[Show abstract][Hide abstract] ABSTRACT: Introduction and Aims: Admissions and deaths have been shown to vary according to day of the week in patients receiving haemodialysis. Patients
with a range of chronic diseases are more likely to be admitted on a Monday, and have higher hospital associated mortality
at the weekend. We set out to explore these associations in patients receiving peritoneal dialysis (PD).mortality at the weekend.
These associations are explored in patients receiving peritoneal dialysis (PD).
Methods: Information on patients receiving PD from a cohort of patients starting renal replacement therapy in England between 2002
and 2006 collected by the UK Renal Registry was linked to hospitalisation data. Admission and death rates (in hospital and
out of hospital) by day of the week whilst receiving PD were calculated. 90 day technique survival following admission for
PD peritonitis according to day of the week was analysed using cox regression with a random effects term for renal centre,
comparing each day of the week to Wednesday when services should be optimal.
Results: 27,649 admissions in 6363 patients over 17,620 patient years were available for analysis. Mortality rate was 7.8 per 100
patient years and was stable across the week for both in hospital and out of hospital death. Acute admission rate was 1.15/year
for Monday to Friday and 0.85/year for the weekend (P<0.001). Admissions specifically for peritonitis were slightly lower
at the weekend (25.0 vs 26.5 per 100 patient years, P=0.004). Compared with technique survival following admission with peritonitis
on a Wednesday, Monday was associated with an increased risk (hazard ratio 1.18, 95% CI 1.01 - 1.38, P=0.04) an association
that persisted adjusting for age, comorbidity, ethnicity and including death as a technique failure event (hazard ratio 1.20,
95% CI 1.02 - 1.40 P=0.027).
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[Show abstract][Hide abstract] ABSTRACT: We aimed to estimate dietary intakes of trace elements, minerals, and vitamins in hemodialysis patients (HDP) of three centers in one metropolitan and two urban areas of Italy.
Daily dietary intake was assessed using a 3-day diet diary in 128 HDP.
Mean daily intakes of trace elements were as follows: zinc, 7.6 ± 5.4 mg; copper, 14.3 ± 11.8 mg; selenium, 28.3 ± 18.1 μg; and iron, 7.2 ± 4.1 mg (7.8 ± 2.6 mg in women, 6.9 ± 2.4 mg in men). The distribution of patients by daily intakes of trace elements showed most were under the recommended values, with the exception of copper intake, which was much higher. Mean daily intakes of minerals were as follows: magnesium, 174.4 ± 94.3 mg; phosphorus, 842.6 ± 576.8 mg; calcium, 371.8 ± 363.7 mg; potassium, 1,616.2 ± 897.3 mg; and sodium, 1,350 ± 1,281 mg. Mean daily intakes of vitamins were as follows: vitamin A, 486.1 ± 544.6 μg; vitamin B1, 0.86 ± 0.7 mg; vitamin B2, 1.1 ± 0.7 mg; vitamin B3, 13.3 ± 8.1 mg; vitamin C, 47.8 ± 50.3 mg; and vitamin E, 9.5 ± 3.6 mg. The distribution of patients by daily intakes of vitamins showed most were under the recommended values. Daily intakes of trace elements and vitamins were similar among the three centers and did not differ between dialysis and non-dialysis days.
Many HDP have daily dietary intakes of trace elements and vitamins below the recommended values, whereas the intake of copper is much higher.
International Urology and Nephrology 03/2014; 46(4). DOI:10.1007/s11255-014-0689-y · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction and Aims: Almost one-third of critically ill patients in intensive care units have acute kidney injury (AKI), predominantly due to
acute tubular necrosis and as part of multiple organ failure. The optimal dialysis in these patients is still unclear. The
purpose of the study is to compare clinical outcomes between intermittent hemofiltration and standard hemodialysis in this
Methods: The purpose of this prospective randomized controlled single centre clinical study was to compare mortality and recovery
of kidney function between intermittent hemofiltration (HF) and hemodialysis (HD) in critically ill patients with AKI. From
2010 to 2012 we randomly assigned 86 patients with AKI to intermittent HF or HD. Death from any cause within 30 and 60 days
were primary study outcomes. In subgroup of patients with in hospital recovery of kidney function time to kidney function
recovery and the number of required dialysis procedures were analyzed.
Results: Forty-four patients were given intermittent HF and 42 were given HD. The mean age (±SD) was 62.1±8.8 years. 72.5% of patients
were male, 52.1% were oligouric and 60.2% required mechanical ventilation. The most attributed conditions in AKI were sepsis
and ischaemia. The two groups had similar baseline characteristics and received treatment for an average of 10.2 days (HF)
and 9.8 days (HD). Total all cause mortality by day 60 was 74.8% and was similar between the HF and the HD study groups. There
were no significant differences between the groups in number of deaths at 30 and 60 days. Kidney function has recovered during
hospitalization in 86 (39.8%) patients. In survivors at day 60 the two groups were similar for renal outcome.
Conclusions: In this randomized, controlled clinical study,intermittant HF in critically ill patients with AKI does not improve survival or recovery of kidney function compared to standard
intermittent HD. The optimal treatment modality in AKI in critically ill patients remains unclear and needs further studies.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Videolaparoscopy is considered the reference method for peritoneal catheter placement in patients with previous abdominal surgery. The placement procedure is usually performed with at least two access sites: one for the catheter and the second for the laparoscope. Here, we describe a new one-port laparoscopic procedure that uses only one abdominal access site in patients not eligible for laparotomic catheter placement. Method: We carried out one-port laparoscopic placement in 21 patients presenting contraindications to blind surgical procedures because of prior abdominal surgery. This technique consists in the creation of a single mini-laparotomy access through which laparoscopic procedures and placement are performed. The catheter, rectified by an introducer, is inserted inside the port. Subsequently, the port is removed, leaving the catheter in pelvic position. The port is reintroduced laterally to the catheter, confirming or correcting its position. Laparotomic placement was performed in a contemporary group of 32 patients without contraindications to blind placement. Complications and long-term catheter outcome in the two groups were evaluated. RESULTS: Additional interventions during placement were necessary in 12 patients of the laparoscopy group compared with 5 patients of the laparotomy group (p = 0.002). Laparoscopy documented adhesions in 13 patients, with need for adhesiolysis in 6 patients. Each group had 1 intra-operative complication: leakage in the laparoscopy group, and intestinal perforation in the laparotomy group. During the 2-year follow-up period, laparoscopic revisions had to be performed in 6 patients of the laparoscopy group and in 5 patients of the laparotomy group (p = 0.26). The 1-year catheter survival was similar in both groups. Laparoscopy increased by 40% the number of patients eligible to receive peritoneal dialysis. CONCLUSIONS: Videolaparoscopy placement in patients not eligible for blind surgical procedures seems to be equivalent to laparotomic placement with regard to complications and long-term catheter outcome. The number of patients able to receive peritoneal dialysis is substantially increased.
[Show abstract][Hide abstract] ABSTRACT: Background: We aimed to measure the dietary intake of calories, proteins, carbohydrates, lipids and fiber in patients on chronic hemodialysis (HD) at 3 centers in 1 metropolitan and 2 urban areas of Italy, and to evaluate whether it met the dietary guidelines for cardiovascular risk reduction. Methods: Daily dietary intake was assessed through a 3-day diet diary in 128 HD patients at the hemodialysis units of the Catholic University of Rome, Hospital A. Murri of Jesi and Hospital Principe di Piemonte of Senigallia, Italy. Results: Mean dietary calorie and protein intakes were 22.9 ± 9.1 kcal/kg per day and 0.95 ± 0.76 g protein/kg per day, respectively. Daily carbohydrate and lipid intakes as a percentage of total calorie intake were 51.8% ± 8.9% and 32.1% ± 7.1%. Mean daily dietary cholesterol intake was 206.6 ± 173.6 mg. Mean daily dietary intakes of omega-3 and omega-6 fatty acids were 0.49 ± 0.28 g and 5.1 ± 2.5 g, respectively, while the mean ratio of omega-6 to omega-3 intake was 11.5 ± 4.8. Forty-eighty percent of patients had an omega-6 to omega-3 ratio =10. Mean daily dietary intakes of saturated fatty acids (SFAs), monounsaturated fatty acids and polyunsaturated fatty acids were 5.5 ± 3.3 g, 28.9 ± 9.1 g and 3.1 ± 1.7 g, respectively. Ninety-six percent of HD patients had an SFA intake <10% of total calories. Most unsaturated fatty acids intakes were under the value of =30%. Mean daily dietary fiber intake was 11.8 ± 6.1 g. Conclusion: In HD patients from a Mediterranean country (Italy), daily intakes of calories, proteins and fiber were lower than the recommended values, whereas the intake of lipids was closer to being adequate.
Journal of nephrology 10/2012; 26(5). DOI:10.5301/jn.5000222 · 2.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Long-term dialysis treatment can be associated with several musculoskeletal complications. Entheseal involvement in dialysis patients remains rarely studied as its prevalence is underestimated due to its often asymptomatic presentation. The aims of the study were to determine the prevalence of subclinical enthesopathy in haemodialysis and peritoneal dialysis patients at the lower limb level, to investigate the inter-observer reliability of ultrasound assessment and to analyse the influence of biometric and biochemical parameters. Ultrasound examination was conducted at the entheses of the lower limbs level in 33 asymptomatic dialysis patients and 33 healthy adopting the Glasgow Ultrasound Enthesitis Scoring System (GUESS). The inter-observer reliability was calculated in 15 dialysis patients. Ultrasound found at least one sign of enthesopathy in 165 out of 330 (50%) entheses of dialysis patients. In healthy subjects, signs of enthesopathy were present in 54 out of 330 (16.3%) entheses (p < 0.0001). No power Doppler signal was detected in healthy controls, in contrast to four of 330 entheses of dialysis patients. No US signs of soft tissue amyloid deposits were found. The GUESS score was significantly higher in dialysis patients than in controls (p < 0.0001). There was no difference in terms of enthesopathy between haemodialysis and peritoneal dialysis. Dialysis duration resulted to be the most important predictor for enthesopathy (p = 0.0004), followed by patient age (p = 0.02) and body mass index (p = 0.035). Parathormone, calcium, phosphorus, C-reactive protein, cholesterol and triglycerides apparently did not play a relevant role in favour of enthesopathy. The inter-observer reliability showed an excellent agreement between sonographers with different degree of experience. Our results demonstrated a higher prevalence of subclinical enthesopathy in both haemodialysis and peritoneal dialysis patients than in healthy subjects. Follow-up will provide further information with respect to the predictive value of US findings for the development of symptomatic dialysis-related arthropathy.
[Show abstract][Hide abstract] ABSTRACT: A 55-year-old female haemodialysis patient presented progressive abdominal liquid formation after having been excluded from peritoneal dialysis therapy because of recurrent peritonitis. Ultrasound was suspicious for ascites secondary to sclerosing peritonitis. Computed tomography revealed a thin-walled mesenteric cyst extending from the epigastric to the pelvic region. The cyst was excised incompletely as extensive adhesions were present. Histology was consistent with a mesothelial cyst of inflammatory origin. Three months after surgery, ultrasound detected a local recurrence at the descending colon. This case emphasizes the relation between mesenteric cyst, persistent inflammatory status and preceding peritoneal dialysis complicated by peritonitis.
[Show abstract][Hide abstract] ABSTRACT: Malfunction of the peritoneal catheter is a frequent complication in peritoneal dialysis (PD). Videolaparoscopy is a minimal invasive technique that allows rescue therapy of malfunctioning catheters and consecutive immediate resumption of PD. Furthermore, Tenckhoff catheters can be safely positioned in patients with previous abdominal surgery. We analysed the clinical diagnosis, videolaparoscopic treatment and the outcome of PD patients on whom videolaparoscopic interventions had been performed at our centre.
Thirty-two cases of videolaparoscopic interventions were performed for salvage of malfunctioning peritoneal catheters, implantation and abdominal surgical interventions in 25 PD patients. The videolaparoscope was inserted through a mini-laparotomy site of 15 mm diameter which was closed with purse-string sutures at the end of the intervention.
Videolaparoscopy was used in 21 cases of catheter malfunction mostly due to omental wrapping (12 cases) and dislocation (five cases). In eight patients with previous surgical abdominal interventions, laparoscopic placement of the PD catheter was performed. In two cases the gall bladder was removed. One case of intestinal occlusion was evaluated laparoscopically in an attempt to minimize invasive surgery. Leakage of the peritoneal fluid presented the only complication caused by insufficient closure of one mini-laparotomy site. Minimal follow-up time of rescued catheters was 5 months. Videolaparoscopy prolonged PD catheter function by a median of 163 days (range 5-1469 days).
Videolaparoscopy prolongs peritoneal catheter survival by treating directly the causes of malfunction. In patients with preceding abdominal interventions, the PD catheter can be placed safely even in cases necessitating surgical preparation like adhesiolysis.