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1.
Isr Med Assoc J ; 23(3): 174-179, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33734631

RESUMEN

BACKGROUND: Peritoneal dialysis (PD) is a treatment option for patients with end-stage renal disease (ESRD) and cardiorenal syndrome (CRS). OBJECTIVES: To evaluate the outcome of this patient population. METHODS: A retrospective study was conducted of patients who underwent an open or laparoscopic insertion of a PD catheter at our institution between 2009 and 2017. Data included demographics, peri-operative parameters, and long-term outcome. Patient and technique survival curves are presented, including subgroup analysis by method of catheter insertion and techniques for infection prevention. RESULTS: The study population included 95 men and 42 women, aged 65.7 ± 12.4 years. Mean follow-up was 34.6 ± 27.3 months. Open insertion was performed in 113 cases, while 24 underwent laparoscopic insertion. There was no difference in technique survival between these groups (P = 0.943). Removal of the catheter was required in 66% of patients. Median technique survival was 12.1 months. Two-year technique survival was 37% and 5-year technique survival was 12%. The leading cause for catheter removal was infection (69%). Application of measures for prevention of infections were significantly associated with prolonged technique survival (P = 0.001). Technique survival after 2 years was 38% with the application of a single measure and 57% with the application of two measures (P = 0.001). CRS patients (n=24) had a significantly lower overall survival rate (2-year survival 20% vs. 74%, P = 0.001). CONCLUSIONS: The method of catheter insertion has no effect on technique survival. Prevention of infections is the most significant factor for improving the technique survival rates.


Asunto(s)
Catéteres de Permanencia , Falla de Equipo , Fallo Renal Crónico/terapia , Diálisis Peritoneal/instrumentación , Anciano , Remoción de Dispositivos , Femenino , Humanos , Estimación de Kaplan-Meier , Laparoscopía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
2.
Nephrol Nurs J ; 48(1): 57-63, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33683844

RESUMEN

Peritoneal dialysis catheter complications that require nonsurgical or noninvasive correction by peritoneal dialysis (PD) nurses or practitioner are reviewed. Topics reviewed include compromised PD fluid flow, pericatheter fluid leakage, mechanical integrity disruption, catheter extrusion, and exit site/tunnel complications.


Asunto(s)
Catéteres , Diálisis Peritoneal , Catéteres/efectos adversos , Humanos , Diálisis Peritoneal/efectos adversos , Diálisis Peritoneal/enfermería
3.
Medicine (Baltimore) ; 100(13): e25293, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33787616

RESUMEN

ABSTRACT: Data on the overall epidemiology and temporal trends of end-stage renal disease (ESRD) requiring hemodialysis in Korea are scarce. We aimed to estimate the prevalence and incidence of ESRD requiring hemodialysis in Korea between 2002 and 2017.Using the National Health Insurance Service database, we analyzed data from the entire Korean population between 2002 and 2017. Hemodialysis patients were identified using rare incurable disease codes (V001) or prescription of medical fee codes of hemodialysis (O7020 and O7021). We only included patients who had been maintained on hemodialysis for more than 90 days from the date of dialysis initiation, to exclude patients who required short-term dialysis for acute kidney injury, conversion to peritoneal dialysis, or kidney transplantation.During the 16-year follow-up, the number of hemodialysis patients in Korea has steadily increased from 11,215 in 2002 to 67,486 in 2017. The mean age of these patients has gradually increased from 55.57 ±â€Š13.31 years in 2002 to 62.13 ±â€Š13.23 years in 2017. In 2017, the crude prevalence rate of hemodialysis was 1303.4 per million population. Overall, the number of men tended to be somewhat higher than that of women, and the proportion of men increased slightly from 55.56% in 2002 to 58.45% in 2017. The proportion of diabetic patients increased rapidly from 23.84% to 47.84%, and the percentage of dyslipidemic patients rose from 18.9% to 86.7%. The number of incident hemodialysis patients increased significantly from 4406 in 2003 to 12,134 in 2014, and then decreased to 8090 in 2017. In the incident cases of hemodialysis, the observed increase in the proportion of male patients and in diabetes and dyslipidemia were similar to that of prevalent patients. The more recent era of hemodialysis initiation, the better 5-year survival rates were observed.The prevalence and incidence of hemodialysis in Korea gradually increased between 2002 and 2017. The proportion of men, and patients with diabetes and dyslipidemia requiring hemodialysis also increased continuously. The survival rate of hemodialysis patients was gradually improving. These findings may serve as a reference for future epidemiological studies on hemodialysis in Korea.


Asunto(s)
Lesión Renal Aguda/epidemiología , Fallo Renal Crónico/epidemiología , Trasplante de Riñón/estadística & datos numéricos , Diálisis Peritoneal/estadística & datos numéricos , Diálisis Renal/estadística & datos numéricos , Lesión Renal Aguda/terapia , Adulto , Anciano , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/estadística & datos numéricos , Prevalencia , República de Corea/epidemiología , Distribución por Sexo , Tasa de Supervivencia , Factores de Tiempo
4.
Int J Nanomedicine ; 16: 2137-2146, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33731995

RESUMEN

Purpose: Vitamin D3 is useful for the treatment of peritoneal dialysis (PD)-related peritoneal damage, but its side effects, such as hypercalcemia and vascular calcification, limit its applicability. Thus, we developed vitamin D-loaded magnetic nanoparticles (MNPs) and determined their therapeutic efficacy and side effects in vivo. Materials and Methods: Alginate-modified MNPs were combined with 1α, 25 (OH)2D3 to generate vitamin D-loaded nanoparticles. The particles were conjugated with an antibody against peritoneum-glycoprotein M6A (GPM6A). The particles' ability to target the peritoneum was examined following intraperitoneal administration to mice and by monitoring their bio-distribution. We also established a PD animal model to determine the therapeutic and side effects of vitamin D-loaded MNPs in vivo. Results: Vitamin D-loaded MNPs targeted the peritoneum better than vitamin D3, and had the same therapeutic effect as vitamin D3 in ameliorating peritoneal fibrosis and functional deterioration in a PD animal model. Most importantly, the particles reduced the side effects of vitamin D3, such as hypercalcemia and body weight loss, in mice. Conclusion: Vitamin D-loaded MNPs could be an ideal future therapeutic option to treat PD-related peritoneal damage.


Asunto(s)
Colecalciferol/administración & dosificación , Sistemas de Liberación de Medicamentos , Nanopartículas de Magnetita/química , Diálisis Peritoneal/efectos adversos , Peritoneo/patología , Alginatos/química , Animales , Anticuerpos/metabolismo , Modelos Animales de Enfermedad , Liberación de Fármacos , Humanos , Nanopartículas de Magnetita/ultraestructura , Masculino , Glicoproteínas de Membrana/metabolismo , Ratones Endogámicos C57BL , Fibrosis Peritoneal/etiología , Fibrosis Peritoneal/patología
5.
Nutr Metab Cardiovasc Dis ; 31(4): 1148-1155, 2021 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-33618923

RESUMEN

BACKGROUND AND AIMS: Iron deficiency is prevalent, but there is limited data about the relationship between iron status and poor outcomes in chronic kidney disease patients undergoing peritoneal dialysis (PD). We aimed to investigate the association between iron status and mortality in PD patients. METHODS AND RESULTS: This retrospective study was conducted on incident PD patients from January 2006 to December 2016 and followed up until December 2018. Patients were categorized into four groups according to baseline serum transferrin saturation (percent) and ferritin levels (ng/ml): reference (20-30%, 100-500 ng/ml), absolute iron deficiency (<20%, <100 ng/ml), function iron deficiency (FID) (<20%, >100 ng/ml), and high iron (>30%, >500 ng/ml). Among the 1173 patients, 77.5% had iron deficiency. During a median follow-up period of 43.7 months, compared with the reference group, the FID group was associated with increased risk for all-cause [adjusted hazard ratio (aHR) 1.87, 95% confidence interval (95% CI) 1.05-3.31, P = 0.032], but not cardiovascular (CV) mortality. Additionally, the high iron group had a more than four-fold increased risk of both all-cause and CV mortality [aHR 4.32 (95% CI 1.90-9.81), P < 0.001; aHR 4.41 (95% CI 1.47-13.27), P = 0.008; respectively]. CONCLUSION: FID and high iron predict worse prognosis of patients on PD.


Asunto(s)
Trastornos del Metabolismo del Hierro/sangre , Hierro/sangre , Enfermedades Renales/terapia , Diálisis Peritoneal/mortalidad , Adulto , Biomarcadores/sangre , China/epidemiología , Femenino , Ferritinas/sangre , Humanos , Hierro/deficiencia , Trastornos del Metabolismo del Hierro/diagnóstico , Trastornos del Metabolismo del Hierro/mortalidad , Enfermedades Renales/sangre , Enfermedades Renales/diagnóstico , Enfermedades Renales/mortalidad , Masculino , Persona de Mediana Edad , Diálisis Peritoneal/efectos adversos , Prevalencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Transferrina/metabolismo , Resultado del Tratamiento
6.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(2): 264-271, 2021 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-33624601

RESUMEN

OBJECTIVE: To assess the effect of salt intake on residual renal function in rats and explore the possible mechanism. OBJECTIVE: SD rats were 5/6-nephrectomized to induce chronic renal failure followed by peritoneal dialysis for 4 weeks (n=18) or without dialysis treatment (control group; n=18). In both groups, the rats were divided into 3 subgroups and were given lowsalt diet (0.02% NaCl), normal salt diet (0.4% NaCl), and high-salt diet (4% NaCl). After 8 and 12weeks, blood pressure and creatinine and sodium levels in the blood, urine, and peritoneal dialysate of the rats were examined. Glomerular sclerosis, tubulointerstitial fibrosis, and protein expression levels of RAS components (ACE-1, AGT, and AT-1) in renal cortical tissue of the rats were evaluated. OBJECTIVE: The residual renal function of the rats all decreased especially in rats with high salt intake for 8and 12 weeks. In peritoneal dialysis group, the rats with high-salt diet showed signficiantly increased renal interstitial fibrosis score (P=0.036), glomerular sclerosis index (P=0.045), systolic blood pressure (P=0.004), diastolic blood pressure (P=0.048), and renal expressions of AGT, ACE-1, and AT1 (P < 0.05) as compared with those with normal salt intake. In the rats fed the same high-salt diet, the renal interstitial fibrosis score, glomerular sclerosis index, diastolic blood pressure increase, and renal AGT and ACE-1 expression levels were significantly lower in the peritoneal dialysis group than in the control group (P < 0.05). A positive correlation was noted between the reduction of residual renal function and sodium intake in the rats. OBJECTIVE: In rats with chronic renal failure, high salt intake promotes the activation of the renal RAS system, increases blood pressure, and agrevates renal fibrosis to accelerate the decline of residual renal function, and peritoneal dialysis partially reduces the damage of residual renal function induced by high-salt diets by removing excessive sodium.


Asunto(s)
Fallo Renal Crónico , Diálisis Peritoneal , Animales , Progresión de la Enfermedad , Fallo Renal Crónico/terapia , Diálisis Peritoneal/efectos adversos , Ratas , Ratas Sprague-Dawley , Cloruro de Sodio Dietético/efectos adversos
7.
Hu Li Za Zhi ; 68(1): 82-89, 2021 Feb.
Artículo en Chino | MEDLINE | ID: mdl-33521922

RESUMEN

Peritoneal dialysis (PD) education, which has been shown to impact life quality and survival rates, is thus crucial to patients with end-stage renal disease. As medical workers in the PD field, it is our hope and obligation to lead every patient to achieve their individual self-care goals. Although the International Society of Peritoneal Dialysis (ISPD) published guidelines for peritoneal dialysis training in 2006 to help build a comprehensive educational program for better outcomes, how to implement related education programs has not yet been taken seriously by clinical health workers. In Taiwan, no articles introducing these guidelines and no report on the clinical implementation of these guidelines have been published. Thus, this article was written to describe the ISPD guidelines on PD education, including education content, space requirements, soft / hard equipment needs, training hours, and mode. Medical workers may use evaluation and periodical retraining to continuously monitor the self-care ability of patients. Aided by timely home visitations, learning outcomes and patient adaption may be followed comprehensively. Furthermore, to help patients under PD strengthen their capabilities of self-management and self-care, practical training suggestions based on the practice experience of our PD center are also included in this article as references for all medical workers in the PD field.


Asunto(s)
Fallo Renal Crónico , Diálisis Peritoneal , Personal de Salud , Humanos , Taiwán
8.
Medicine (Baltimore) ; 100(3): e24195, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33546035

RESUMEN

ABSTRACT: This study is to investigate the risk factors for the drop out from peritoneal dialysis.We retrospectively analyzed patients who underwent catheterization between January 1, 2009 and September 30, 2019. The follow-up period ended on November 30, 2019. End point events were the cessation of peritoneal dialysis, including death, conversion to hemodialysis, and kidney transplantation. Kaplan-Meier method was used to analyze peritoneal dialysis curve. Significant factors were included in the multivariate Cox proportional hazards model. Calibration curve was plotted.A total of 377 patients were included in this study. The dropout rate of peritoneal dialysis was 41.38%. The main drop out reason was conversion to hemodialysis, accounting for 41.67% of the total number of drop out, followed by kidney transplantation (28.21%) and death (25%). According to multivariable Cox proportional hazards model analysis, the medium education level (hazard ratio (HR): 2.53, 95% confidence interval (CI): 1.08-5.91, P = .03), high education level (HR: 2.47, 95% CI: 1.03-5.93, P = .04), diabetes (HR: 1.87, 95% CI: 1.24-2.83, P < .03), hypertension (HR: 2.40, 95% CI: 1.64-3.51, P < .01), repeated peritonitis (HR: 5.18, 95% CI: 3.04-8.80, P < .01), and repeated chest complications (HR: 4.98, 95% CI: 2.79-8.89, P < .01) were independent risk factors for dropping out from peritoneal dialysis, while the number of hospitalizations after catheterization (HR: 0.94, 95% CI: 0.89-0.98, P = .01) was protective factor for maintenance of peritoneal dialysis. The C index of the prediction model was 0.74.Higher education level, diabetes, hypertension, repeated peritonitis, and repeated chest complications were the risk factors of dropping out from peritoneal dialysis, while higher number of hospitalizations after catheterization was a protective factor for the maintenance of peritoneal dialysis. The nomogram could predict the probability of dropping out from peritoneal dialysis.


Asunto(s)
Nomogramas , Pacientes Desistentes del Tratamiento , Diálisis Peritoneal/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo
10.
Medicine (Baltimore) ; 100(3): e23856, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33545952

RESUMEN

ABSTRACT: Although many alternative methods are present, maintaining ideal volume status in peritoneal dialysis (PD) patients still rely on clinical evaluation due to lack of an evidence-based method. Lung ultrasound (LUS) is a new method for evaluation of hidden congestion in this group.LUS findings and its relationship with other volumetric methods are investigated in this observational cross-sectional study.In this observational cross sectional study, LUS was performed to all PD patients and compared with symptoms of hypervolemia, physical examination, vascular endothelial growth factor-C (VEGF-C), and N-terminal pro-brain natriuretic peptide levels, chest radiography, echocardiography, bioelectrical impedance analysis.Data of 21 PD patients were evaluated. There was correlation between number of B lines and VEGF-C levels (r = 0.447, P = .042), daily urine output (r = 0.582, P = .007) and left ventricle mass index (r = -0.456, P = .038). Correlations with all other parameters were not significant. Daily urine output and VEGF-C levels were significantly different when B lines were grouped into 2 according to the median level (P < .05 for all).This is the widest spectrum study looking for LUS findings and other volumetric parameters in a small PD cohort. LUS might be useful to evaluate hidden hypervolemia. Its correlation with VEGF-C level is a novel finding.


Asunto(s)
Diálisis Peritoneal , Edema Pulmonar/diagnóstico por imagen , Adulto , Anciano , Estudios de Cohortes , Estudios Transversales , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Edema Pulmonar/sangre , Ultrasonografía , Factor C de Crecimiento Endotelial Vascular/sangre
11.
Medicine (Baltimore) ; 100(5): e24275, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592871

RESUMEN

ABSTRACT: To investigate serum level of high mobility group box protein-1 (HMGB1) and prognosis of patients with end-stage renal disease (ESRD) on hemodialysis (HD) and peritoneal dialysis (PD).This prospective cohort observational study included a total of 253 ESRD patients who came to our hospital for HD or PD from February 2013 to February 2015. Enzyme linked immunosorbent assay (ELISA) method was used to detect the serum level of HMGB1, interleukin (IL-6), IL-8, and tumor necrosis factor-alpha (TNF-α). The kidney disease quality of life short form (KDQOL-SF) and kidney disease targeted area (KDTA) was applied for evaluating the quality of life. Kaplan-Meier (K-M) curve was performed for survival time.Serum level of HMGB1 in patients on HD was higher than PD. HMGB1 levels were gradually decreased with the treatment of HD or PD. Furthermore, HMGB1 was positively correlated with IL-6 and TNF-α. Moreover, patients with higher HMGB1 had more complications than patients with lower HMGB1, but there was no difference for the survival rate. In addition, the quality of life was associated with different dialysis methods.The serum level of HMGB1 and prognosis of ESRD patients was associated with different dialysis methods.


Asunto(s)
Proteína HMGB1/sangre , Fallo Renal Crónico , Diálisis Peritoneal , Calidad de Vida , Diálisis Renal , China/epidemiología , Correlación de Datos , Femenino , Humanos , Interleucina-6/sangre , Estimación de Kaplan-Meier , Fallo Renal Crónico/sangre , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/psicología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Diálisis Peritoneal/métodos , Diálisis Peritoneal/estadística & datos numéricos , Pronóstico , Estudios Prospectivos , Diálisis Renal/métodos , Diálisis Renal/estadística & datos numéricos , Factor de Necrosis Tumoral alfa/sangre
13.
Niger J Clin Pract ; 24(1): 132-134, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33473039

RESUMEN

Peritonitis is a common and serious complication of peritoneal dialysis and often primary factor of change over to hemodialysis treatment. Raoultella planticola is known as as environmental bacterium and rarely causes infections in humans. We present a case of peritoneal dialysis related peritonitis due to Raoultella planticola and review the clinical manifestations and treatment options of this microorganism. As far as we know, this is the third case of Raoultella planticola peritonitis in the literature.


Asunto(s)
Infecciones por Enterobacteriaceae , Diálisis Peritoneal , Peritonitis , Antibacterianos/uso terapéutico , Enterobacteriaceae , Infecciones por Enterobacteriaceae/diagnóstico , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Humanos , Peritonitis/tratamiento farmacológico , Peritonitis/etiología
14.
J Crit Care ; 62: 190-196, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33422809

RESUMEN

PURPOSE: The aim of this study is to describe the incidence of Acute Kidney Injury (AKI) amongst patients admitted to the Intensive Care Unit (ICU) with COVID-19. In addition we aim to detail the range of Renal Replacement Therapy (RRT) modalities offered to these patients (including peritoneal dialysis - PD - and intermittent haemodialysis - IHD) in order to meet demand during pandemic conditions. MATERIALS AND METHODS: Single-centre retrospective case note review of adult patients with confirmed COVID-19 admitted to ICU. RESULTS: Amongst 136 patients without a prior history of End Stage Kidney Disease (ESKD), 108 (79%) developed AKI and 63% of admitted patients received RRT. Due to resource limitations the range of RRT options were expanded from solely Continuous Veno-Venous HaemoDiaFiltration (CVVHDF - our usual standard of care) to include PD (in 35 patients) and IHD (in 15 patients). During the study period the proportion of RRT provided within ICU as CVVHDF fell from 100% to a nadir of 39%. There were no significant complications of either PD or IHD. CONCLUSIONS: During periods of resource limitations PD and IHD can safely be used to reduce dependence on CVVHDF in select patients with AKI secondary to COVID-19.


Asunto(s)
Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Cuidados Críticos/métodos , Terapia de Reemplazo Renal/métodos , Adulto , Anciano , Terapia de Reemplazo Renal Continuo/métodos , Femenino , Humanos , Unidades de Cuidados Intensivos , Terapia de Reemplazo Renal Intermitente/métodos , Masculino , Persona de Mediana Edad , Diálisis Peritoneal/estadística & datos numéricos , Estudios Retrospectivos , Centros de Atención Terciaria , Reino Unido/epidemiología
15.
Perit Dial Int ; 41(1): 101-103, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33499779

RESUMEN

Peritoneal dialysis treatment generates significant amounts of waste for disposal from patients' homes. In Australia, in the days after the onset of the COVID-19 pandemic, waste collection from homes was temporarily stopped. Our patient tried to dispose of his waste by burning the used bags and tubing, using paint thinner as an accelerant. We present a case report of the unusual neurological complication he developed.


Asunto(s)
/prevención & control , Exposición a Riesgos Ambientales/efectos adversos , Mioclonía/etiología , Diálisis Peritoneal , Solventes/efectos adversos , Tolueno/efectos adversos , Australia , /transmisión , Control de Enfermedades Transmisibles , Fuego , Calefacción , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Mioclonía/diagnóstico , Mioclonía/terapia
16.
Cochrane Database Syst Rev ; 1: CD012899, 2021 01 27.
Artículo en Inglés | MEDLINE | ID: mdl-33501650

RESUMEN

BACKGROUND: Patients with chronic kidney disease (CKD) who require urgent initiation of dialysis but without having a permanent dialysis access have traditionally commenced haemodialysis (HD) using a central venous catheter (CVC). However, several studies have reported that urgent initiation of peritoneal dialysis (PD) is a viable alternative option for such patients. OBJECTIVES: This review aimed to examine the benefits and harms of urgent-start PD compared to HD initiated using a CVC in adults and children with CKD requiring long-term kidney replacement therapy. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 25 May 2020 for randomised controlled trials through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. For non-randomised controlled trials, MEDLINE (OVID) (1946 to 11 February 2020) and EMBASE (OVID) (1980 to 11 February 2020) were searched. SELECTION CRITERIA: All randomised controlled trials (RCTs), quasi-RCTs and non-RCTs comparing urgent-start PD to HD initiated using a CVC. DATA COLLECTION AND ANALYSIS: Two authors extracted data and assessed the quality of studies independently. Additional information was obtained from the primary investigators. The estimates of effect were analysed using random-effects model and results were presented as risk ratios (RR) with 95% confidence intervals (CI). The GRADE framework was used to make judgments regarding certainty of the evidence for each outcome. MAIN RESULTS: Overall, seven observational studies (991 participants) were included: three prospective cohort studies and four retrospective cohort studies. All the outcomes except one (bacteraemia) were graded as very low certainty of evidence given that all included studies were observational studies and few events resulting in imprecision, and inconsistent findings. Urgent-start PD may reduce the incidence of catheter-related bacteraemia compared with HD initiated with a CVC (2 studies, 301 participants: RR 0.13, 95% CI 0.04 to 0.41; I2 = 0%; low certainty evidence), which translated into 131 fewer bacteraemia episodes per 1000 (95% CI 89 to 145 fewer). Urgent-start PD has uncertain effects on peritonitis risk (2 studies, 301 participants: RR 1.78, 95% CI 0.23 to 13.62; I2 = 0%; very low certainty evidence), exit-site/tunnel infection (1 study, 419 participants: RR 3.99, 95% CI 1.2 to 12.05; very low certainty evidence), exit-site bleeding (1 study, 178 participants: RR 0.12, 95% CI 0.01 to 2.33; very low certainty evidence), catheter malfunction (2 studies; 597 participants: RR 0.26, 95% CI: 0.07 to 0.91; I2 = 66%; very low certainty evidence), catheter re-adjustment (2 studies, 225 participants: RR: 0.13; 95% CI 0.00 to 18.61; I2 = 92%; very low certainty evidence), technique survival (1 study, 123 participants: RR: 1.18, 95% CI 0.87 to 1.61; very low certainty evidence), or patient survival (5 studies, 820 participants; RR 0.68, 95% CI 0.44 to 1.07; I2 = 0%; very low certainty evidence) compared with HD initiated using a CVC. Two studies using different methods of measurements for hospitalisation reported that hospitalisation was similar although one study reported higher hospitalisation rates in HD initiated using a catheter compared with urgent-start PD. AUTHORS' CONCLUSIONS: Compared with HD initiated using a CVC, urgent-start PD may reduce the risk of bacteraemia and had uncertain effects on other complications of dialysis and technique and patient survival. In summary, there are very few studies directly comparing the outcomes of urgent-start PD and HD initiated using a CVC for patients with CKD who need to commence dialysis urgently. This evidence gap needs to be addressed in future studies.


Asunto(s)
Catéteres Venosos Centrales , Tratamiento de Urgencia/métodos , Diálisis Renal/métodos , Insuficiencia Renal Crónica/terapia , Tiempo de Tratamiento , Bacteriemia/epidemiología , Bacteriemia/prevención & control , Sesgo , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Tratamiento de Urgencia/efectos adversos , Tratamiento de Urgencia/instrumentación , Tratamiento de Urgencia/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Estudios Observacionales como Asunto/estadística & datos numéricos , Diálisis Peritoneal/efectos adversos , Diálisis Peritoneal/instrumentación , Diálisis Peritoneal/métodos , Diálisis Peritoneal/mortalidad , Peritonitis/epidemiología , Diálisis Renal/efectos adversos , Diálisis Renal/instrumentación , Diálisis Renal/mortalidad , Insuficiencia Renal Crónica/mortalidad
19.
Dentomaxillofac Radiol ; 50(1): 20200108, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-32706991

RESUMEN

OBJECTIVE: The aim was to compare dental and skeletal indices in panoramic radiography between patients undergoing haemodialysis, peritoneal dialysis and age- and sex-matched control group. METHODS: In this comparative cross-sectional study, quantitative Indices including Antegonial Index (AI), Mental Index (MI), Panoramic Mandibular Index (PMI) and qualitative indices including Mandibular Cortical Index (MCI) and Trabecular Pattern (TP) were evaluated in panoramic images of 32 haemodialysis patients, 14 patients under peritoneal dialysis and 52 healthy individuals. The images were also investigated for pulp canal calcification, pulp stones, soft tissue calcification, changes in or loss of lamina dura, radiolucencies associated with brown tumour and ridge resorption. The indices were compared between the three groups and were investigated for association with the patients' blood test parameters and their diseases causing chronic renal failure (CRF). Intraobserver agreement for the 2-week interval of assessment was calculated for the indices. RESULTS: MI (p = 0.574) and PMI (p = 0.100) were not significantly different, but AI (p = 0.01), MCI (p < 0.001) and TP (p = 0.002) were significantly different between the two case groups and the control group. The prevalence of pulp calcification (p = 0.03) and ridge resorption (p = 0.005) was higher in the haemodialysis group. Soft tissue calcification (p = 0.85) and lamina dura changes (p = 0.9) showed no significant difference. Brown tumours were observed in only one case in the haemodialysis group. CONCLUSIONS: AI, MCI and TP showed a reduction in mineral density of the cortical and trabecular bone in CRF patients and more severely in patients under haemodialysis than those under peritoneal dialysis.


Asunto(s)
Densidad Ósea , Diálisis Peritoneal , Estudios Transversales , Humanos , Mandíbula/diagnóstico por imagen , Diálisis Peritoneal/efectos adversos , Radiografía Panorámica , Diálisis Renal
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