Effects of incremental peritoneal dialysis with low glucose-degradation product neutral pH solution on clinical outcomes.

PURPOSE: Incremental peritoneal dialysis (IPD) could decrease unfavorable glucose exposure results and preserve (RKF). However, there is no standardization of dialysis prescriptions for patients undergoing IPD. We designed a prospective observational multi-center study with a standardized IPD prescription to evaluate the effect of IPD on RKF, metabolic alterations, blood pressure control, and adverse outcomes. METHODS: All patients used low GDP product (GDP) neutral pH solutions in both the incremental continuous ambulatory peritoneal dialysis (ICAPD) group and the retrospective standard PD (sPD) group. IPD patients started treatment with three daily exchanges five days a week. Control-group patients performed four changes per day, seven days a week. RESULTS: A total of 94 patients (47 IPD and 47 sPD) were included in this study. The small-solute clearance and mean blood pressures were similar between both groups during follow-up. The weekly mean glucose exposure was significantly higher in sPD group than IPD during the follow-up (p < 0.001). The patients with sPD required more phosphate-binding medications compared to the IPD group (p = 0.05). The rates of peritonitis, tunnel infection, and hospitalization frequencies were similar between groups. Patients in the sPD group experienced more episodes of hypervolemia compared to the IPD group (p = 0.007). The slope in RKF in the 6th month was significantly higher in the sPD group compared to the IPD group (65% vs. 95%, p = 0.001). CONCLUSION: IPD could be a rational dialysis method and provide non-inferior dialysis adequacy compared to full-dose PD. This regimen may contribute to preserving RKF for a longer period.

The effect of body mass index on mortality, peritonitis, technique proficiency and residual renal function in peritoneal dialysis patients.

BACKGROUND: The prevalence of obesity is increasing worldwide. Obesity is also increasing in the chronic kidney disease (CKD) population. There are conflicting data on complications such as mortality, peritonitis, and technique proficiency of peritoneal dialysis (PD) in underweight and obese patients according to body mass index (BMI). We aimed to present the data in our region to the literature by comparing the residual renal function (RRF), peritonitis, technique proficiency, and mortality rates of the patients we grouped according to BMI. METHODS: The data of 404 patients who were started and followed up in our clinic between March 2005 and November 2021 were evaluated retrospectively. They were grouped as underweight, normal weight, overweight, and obese according to BMI. RRF, mortality, technique proficiency and peritonitis data of the groups were compared. RESULTS: Of the 404 patients, 44 were underweight, 199 were normal weight, 110 were overweight, and 55 were obese. No difference was found between the groups in the technique survey and in the time to first peritonitis with Kaplan-Meier analysis (respectively; p = 0.610, p = 0.445). Multivariate Cox regression analysis showed that BMI did not affect mortality (HR 1.196 [95% CI 0.722-1.981] (p = 0.488)). CONCLUSION: In conclusion, we report that BMI has no effect on RRF, peritonitis, technique proficiency, and mortality in patients undergoing PD, and that mortality may depend on additional factors such as mean albumin, time to first peritonitis, and loss of RRF.

Fractal characteristics of the trabecular pattern of the mandible in patients with renal transplantation.

OBJECTIVE: In this study, we examined the mandibular trabecular bone structures by performing fractal dimension (FD) analysis in patients who underwent renal transplantation (RTx). METHODS: Our study is an observational study with 69 RTx patients and 35 control group patients. The mean FD values of the patient and control groups were calculated and compared. In addition, biochemical parathyroid hormone (PTH), serum calcium, phosphorus, alkaline phosphatase (ALP), and vitamin-D parameters and FD values of both groups were analyzed. RESULTS: FD values were significantly lower in the patient group than in the healthy group (p < .05). In the RTx group compared to the control group, ALP (90.71 ± 34.25-66.54 ± 16.8, respectively) (p < .001) and PTH (75.76 ± 38.01-38.17 ± 12.39, respectively) (p < .001) values were higher. There was a positive correlation between the FD values and ALP (rspearman  = .305, p = .011) and a negative correlation between FD values and vitamin-D (rspearman  = .287, p = .017) of patients with RTx. CONCLUSION: FD values were found to be lower in patients who underwent RTx compared to the control group. It should be considered that FD analysis can be a method that can be used to evaluate trabecular bone structure in patients undergoing RTx.

Evaluation of the Inflammatory Response After Eradication of Helicobacter pylori in Patients With Familial Mediterranean Fever.

PURPOSE: Evaluation of the inflammatory response after Helicobacter pylori (Hp) eradication in patients with Familial Mediterranean Fever (FMF) during the non-attack period and determining whether there is a change in the ongoing inflammation during the non-attack period. MATERIALS AND METHODS: Sixty-four patients, who have not been eradicated for Hp in the last 2 years, diagnosed with FMF, and evaluated in the non-attack period, were included in the study. Hp eradication therapy was administered to patients who were found to be Hp-positive. C-reactive protein (CRP), high-sensitive C-reactive protein (hs-CRP), interleukin-6, interleukin-8, tumor necrosis factor-alpha, and serum amyloid A values were compared between the groups before and after eradication. RESULTS: CRP and hs-CRP levels were found to be statistically higher in the FMF group than in the control group. A statistically significant decrease was found in the values of CRP and hs-CRP, in the number of patients with attacks, and in attack frequency after eradication in the Infected Patients compared to the values before eradication. CONCLUSIONS: We determined a decrease in CRP and hs-CRP values, the number of patients with attacks, and attack frequency with the eradication of Infected Patients. In patients with FMF, in whom it has been proven by different studies that the inflammation continues during the non-attack period, it may be recommended to investigate the presence of Hp infection, which is thought to contribute to this inflammation and to give Hp eradication therapy to patients who are found positive to reduce the development of secondary complications caused by chronic inflammation.

Comparison of young and old patients on peritoneal dialysis: A retrospective observational study.

BACKGROUND: With a global increase in life expectancy around the world, the burden of chronic kidney disease in the elderly is increasing. The number of elderly patients undergoing peritoneal dialysis (PD) is also increasing. There is still a perception that PD may be associated with an increased risk of complications in these elderly patients. METHODS: A total of 311 patients, of which 103 PD patients aged 65 and over and 208 PD patients under 65 years of age, were followed in a single center and evaluated, retrospectively. Demographic data of these patients, albumin values at first PD and during PD time, residual urine amount, number of peritonitis, time to the first peritonitis attack, PD endpoints, and mortality were compared. RESULTS: Peritonitis and technique failure rates were lower in patients aged 65 and over who applied PD (0.61-0.75, 6.8%-23.1%, respectively). There was no difference in peritonitis-free survival (p = 0.931). Need for help HR 2.569 [95%CI 1.564-4.219] (p < 0.05), time to first peritonitis attack HR 0.983 [95%CI 0.974-0.992] (p < 0.05), mean albumin value HR 0.191 [95%CI 0.088-0.413] (p < 0.05), urine output level HR 1.154 [95%CI 1.010-1.318] (p < 0.05) were factors affecting mortality. CONCLUSION: Peritonitis and technical survival evaluations of elderly PD patients, other than mortality, were lower than younger PD patients. However, the need for help is one of the biggest obstacles to this method for the elderly. We believe that incentives in this regard will increase the number of elderly PD patients.

Investigation of the reasons for patients who choose peritoneal dialysis as kidney replacement therapies to change their decisions.

INTRODUCTION: Peritoneal dialysis (PD) is one of the kidney replacement therapies (KRT). Patients' choice of KRT is influenced by personal causes, familial factors, factors related to healthcare professionals, and social factors. METHODS: This study included 341 patients. PD patients who changed their KRT selection were asked for the reasons to change with a questionnaire. RESULTS: Of the patients who initially chose PD, only 48.5% received KRT by PD. Five (20%) of the patients gave up PD compulsorily because they heard that the risk of infection with PD was higher, eight (40%) thought they could not do it, four (20%) because they needed to do assisted PD but had no relatives to do it, and three (15%) because they had abdominal surgery. CONCLUSION: We believe that the fact that KRT training is carried out by a PD trained team and that patients are provided with assistance for PD will be effective in addressing the concerns of patients with PD undecided.

Comparison of mortality according to baseline, first year, and mean albumin levels in peritoneal dialysis: a retrospective study.

BACKGROUND: The relationship between hypoalbuminemia in peritoneal dialysis (PD) and mortality, risk of peritonitis, and decreased residual renal function (RRF) is known. However, we have not encountered a comprehensive study on which of the mean albumin values, at the beginning of peritoneal dialysis, in the first year, and during the peritoneal dialysis period, provide more predictive predictions regarding mortality, peritonitis risk, and RRF reduction. METHODS: A total of 407 PD patients in whom PD was initiated and followed up and PD was terminated were included in the study. Albumin levels, peritonitis, and RRF at the beginning of PD and at 3-month periods during PD were recorded. RESULTS: In the evaluation of the patients, there was a significant relationship between mean, first-year albumin values in RRF loss (p = 0.001, p = 0.006, respectively) and peritonitis (p < 0.001), but no significant correlation was found with baseline albumin values (p = 0.213, p = 0.137, respectively). In the comparison of mortality ROC analysis of PD patients, a significant correlation was found with mortality at baseline, first year, and mean albumin values (p < 0.001). However, in the multivariate Cox regression analysis, it was determined that there was a more significant relationship between first-year albumin and mean albumin values compared to baseline albumin values (HR 0.918 [95% CI 0.302-0.528] (p < 0.001)), (HR 1.161 [95% CI 0.229-0.429] (p < 0.001)), (HR 0.081 [95% CI 0.718-1.184] (p = 0.525)). CONCLUSIONS: In conclusion, mean and first-year mean albumin levels provide more determinative predictions for mortality, risk of peritonitis, and maintenance of residual renal functions in peritoneal dialysis patients compared to baseline albumin.

The effect of rural and urban life on peritonitis rates in chronic peritoneal patients.

BACKGROUND: It has been reported that living far from the peritoneal dialysis (PD) unit is a risk factor for peritonitis. Considering that PD units are urban located; the question of whether living in a rural area compared to an urban area is a risk factor for peritonitis has arisen. METHODS: From March 2010 to August 2020, 335 episodes of peritonitis in 202 PD patients followed in a single center were evaluated retrospectively. People living in areas with a population <1000 were defined as living in rural areas regardless of their distance from the PD center. Cox regression analysis was used to identify independent factors associated with peritonitis. RESULTS: A total of 202 PD patients were followed during 791 patient-years (mean follow-up of 3.9 years per patient). Total patients had 335 episodes of peritonitis and the rate of peritonitis was 0.42 episodes per year (episodes/patient-year). Cox regression analysis revealed that living environment (urban vs. rural) was not a risk factor for peritonitis (p = 0.57). CONCLUSIONS: In Turkey, we report that living in a rural area in our region is not a risk factor for peritonitis. It is not the right approach for both the physician and the patient to be reluctant in the choice of PD due to the concern of peritonitis in rural areas.