[Show abstract][Hide abstract] ABSTRACT: Background: While area detector computed tomography (ADCT) is a useful tool for coronary artery disease (CAD) evaluation, myocardial perfusion imaging (MPI) with single photon emission computed tomography is a well-established method of predicting functional relevance of CAD. Purpose: We assess the usefulness for decision making using both ADCT and MPI and discussed from the standpoint of cost for diagnostic work-up and contrast agent. Method: Between January, 2013 to September, 2014, 78 patients underwent both ADCT and MPI within two months were analyzed their therapeutic strategy. From ADCT, severity of stenosis was divided non-significant(less than 50%), moderate (over or equal to 50% and less than 75%) and severe (over or equal to 75%). Summed difference score of MPI was judged as ischemia positive.
Result: Table showed the result and executed treatment strategy. Patients with significant stenosis by ADCT were 40 patients (51.3%) and patients with ischemia positive were 25 patients (33.8%). Invasive revasculization was performed higher (82.3%, p<0.01) for the patients with significant stenosis and ischemia than moderate stenosis with ischemia (25%) or significant stenosis without ischemia (39.1%). Before taking invasive therapy, examination with ADCT and MPI saved 63700 yen and about 100ml of contrast agent in each case based study as it was compared with the case with ADCT and coronary angiography without MPI in spite of slightly higher radiation dose (4mSv). Conclusion: The combined use of ADCT and MPI could choose effectively treatment strategy of CAD with a reduction of cost and contrast agent.
European heart journal cardiovascular Imaging; 05/2015
[Show abstract][Hide abstract] ABSTRACT: To investigate the response of serum fibroblast growth factor 21 (FGF21) to a meal and to insulin infusion in haemodialysis (HD) patients.
Meal study: in a cross-over design, 12 non-diabetic HD patients were randomly assigned to: 1) a non-HD day with one meal served, 2) a HD day with one meal served during HD, and 3) a HD day with two meals served during and after HD, respectively. Twelve healthy controls participated in an experiment identical to the non-HD day. Insulin infusion study: in a cross-over design, 11 non-diabetic HD patients were randomly assigned to receive a 4-h HD session with either: 1) no infusion, 2) glucose infusion, or 3) glucose-insulin infusion. A meal was served 2 h before HD start.
Meal study: serum FGF21 was 23-fold higher in HD patients than controls (P < 0∙001). Postprandial FGF21 decreased on all four study days (P ˂ 0∙006), but the relative reductions from baseline were significantly greater in controls (P < 0∙008). Postprandial changes in FGF21 were inversely related with triglycerides (P = 0∙042) and positively related with insulin-like growth factor binding protein-1 (IGFBP-1) (P < 0∙001). Serum FGF21 was only associated with changes in adiponectin (P = 0∙001) and free fatty acids (P = 0∙04) in the healthy controls. Insulin infusion study: as compared with no infusion, glucose and glucose-insulin infusion prevented the postprandial decrease in FGF21 and resulted in higher FGF21 concentrations by up to 25% (P = 0∙003).
Serum FGF21 was highly elevated in HD patients but the response of serum FGF21 to meal intake and insulin infusion seemed to be intact. Our results indicate that FGF21 may play an important role in short-term metabolic homeostasis. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: Introduction and Aims: It is estimated that up to 20% of all emergency admissions to UK hospitals develop acute kidney injury (AKI). The UK National
Confidential Enquiry into Patient Outcome (NCEPOD) Report in 2009 identified ‘top ten’ risk factors for developing AKI. Early
identification of these risk factors would facilitate more effective risk stratification and early targeted investigation
and management where AKI has developed. However, no AKI risk stratification tool has yet been validated in a general hospital
population.We have developed a risk tool, 'CRASHED', incorporating 7 of the 10 risk factors identified by NCEPOD Report (See
Table 1). It can realistically be applied in an emergency admission setting using basic background information and early observational
values to stratify risk of developing AKI. The aim of this study is to establish the effectiveness of ‘CRASHED’ score in predicting
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[Show abstract][Hide abstract] ABSTRACT: Cardiovascular disease is the leading cause of death in patients with end stage renal disease (ESRD). The vasodilator mechanisms in small resistance arteries are in earlier studies shown to be reduced in patients with end stage renal disease. We studied whether endothelium dependent vasodilatation were diminished in ESRD patients and the interaction between the macro- and microcirculation.
Eleven patients with ESRD had prior to renal transplant or insertion of peritoneal dialysis catheter measured pulse wave velocity. During surgery, a subcutaneous fat biopsy was extracted. Resistance arteries were then dissected and mounted on a wire myograph for measurements of dilator response to increasing concentrations of acetylcholine after preconstriction with noradrenaline. Twelve healthy kidney donors served as controls.
Systolic blood pressure was elevated in patients compared to the healthy controls; no difference in the concentration of asymmetric dimethyl arginine was seen. No significant difference in the endothelium dependent vasodilatation between patients and controls was found. Correlation of small artery properties showed an inverse relationship between diastolic blood pressure and nitric oxide dependent vasodilatation in controls. Pulse pressure was positively correlated to the total endothelial vasodilatation in patients. A negative association between S-phosphate and endothelial derived hyperpolarisation-like vasodilatation was seen in resistance arteries from controls.
This study finds similar vasodilator properties in kidney patients and controls. However, correlations of pulse pressure and diastolic blood pressure with resistance artery function indicate compensating measures in the microcirculation during end stage renal disease.
PLoS ONE 04/2014; 9(4):e94638. DOI:10.1371/journal.pone.0094638 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Late referral of patients with chronic kidney disease (CKD) and unforeseeable deterioration of residual renal function in known CKD patients remain a major problem leading to the need of unplanned start on chronic dialysis without a mature access for dialysis. In most centres worldwide, these patients are started on haemodialysis (HD) using a temporary tunnelled central venous catheter (CVC) for access. However, during the last decade, increasing clinical experience with unplanned start on peritoneal dialysis (PD) right after PD catheter implantation has been published. Key studies are reviewed in the present paper, and the results seem to indicate that compared with patients starting PD in a planned setting with peritoneal resting after PD catheter implantation, patients starting unplanned PD have an increased risk of mechanical complications but apparently no increased risk of infectious complications. In contrast, patients starting unplanned HD using a temporary CVC have an increased risk of both mechanical and infectious complications when compared with patients starting planned HD using an arterio-venous fistula or a permanent CVC. Regarding clinical outcome in terms of survival, unplanned PD seems to be at least as safe as unplanned HD. Combining the unplanned PD programme with a nurse-assisted PD programme is crucial in order to offer the patient a real opportunity to choose a home-based dialysis option. In conclusion, unplanned start on PD seems to be a feasible, safe and efficient alternative to unplanned start on HD for the late referred patient with end-stage renal disease and urgent need for dialysis.
[Show abstract][Hide abstract] ABSTRACT: Patients on maintenance hemodialysis (HD) have reduced circulating free and bioactive insulin-like growth factor I (IGF-I) due to increased IGF-binding proteins (IGFBPs). The present study investigated the postprandial response of the IGF system in HD patients compared with matched healthy subjects.
In a cross-over study, twelve non-diabetic HD patients were assigned in random order to three 10-h lasting study days: 1) a non-HD day with one meal served at baseline (NHDM1), 2) a HD day with one meal served during HD (HDM1), and 3) a HD day with two meals served during and after HD, respectively (HDM2). Twelve healthy controls conducted session 1.
After the baseline meal, insulin concentrations changed similarly in HD patients and controls, whereas hyperglycemia was more prolonged in HD patients (P<0·001). Postprandial IGFBP-1 showed greater reductions from baseline in controls (-76% [-81; -70%], mean [95% confidence intervals], P<0·001) than in patients on non-HD days (-45% [-57; -30%], P<0·001). In the latter group the response was even more attenuated during HD (-22% [-38; -1%] and -24% [-40; -4%], P≤0·041). After the second meal on HDM2 days, IGFBP-1 further decreased (-50% [-61; -37%], P<0·001), whereas IGFBP-1 returned to baseline levels on the other study days. Consistently, at the end of the study days, bioactive IGF-I was significantly above baseline only on HDM2 days (+22% [+5; +43%], P=0·012).
HD patients were unable to suppress IGFBP-1 to the same extent as healthy controls, which may increase the risk of protein-energy wasting in maintenance HD. A second meal after HD, however, effectively suppressed IGFBP-1 and raised bioactive IGF-I. This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: A marked reduction in serum levels of bioactive insulin-like growth factor-I (IGF-I) has been observed in fasting hemodialysis (HD) patients during a 4-h HD session. The aim of the present study was to investigate the beneficial effect of hyperinsulinemia during HD on bioactive IGF-I and inflammatory biomarkers.
In a randomized cross-over study, 11 non-diabetic HD patients received a standardised HD session with either: 1) no treatment, 2) glucose infusion (10% glucose, 2.5 mL/kg/h), or 3) glucose-insulin infusion (10% glucose added 30 IU NovoRapid® per litre, 2.5 mL/kg/h). Each experiment consisted of three periods: pre-HD (−120 to 0 min), HD (0 to 240 min), and post-HD (240 to 360 min). A meal was served at baseline (−120 min); infusions were administered from baseline to 240 min. The primary outcome was change in bioactive IGF-I during the experiment. Secondary outcomes were changes in high-sensitivity C-reactive protein, interleukin-1β, interleukin-6, and tumor necrosis factor α. Comparisons were performed using mixed-model analysis of variance for repeated measures.
From baseline to the end of study, no significant differences were observed in the changes in either serum bioactive IGF-I or total IGF-I between study days. Overall, serum bioactive IGF-I levels rose above baseline at 120 to 300 min with a maximum increase of 20% at 120 min (95% confidence interval (CI), 9 to 31%; p < 0.001), whereas total IGF-I levels rose above baseline at 180 to 300 min with a maximum increase of 5% at 240 min (95% CI, 2 to 9%; p = 0.004). A significant difference was observed in the changes in serum IGF-binding protein-1 (IGFBP-1) between study days (p = 0.008), but differences were only significant in the post-HD period. From baseline to the end of HD, no significant difference was observed in the changes in serum IGFBP-1 levels between study days, and in this time period overall serum IGFBP-1 levels were below baseline at all time points with a maximum decrease of 51% at 180 min (95% CI, 45 to 57%; p < 0.001). None of the investigated inflammatory biomarkers showed any differences in the changes over time between study days.
Postprandial insulin secretion stimulated the IGF-system during HD with no further effect of adding glucose or glucose-insulin infusion. Hyperinsulinemia during HD had no effect on biomarkers of inflammation.
ClinicalTrials.gov registry: NCT01209403
[Show abstract][Hide abstract] ABSTRACT: The vitamin D receptor activator paricalcitol has been shown to reduce albuminuria. Whether this is a unique property of paricalcitol, or common to all vitamin D analogues, is unknown. The primary aim of this study was to evaluate the effect of alfacalcidol on proteinuria, measured as 24 hour (24 h) albuminuria, in patients with chronic kidney disease (CKD) stage 4-5 being treated for secondary hyperparathyroidism (sHPT).
A retrospective single-center study including adult patients with CKD 4-5, undergoing treatment for sHPT with alfacalcidol, with macroalbuminuria in minimum one 24 h urine collection. Patients were identified in a prospectively collected database of all patients with S-creatinine > 300 μM or creatinine clearance < 30 ml/min. The observation period was from 1st of January 2005 to 31st of December 2009. Phosphate binders and alfacalcidol were provided to patients free of charge.
A total of 146 macroalbuminuric patients were identified, and of these, 59 started alfacalcidol treatment during the observation period. A 12% reduction in 24 h albuminuria was seen after starting treatment. In 19 patients with no change in renin-angiotensin-aldosteron-system (RAAS) inhibition, the reduction in albuminuria was 16%. The reduction remained stable over time (9%) in a subgroup of patients (n = 20) with several urine collections before and after the start of alfacalcidol-treatment.
The present study supports experimental and clinical data on antiproteinuric actions of activated vitamin D analogues, and suggests that this may be a class-effect.
[Show abstract][Hide abstract] ABSTRACT: Abstract Objective. Left ventricular hypertrophy (LVH) is highly prevalent in chronic kidney disease (CKD) and a risk marker for cardiovascular mortality. It was hypothesized that vitamin D deficiency could play an important role in the pathogenesis of left ventricular hypertrophy and dysfunction in CKD. An open-labelled randomized study was performed comparing the effect of alfacalcidol versus no treatment in patients with CKD 4, secondary hyperparathyroidism and LVH. The primary endpoint was regression of LVH. Secondary endpoints were changes in left ventricular function. Material and methods. Twenty-four patients were screened. Of these, 14 had LVH according to the criteria used. Six were randomized to alfacalcidol and seven to no treatment. The patient follow-up was 6 months. Left ventricular mass and function were measured by echocardiography. Results. Parathyroid hormone decreased by 72% and -3% in the alfacalcidol-treated and non-treated groups, respectively (p < 0.05), while serum Ca(2+) increased by 9% and -1.6%, respectively (p < 0.05), and serum phosphate was unchanged. The left ventricular mass index was unchanged, whereas fractional shortening (20% vs 2%, p < 0.005) and Tei index (36% vs 12%, p < 0.05) increased significantly. Systolic and diastolic blood pressure was unchanged. Conclusion. Short-term treatment with alfacalcidol did not induce regression of LVH; however, left ventricular function became hyperdynamic but less effective in patients with CKD. This could be problematic in the long term.
Scandinavian Journal of Urology and Nephrology 06/2012; 46(5):381-8. DOI:10.3109/00365599.2012.693131 · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Plasma exchange (PE) has been shown to improve renal outcome in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) and severe renal failure; however the effect of PE in AAV with moderate renal impairment is controversial.
A single-centre, retrospective one-year follow-up study, including patients with renal AAV and eGFR <60 ml/min/1.73 m2. Since 2007, all patients with renal AAV and eGFR <60 ml/min/1.73 m2 had PE in addition to induction therapy with cyclophosphamide and prednisolone. Patients admitted from 1999 to 2007 that did not receive PE served as controls. The primary outcome was the combination of death, end-stage renal disease, and relapses after one year.
A significant reduction in the primary endpoint was observed following the addition of PE (25% vs. 43%, p=0.04). Furthermore, a greater improvement in renal function after one year was observed among surviving PE treated patients not on dialysis (ΔeGFR 36.1 vs. 19.7 ml/min, p=0.03). There was a significant reduction in serious adverse events in the PE treated group (4% vs. 30%, p=0.02) despite no differences in types and doses of induction immunosuppressive therapy. The advantageous effect of PE was related to the presence of anti-proteinase3 (PR3)-antibodies and also evident among patients with plasma creatinine less than 500 μM.
This study suggests the use of PE in addition to standard induction treatment with cyclophosphamide and glucocorticoids to patients with renal PR3-AAV and an estimated-GFR <60 ml/min/1.73m2.
[Show abstract][Hide abstract] ABSTRACT: Hemodialysis (HD) patients lose lean body mass, even when they are adequately dialysed. One reason may be a decreased activity of the IGF-system. However, data on changes in bioactive IGF-I during HD are sparse.
Ten stable, non-diabetic HD patients were studied with 30 min intervals during a scheduled HD, with blood sampling before (-15 and 0 min), during (4 h) and after (1 h) the session. Patients were fasted for at least 6 h before and during the study. Arterial and venous blood was sampled for determination of IGF-I bioactivity, free and total IGF-I and IGF-II, IGF binding protein-1 (IGFBP-1), IGFBP-1 complexed IGF-I and IGFBP-2.
Total IGF-I and -II decreased marginally (<12%) at the very end of the study (P<0.05). By contrast, at 3 h free and bioactive IGF-I had declined by approximately 35% and 50%, respectively, and levels remained suppressed for the rest of the study (P<0.05). Concomitantly, IGFBP-1 and IGFBP-1:IGF-I complex formation increased 5.0-fold and 2.6-fold, respectively (P<0.05). By contrast, IGFBP-2 did not increase as a result of HD. No major differences between arterial and venous concentrations were observed.
Despite marginal reductions in total IGF-I and -II, bioactive and free IGF-I declined markedly during and after HD. This is likely a consequence of the increase in IGFBP-1, sequestering free IGF-I, and reducing bioactive IGF-I. Based on the present data we hypothesize that the catabolism induced by HD is in part related to the observed reductions in bioactive IGF-I.
Growth hormone & IGF research: official journal of the Growth Hormone Research Society and the International IGF Research Society 04/2010; 20(2):156-61. DOI:10.1016/j.ghir.2009.12.001 · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hyperthyroidism increases energy expenditure, glucose turnover, lipolysis, and protein breakdown.
Our objective was to test whether increased protein breakdown occurs independently of other catabolic effects in mild experimental hyperthyroidism.
We conducted a single-blind, randomized, placebo-controlled, crossover study. Protein dynamics of the whole body and of the forearm muscles were measured by amino acid tracer dilution technique ([(15)N]phenylalanine and [(2)H(4)]tyrosine). All subjects underwent a 3-h study in the basal state followed by a 3-h euglycemic clamp study.
The study took place at a university clinical research unit.
Eight healthy women (24-46 yr old) participated.
Intervention included 6 d thyroid hormone (T(4) 50 microg and T(3) 0.67 microg/kg.d) or placebo administration.
Thyroid hormone administration led to mild T(3) hyperthyroidism with more than a doubling of T(3) levels and suppression of TSH. Energy expenditure and body composition was unchanged. Glucose infusion rates, forearm glucose uptake, and levels of lipid intermediates were also alike. Basal whole-body phenylalanine flux and tyrosine flux (reflecting whole-body protein breakdown) were increased (P < 0.05) as were whole-body protein synthesis rate (P = 0.05). Basal forearm rate of appearance and disappearance for phenylalanine (reflecting muscle protein breakdown and synthesis) were similar.
Mild short-term experimental hyperthyroidism increases whole-body protein turnover and breakdown before any measurable changes in energy expenditure or glucose and fat metabolism, suggesting that amino acid and protein metabolism is an early and primary target for thyroid hormone action in humans.
[Show abstract][Hide abstract] ABSTRACT: It is generally accepted that peritoneal dialysis (PD) affects systemic haemodynamics less than haemodialysis, but little is known about changes in haemodynamics during PD. It is unknown if increasing PD volume causes changes in cardiovascular haemodynamics possibly increasing the demand on the heart even during normal daily activities.
Fifteen stable PD patients were included in this randomized, controlled, open-label crossover study. After drainage, we measured blood pressure, pulse rate and cardiac output (CO) after 30 min in the supine position. The measurements were repeated 5 min later in an upright position. Subsequently, following fill, the measurements were repeated after 30 min in the supine and 5 min later in the upright position. The two procedures were repeated twice. The fill was either 2 l or 3 l of dialysate. CO was measured with a non-invasive device based on foreign gas rebreathing. Stroke volume (SV) and total peripheral systemic resistance were calculated.
In the supine position, no difference was found between drained and 2 l fill. With 3 l fill both SV and CO decreased and total peripheral systemic resistance increased, while pulse rate and mean arterial blood pressure remained unchanged. In the upright position, SV and CO decreased and total peripheral systemic resistance increased. Pulse rate and mean arterial blood pressure were unchanged independent of fill volume when compared with the drained situation. During postural change, no significant differences were found between drained and 2 l and 3 l fill.
The present study showed that cardiac performance decreased when increasing fill volume from 2 to 3 l in the supine position. The decreased cardiac performance was already present after 2 l fill in the upright position and did not change negatively by increasing fill. It was also shown that cardiovascular response from the supine to upright position was preserved.
[Show abstract][Hide abstract] ABSTRACT: Elderly patients are the largest and fastest growing group of patients with chronic kidney disease maintained on dialysis in the world. Because of advanced age and a heavy burden of comorbidities, the elderly are usually not candidates for kidney transplantation and are less likely to be offered peritoneal dialysis (PD). There is, however, growing evidence that the use of community nurses to assist with PD and the introduction of programs for assisted peritoneal dialysis (aPD) targeting these frail, elderly patients may enable more elderly patients to have their PD treatment at home. Suitable candidates for aPD are incident end-stage kidney disease patients preferring PD but unable to perform their own treatment because of comorbidities, physical disabilities, or psychosocial problems; prevalent, previous autonomous PD patients who have lost their independence because of advanced age or an increased burden of comorbidities; or prevalent hemodialysis (HD) patients switched from HD to aPD because of their own preference, failure of vascular access for HD, or an inability to tolerate HD. We believe that aPD in the future will prove to be a safe and feasible complementary alternative to in-center HD for the growing group of frail, elderly patients with end-stage kidney disease.
[Show abstract][Hide abstract] ABSTRACT: Peritoneal dialysis (PD) has become a well-established complementary alternative to haemodialysis (HD) as first-line renal replacement modality. At our department, approximately 50% of the end-stage renal disease patients are started urgently on chronic dialysis due to late referral or unexpected deterioration of residual renal function. These patients--although suitable for PD--were previously started on HD via a temporary central venous catheter. Since January 2000, patients have been offered urgent start on chronic PD right after PD-catheter insertion by open surgery.
Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (<24 h) PD catheter placement and comparing short-term (3 months) outcome measures and dialysis-related complications between a group of patients started acutely on chronic PD and a non-matched group of patients with a planned start on chronic PD.
The number and type of infectious complications were equal in both the groups. The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P < 0.05). Consequently, the need for surgical replacement of catheters was also significantly higher in the study group (P < 0.02). With death and transplantation being the censored events, there was no difference in short-term PD technique survival rates between the two groups [39/45 (86.7%) vs 45/50 (90.0%)].
The PD modality may be a feasible, safe and complementary alternative to HD not only in the chronic, but also in the acute setting. The concept of acute start on chronic PD may be an yet another tool to increase the PD penetration rate among incident patients starting chronic dialysis therapy.
[Show abstract][Hide abstract] ABSTRACT: Thyroid hormones have significant metabolic effects, and muscle wasting and weakness are prominent clinical features of chronic hyperthyroidism. To assess the underlying mechanisms, we examined seven hyperthyroid women with Graves' disease before (Ht) and after (Eut) medical treatment and seven control subjects (Ctr). All subjects underwent a 3-h study in the postabsorptive state. After regional catheterization, protein dynamics of the whole body and of the forearm muscles were measured by amino acid tracer dilution technique using [15N]phenylalanine and [2H4]tyrosine. Before treatment, triiodothyronine was elevated (6.6 nmol/l) and whole body protein breakdown was increased 40%. The net forearm release of phenylalanine was increased in hyperthyroidism (microg.100 ml(-1).min(-1)): -7.0 +/- 1.2 Ht vs. -3.8 +/- 0.8 Eut (P = 0.04), -4.2 +/- 0.3 Ctr (P = 0.048). Muscle protein breakdown, assessed by phenylalanine rate of appearance, was increased (microg.100 ml(-1).min(-1)): 15.5 +/- 2.0 Ht vs. 9.6 +/- 1.4 Eut (P = 0.03), 9.9 +/- 0.6 Ctr (P = 0.02). Muscle protein synthesis rate did not differ significantly. Muscle mass and muscle function were decreased 10-20% before treatment. All abnormalities were normalized after therapy. In conclusion, our results show that hyperthyroidism is associated with increased muscle amino acid release resulting from increased muscle protein breakdown. These abnormalities can explain the clinical manifestations of sarcopenia and myopathy.
[Show abstract][Hide abstract] ABSTRACT: To describe basic demographics and clinical outcomes among elderly end-stage renal disease (ESRD) patients physically dependent on a caregiver and maintained on an assisted automated peritoneal dialysis (AAPD) program.
Retrospective single-center study based on patient records and data files.
64 physically dependent AAPD patients followed for 1.012 treatment months. Assistance and care was delivered by 52 briefly trained teams of visiting nurses or nursing home staff.
Crude 1-year survival was 58% and 2-year survival was 48%. Crude 1- and 2-year survivals, excluding deaths within 90 days, were 66% and 54% respectively. We found no significant effect on survival by main causes of ESRD, gender, age, late referral, need for acute start, social isolation, physical dependency on help at inclusion, or residence in a nursing home. 10% of patient-days on AAPD were spent in hospital. 13 (20%) of the patients were converted permanently to hemodialysis due to PD technique failure. The incidence of peritonitis was 1 in every 25.3 treatment-months.
AAPD may be a feasible and safe option for renal replacement therapy for frail, elderly, and physically dependent patients with ESRD. Despite the special patient selection for this AAPD program, we achieved results of international standards for patient survival, PD technique survival, and incidence of acute peritonitis. These results do notjustify withholding dialysis from this group of patients.
Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis 03/2005; 25 Suppl 3(Suppl 3):S60-3. · 2.20 Impact Factor