hong Kong, to assess their sleep complaints. RESULTS: The mean age was 49.5 +/- 11.3 years (mean I SD) with mean body mass index (BMI) of 22.6 +/- 3.6 kg/m2. Frequent awakenings and sleep onset insomnia were the most frequent complaints (79% each), while daytime sleepiness occurred in 74% of patients. Sleep maintenance insomnia and pruritus occurred in 64% and 60% of patients respectively. Symptoms of RLS were reported by 70% of patients. The prevalence of OSAS was estimated by the frequency of observed choking (4.7% of cases), witnessed apnea (14%), snoring and witnessed apnea (9.3%), disruptive snoring (14%), disruptive snoring and witnessed apnea (2.3%), extremely loud snoring (4.7%). CONCLUSIONS: Our questionnaire survey revealed a high prevalence of sleep complaints such as frequent awakenings, daytime sleepiness, insomnia and RLS in patients with ESRF on maintenance HD, but a relatively low prevalence of OSAS, which may be related to the low BMI of our ESRF patients.