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Objectives Peritoneal dialysis (PD) allows patients increased autonomy and flexibility; however, both infectious and non-infectious complications may lead to technique failure, which shortens treatment longevity. Maintaining patients on PD remains a major challenge for nephrologists. This study aims to describe nephrologists’ perspectives on technique survival in PD.Design Qualitative semistructured interview study. Transcripts were thematically analysed.Setting and participants 30 nephrologists across 11 countries including Australia, the USA, the UK, Hong Kong, Canada, Singapore, Japan, New Zealand, Thailand, Colombia and Uruguay were interviewed from April 2017 to November 2019.Results We identified four themes: defining patient suitability (confidence in capacity for self-management, ensuring clinical stability and expected resilience), building endurance (facilitating access to practical support, improving mental well-being, optimising quality of care and training to reduce risk of complications), establishing rapport through effective communications (managing expectations to enhance trust, individualising care and harnessing a multidisciplinary approach) and confronting fear and acknowledging barriers to haemodialysis (preventing crash landing to haemodialysis, facing concerns of losing independence and positive framing of haemodialysis).Conclusion Nephrologists reported that technique survival in PD is influenced by patients’ medical circumstances, psychological motivation and positively influenced by the education and support provided by treating clinicians and families. Strategies to enhance patients’ knowledge on PD and communication with patients about technique survival in PD are needed to build trust, set patient expectations of treatment and improve the process of transition off PD.

National strategies for addressing chronic kidney disease (CKD) are crucial to improving kidney health. We sought to describe country-level variations in non-communicable disease (NCD) strategies and CKD-specific policies across different regions and income levels worldwide. The International Society of Nephrology Global Kidney Health Atlas (GKHA) was a multinational cross-sectional survey conducted between July and October 2018. Responses from key opinion leaders in each country regarding national NCD strategies, the presence and scope of CKD-specific policies, and government recognition of CKD as a health priority were described overall and according to region and income level. 160 countries participated in the GKHA survey, comprising 97.8% of the world's population. Seventy-four (47%) countries had an established national NCD strategy, and 53 (34%) countries reported the existence of CKD-specific policies, with substantial variation across regions and income levels. Where CKD-specific policies existed, non-dialysis CKD care was variably addressed. 79 (51%) countries identified government recognition of CKD as a health priority. Low- and low-middle income countries were less likely to have strategies and policies for addressing CKD and have governments which recognise it as a health priority. The existence of CKD-specific policies, and a national NCD strategy more broadly, varied substantially across different regions around the world but was overall suboptimal, with major discrepancies between the burden of CKD in many countries and governmental recognition of CKD as a health priority. Greater recognition of CKD within national health policy is critical to improving kidney healthcare globally.

Introduction: Hypokalemia, including normal range values

Rationale & Objective: There is a concern regarding increased risk of vascular calcification with the use of calcium-based phosphorus binders. This study aimed to compare the effects of sevelamer used as a second-line, low-dose therapy with calcium-based phosphorus binders with those of sevelamer used as a first-line, high-dose therapy on coronary artery and heart valve calcification, aortic pulse wave velocity (PWV), and calcification propensity over 2 years in patients with hyperphosphatemia receiving peritoneal dialysis (PD). Study Design: A 2-year-long prospective, multicenter, open-label, randomized pilot study. Setting & Participants: Prevalent patients with hyperphosphatemia receiving PD from 2 university-affiliated hospitals in Hong Kong. Interventions: The patients were randomized to receive sevelamer either as a first-line therapy at a high dose of 800 mg thrice daily (can titrate up to 1,200 mg thrice daily as required) or a second-line therapy at a low dose of 400 mg thrice daily with calcium carbonate to achieve a serum phosphorus target of ≤5.5 mg/dL. Outcomes: The primary endpoints were changes in coronary artery calcium score and aortic PWV over 104 weeks. The secondary endpoints were changes in heart valve calcium scores, calcification propensity measure, and biochemical parameters of chronic kidney disease–mineral bone disease over 104 weeks. Results: Among 60 prevalent patients receiving PD, with a mean age of 53 ± 10 years and with 57% men, changes in the coronary artery calcium score (median [interquartile range], 225 [79-525] vs 223 [56-1,212], respectively; P = 0.21), aortic PWV (mean ± standard error, 0.3 ± 0.1 vs 0.8 ± 0.2 m/s, respectively; P = 0.31), heart valve calcium score, maturation or transformation time, serum calcium levels, and phosphorus levels over 104 weeks were similar for the second-line, low-dose and first-line, high-dose sevelamer groups. Alkaline phosphatase and intact parathyroid hormone levels increased and low-density lipoprotein cholesterol decreased in both the groups, with no significant between-group differences. Limitations: The sample size was small, and the dropout rates were relatively high. Conclusions: Low-dose sevelamer used as a second-line therapy for hyperphosphatemia in combination with a calcium-based phosphorus binder had similar effects on vascular calcification, valvular calcification, and arterial stiffness compared with high-dose sevelamer used as a first-line therapy. This approach may be considered in resource-constrained countries to minimize calcium loading. Funding: The study was supported by a competitive grant from SK Yee Medical Foundation. T50 assays and other biochemical assays were funded by a research grant from Sanofi Renal Corporation. Trial Registration: NCT00745589.

Objectives The Global Kidney Health Atlas (GKHA) is a multinational, cross-sectional survey designed to assess the current capacity for kidney care across all world regions. The 2017 GKHA involved 125 countries and identified significant gaps in oversight, funding and infrastructure to support care for patients with kidney disease, especially in lower-middle-income countries. Here, we report results from the survey for the second iteration of the GKHA conducted in 2018, which included specific questions about health financing and oversight of end-stage kidney disease (ESKD) care worldwide.Setting A cross-sectional global survey.Participants Key stakeholders from 182 countries were invited to participate. Of those, stakeholders from 160 countries participated and were included.Primary outcomes Primary outcomes included cost of kidney replacement therapy (KRT), funding for dialysis and transplantation, funding for conservative kidney management, extent of universal health coverage, out-of-pocket costs for KRT, within-country variability in ESKD care delivery and oversight systems for ESKD care. Outcomes were determined from a combination of desk research and input from key stakeholders in participating countries.Results 160 countries (covering 98% of the world’s population) responded to the survey. Economic factors were identified as the top barrier to optimal ESKD care in 99 countries (64%). Full public funding for KRT was more common than for conservative kidney management (43% vs 28%). Among countries that provided at least some public coverage for KRT, 75% covered all citizens. Within-country variation in ESKD care delivery was reported in 40% of countries. Oversight of ESKD care was present in all high-income countries but was absent in 13% of low-income, 3% of lower-middle-income, and 10% of upper-middle-income countries.Conclusion Significant gaps and variability exist in the public funding and oversight of ESKD care in many countries, particularly for those in low-income and lower-middle-income countries.

The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on Chronic Kidney Disease–Mineral and Bone Disorder (CKD–MBD) 2009 provided recommendations on the detection, evaluation, and treatment of CKD-MBD in patients CKD who are and are not undergoing dialysis. Because of the accumulation of evidence since this initial publication, the CKD-MBD Guideline underwent a selective update in 2017. In April 2018, KDIGO convened a CKD-MBD Guideline Implementation Summit in Japan with the key objective to discuss various barriers to the uptake and implementation of the CKD-MBD Guideline in 8 Asian countries/regions. These countries/regions were comparable according to their high-to-middle economic ranking assigned by the World Bank. The discussion took into account the availability of CKD-MBD medication therapies and government health policies that may influence reimbursement and practice patterns in the region. Most importantly, Summit participants developed a framework of multifaceted strategies aimed at overcoming barriers to guideline implementation. The Summit attendees suggested a shared decision-making approach between clinicians and patients in CKD-MBD management, as well as individualized care based on the treatment risk-benefit ratio. The Summit participants also discussed how KDIGO, as a guideline development organization, may work in partnership with local and national nephrology societies to provide education and facilitate implementation of the guideline by clinicians. The conclusions drawn from this Summit in Asia may serve as an important guide for other regions to follow. Keywords: bone mineral density, calcium, CKD, dialysis, hyperparathyroidism, hyperphosphatemia, KDIGO CKD-MBD Guideline

Introduction: Dialysis patients are frequently advised to restrict fruit and vegetable intake due to their high potassium content. This study aimed to evaluate the association between dietary fiber intake and major adverse cardiovascular events (MACE) among dialysis patients. Methods: A total of 219 prevalent dialysis patients were prospectively recruited from a major university teaching hospital and regional dialysis center in Hong Kong. Dietary fiber intake estimated using a 7-day locally validated food frequency questionnaire was examined in relation to a primary composite outcome of MACE over a follow-up period of 4 years. Results: A total of 127 patients were complicated with 1 or more MACE. In the multivariable Cox regression analysis, every 1 g higher fiber intake, and every 1 g/d per 1000 kcal higher fiber intake density were associated with an 11% (95% confidence interval [CI]: 0.81–0.97) and a 13% lower risk of MACE (95% CI: 0.77–0.99), respectively, independent of clinical, demographic, biochemical, hemodynamic, adequacy parameters, dietary protein, energy intake, inflammatory, and cardiac markers. Patients in the lower tertile of fiber intake density showed an increased hazard for MACE (adjusted hazard ratio: 1.78; 95% CI: 1.13–2.80) than those in the upper tertile. Conclusion: Higher fiber intake and higher fiber intake density may be associated with less inflammation, less myocardial hypertrophy, injury, and lower risk of MACE in dialysis patients. These data form an important basis for a randomized controlled trial to examine fiber supplementation on cardiovascular outcomes in the dialysis population. Keywords: dialysis, fiber intake, major adverse cardiovascular events

Background: Chronic kidney disease (CKD) measures (estimated glomerular filtration rate [eGFR] and albuminuria) are frequently assessed in clinical practice and improve the prediction of incident cardiovascular disease (CVD), yet most major clinical guidelines do not have a standardized approach for incorporating these measures into CVD risk prediction. “CKD Patch” is a validated method to calibrate and improve the predicted risk from established equations according to CKD measures. Methods: Utilizing data from 4,143,535 adults from 35 datasets, we developed several “CKD Patches” incorporating eGFR and albuminuria, to enhance prediction of risk of atherosclerotic CVD (ASCVD) by the Pooled Cohort Equation (PCE) and CVD mortality by Systematic COronary Risk Evaluation (SCORE). The risk enhancement by CKD Patch was determined by the deviation between individual CKD measures and the values expected from their traditional CVD risk factors and the hazard ratios for eGFR and albuminuria. We then validated this approach among 4,932,824 adults from 37 independent datasets, comparing the original PCE and SCORE equations (recalibrated in each dataset) to those with addition of CKD Patch. Findings: We confirmed the prediction improvement with the CKD Patch for CVD mortality beyond SCORE and ASCVD beyond PCE in validation datasets (Δc-statistic 0.027 [95% CI 0.018–0.036] and 0.010 [0.007–0.013] and categorical net reclassification improvement 0.080 [0.032–0.127] and 0.056 [0.044–0.067], respectively). The median (IQI) of the ratio of predicted risk for CVD mortality with CKD Patch vs. the original prediction with SCORE was 2.64 (1.89–3.40) in very high-risk CKD (e.g., eGFR 30–44 ml/min/1.73m2 with albuminuria ≥30 mg/g), 1.86 (1.48–2.44) in high-risk CKD (e.g., eGFR 45–59 ml/min/1.73m2 with albuminuria 30–299 mg/g), and 1.37 (1.14–1.69) in moderate risk CKD (e.g., eGFR 60–89 ml/min/1.73m2 with albuminuria 30–299 mg/g), indicating considerable risk underestimation in CKD with SCORE. The corresponding estimates for ASCVD with PCE were 1.55 (1.37–1.81), 1.24 (1.10–1.54), and 1.21 (0.98–1.46). Interpretation: The “CKD Patch” can be used to quantitatively enhance ASCVD and CVD mortality risk prediction equations recommended in major US and European guidelines according to CKD measures, when available. Funding: US National Kidney Foundation and the NIDDK.

Plasma adiponectin (ADPN) is markedly elevated in end-stage renal disease (ESRD) patients compared to healthy controls. In this study, we aimed to evaluate clinical correlates of plasma ADPN and its importance in predicting clinical outcomes in chronic peritoneal dialysis (PD) patients. Furthermore, we evaluated the relationship between ADPN and C-reactive protein (CRP) in predicting outcomes of these patients. We prospectively measured plasma ADPN, CRP and other biochemical parameters and body composition in 238 ESRD patients on maintenance PD ≥3 months. Patients were followed for a median of 48 months. The plasma ADPN was 24.6 (13.9, 39.8) and 23.0 (13.9, 32.7)μg/ml for men and women, respectively (P=0.42). Multiple linear regression analysis showed that log-transformed ADPN was correlated with body fat mass (P=0.008), residual glomerular filtration rate (P=0.005), log-CRP (P

There is an increasing global recognition of nutritional vitamin D deficiency in patients with chronic kidney disease (CKD). Yet, there is not much data in the Chinese population. We performed this prospective cross-sectional survey, with an aim to determine the prevalence of vitamin D deficiency (defined as serum 25-hydroxyvitamin D [25(OH)D] level

Anorexia is common in patients with chronic kidney disease (CKD) and predicts poor survival. We performed this prospective study with an aim to determine factors associated with poor appetite in patients with stage 3-5 CKD. A cohort of 296 stage 3-5 CKD patients (168 men and 128 women) was invited to grade their own appetite in the recent one month on a scale from 1 to 4 (namely, very good, good, fair, and poor appetite, respectively). In addition, these patients underwent echocardiographic examination and other clinical and biochemical assessments. The mean age of these patients was 60±10 years with an average estimated glomerular filtration rate (eGFR) of 32±14ml/min per 1.73m2. Appetite was graded as very good, good, fair and poor in 61, 114, 110 and 11 patients, respectively. Patients who graded their own appetite as poor were noted to have the lowest eGFR (P=0.047), lowest left ventricular (LV) ejection fraction (p=0.006), lowest midwall fractional shortening (p=0.004), highest prevalence of diabetes (P=0.19) and symptomatic atherosclerotic vascular disease (AVD) (P=0.003). Notably, serum albumin in the poor appetite group did not differ from the other 3 groups. In the multiple logistic regression analysis, LV ejection fraction [Odds ratio (OR), 0.92, 95% confidence intervals (CI), 0.86–0.98; P=0.014] and symptomatic AVD [OR, 4.56, 95% CI, 1.16–17.96; P=0.03] showed independent association with poor appetite and their significance appeared to outweigh that of eGFR [OR, 0.94, 95% CI, 0.89–1.00; P=0.058]. In conclusion, poor appetite in CKD patients is frequently associated with the presence of cardiovascular co-morbidity and cardiac dysfunction. These data suggest that a simple subjective scoring of appetite may be useful in identifying CKD patients with underlying cardiac disease. Further study is needed to determine the exact mechanism linking cardiac disease and anorexia in CKD patients.

Cardiovascular disease accounts over half of the total mortality in peritoneal dialysis (PD) patients. In addition, there is an increasing recognition of a high prevalence of vascular and valvular calcification that may contribute to the increased all-cause and cardiovascular mortality in the PD patients. Disturbed mineral metabolism in association with chronic kidney disease has been suggested as one of the major contributing factors to the increased vascular/valvular calcification in this population. In this paper, we provide an overview of the prevalence and importance of this complication in the PD patients. In addition, we review the contributing factors and some emerging mechanisms for this complication. Furthermore, we discuss some therapeutic strategies that may be useful in limiting the progression of vascular/valvular calcification in the PD population.

Diabetes mellitus is the leading cause of end-stage renal disease (ESRD), accounting for 54% of all incident cases according to the US Renal Data System. These patients suffer an extremely high mortality rate due to the very high incidence of cardiovascular disease. A significant proportion of these patients already has established cardiovascular disease at the time of initiation of dialysis treatment. More importantly, as these patients develop progressive kidney dysfunction, they are not only subjected to traditional Framingham risk factors, but, more importantly, to a whole host of 'kidney disease-related risk factors' that further accelerate the progression of cardiovascular disease and thus contribute to adverse cardiovascular outcomes. The present article provides an updated view on the multitude of traditional Framingham risk factors and kidney disease-related risk factors that diabetic ESRD patients are subjected to. A better understanding of the different cardiovascular risk factors will be fundamental to institute early detection programs, as well as to provide aggressive cardiovascular management of these patients. [ABSTRACT FROM AUTHOR]

Background. Fetuin-A (a2-Heremans Schmid glycoprotein) has recently been identified as a circulating inhibitor of calcification and is regulated as a negative acute phase protein. However, its relationships with cardiac valvular calcification and atherosclerosis and outcome have not been evaluated in peritoneal dialysis (PD) patients.Method. We performed a prospective follow-up study in 238 PD patients with echocardiography done at baseline to detect cardiac valvular calcification and biochemical analysis performed for serum fetuin-A, albumin and C-reactive protein (CRP).Results. Baseline serum fetuin-A concentration was (meanSD) 0.3090.068?g/l (normal range 0.40.95). Across the three tertiles of increasing serum fetuin-A, a significant trend effect was observed for age (P = 0.023), diabetes (P = 0.008), background atherosclerotic vascular disease (P = 0.010), cardiac valvular calcification (P = 0.002), serum albumin (P<0.001), subjective global assessment (P = 0.005) and CRP (P<0.001). Adjusting for CRP and calcium phosphorus product, every 0.01?g/l increase in serum fetuin-A remained independently associated with a 6% decrease in the risk of valvular calcification (95% confidence intervals, 0.900.99; P = 0.028). Furthermore, serum fetuin-A showed a significant decrease across the four groups of patients with increasing components of the malnutrition, inflammation, atherosclerosis/calcification (MIAC) syndrome (P<0.001) and was the lowest among patients with all components of the MIAC syndrome (0.2630.055?g/l) and highest among those who do not have the MIAC syndrome at all (0.3380.063?g/l). Lower serum fetuin-A was associated with greater all-cause mortality (P = 0.0011) and fatal and non-fatal cardiovascular events (P = 0.0017), but its significance was lost when atherosclerotic vascular disease, valvular calcification, inflammation and malnutrition were included in the model.Conclusions. Serum fetuin-A showed important associations with valvular calcification, atherosclerosis, malnutrition and inflammation, and was linked to mortality and cardiovascular events in PD patients via its close relationships with the MIAC syndrome. [ABSTRACT FROM AUTHOR]

Background Patients with end-stage renal disease (ESRD) are at increased risk for tissue calcifications as a result of deranged mineral metabolism. We tested the hypothesis that valvular calcification is a marker of atherosclerosis in patients with ESRD. Methods Echocardiography was performed in 92 patients undergoing peritoneal dialysis with no background atherosclerotic vascular complications to detect valvular calcification. We used B-mode ultrasonography to determine carotid artery intima-media thickness and the presence of plaque and calcification. Results Compared with patients without valvular calcification (n = 66), those with valvular calcification (n = 26) had higher C-reactive protein levels (P = .01) and greater mean ± SE carotid intima-media thickness (1.12 ± 0.06 vs 0.88 ± 0.04 mm; P = .003). Carotid artery calcification was present unilaterally and bilaterally in 4 patients (15%) and 17 patients (65%) with valvular calcification vs 11 (17%) and 14 (21%) without, respectively (P<.001). Carotid artery plaque was present unilaterally and bilaterally in 11 patients (12%) and 16 patients (65%) with valvular calcification vs 3 (17%) and 17 (24%) without, respectively (P = .001). Using multiple logistic regression analysis, every 1-mm increase in carotid intima-media thickness was independently associated with a 6.51-fold (95% confidence interval, 1.58-26.73; P = .009) increased risk of valvular calcification, and calcification and plaque in the carotid arteries were associated with a 7.18-fold (95% confidence interval, 2.39-21.51; P<.001) and a 5.00-fold (95% confidence interval, 1.77-14.13; P = .002) increased risk of valvular calcification, respectively. Conclusion The associations among valvular calcification, inflammation, carotid atherosclerosis, and arterial calcification suggest that valvular calcification is a marker of atherosclerosis and arterial calcification in patients with ESRD. [ABSTRACT FROM AUTHOR]

Background. Residual renal function (RRF) is an important predictor of outcome in peritoneal dialysis (PD) patients. Whether results from survival studies in dialysis patients with RRF can also be extrapolated to anuric patients remains uncertain. In this observational study, we examined the characteristics of PD patients with a residual glomerular filtration rate (GFR) =1?ml/min per 1.73?m2vs those with complete anuria and differentiated factors that predict outcome in the two groups of patients.Methods. Two hundred and forty-six continuous ambulatory peritoneal dialysis (CAPD) patients (39% being completely anuric) were recruited from a single regional dialysis centre. Assessments of haemodynamic, echocardiographic, nutritional and biochemical parameters and indices of dialysis adequacy were done at study baseline and were related to outcomes.Results. During the prospective follow-up of 30.813.8 (meanSD) months, 28.0% of patients with residual GFR =1?ml/min per 1.73?m2vs 50.5% of anuric patients had died (P = 0.005). The overall 2 year patient survival was 89.7 and 65.0% for patients with GFR =1?ml/min per 1.73?m2 and anuric patients, respectively (P = 0.0012). Compared with patients with GFR =1?ml/min per 1.73?m2, anuric patients were dialysed for longer (P<0.001), were more anaemic (P<0.005), and had higher calciumphosphorus product (P<0.01), higher C-reactive protein (P<0.001), lower serum albumin (P<0.05), greater prevalence of malnutrition according to subjective global assessment (P<0.05) and more severe cardiac hypertrophy (P<0.001) at baseline. Using multivariable Cox regression analysis, serum albumin, left ventricular mass index and residual GFR were significant factors associated with mortality in patients with GFR =1?ml/min per 1.73?m2, while increasing age, atherosclerotic vascular disease and higher C-reactive protein were associated with greater mortality in anuric PD patients.Conclusions. Our study demonstrates more adverse cardiovascular, inflammatory, nutritional and metabolic profiles as well as higher mortality in anuric PD patients. Furthermore, factors associated with mortality are also not equivalent for PD patients with and without RRF, suggesting that patients with and without RRF are qualitatively different. [ABSTRACT FROM AUTHOR]

Dialysis patients show a high prevalence of cardiovascular complications among which left ventricular hypertrophy is one of the most frequent and is independently predictive of mortality. A recent study indicates that partial regression of left ventricular hypertrophy improves mortality and reduces cardiovascular events in end-stage renal disease (ESRD) patients, suggesting the importance of targeting therapeutic strategies to reduce cardiac hypertrophy and improve the outcome in these patients. The pathogenesis of left ventricular hypertrophy in ESRD patients is multifactorial and includes hypertension, activation of the renin-angiotensin system, increased sympathetic activity, chronic volume overload, chronic anaemia and hyperparathyroidism. In this paper, we review the available experimental and clinical evidence showing the important contribution of the renin-angiotensin system as well as its interaction with the sympathetic nervous system in the pathogenesis of left ventricular hypertrophy in ESRD patients. Furthermore, we summarize the results of currently available clinical studies that examined the effects of angiotensin-converting enzyme inhibition or angiotensin receptor antagonism on left ventricular hypertrophy in ESRD patients, and review evidences that support the use of angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists in the ESRD population. [ABSTRACT FROM AUTHOR]

Background: Anorexia that results in inadequate nutrient intake is considered one of the most important causes of malnutrition in dialysis patients. Objective: The objective was to determine factors other than dialysis adequacy that are associated with inadequate protein and energy intakes in patients receiving continuous ambulatory peritoneal dialysis. Design: Dietary protein and energy intakes were assessed with a food-frequency questionnaire in 266 patients, and factors other than dialysis adequacy that are potentially associated with reductions in energy and protein intakes were examined. Results: Only 39% of the patients had protein intakes≥ 1.2 g · kg-1 · d-1, and 26% had energy intakes≥ 126 kJ · kg-1 · d-1. Other than having a greater total urea clearance and glomerular filtration rate, patients with protein intakes≥ 1.2, as opposed to < 1.2, g · kg-1 · d-1 had lower high-sensitive C-reactive protein concentrations and fewer complications with volume overload (29% compared with 46%; P = 0.006). Patients with energy intakes≥ 126, as opposed to < 126, kJ · kg-1 · d-1 were younger, had lower high-sensitive C-reactive protein concentrations, and had a lower prevalence of diabetes (P = 0.006), atherosclerotic vascular disease (P = 0.020), and history of volume overload (P = 0.013). Multiple regression analysis showed that other than increasing age, diabetes, and total urea clearance, having a history of volume overload was independently associated with a 0.22-g · kg-1 · d-1decrease in protein (P = 0.001) and a 13.07-kJ · kg-1 · d-1 decrease in energy intake (P = 0.006). Conclusion: An important yet unrecognized association was observed between a history of volume overload and dietary intake in peritoneal dialysis patients. [ABSTRACT FROM AUTHOR]

Background: Dialysis patients are at risk of vitamin and mineral deficiencies, not only because of losses during chronic hemodialysis or peritoneal dialysis but also because of low intakes. Objective: The objective was to determine the importance of urea clearance (calculated as Kt/V) and residual renal function (RRF) in predicting micronutrient intakes in a large cohort of patients receiving continuous ambulatory peritoneal dialysis (CAPD). Design: We conducted a survey of dietary intakes in 242 CAPD patients and divided them into 3 groups according to their weekly urea clearance and RRF: WD group (n = 84), a urea clearance ⩾ 1.7 and a glomerular filtration rate (GFR) =1 mL· min-1 · 1.73 m-2; DD group (n = 71), a urea clearance = 1.7 and a GFR < 1 mL·min-1 · 1.73 m-2; and ID group (n = 87), a urea clearance < 1.7. Results: Most of the patients had intakes of water-soluble vitamins and minerals that were lower than the recommended dietary allowance; most intakes were significantly higher in the WD group than in the DD and ID groups, except those of niacin and calcium. After age, sex, body weight, and the presence of diabetes were controlled for, total weekly urea clearance and the GFR (but not peritoneal dialysis urea clearance) were significantly associated with intakes of vitamins A and C, the B vitamins, and minerals (calcium, phosphate, iron, and zinc). Low intakes of vitamins and minerals with low RRF and urea clearance were the result of reduced overall food intakes, except for thiamine, vitamin B-6, and folic acid, which were deficient in the diet. Conclusions: Supplementation with most water-soluble vitamins and minerals, including iron and zinc, should be considered in CAPD patients, especially those with low RRF and low urea clearance. The optimal dose needs to be determined. [ABSTRACT FROM AUTHOR]