BACKGROUND: Failure to achieve target values for both urea (Kt/V) and creatinine clearance has been associated with increased morbidity and mortality in CAPD patients. Current standard of adequacy CAPD is to provide a weekly normalized urea clearance of 2.0 or more and a creatinine clearance of 60 liter/ 1.73 m2 or more. Conventional CAPD in patients without residual renal function is associated with worse clinical outcomes. This study was designed to study the effect of increasing daily exchange frequency on dialysis adequacy in anuric CAPD patients. METHODS: The 27 anuric CAPD patients (patients on 4x2 L daily exchanges for 7 days) were selected and then they received standard dose dialysis (4x2 L daily exchanges for 7 days) followed by high dose dialysis (5x2 L daily exchanges). Weekly Kt/Vurea and weekly Ccr were measured at the end of standard and high dose dialysis. Adequate dialysis was defined as satisfying both weekly Kt/Vurea >2.0, weekly Ccr >60 L/1.73 m2 according to DOQI guideline. RESULTS: Selected patients were 12 men and 15 women, mean age was 49+/-2 years, mean weight was 59.2+/-0.1 kg , mean peritoneal dialysis duration was 51+/-5 months. Weekly Kt/V was 1.7+/-.3 in standard dose dialysis patients and 2.1+/-.4 in high dose dialysis patients, mean Ccr was 48.8+/-.2 L/ week/1.73 m2 in standard dose dialysis patients and 63.1+/-2.1 L/week/1.73 m2 in high dose dialysis patients. This difference is statistically significant (p< 0.05). Among 27 patients, only 2 standard dose dialysis patients were on adequate dialysis but in high dose dialysis group, 14 patients were on adequate dialysis according to DOQI guideline. In high dose dialysis, 14 on adequate dialysis and 13 inadequate dialysis were divided and their clinical factors were analyzed. Only volume of urea distribution (30.9+/-.9 L vs 37.7+/-.6 L) was significantly different (p<0.05). CONCIUSION: This study revealed most standard dose of anuric CAPD patients, who receiving daily 8 L dialysis did not dialyzed adequately by DOQI guideline. Increasing the number of exchanges effectively increased Kt/Vurea and weekly creatinine clearance in anuric CAPD patients.
Anuria ; Creatinine ; Dialysis* ; Female ; Humans ; Male ; Mortality ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Urea

BACKGROUND: Failure to achieve target values for both urea (Kt/V) and creatinine clearance has been associated with increased morbidity and mortality in CAPD patients. Current standard of adequacy CAPD is to provide a weekly normalized urea clearance of 2.0 or more and a creatinine clearance of 60 liter/ 1.73 m2 or more. Conventional CAPD in patients without residual renal function is associated with worse clinical outcomes. This study was designed to study the effect of increasing daily exchange frequency on dialysis adequacy in anuric CAPD patients. METHODS: The 27 anuric CAPD patients (patients on 4x2 L daily exchanges for 7 days) were selected and then they received standard dose dialysis (4x2 L daily exchanges for 7 days) followed by high dose dialysis (5x2 L daily exchanges). Weekly Kt/Vurea and weekly Ccr were measured at the end of standard and high dose dialysis. Adequate dialysis was defined as satisfying both weekly Kt/Vurea >2.0, weekly Ccr >60 L/1.73 m2 according to DOQI guideline. RESULTS: Selected patients were 12 men and 15 women, mean age was 49+/-2 years, mean weight was 59.2+/-0.1 kg , mean peritoneal dialysis duration was 51+/-5 months. Weekly Kt/V was 1.7+/-.3 in standard dose dialysis patients and 2.1+/-.4 in high dose dialysis patients, mean Ccr was 48.8+/-.2 L/ week/1.73 m2 in standard dose dialysis patients and 63.1+/-2.1 L/week/1.73 m2 in high dose dialysis patients. This difference is statistically significant (p< 0.05). Among 27 patients, only 2 standard dose dialysis patients were on adequate dialysis but in high dose dialysis group, 14 patients were on adequate dialysis according to DOQI guideline. In high dose dialysis, 14 on adequate dialysis and 13 inadequate dialysis were divided and their clinical factors were analyzed. Only volume of urea distribution (30.9+/-.9 L vs 37.7+/-.6 L) was significantly different (p<0.05). CONCIUSION: This study revealed most standard dose of anuric CAPD patients, who receiving daily 8 L dialysis did not dialyzed adequately by DOQI guideline. Increasing the number of exchanges effectively increased Kt/Vurea and weekly creatinine clearance in anuric CAPD patients.
Anuria ; Creatinine ; Dialysis* ; Female ; Humans ; Male ; Mortality ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Urea

Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis associated with a high mortality rate. Bacterial peritonitis (BP), a complication of EPS treatment, is uncommon, and treatments for BP are not well known. We report two patients who had undergone steroid treatment who developed BP after hemodialysis transfer. In the first case, we treated the BP with antibiotics and performed several surgical drainage procedures; however, the fluid became too thick to drain. This patient died of malnutrition and sepsis. In the second case, antibiotics and surgical enterolysis with peritonectomy were used to treat the BP. Solid food was accepted on day 7 postoperatively, and the patient was stable after 20 months. Thus, surgical enterolysis with peritonectomy may be a good treatment modality for patients with EPS and BP.
Anti-Bacterial Agents ; Drainage ; Humans ; Malnutrition ; Mortality ; Peritoneal Dialysis ; Peritoneal Fibrosis* ; Peritonitis* ; Renal Dialysis ; Sepsis

BACKGROUND: Although patients with end-stage renal disease (ESRD) experience excess mortality compared with the general population, the standardized mortality ratio (SMR) for Korean patients on dialysis has not yet been investigated. In this study, we evaluated the SMR among all Korean ESRD patients on maintenance ialysis in 2009 and 2010, and compared it according to age categories, sex, and dialysis modality. METHODS: We used data from all patients on maintenance dialysis between January 1, 2009 and December 31, 2010 in Korea using the database of the Korean Health Insurance Review and Assessment Service, and the SMR was determined by calculating of the ratio between the number of actual deaths and expected deaths. RESULTS: A total of 45,568 patients in 2009 and 48,170 patients in 2010 were included in the analysis. The overall age- and sex-adjusted SMR was 10.3 [95% confidence interval (CI), 10.0-10.6] in 2009 and 10.9 (95% CI, 10.7-11.2) in 2010. The SMR for females was much higher than for males. The SMR gradually decreased with increasing age groups. The overall SMR for maintenance hemodialysis patients was lower than that of peritoneal dialysis patients. CONCLUSION: The SMR among Korean ESRD patients is likely to be higher than in other countries. Further evaluation is needed to attempt to improve the outcomes.
Dialysis* ; Female ; Humans ; Insurance, Health ; Kidney Failure, Chronic ; Korea ; Male ; Mortality* ; Peritoneal Dialysis ; Renal Dialysis

Protein and energy malnutrition are common in dialysis patients. Nutritional assessment is of great importance because undernutrition has been shown to be associated with increased morbidity and mortality in both hemodialysis and peritoneal dialysis. To validate subjective global assessment(SGA) in dialysis patients we compared subjective global assessment with objective measurements(anthropometry, bioelectrical impedance, biochemical measurements) in 54 chronic hemodialysis patients. We divided patients into three groups(SGA1, SGA2, SGA3) according to modified subjective global assessment performed by an observer. Body weight, %IBW, BMI, TSF, MAC, nPCR were different significantly among three groups. SGA was related objective measurements such as body weight, %IBW, BMI, %Fat, TSF, MAC, nPCR(p<0.001). Multiple regression analysis showed that the relationship of SGA(as a dependent variable) with objective measurement(covariate) was stronger(multiple r=0.789, R2=60%) than the relationship found with univariate analysis. In other words, since no single objective method can be considered a gold standard of nutritional assessment, our data show that subjective global assessment is a clinically adequate method for assessing nutritional status in maintenance hemodialysis patients.
Body Weight ; Dialysis ; Electric Impedance ; Humans ; Malnutrition ; Mortality ; Nutrition Assessment ; Nutritional Status ; Peritoneal Dialysis ; Renal Dialysis*

PURPOSE: Hyperglycemia, hypoalbuminemia and other factors make diabetic CRF patient vulnerable to salt and fluid retention, which is partial explanation of high mortality rate of DM dialysis patients. This prospective study was carried out to investigate the different membrane characteristics associated with ultrafiltration between diabetic and non diabetic CAPD patients. METHODS: Among new CAPD patients from May 2001 to January 2004 in our hospitals, 60 patients who had complete data more than 12 month were enrolled. Peritoneal equilibration test and D/P1hr Na using 4.25% dialysate, daily ultrafiltration and urine volume, serum albumin and glucose level, daily exposed and daily absorbed glucose amount through the peritoneal cavity and clinical indices were measured at 1st, 6th, and 12th months after initiation of CAPD. We analyzed data with independent t test, repeated measure of ANOVA and multiple regression by STATA. RESULTS: We can summarized the RESULTS: Changes of body weight, total body water, daily ultrafiltration volume (UFV), D/P4Cr, UFV during PET and RRF were not significantly different between DM and non-DM at 1st, 6th, and 12th months. But 1st month serum albumin was lower in DM (p=0.01). Daily exposed glucose amount was significantly higher in DM group at 1st and 12th months (161.7+/-44.5 g/day vs. 140.3+/-21.1 g/day and 157.4+/-43.8 g/ day vs. 134.0+/-11.3 g/day, p=0.019, p=0.006, respectively). At 1st month, D/P1hr Na was not significantly different between DM and non-DM but DM group showed getting higher (D/P)1hr Na at 6th and 12th month (p=0.04, p=0.006, respectively). Factors associated with D/P1hr Na were DM (beta-coeff= -0.015, p=0.042), log hs CRP (beta-coeff=0.012, p= 0.025), 24 hours dialysate albumin (beta-coeff=-0.010, p=0.000), and D/P4Cr (beta-coeff=0.150, p=0.000). CONCLUSION: Diabetic CAPD patients showed more rapid increase of D/P1hr Na during initial 1 year. It might be due to more rapid deterioration of water channel function with time on PD. In terms of achieving adequate ultrafiltration in diabetic peritoneal dialysis patient with time, higher concentration of glucose or icodextrin containing dialysate might be needed to overcome decreased water channel function.
Body Water ; Body Weight ; Dialysis ; Glucose* ; Humans ; Hyperglycemia ; Hypoalbuminemia ; Membranes ; Mortality ; Peritoneal Cavity ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Prospective Studies ; Serum Albumin ; Ultrafiltration*

BACKGROUND: Volume overload results in higher mortality rates in patients on continuous ambulatory peritoneal dialysis (CAPD). The ratio of bioimpedance (RBI) might be a helpful parameter in adjusting dry body weight in CAPD patients. This study examined whether it is possible to distinguish between non-hypervolemic status and hypervolemic status in CAPD patients by using only RBI. METHODS: RBI was calculated as follows: RBI = impedance at 50 kHz/impedance at 500 kHz. Based on the experts’ judgements, a total of 64 CAPD patients were divided into two groups, a non-hypervolemic group and a hypervolemic group. The RBI was measured from right wrist to right ankle (rw-raRBI) by bioimpedance spectroscopy (BCM®, Fresenius Medical Care) before and after the peritosol was emptied. Other RBIs were measured from the right side of the anterior superior iliac spine to the ipsilateral ankle (rasis-raRBI) to control for the electro-physiological effects of peritoneal dialysate. RESULTS: The mean rw-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients in the presence (1.141 ± 0.022 vs. 1.121 ± 0.021, P < 0.001) of a peritosol. Likewise, the mean rasis-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients (presence of peritosol: 1.136 ± 0.026 vs. 1.109 ± 0.022, P < 0.001; absence of peritosol: 1.131 ± 0.022 vs. 1.107 ± 0.022, P < 0.001). CONCLUSION: The volume status of CAPD patients was able to be simply expressed by RBI. Therefore, this study suggests that when patients cannot be analyzed using BCM, RBI could be an alternative.
Ankle ; Body Weight ; Electric Impedance ; Humans ; Mortality ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Pilot Projects* ; Spectrum Analysis ; Spine ; Wrist

OBJECTIVE: To investigate the associations between mean arterial pressure (MAP) and mortality in patients with peritoneal dialysis (PD). METHODS: A total of 1737 patients with terminal renal diseases under PD in the First Affiliated Hospital of Zhejiang University from 2008 to 2016 were enrolled. Patients were followed up for 33.0(19.3, 52.4) months. The mean arterial pressure over the first 3 months of PD therapy were calculated. All-cause death and cardiovascular death were assessed using Cox regression models adjusted for demographics, laboratory measurements, comorbid conditions and antihypertensive medications. RESULTS: During the follow-up, 208 patients died, among which 95(45.7%) patients died of cardiovascular causes. Compared with patients with MAP >95-<120 mmHg, patients with MAP ≤ 95 mmHg were associated with significantly higher risk of all-cause death (=1.40,95%:1.01-1.93,<0.05); patients with MAP ≥ 120 mmHg were associated with significantly higher risk of all-cause (=2.12,95%:1.32-3.40, <0.01) and cardiovascular morality (=2.55, 95%:1.38-4.70, <0.01). MAP presents a U-shaped association with all-cause mortality and a J-shaped association with cardiovascular mortality. CONCLUSIONS Both high MAP and low MAP are associated with higher risk of mortality in PD patients.
Arterial Pressure ; Humans ; Kidney Failure, Chronic ; mortality ; pathology ; Peritoneal Dialysis ; Renal Dialysis ; Risk Factors

BACKGROUND/AIMS: Liver cirrhosis (LC) is an important problem in patients withend-stage renal disease (ESRD). Few studies have investigated the inf luence ofLC on mortality in patients with ESRD. This study investigated the associationbetween LC and mortality among patients with ESRD and compare mortality betweentwo dialysis modalities. METHODS: Adult patients (≥ 18 years of age) starting dialysis for ESRD were enrolledin the present study from 2000 to 2011. We analyzed 1,069 patients withESRD; of these, 742 patients were undergoing hemodialysis (HD) and 327 patientswere undergoing peritoneal dialysis (PD). RESULTS: The prevalence of LC was 44 of 1,069 patients (4.1%). The cumulative 1-,3-, and 5-year survival rates of noncirrhotic patients were 93%, 83%, and 73%, respectively,whereas the equivalent survival rates of cirrhotic patients were 90%,68%, and 48%, respectively (p = 0.011). After adjustment, LC was an independentrisk factor for death in patients with ESRD. No difference in mortality associatedwith LC was found between the HD and PD subgroups. CONCLUSIONS: Of the patients with ESRD, cirrhotic patients had poorer survivalthan noncirrhotic patients. Among patients with ESRD and LC, survival of patientsundergoing PD may be comparable with that of patients undergoing HD.
Adult ; Dialysis ; Humans ; Kidney Failure, Chronic* ; Liver Cirrhosis* ; Liver* ; Mortality ; Peritoneal Dialysis ; Prevalence ; Renal Dialysis ; Survival Rate

BACKGROUND/AIMS: Since comorbidities are major determinants of modality choice, and also interact with dialysis modality on mortality outcomes, we examined the pattern of modality choice according to comorbidities and then evaluated how such choices affected mortality in incident dialysis patients. METHODS: We analyzed 32,280 incident dialysis patients in Korea. Patterns in initial dialysis choice were assessed by multivariate logistic regression analyses. Multivariate Poisson regression analyses were performed to evaluate the effects of interactions between comorbidities and dialysis modality on mortality and to quantify these interactions using the synergy factor. RESULTS: Prior histories of myocardial infarction (p = 0.031), diabetes (p = 0.001), and congestive heart failure (p = 0.003) were independent factors favoring the initiation with peritoneal dialysis (PD), but were associated with increased mortality with PD. In contrast, a history of cerebrovascular disease and 1-year increase in age favored initiation with hemodialysis (HD) and were related to a survival benefit with HD (p < 0.001, both). While favoring initiation with HD, having Medical Aid (p = 0.001) and male gender (p = 0.047) were related to increased mortality with HD. Furthermore, although the severity of comorbidities did not inf luence dialysis modality choice, mortality in incident PD patients was significantly higher compared to that in HD patients as the severity of comorbidities increased (p for trend < 0.001). CONCLUSIONS: Some comorbidities exerted independent effects on initial choice of dialysis modality, but this choice did not always lead to the best results. Further analyses of the pattern of choosing dialysis modality according to baseline comorbid conditions and related consequent mortality outcomes are needed.
Cerebrovascular Disorders ; Comorbidity ; Dialysis* ; Heart Failure ; Humans ; Korea* ; Logistic Models ; Male ; Mortality* ; Myocardial Infarction ; Peritoneal Dialysis ; Renal Dialysis