Educational interventions and identification of risk factors to prevent and reduce peritonitis in peritoneal dialysis: A scoping review.

BACKGROUND: Peritonitis is a common and serious complication of peritoneal dialysis and is one of the main causes of peritoneal dialysis technique failure and long-term hemodialysis conversion. OBJECTIVES: The aim of the review was to identify and clarify peritonitis risk factors and learn about strategies employed at international level to prevent and reduce the occurrence of peritoneal dialysis associated infections and their complications. DESIGN: A scoping review. PARTICIPANTS: Adults in pertitoneal dialysis. MEASUREMENTS: The methodology framework of Arksey and O'Malley and PRISMA for Scoping Reviews guidelines were applied. A search was conducted of PubMed, Scopus and CINAHL using terms to identify peritoneal dialysis -associated risk factors and interventions carried out for the prevention and reduction of peritonitis in adult persons living at home. RESULTS: The 17 studies selected were based on work carried out in nine different countries. Eleven articles analysed modifiable risk factors (low educational level, being a foreigner and low adherence to aseptic technique) and non-modifiable risk factors (age and comorbidities) that predispose to peritonitis in peritoneal dialysis. The other six studies applied an intervention to improve the prevalence of peritonitis considering educational practices adapted to patient characteristics and the application of retraining. CONCLUSIONS: Personalised patient training and the identification of risk factors for peritonitis are key to reducing complications and enhancing the survival of peritoneal dialysis patients and the effectiveness of the technique.

Fenotipo de Cintura Hipertrigliceridémica en la población con Enfermedad Renal Crónica. Cohorte NEFRONA / Hypertriglyceridaemic waist phenotype for Chronic Kidney Disease population: NEFRONA cohort

ANTECEDENTES Y OBJETIVO: El fenotipo de cintura hipertrigliceridémica (FCH) se define para población general. La Enfermedad Renal Crónica (ERC) asocia cambios en la composición corporal, elevada comorbilidad y una epidemiología reversa en relación con el colesterol y el índice de masa corporal. Nuestro objetivo fue identificar los puntos de corte en población con ERC y analizar su relación con el riesgo cardiovascular (RCV). MÉTODOS: Incluimos 2271 enfermos renales de la cohorte NEFRONA. Seleccionamos los puntos de corte de triglicéridos y cintura mediante análisis de quintiles y curvas ROC, utilizando presencia de enfermedad ateroesclerótica moderada-severa (EA2-3) como variable resultado. Analizamos la prevalencia del mismo y su asociación con otros factores de riesgo cardiovascular, incluimos análisis de regresión multivariable para medir la magnitud de su efecto frente a las variables EA2-3 y evento o muerte cardiovascular (EoMCV). RESULTADOS: Seleccionamos los puntos de corte: Triglicéridos ≥ 143mg/dl con cintura> 102cm en varones o 94cm en mujeres (Sensibilidad 26%; Especificidad 87%). La prevalencia del FCH específico fue 22.4%, sin diferencias entre estadios de ERC. Asoció aumento de riesgo independiente frente a EA2-3 (OR 1.61; IC 95%: 1.12-2.32, p = 0.011) y EoMCV (HR 3.08; IC 95%: 1.66-5.72, p = 0.000). Identificamos una interacción entre FCH y fósforo. CONCLUSIONES: Adaptar la definición del FCH en la población con ERC mejora su rendimiento diagnóstico. Identifica un RCV adicional en una población donde otros métodos de cribado no han mostrado utilidad, siendo de fácil acceso clínico. Su interacción con los niveles de fósforo podría reflejar un papel en la regulación del metabolismo óseo-mineral

BACKGROUND AND OBJECTIVE: The hypertriglyceridaemic waist (HTW) phenotype is defined for the general population. Chronic kidney disease (CKD) tends to bring on changes in body composition, is associated with higher comorbidity than the general population and, furthermore, shows reverse epidemiology with related prognostic variables like cholesterol and body mass index. Our objective was to identify cut-off points in the population with CKD and to analyse its relationship with cardiovascular risk (CVR). METHODS: We included 2271 CKD patients from the NEFRONA cohort. Triglyceride and waist cut-off points were selected through quintiles analysis and receiver operating characteristic (ROC) curves evaluation, using the presence of moderate to severe atherosclerosis score (AS 2-3) as outcome variable. Then, we analysed HTW prevalence and its association with other cardiovascular risk factors, and we measured the magnitude of its effect on AS 2-3 and cardiovascular event or death (CVEoD) by multivariate regression analysis. RESULTS: We selected the cut-off points: triglyceride concentrations ≥143 mg/dl with waist circumference values>102cm in men and 94cm in women (sensitivity 26%; specificity 87%). Specific HTW prevalence was 22.4%, without significative differences between CKD stages. The multivariate regression analysis shows specific HTW as an independent AS 2-3 (OR 1.61; 95% CI: 1.12-2.32, p = 0.011) and CVEoD (HR 3.08; 95% CI: 1.66-5.72, p = 0.000) risk factor. An interaction between phosphorus level and specific HTW was identified. CONCLUSIONS: Adapting the HTW definition might improve specificity to assess cardiovascular risk in the population with CKD. It identifies an additional CVR in a population in which other screening methods have not proven to be useful, and it is easily clinically accessible. Its interaction with phosphorus levels suggests an association between HTW and bone-mineral metabolism regulation

Hypertriglyceridaemic waist phenotype for Chronic Kidney Disease population: NEFRONA cohort. / Fenotipo de Cintura Hipertrigliceridémica en la población con Enfermedad Renal Crónica. Cohorte NEFRONA.

BACKGROUND AND OBJECTIVE: The hypertriglyceridaemic waist (HTW) phenotype is defined for the general population. Chronic kidney disease (CKD) tends to bring on changes in body composition, is associated with higher comorbidity than the general population and, furthermore, shows reverse epidemiology with related prognostic variables like cholesterol and body mass index. Our objective was to identify cut-off points in the population with CKD and to analyse its relationship with cardiovascular risk (CVR). METHODS: We included 2271 CKD patients from the NEFRONA cohort. Triglyceride and waist cut-off points were selected through quintiles analysis and receiver operating characteristic (ROC) curves evaluation, using the presence of moderate to severe atherosclerosis score (AS 2-3) as outcome variable. Then, we analysed HTW prevalence and its association with other cardiovascular risk factors, and we measured the magnitude of its effect on AS 2-3 and cardiovascular event or death (CVEoD) by multivariate regression analysis. RESULTS: We selected the cut-off points: triglyceride concentrations ≥143 mg/dl with waist circumference values>102cm in men and 94cm in women (sensitivity 26%; specificity 87%). Specific HTW prevalence was 22.4%, without significative differences between CKD stages. The multivariate regression analysis shows specific HTW as an independent AS 2-3 (OR 1.61; 95% CI: 1.12-2.32, p=0.011) and CVEoD (HR 3.08; 95% CI: 1.66-5.72, p=0.000) risk factor. An interaction between phosphorus level and specific HTW was identified. CONCLUSIONS: Adapting the HTW definition might improve specificity to assess cardiovascular risk in the population with CKD. It identifies an additional CVR in a population in which other screening methods have not proven to be useful, and it is easily clinically accessible. Its interaction with phosphorus levels suggests an association between HTW and bone-mineral metabolism regulation.

Hidden sources of phosphorus: presence of phosphorus-containing additives in processed foods.

INTRODUCTION AND OBJECTIVES: An increased consumption of processed foods that include phosphorus-containing additives has led us to propose the following working hypothesis: using phosphate-rich additives that can be easily absorbed in processed foods involves a significant increase in phosphorus in the diet, which may be considered as hidden phosphorus since it is not registered in the food composition tables. MATERIALS AND METHOD: The quantity of phosphorus contained in 118 processed products was determined by spectrophotometry and the results were contrasted with the food composition tables of the Higher Education Centre of Nutrition and Diet, those of Morandeira and those of the BEDCA (Spanish Food Composition Database) Network. RESULTS: Food processing frequently involves the use of phosphoric additives. The products whose label contains these additives have higher phosphorus content and higher phosphorus-protein ratio. We observed a discrepancy with the food composition tables in terms of the amount of phosphorus determined in a sizeable proportion of the products. The phosphorus content of prepared refrigerated foods hardly appears in the tables. CONCLUSIONS: Product labels provide little information on phosphorus content. We observed a discrepancy in phosphorus content in certain foods with respect to the food composition tables. We should educate our patients on reviewing the additives on the labels and on the limitation of processed foods. There must be health policy actions to deal with the problem: companies should analyse the phosphorus content of their products, display the correct information on their labels and incorporate it into the food composition tables. Incentives could be established to prepare food with a low phosphorus content and alternatives to phosphorus-containing additives.