Efficacy and safety of fluoroscopic manipulation using the alpha-replacer for peritoneal catheter malposition.

BACKGROUND: Catheter malposition is one of the reasons for outflow failure in peritoneal dialysis (PD) patients. Fluoroscopic manipulation is a non-surgical treatment option for catheter malposition. We retrospectively analyzed the efficacy and safety of fluoroscopic manipulation using an alpha-replacer guidewire. METHODS: The alpha-replacer (JMS Co. Ltd., Tokyo, Japan) is a guidewire for the treatment of catheter malposition. We used the alpha-replacer in 23 PD cases at our hospital from January 2008 to December 2012. We evaluated body mass index, time interval between catheter placement and malposition, and interval between catheter exteriorization and malposition. Primary failure was defined as malposition at the time of catheter exteriorization, and secondary failure as malposition after functional PD therapy (correct position at time of exteriorization). RESULTS: Successful catheter replacement rate using the alpha-replacer was 60.8 % (14 of 23 cases). This was similar to the rates in previous reports. Successful replacement was mostly observed in those with a long interval between catheter placement and malposition (p = 0.048), between catheter placement and exteriorization (p = 0.047) and with secondary failure (p = 0.030). In multivariate analysis, secondary failure cases had a higher rate of successful replacement than primary failure cases (odds ratio [OR] 7.33, p = 0.038). Serious complications, such as abdominal trauma or peritonitis, were not observed. CONCLUSION: Fluoroscopic manipulation using an alpha-replacer may be safe and effective for the management of peritoneal catheter malposition, particularly in patients who were under functional PD therapy until catheter malposition.

When should icodextrin be started to improve atherosclerosis in peritoneal dialysis patients?

Icodextrin-based peritoneal dialysis (PD) has many advantages over glucose-based PD. The present study aimed to investigate when icodextrin should be started for better management of cardiovascular status (as defined by echocardiography findings) and residual renal function (RRF). We retrospectively analyzed 40 patients treated with continuous ambulatory PD or automated PD. The patients were divided into these groups: Group A: started icodextrin within 2 weeks after PD onset. Group B: started icodextrin 1 year after PD onset. Group C: started icodextrin 2 years after PD onset. Group D: never used icodextrin during the study period. At the start of PD, we observed no significant difference in left ventricular mass index (LVMI) or urine volume (UV) between the groups. At 4 years, LVMI and UV were both significantly improved in group A compared with group D. The amelioration in LVMI was negatively associated with phosphate elimination. Our study showed that icodextrin preserved RRF and ameliorated left ventricular hypertrophy. Moreover, the timing of icodextrin introduction in PD patients influenced the clinical effects, including progression of cardiac hypertrophy and RRF.

Icodextrin eliminates phosphate and ameliorates cardiac hypertrophy and valvular calcification in patients with end-stage renal disease and diabetes mellitus undergoing peritoneal dialysis.

Among end-stage renal disease (ESRD) patients, cardiovascular disease is a common comorbidity and one of most important factors affecting clinical prognosis. Calcium deposition has been reported to correlate with plasma phosphate. Icodextrin (Ico)-based peritoneal dialysis (PD) has many advantages over glucose (Glu)-based PD. We aimed to identify factors that suppress arteriosclerosis and valvular disease in patients with ESRD and diabetes mellitus (DM) undergoing Ico-based PD. In this retrospective study, we evaluated the effects of Ico-based PD (n = 20) on phosphate elimination and cardiovascular disease progression in patients with ESRD andDM, and we compared the results with those for Glu-based PD (n = 20). Left ventricular mass index (LVMI) and aortic valve calcification (AVC) score were significantly decreased and daily phosphate elimination was significantly increased in the Ico group compared with the Glu group. Furthermore, mean daily phosphate elimination was significantly and negatively correlated with the amelioration in LVMI and AVC score. Our study suggests that, compared with glucose, icodextrin has the ability to eliminate more phosphate from the body, indicating that phosphate elimination might potentially be a means of controlling cardiovascular disease in PD patients with DM.