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Objective: Temporary vascular access (TVA) is frequently used during the first dialysis in patients with chronic kidney disease (CKD), and it is associated with an increased risk of infection, central vein stenosis, and mortality. Here, factors associated with TVA in patients with CKD were explored., Methods: This study included patients in a single-center CKD care program who initiated long-term renal replacement therapy. The primary outcome was TVA use at first dialysis. Factors possibly associated with TVA use were analyzed using Cox regression., Results: Temporary vascular access was used in 53.2% of the patients at first dialysis. In total, 73.2% (n = 865) and 26.8% (n = 317) of the patients were on hemodialysis and peritoneal dialysis, respectively. Multivariate Cox regression analysis showed that TVA use in patients with CKD was associated with diabetes (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.28-1.81, p < 0.001), lower albumin (HR 0.82, 95% CI 0.75-0.91, p < 0.001), lower education level (HR 0.75, 95% CI 0.56-1.00, p = 0.055), and total care dependency (HR 1.92, CI 1.44-3.43, p = 0.003)., Conclusion: Diabetes, education level, and care dependency are associated with TVA at dialysis initiation in patients with CKD., (© 2020 Wiley Periodicals LLC.)

Background: Bacterial cultures allow the identification of infectious disease pathogens. However, obtaining the results of conventional culture methods is time-consuming, taking at least two days. A more efficient alternative is the use of concentrated bacterial samples to accelerate culture growth. Our study focuses on the development of a high-yield sample concentrating technique., Results: A total of 71 paired samples were obtained from patients on peritoneal dialysis (PD). The peritoneal dialysates were repeat-centrifuged and then washed with saline, namely the centrifuging and washing method (C&W method). The concentrated samples were Gram-stained and inoculated into culture plates. The equivalent unprocessed dialysates were cultured as the reference method. The times until culture results for the two methods were compared. The reference method yielded no positive Gram stain results, but the C&W method immediately gave positive Gram stain results for 28 samples (p < 0.001). The culture-negative rate was lower in the C&W method (5/71) than in the reference method (13/71) (p = 0.044). The average time for bacterial identification achieved with the C&W method (22.0 h) was shorter compared to using the reference method (72.5 h) (p < 0.001)., Conclusions: The C&W method successfully concentrated bacterial samples and superseded blood culture bottles for developing adequate bacterial cultures. The C&W method may decrease the culture report time, thus improving the treatment of infectious diseases.

Aim: Abdominal aortic calcification (AAC) score in dialysis patients was associated with coronary artery disease (CAD) in cross-sectional study, but the use of AAC score in the CAD prediction was not clear. We aimed to use AAC score in the estimation of CAD occurrence in middle-aged peritoneal dialysis (PD) patients., Methods: Middle-aged (45-65 years old) PD patients were recruited and followed up until CAD occurrence, patient mortality, or PD failure. We quantified AAC score by lateral lumbar radiography, and used receiver operation curve (ROC) analysis to find the cut-off value for CAD prediction., Results: There were 187 patients recruited for study with a mean follow-up of 1027 ± 427 days. AAC score in patients with CAD during follow-up period (9.7 ± 7.6, n = 41) was higher than in patients without CAD occurrence (5.5 ± 6.1, n = 146) (P < 0.001). Multivariate hazard ratio of AAC score for CAD was 1.07 (P = 0.044). ROC showed that AAC score of 5.5 had a sensitivity of 0.667 and a specificity of 0.581 in the prediction of CAD occurrence. Patients with AAC score above 5.5 had significantly higher cumulative incidence of CAD than patients with AAC score below 5.5 (Log-rank test, P = 0.003). Age (P = 0.002), diabetes (P = 0.002), hypertension (P = 0.032), longer dialysis vintage (P < 0.001) and lower serum potassium (P = 0.012) were parameters significantly associated with higher AAC score., Conclusion: AAC score can predict CAD occurrence in PD patients. Age, diabetes, hypertension, dialysis vintage and serum potassium level are factors associated with higher AAC score., (© 2018 Asian Pacific Society of Nephrology.)

Aim: We used insurance claims data of Taiwan to compare the risk of non-traumatic lower extremity amputation between haemodialysis (HD) and peritoneal dialysis (PD) patients., Methods: We identified 77 669 HD patients and 10 035 PD patients without prior amputation from 2000 to 2010. Incidence rates and hazard ratios (HRs) of lower extremity amputation, and subsequent 30-day mortality after amputation were evaluated up to 31 December 2011., Results: There were 2427 and 216 patients undergoing lower extremity amputation during follow-up in the HD and PD groups with incidence rates of 8.35 and 5.79 per 1000 person-years, respectively. Compared with the HD group, the overall adjusted HR of lower extremity amputation for the PD group was 1.27 (95% CI = 1.10-1.46). The impact of diabetes status on the risk of lower extremity amputation interacted with dialysis modality significantly (P < 0.001). Compared with the corresponding HD patients, the PD patients with diabetes had an adjusted HR of 1.44 (95% CI = 1.24-1.67) for amputation, whereas those without diabetes had an adjusted HR of 0.58 (95% CI = 0.36-0.95). The subsequent 30-day mortality rates after amputation were not significantly different between the HD and PD groups (8.45% vs. 9.72%) with an adjusted odds ratio of 1.41 (95% CI = 0.87-2.28, PD versus HD)., Conclusion: Compared with corresponding HD patients, the amputation risk is higher for PD patients with diabetes, while the risk is lower for PD patients without diabetes. Dialysis patients have a high 30-day mortality risk after amputation., (© 2016 Asian Pacific Society of Nephrology.)

Aim: Prolonged QT interval is related to changes of electrolytes in haemodialysis (HD) and is associated with all-cause mortality in HD patients. It is unknown if prolonged QT interval is associated with all-cause mortality in peritoneal dialysis (PD) patients as the electrolytes were relatively stable in PD. We therefore investigated the association of prolonged QT interval and all-cause mortality in chronic PD patients., Methods: The QT intervals were measured in 2003 and all patients were followed to December 2012. A prolonged QT interval was defined as a QT interval > 450 ms. The association of prolonged QT interval with all-cause and cardiac-specific mortality was analyzed using Cox regression and Kaplan-Meier analysis., Results: Of 306 patients, 196 (64%) patients had prolonged QT interval. The incidence density rate was 9.7 per 100 persons-years for all-cause mortality and 5.6 for cardiac specific mortality in patients with prolonged QT interval. Prolonged QT interval was associated with all-cause mortality with a hazard ratio (HR) of 1.59 (95% confidence interval (CI): 1.06-2.39, P = 0.03] and cardiac mortality (HR: 1.66, 95% CI: 1.00-2.78, P = 0.05) with adjustments for age, gender, diabetes, and vintage of dialysis. Longer QT interval (>500 ms, 450-500 ms, and < 450 ms) was significantly associated with a worse overall survival (P = 0.03, log-rank test) and cardiac mortality free survival (P = 0.05, log-rank test)., Conclusions: Prolonged QT interval was associated with all-cause and cardiac mortality in patients on peritoneal dialysis. The association is independent of patient's age and diabetes., (© 2016 Asian Pacific Society of Nephrology.)

Background: Bacterial peritonitis is the most common cause of peritoneal dialysis (PD) therapy drop-out. A quick and accurate diagnosis of the bacterial pathogen can reduce the PD drop-out rate. Surface-enhanced Raman spectroscopy (SERS) can rapidly identify bacteria using chips coated with nano-sized metal particles., Methods: Known bacteria were loaded in the SERS-chips and illuminated with laser light to establish a reference Raman spectra library. Dialysate from PD peritonitis patients was concentrated by centrifuge and examined with the same SERS, and the resulting Raman spectra were compared with library spectra for bacteria identification. Principal component analysis was used for further confirmation. The same batches of dialysate were sent to routine culture as a reference bacteria identification method. The results of the 2 identification methods were compared., Results: A total of 43 paired-samples were sent for study. There were 37 samples with bacteria identified but 6 were culture-negative by the reference method. 31 bacteria were identified in paired-samples by SERS, among which, 29 bacteria were exactly the same as those identified by the reference method. Bacteria not included in the reference library spectra cannot be identified., Conclusions: SERS techniques can rapidly identify bacterial pathogens in the dialysate of PD peritonitis patients., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Purpose: This study used national claims data to investigate the technique and patient survival over time in incident peritoneal dialysis (PD) patients., Methods: Incident end-stage renal disease patients undergoing PD and older than 18 years were selected from Taiwan health insurance databases. These patients were grouped into three study periods according to year of dialysis initiation: 1997-2001, 2002-2006, and 2007-2011. The study end-points included technique failure and mortality., Results: The patients in the most recent era were older and more likely to have higher levels of comorbidity. Compared with the 1997-2001 group, the risks of technique failure were similar in the in the 2002-2006 (hazard ratio [HR] 1.10, 95 % confidence interval [CI] 0.98-1.24) and 2007-2011 groups (HR 1.11, 95 % CI 0.98-1.26), respectively. Relative to the 1997-2001 group, the risks of mortality were higher in the 2002-2006 group (HR 1.59, 95 % CI 1.26-2.02) and similar in the 2007-2011 group (HR 1.20, 95 % CI 0.93-1.55). Using icodextrin and automated peritoneal dialysis (APD) were associated with lower risks of technique failure (HR 0.62 and 0.86, 95 % CI 0.56-0.68 and 0.77-0.95, respectively) and mortality (HR 0.55 and 0.81, 95 % CI 0.45-0.66 and 0.67-0.99, respectively)., Conclusions: Despite increase in disease burden in the most recent era, the outcomes remained relatively stable. The use of APD and icodextrin appears to have significantly ameliorated the impact of the increase in comorbidity burden.

Background: Studies on the effectiveness of seasonal influenza vaccination in peritoneal dialysis (PD) patients are limited. The aim of the present study is to evaluate the effectiveness of seasonal influenza vaccination in reducing morbidity and mortality in incident end-stage renal disease patients on PD., Methods: From Taiwan's National Health Insurance Research Database, we identified 2089 incident PD patients with seasonal influenza vaccination and 2089 propensity score matched incident PD patients without the vaccination during 1998-2010. Each study subject was followed up to measure the 12-month incident cardiovascular and infectious diseases, and deaths. The effects of multi-year vaccinations were also estimated., Results: Compared with the non-vaccinated cohort, the vaccinated cohort had a lower hospitalization rate (68.5 versus 80.2 per 100 person-years) with an adjusted hazard ratio (aHR) of 0.85 [95% confidence interval (CI) = 0.78-0.92]. Hazards of hospitalization were significantly reduced for sepsis (aHR = 0.79, 95% CI = 0.65-0.96), heart disease (aHR = 0.74, 95% CI = 0.63-0.89) and intensive care (aHR = 0.85, 95% CI = 0.73-0.99). In addition, hazards of peritonitis (aHR = 0.84, 95% CI = 0.73-0.97) and overall mortality (aHR = 0.66, 95% CI = 0.55-0.78) were also reduced. The aHR of mortality was reduced much further to 0.28 (95% CI = 0.22-0.35) for those with multiple-year vaccinations., Conclusions: Seasonal influenza vaccination for PD patients is associated with significant reduction in morbidities and a 34% reduction in mortality. Multi-year vaccinations could reduce the death hazard further to 72%., (© The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)

Peritoneal dialysis (PD) can be an ideal treatment in cirrhotic patients with ascites and chronic kidney disease stage 5 (CKD 5D) who require dialysis. The survival of cirrhotic patients with CKD 5D on PD, however, is not clear. We compared the survival of cirrhotic patients with CKD 5D on PD and the survival of those on HD. Two datasets including a cohort study of China Medical University Hospital (CMUH) from 2004 to 2013 and the Longitudinal National Health Insurance Database for Catastrophic Illness Patients (LHID-CIP) of Taiwan from 1996 to 2011 were analyzed. The survival of cirrhotic patients on PD and the propensity score matched cirrhotic patients on HD were analyzed using Cox proportional hazards regression. In CMUH cohort of 85 PD and 340 HD patients, the all-cause mortality was lower in PD patients compared to it in HD patients (hazard ratio [HR]: 0.48, 95% confidence interval [CI]: 0.31-0.74, P < 0.01) after adjustments for confounders. The severity of liver cirrhosis defined by Child-Turcotte-Pugh (CTP) class (P < 0.01) was independently associated with all-cause mortality. The model for end-stage liver disease (MELD) score, however, was not associated with all-cause mortality. In the LHID-CIP cohort of 285 PD and 1140 HD patients, the HR of all-cause mortality in PD patients was 0.61 (95% CI: 0.47 - 0.79, P < 0.01), as compared with HD patients. PD in cirrhotic patients who need dialysis is associated with lower all-cause mortality than HD is. This association is independent of patients' comorbidity, severity of liver cirrhosis, and serum albumin levels., Competing Interests: The authors declare that they have no competing interests The authors have no conflicts of interest to disclose.

Background and Objectives: This study compared the risk of subdural hematoma (SDH) and subsequent mortality in hemodialysis (HD) and peritoneal dialysis (PD) patients with ESRD., Design, Setting, Participants, & Measurements: Claims data were obtained from the National Health Insurance Administration Research Database in Taiwan. This retrospective cohort study comprised 10,136 PD patients and 10,136 HD patients with newly diagnosed ESRD from 1998 to 2010. Patients were matched by propensity score and year of dialysis initiation. Incidence rates and hazard ratios of SDH as well as odds ratios of subsequent 30-day deaths from SDH were evaluated from the date of the first dialysis session to the date when SDH was diagnosed, or the date of renal transplantation, death, withdraw from insurance, or the end of the follow-up period (December 31, 2011)., Results: Median (25th percentile, 75th percentile) follow-up times for SDH events were 3.61 years (1.91, 6.33) and 3.33 years (1.83, 5.66) in the HD and PD cohorts, respectively. The overall SDH incidence rate (95% confidence interval [95% CI]) was 61.4% higher in the HD cohort than in the PD cohort (34.7 [95% CI, 31.4 to 35.4] versus 21.5 [95% CI, 20.2 to 22.9] per 10,000 person-years, with an adjusted hazard ratio of 1.62 [95% CI, 1.17 to 2.33]). Approximately 152 of 253 (60%) of SDH events were associated with trauma. Subsequent 30-day SDH-related mortality was not statistically higher in HD patients than in PD patients (29.1% versus 25.3%; adjusted odds ratio, 1.30; 95% CI, 0.70 to 2.41)., Conclusions: HD patients have a higher risk of developing SDH than PD patients. Both patient groups have a high risk of mortality. Routine education on fall prevention is needed for dialysis patients., (Copyright © 2015 by the American Society of Nephrology.)

Aim: It remains unclear whether long-term daily icodextrin use can decrease technique failure and improve survival in peritoneal dialysis (PD) patients. The aim of the present study was to investigate whether icodextrin use, once daily, can decrease technique failure and prolong patient survival in incident PD patients., Methods: Incident PD patients who survived more than 90 days were recruited from the China Medical University Hospital, Taiwan, between 1 January 2007 and 31 December 2011. All patients were followed until transfer to haemodialysis (HD), renal transplantation, transfer to another centre, death, or 31 December 2011., Results: A total of 306 incident PD patients (89 icodextrin users, 217 icodextrin non-users) were recruited during the study period. Icodextrin users were more likely to have hypertension, diabetes and high or high-average peritoneal transport compared with non-users. During the follow-up period, 43 patients were transferred to HD: seven (7.87%) of the icodextrin group, and 36 (16.59%) of the non-icodextrin group. Thirty-two patients died during the follow-up period: five (5.62%) of the icodextrin group, and 27 (12.44%) of the non-icodextrin group. Icodextrin use was significantly associated with a better prognosis, in terms of technique failure (adjusted HR = 0.32; 95% CI = 0.14-0.72). With regard to patient survival, icodextrin use (adjusted HR = 0.33; 95% CI = 0.12-0.87) was associated with a significantly lower risk of death., Conclusion: The use of icodextrin once daily may decrease technique failure and improve survival in incident PD patients., (© 2014 Asian Pacific Society of Nephrology.)

Background: The question of which modality, either peritoneal dialysis (PD) or hemodialysis (HD), confers the survival advantage for incident ESRD patients with pre-existing cardiovascular disease (CVD) remains unanswered., Methods: Data used in this study were extracted from the National Health Insurance Research Database in Taiwan. From 1997 to 2007, incident ESRD patients who underwent dialysis longer than three months were selected. The established dialysis modality at day 90 was used to analyze the impact of dialysis modality on survival. For each PD patient indentified, five HD patients matched for age, sex, and year in which the patients received their first dialysis treatment were randomly selected. Finally, a total of 35 664 patients including 29 720 HD patients and 5944 PD patients were selected. The primary outcome was death after commencing dialysis., Results: For diabetic ESRD patients with or without coronary artery disease (CAD) or congestive heart failure (CHF), patients receiving PD had inferior survival compared with those receiving HD (P<.001, adjusted HR=1.34 to 1.43). For nondiabetic patients with CAD or CHF, patients receiving PD also had inferior survival compared with those receiving HD (adjusted HR=1.30, CI: 1.08 to 1.57; adjusted HR=1.31, CI: 1.11 to 1.55). For nondiabetic ESRD patients without CAD or CHF, there was no statistically significant difference in survival between PD and HD (adjusted HR=1.00, CI: 0.92 to 1.09; adjusted HR=0.98, CI: 0.90 to 1.07)., Conclusions: PD was associated with poorer survival among ESRD patients with CVD or diabetes mellitus compared with HD.

Peripheral artery disease (PAD) is known to be an increased mortality risk in patients with end-stage renal disease (ESRD). The aim of this study was to compare patient survival between patients with subclinical PAD undergoing peritoneal dialysis (PD) and hemodialysis (HD). Subclinical peripheral artery was defined as an ankle-brachial index of less than 0.9. This study was conducted from April 2005, and the observation period ended on 30 June 2011. At the end of the follow-up, the status of all patients was assessed and data on mortality were obtained for the entire cohort. A total of 91 patients (61 HD and 30 PD) were included for analyses in this study. Mortality rate was 60.0% (18/30) for PD and 52.5% (32/61) for HD. Kaplan-Meier estimate demonstrate that PD patients had a higher mortality rate than those underwent HD (log-rank p = 0.0039). Cox regression model demonstrated that PD was an independent predictor for further mortality in ESRD patients with subclinical peripheral artery disease.(p = 0.012, HR: 1.776, 95% CI: 1.136-2.775). In multivariate analysis, the HD group still had a greater survival than PD group (p = 0.005, HR:1.916, 95% CI: 1.218-3.015). In patients with subclinical peripheral artery disease, the patient survival is better in HD patients as compared with PD patients.

Bifidobacterium and Lactobacillus can beneficially affect the host by producing acetic acid and lactic acid, which lower pH and thereby inhibit the growth of pathogens or allow the probiotic bacteria to compete with pathogens for epithelial adhesion sites and nutrients. The transmural migration of enteric organisms into the peritoneal cavity can cause peritonitis in peritoneal dialysis (PD) patients. We hypothesized that the composition of the intestinal microbiota with regard to Lactobacillus species and Bifidobacterium species differed between PD patients and healthy controls. The aim of the study was to investigate these differences by real-time PCR analysis of fecal samples. From 1 August 2009 to 31 March 2010, a total of 29 nondiabetic PD patients and 41 healthy controls from China Medical University Hospital were recruited after giving their informed consent. Fecal samples were collected from the PD patients and their age-matched counterparts in the morning using a standardized procedure. DNA extracted from these samples was analyzed by real-time PCR. All bifidobacteria, Bifidobacterium catenulatum, B. longum, B. bifidum, Lactobacillus plantarum, L. paracasei, and Klebsiella pneumoniae were less frequently detected in the patient samples. Dysbiosis (microbial imbalance) may impair intestinal barrier function and increase host vulnerability to pathogen invasion. Further studies are necessary to confirm our findings before clinical trials with probiotic supplementation in PD patients.

Objective: To analyze the incidence rates and risk factors for bacteremia in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD)., Methods: The records of 898 consecutive patients undergoing dialysis from January 2003 to December 2008 were reviewed retrospectively. Episodes of bacteremia were recorded. China Medical University (Taichung, Taiwan)., Results: The overall incidence rate of bacteremia was 7.63 per 100 patient-years in HD patients and 3.56 per 100 patient-years in PD patients and it was higher in HD patients each year from 2003 to 2008. S. aureus (27.53%) was the most common pathogen in HD patients, whereas Coagulase-negative Staphylococcus (21.3%) was the most common pathogen in PD patients. Vascular access infection was the most common etiology in HD patients, whereas peritonitis was the most common etiology in PD patients. Older age, shorter dialysis vintage, use of HD rather than PD, current smoker, use of a venous dialysis catheter, presence of diabetes mellitus, higher comorbidity score, and lower serum albumin were significant risk factors for bacteremia. Diabetes mellitus and lower serum albumin were significant risk factors for bacteremia-associated mortality., Conclusion: Placement of a permanent access (fistula, graft, or PD catheter) prior to initiation of dialysis, smoking cessation, and better nutritional status (i.e. higher serum albumin) were associated with a reduced risk of bacteremia in dialysis patients. Higher serum albumin was also associated with a reduced bacteremia-associated mortality.

This longitudinal study investigated whether renal survival can affect the course and outcome of systemic lupus erythematosus (SLE) patients treated with chronic peritoneal dialysis (PD). Thirty-five SLE patients, out of 1115 end-stage renal disease (ESRD) patients treated with chronic PD, were seen between 1990 and 2007 at the Chang Gung Memorial Hospital. Patients were followed up for a mean of 38.8 +/- 22.9 months. There were no significant differences between patients with short renal survival (<3 years) and long renal survival (>3 years) for the various demographic variables such as age, sex, PD duration, immunosuppressive drug administration, or exchange system (P > 0.05). Interestingly, before PD, patients with short renal survival had lower serum complement levels than patients with long renal survival (C3, 40.2 +/- 14.4 vs 76.3 +/- 18.5 mg/dL, P < 0.001; and C4, 14.8 +/- 4.7 vs 22.4 +/- 8.1 mg/dL, P < 0.05). However, the differences in complement levels between the groups disappeared after PD (C3, 76.5 +/- 27.3 vs 84.2 +/- 27.8 mg/dL; and C4, 26.7 +/- 11.3 vs 22.6 +/- 10.8 mg/dL, both P > 0.05). Patients with short renal survival were more likely to have a high peritoneal solute transporter rate (PSTR) than their long renal survival counterparts (chi(2)-test, P = 0.02, and AUROC = 0.744 and P = 0.040); however, there were no significant differences for other variables such as cardiothoracic ratio (CTR), Kt/V, residual renal function, exit site infection, and peritonitis (P > 0.05). Finally, Kaplan-Meier analysis revealed that the two groups did not differ in patient and technical survival (P > 0.05). Therefore it was concluded that renal survival might be associated with PSTR, but not with patient and technical survival in SLE patients treated with PD.

Lactobacilli are part of the normal gastrointestinal and female genitourinary flora in humans and they are seldom pathogenic and rarely cause human disease. In the literature, Lactobacillus peritonitis was most common in immunocompromised patients, including patients under chronic peritoneal dialysis. We also suspect that the presence of Lactobacillus spp. in the peritoneal fluid might indicate the leakage of normal flora from a perforated intraabdominal hollow organ. To access the versatile clinical pictures of Lactobacillus peritonitis, this investigation retrospectively reviewed the medical records for Lactobacillus spp. isolated from peritoneal fluid from July 1998 to January 2002 at Chang-Gung Memorial Hospital, Taipei, Taiwan. A total of 10 patients were enrolled in the study. Six of these 10 patients had concomitant intraabdominal hollow organ perforation, and peritoneal fluid cultures in these six patients also contained bacteria other than Lactobacillus spp. All six patients had recently experienced either abdominal surgery or blunt abdominal trauma. The remaining four patients who had not undergone surgery had decompensated liver cirrhosis with ascites and spontaneous bacterial peritonitis. The results suggested that the presence of Lactobacillus spp. in the peritoneal fluid other than immunocompromised patients should raise the suspicion of hollow organ perforation in patients with recent abdominal surgery or blunt abdominal trauma.

Aims: Previous study on association between pro-inflammatory cytokines and mortality in PD population is limited. We aimed to investigate here. Methods: Total 50 patients who underwent incident PD were enrolled in this study. We measured the titers of pro-inflammatory cytokines Interleukin-18(IL-18), Interleukin-6 (IL-6), and Interleukin-1ß (IL-1ß). Study outcomes were all-cause mortality, cardiovascular-related mortality, and infection-caused mortality. Cox-regression model was used. Results: In this 7 year prospective study, IL-18 ≥ 804.3pg/ml, IL-6 ≥ 3.92 pg/ml, IL-1ß ≥ 0.86pg/ml, age ≥ 50 years-old, and existence of diabetes could be used as individual significant predictors for mortality in PD patients. Higher titers of IL-6 were associated with lower averaging albumin levels within 1st year of PD. Increasing numbers of these risk markers of mortality was associated with decreasing survival advantages (P = 0.001). Conclusion: Age ≥ 50 years-old, diabetes, and inflammatory cytokines profiles at the start of PD therapy could predict for 7-year mortality in PD population.

: Chronic kidney disease (CKD) patients are at risk for developing new-onset diabetes mellitus (NODM) even after hemodialysis (HD) and peritoneal dialysis (PD) treatment. It is not clear if the incidence for NODM is different in CKD patients receiving HD and PD. This study compared the risk of NODM in PD patients and HD patients. Methods: All HD and PD patients in Taiwan Renal Registry Database from 1997 to 2005 were included and all patients were followed to December 31, 2008. The risk of NODM was analyzed in PD patients and propensity score matched HD patients using logistic regression for early type NODM (< = 6 months after dialysis) and Cox regression for late type NODM (>6 months after dialysis). Results: A total of 2548 PD patients and 10192 HD patients who had no diabetes on the initiation of dialysis were analyzed. The incidence for NODM was 3.7 per 100 patient/year for HD and 2.4 for PD patients. HD patients are more at risk for developing early type NODM (p<0.001) with an adjusted odds ratio of 1.41 [95% confidence interval (CI) 1.12–1.78)]. HD patients are more at risk for late type NODM (p<0.001) with an adjusted hazard ratio of 2.01 (95% CI: 1.77–2.29). Patient’s age was negatively associated with risk of early type of NODM (p<0.001) but positively associated with risk of late type NODM (p<0.001). Conclusions: Chronic kidney disease patients receiving hemodialysis are more at risk for developing new-onset diabetes mellitus compared to those receiving peritoneal dialysis. [ABSTRACT FROM AUTHOR]

Peritonitis is a serious complication in peritoneal dialysis (PD) patients; however, the clinical outcome of culture-negative peritonitis (CNP) is controversial. This retrospective study of CNP attempts to resolve this controversy. In 813 episodes of peritonitis, 202 episodes of CNP in 152 PD patients were reviewed. Two different methods of effluent culture were utilized during the study period. The incidence of CNP was lower with 50 ml centrifugation culture than 10 ml direct inoculation culture (20.7% vs. 35.7%; p < 0.05). The overall cure rate of CNP was greater than 80% of patients receiving cefamezine and gentamicin as initial therapy. Relapse within 30 days after completion of treatment happened in 9.6% of cases, and antibiotic therapy failed in 8.1% of CNP cases. In comparison with cured patients, patients with relapse or treatment failure are older (62.0 ± 15.0 years vs. 54.3 ± 15.3 years; p = 0.007) and have a higher rate of abdominal pain (91.4% vs. 69.3%; p = 0.007) and greater need for salvage therapy (54.3 % vs. 11.0%; p < 0.001). A history of antibiotic use or peritonitis within 30 days before onset of CNP was noted in 23.3% and 12.5% of cases, respectively, but was not associated with clinical outcome. The clinical outcome of CNP was benign in this study. Older age, abdominal pain, and need for salvage therapy were associated with an increased risk for relapse and treatment failure in CNP cases. Moreover, 50 ml centrifugation culture method was better than 10 ml direct inoculation culture in reducing the incidence of CNP. [ABSTRACT FROM AUTHOR]

Candida parapsilosis is the most prevalent pathogen of fungal peritonitis in peritoneal dialysis (PD). The difference between C. parapsilosis peritonitis and other C . species for clinical outcomes and treatment responses to fungal peritonitis remains unclear. This retrospective study of fungal peritonitis attempts to answer that question. A total 22 patients with fungal peritonitis in 762 PD patients were enrolled in this study. The mean age of the 22 patients, 9 males and 13 females, was 54.7 ± 12.5 years with a mean PD duration of 39.7 ± 33.4 months. Candida species accounted for 86% (19 cases) of fungal peritonitis and 41% (9 cases) were C. parapsilosis . Thirteen (59%) patients received fluconazole as monotherapy; others received either amphotericin B alone or in combination with fluconazole. Catheters were removed for all patients. The mean duration from peritonitis onset to catheter removal was 5.8 ± 4.1 days. Eleven (50%) patients developed severe complications, with abscess formation or persistent peritonitis after catheter removal. C. parapsilosis peritonitis had a higher complication rate than other Candida species (78% versus 20%, p = 0.012). In patients who received fluconazole as monotherapy, the rate of severe complications of C. parapsilosis peritonitis was statistically higher than those of other Candida species (100% versus 29%, p = 0.013). Because of different severity and prognosis, C. parapsilosis peritonitis in PD patients should be treated more aggressively than other Candida species. [ABSTRACT FROM AUTHOR]