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Cardiovascular disease (CVD) is a major cause of mortality and morbidity in peritoneal dialysis (PD) patients. Two decades ago, the common co‐existence of malnutrition and systemic inflammation PD patients with atherosclerosis and CVD led to the proposed terminology of 'malnutrition‐inflammation‐atherosclerosis (MIA) syndrome'. Although the importance of malnutrition is well accepted, frailty represents a more comprehensive assessment of the physical and functional capability of the patient and encompasses the contributions of sarcopenia (a key component of malnutrition), obesity, cardiopulmonary as well as neuropsychiatric impairment. In recent years, it is also increasingly recognized that fluid overload is not only the consequence but also play an important role in the pathogenesis of CVD. Moreover, fluid overload is closely linked with the systemic inflammatory status, presumably by gut oedema, gastrointestinal epithelial barrier dysfunction and leakage of bacterial fragments to the systemic circulation. There are now a wealth of published evidence to show intricate relations between frailty, inflammation, fluid overload and atherosclerotic disease in patients with chronic kidney disease (CKD) and those on PD, a phenomenon that we propose the term 'FIFA complex'. In this system, frailty and atherosclerotic disease may be regarded as two patient‐oriented outcomes, while inflammation and fluid overload are two inter‐connected pathogenic processes. However, there remain limited data on how the treatment of one component affect the others. It is also important to define how treatment of fluid overload affect the systemic inflammatory status and to develop effective anti‐inflammatory strategies that could alleviate atherosclerotic disease and frailty. Summary at a Glance: There are intricate relations between frailty, inflammation, fluid overload and atherosclerotic disease in patients with chronic kidney disease (CKD) and those on peritoneal dialysis (PD).We propose the term 'FIFA complex', with frailty and atherosclerotic disease as two patient‐oriented outcomes, while inflammation and fluid overload as two inter‐connected pathogenic processes. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a leading cause of mortality and morbidity around the world. The prevalence of CKD increases steadily over the past decade in parallel to the rapid expansion of diabetic population. Apart from increased mortality, CKD also has significant impact on quality of life and the economy. The approach to deal with the global CKD epidemic is multifaceted. Early detection by screening high‐risk individuals such as those with hypertension and diabetes is important and cost‐effective. However, low CKD awareness in many countries may impose barriers to early intervention. Hence raising CKD awareness among public and policy makers should be encouraged. In addition, the use of peritoneal dialysis, a less costly and home‐based dialysis modality compared with in‐center haemodialysis, should be promoted to maximize access to dialysis with limited resources. Finally, ongoing research and clinical trials through international collaborations could provide further insight into the pathophysiology of CKD progression, and establish the foundation for development of specific therapeutic agents to retard progression to end stage renal failure. Summary at a Glance: Facing the global healthcare challenges posed by chronic kidney disease (CKD), this review outlines multiple practical strategies to tackle the CKD epidemic. [ABSTRACT FROM AUTHOR]

ABSTRACT To address the issue of heavy dialysis burden due to the rising prevalence of end-stage renal disease around the world, a roundtable discussion on the sustainability of managing dialysis burden around the world was held in Hong Kong during the First International Congress of Chinese Nephrologists in December 2015. The roundtable discussion was attended by experts from Hong Kong, China, Canada, England, Malaysia, Singapore, Taiwan and United States. Potential solutions to cope with the heavy burden on dialysis include the prevention and retardation of the progression of CKD; wider use of home-based dialysis therapy, particularly PD; promotion of kidney transplantation; and the use of renal palliative care service. [ABSTRACT FROM AUTHOR]