Bioimpedance-Guided Monitoring of Volume Status in Patients With Kidney Disease: A Systematic Review and Meta-Analysis.

Background and Objective: Bioimpedance technologies are increasingly used to determine fluid status in patients with chronic kidney disease and those with end-stage kidney disease on dialysis. We aimed to determine whether this technology improves clinical outcomes as compared with usual care. Methods: We performed a systematic review and meta-analysis of trials, comparing fluid management guided by bioimpedance technologies to standard of care in patients with chronic kidney disease. Our primary outcome was all-cause mortality. Secondary outcomes included blood pressure control, all-cause hospitalization, major adverse cardiovascular events, and change in left ventricular mass index. Results: Our search identified 819 citations of which 12 randomized controlled trials were included (2420 patients). No studies of non-dialysis-dependent chronic kidney disease patients met inclusion criteria. Mean age was 55 years and mean follow-up was 1 year. There was a statistically significant difference in all-cause mortality between both arms studied (risk ratio [RR] 0.64, 95% confidence interval [CI]: 0.44, 0.99). Better blood pressure control was observed in the bioimpedance arm of the included articles, weighted mean differences (WMD) -3.13 mm Hg (95% CI: -5.73, -0.53 mm Hg) for systolic blood pressure and WMD -2.50 mm Hg (95% CI: -4.36, -0.64 mm Hg) for diastolic blood pressure. No difference was observed concerning the other outcomes. Conclusions: Among patients on maintenance dialysis, bioimpedance-guided volume management showed decreased all-cause mortality and blood pressure but no significant difference in all-cause hospitalization, major adverse cardiac event, or change in left ventricular mass index. This may be due to a younger population sample than previous articles. Moreover, our study identified a knowledge gap by highlighting the lack of studies evaluating this technology in non-dialysis-dependent chronic kidney disease patients.

Contexte et objectif: Les technologies de bio-impédance sont de plus en plus utilisées pour déterminer le statut hydrique des patients atteints d'insuffisance rénale chronique et des patients atteints d'insuffisance rénale terminale sous dialyze. Notre objectif était de vérifier si cette technologie améliore les résultats cliniques des patients par rapport aux soins habituels. Méthodologie: Nous avons procédé à une revue systématique et à une méta-analyze d'essais comparant la gestion des fluides guidée par les technologies de bio-impédance aux normes de soins chez les patients atteints d'insuffisance rénale chronique. Le principal critère de jugement était la mortalité toutes causes confondues. La régulation de la pression artérielle, l'hospitalization toutes causes confondues, les événements cardiovasculaires majeurs indésirables et la modification de l'index de masse ventriculaire gauche constituaient les critères de jugement secondaires. Résultats: Notre recherche a permis de répertorier 819 citations, desquelles 12 essais contrôlés randomisés ont été retenus (2 420 patients). Aucune étude portant sur des patients atteints d'insuffisance rénale chronique non dépendants de la dialyze ne remplissait les critères d'inclusion. L'âge moyen des sujets était de 55 ans et le suivi moyen était d'un an. Une différence statistiquement significative a été observée entre les deux bras étudiés en ce qui concerne la mortalité toutes causes confondues (RR: 0.64; IC 95% entre: 0.44, 0.99). Une meilleure régulation de la pression artérielle a été observée dans le bras de bio-impédance des manuscrits inclus, soit une moyenne pondérée des écarts de −3.13 mm Hg (IC 95% entre: −5.73, −0.53 mm Hg) pour la pression artérielle systolique et de −2.50 mm Hg (IC 95% entre: −4.36, −0.64 mm Hg) pour la pression artérielle diastolique. Aucune différence n'a été observée pour les autres résultats. Conclusion: Chez les patients sous dialyze d'entretien, la prise en charge du volume guidée par la bio-impédance a montré une diminution de la mortalité toutes causes confondues et une meilleure régulation de la pression artérielle. Aucune différence significative n'a été cependant observée dans les hospitalisations toutes causes confondues, les événements cardiaques majeurs indésirables ou la modification de l'index de masse ventriculaire gauche. Ce résultat pourrait être attribuable au fait que l'échantillon de population était cette fois-ci plus jeune que les populations étudiées dans les manuscrits précédents. De plus, notre étude a permis d'identifier un écart dans les connaissances en soulignant le manque d'études évaluant cette technologie chez les patients atteints d'insuffisance rénale chronique non dépendants de la dialyze.

Late Peritoneal Dialysis Exit-Site Leak: A Case Report.

Peritoneal dialysis (PD) pericatheter exit-site leaks most commonly occur early, within 30 days of catheter insertion. Late exit-site leaks are rare. The distinction between early and late exit-site leaks is important because the causes and subsequent management strategies may be different. Early leaks can often be first treated by delaying or holding PD therapy, allowing the prolongation of the healing time because fibrous tissue continues to form around the deep cuff. Late leaks are less likely to heal with cessation of PD alone and often require PD catheter replacement. In this case report, we provide an overview of the diagnosis and management of PD catheter exit-site leaks while highlighting a case of a late presenting exit-site leak resulting from a unique cause of PD catheter trauma.

Aggression and withdrawal related behavior within conflict management progression in preschool boys with language impairment.

OBJECTIVE: This study examined conflict behavior in naturalistic preschool settings to better understand the role of non-affiliative behavior and language in conflict management. METHOD: Free-play at preschool was filmed among 20 boys with typically developing language (TL) and among 11 boys with Language Impairment (LI); the boys 4-7 years old. Conflict behavior was coded and analyzed with a validated system. Post-conflict non-affiliative behavior (aggression and withdrawal) displays, and the links between the displays and reconciliation (i.e., former opponents exchange friendly behavioral shortly after conflict termination) was examined. RESULTS: Group comparisons revealed boys with LI displayed aggression in a smaller share of conflicts, but exhibited [Symbol: see text]active' withdrawal (left the room), in a larger conflict share. Boys with TL overcame aggression (more common TL behavior) and after reconciled, to a greater extent than the boys with LI after active withdrawal (more common LI behavior). Also, after reciprocal or only verbal aggression, boys with LI reconciled to a lesser extent than boys with TL. CONCLUSIONS: The boys with LI demonstrated difficulties confronting conflict management, as well as concluding emotionally heightened and aggressive behavioral turns.

Interaction before conflict and conflict resolution in pre-school boys with language impairment.

BACKGROUND: Children with language impairment (LI) experience social difficulties, including conflict management. The factors involved in peer-conflict progression in pre-school children with LI, and which of these processes may differ from pre-school children with typical language development (TL), is therefore examined. AIMS: To describe the relationship between opponents interacting before conflict, aberrant conflict causes, the conflict-resolution strategy reconciliation (i.e. friendly contact between former opponents shortly following conflict termination), and conflict outcome in the form of social interaction after a conflict has run its course. It is hypothesized that without social interaction before conflict, children with LI will experience increased difficulties attaining reconciliation. METHODS AND PROCEDURES: Unstructured play of 11 boys with LI (4-7 years old), at a specialized language pre-school, and 20 boys with TL (4-6 years old), at mainstream pre-schools, were video filmed. Conflicts were identified and recorded according to a validated coding system. Recorded conflict details include social interaction between conflict in the pre-conflict period, behavioural sequences constituting conflict cause (conflict period), reconciliatory behaviours in the post-conflict period, and social interaction between former opponents in the succeeding non-conflict period. The group's mean proportion of individual children's conflicts in which specific behavioural sequences occurred were calculated and compared between and within the groups. OUTCOMES AND RESULTS: When conflicts with and without pre-conflict social interaction were analysed separately, aberrant caused conflicts occurred more often in LI group conflicts than in TL group conflicts. However, in conflicts without social interaction in the pre-conflict period, boys with LI exhibit reconciliatory behaviours in, and reconcile a comparatively smaller proportion of, conflicts. Social interaction in the succeeding non-conflict period was proportionately less for boys with LI. This appears to stem from lower reconciliation rates in LI conflicts that do not begin with social interaction in the pre-conflict period. It was also confounded by the larger number of aberrant caused LI conflicts that were rarely reconciled. In turn, non-reconciliation and aberrant caused conflicts were independently associated with comparatively less social interaction in the succeeding non-conflict period. CONCLUSIONS: The results suggest that in addition to traditional psycholinguistic training, children with LI may gain from interventions that support concluding behavioural turns, as in aberrant caused conflicts; and in initiating contact in conflict situations, even when a frame of reference is not immediately available, as was the case when opponents have not established social interaction in the pre-conflict period.

Behavioural patterns of conflict resolution strategies in preschool boys with language impairment in comparison with boys with typical language development.

BACKGROUND: Children with language impairment (LI) experience social difficulties, including conflict management. This paper is therefore motivated to examine behavioural processes guiding preschool peer conflict progression, which ultimately contributes to overall development. AIMS: To describe behavioural sequences in conflicts between children with typically developing language (TL) and between children with LI. Attention is particularly focused on the conflict resolution strategy reconciliation, i.e. friendly contact between former opponents shortly following conflict termination. It is hypothesized that children with LI, with weaker language skills, experience difficulties attaining effective reconciliation. METHODS & PROCEDURES: Unstructured play of 11 boys with LI (4-7-years-old), at a specialized language preschool, and 20 TL boys (4-6-years-old), at mainstream preschools, were video filmed. Conflicts were identified and recorded according to a validated coding system. Recorded conflict details included behavioural sequences constituting conflict cause (conflict period) and in the post-conflict period, reconciliatory behaviours that were classified into six 'categories' (Invitation to play, Body contact, Object offer, Verbal apology, Self-ridicule, Cognition, i.e. offering privileges/negotiating) and the verbal character of accepted behaviours were determined. The mean proportion of individual target children's conflicts in which specific behavioural sequences had occurred were calculated and thereafter compared between and within the groups. OUTCOMES & RESULTS: Boys with LI reconcile fewer conflicts than TL boys (LI: 47.3 +/- 4.5%; TL: 63.6 +/- 2.0%). Contributory factors include the occurrence of conflicts caused by aberrance, i.e. conflicts initiated by inappropriate behavioural play intensities (i.e. 'a pillow fight' where one partner swings so intensively the other partner cannot participate as a player in the game) and protests that are no longer directed to the opponent within reciprocal exchanges, but escalate to screaming/physical ranting. Aberrant caused conflicts were rarely observed as the conflict cause for TL boys, but represent nearly 15% of LI conflicts and aberrant caused conflicts are reconciled at lower rates than conflicts not caused by aberrance. Displayed reconciliatory behaviours were accepted by opponents at similar rates in both groups and the distribution of reconciliatory behavioural 'categories' was similar between the groups. However, boys with LI attempt reconciliation in relatively fewer conflicts. In addition, the individual boys with LI attain reconciliation with strictly verbal reconciliatory behaviours in a smaller proportion of conflicts. CONCLUSIONS: The findings suggest that in addition to traditional psycholinguistic remediation, intervention programmes for children with LI should address that learned language and communication skills are applied effectively in initiating and maintaining naturalistic peer interactions.