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Introduction: Inadequate dialysis and fluid overload are corrected after starting combined therapy with peritoneal dialysis (PD) and hemodialysis (HD). However, the effects on anemia management has not been elucidated., Methods: We conducted a prospective, multicenter, observational cohort study of 40 PD patients (age, 60 ± 10 years; male, 88%; median PD duration, 28 months) starting combined therapy and investigated changes in several clinical parameters, including erythropoiesis-stimulating agent (ESA) resistance index (ERI)., Results: ERI decreased significantly during 6 months after switching to combined therapy (from 11.8 [IQR 8.0-20.4] units/week/kg/(g/dL) to 7.8 [IQR 3.9-18.6] units/week/kg/(g/dL), p = 0.047). Body weight, urinary volume, serum creatinine and the dialysate-to-plasma creatinine ratio (D/P Cr) decreased, whereas hemoglobin and serum albumin increased. In subgroup analysis, the changes in ERI were not affected by cause for starting combined therapy, PD holiday and D/P Cr., Conclusion: Although detailed mechanism was unclear, ESA responsiveness improved after switching from PD alone to combined therapy., (© 2023 International Society for Apheresis and Japanese Society for Apheresis.)

Introduction: Although combined therapy with peritoneal dialysis (PD) and hemodialysis (HD) is widespread in Japan, its clinical utility has been reported only in retrospective or before-and-after test lacking a control group., Methods: We conducted a prospective, multicenter, observational cohort study of 176 incident PD patients and compared patient survival and changes in clinical parameters between patients on different dialysis modalities., Results: During a median follow-up of 41 months, 47 patients transferred to combined therapy and 35 patients transferred directly to HD. Patients transferred to combined therapy had a significantly better survival than those transferred directly to HD. However, we could not establish this difference in a multivariate analysis because only six patients died among these groups. The decreases in urea nitrogen and serum creatinine were more prominent among patients directly transferred to HD., Conclusion: This is the first report revealing clinical feasibility of transfer to combined therapy for PD patients., (© 2022 International Society for Apheresis and Japanese Society for Apheresis.)

Background: The Japanese Society for Dialysis Therapy established 14 clinical practice guidelines (CPGs) for various fields of renal replacement therapy. About 10 years have passed since the previous peritoneal dialysis (PD) guidelines were established. We commenced the establishment of new PD guidelines in 2016. Recently, the methods for development of CPGs have changed dramatically., Summary: The previous guidelines were described in a textbook-like format. However, these kinds of guidelines no longer meet the definition of CPGs as defined by the National Academy of Medicine in the USA, according to which "CPGs are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options." Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a systematic approach to rating the certainty of evidence in systematic reviews and other evidence syntheses. We have commenced the creation of new guidelines based on the same policy. The new guidelines are presented in 2 parts. Part 1 is described in a textbook-style format and includes 7 chapters, namely, Initiation of PD, Adequacy of PD, Adequate nutrition in PD patients, Evaluation of peritoneal membrane function, Discontinuation of PD for prevention of encapsulating peritoneal sclerosis, Management of peritonitis, and Management of the PD catheter and exit site. Part 2 comprises systematic reviews and recommendations on clinical questions (CQs) according to the GRADE system. Six CQs are included in Part 2: CQ1. Are renin-angiotensin inhibitors useful in the management of PD? CQ2. Is combination of icodextrin solution with glucose-based solution useful or not in the management of PD? CQ3. Is mupirocin or gentamicin ointment useful in the prevention of exit site infection? CQ4. Which method is more useful for the insertion of the PD catheter - open or laparoscopic surgery? CQ5. Intravenous or intraperitoneal administration, which route is more effective in the treatment of patients with PD-related peritonitis? CQ6. Which therapy is preferable for the management of diabetic end-stage renal failure, PD or HD? Key Messages: The new PD guidelines are under construction and will be completed by the beginning of 2019., (© 2019 S. Karger AG, Basel.)

In the general population, hypertension (HT) is defined as systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg. In dialysis patients, the definition is thought to be the same as in the general population. But there is no clear description about the definition of HT for dialysis patients, especially in peritoneal dialysis (PD) patients. The prevalence of HT in PD patients is much higher compared to the general population. The association of BP and cardiovascular (CV) mortality in PD patients who are not exposed to huge hemodynamic changes during hemodialysis (HD) has been inconsistently reported. The International Society of Peritoneal Dialysis (ISPD) guideline recommends that BP be evaluated by home BP measurement at least once a week and at each visit to the clinic and that active screening and periodic monitoring of BP be performed in this population. When collecting BP data via our telemedicine system, HD patients' weekly BP variability was unclear if data were analyzed by the day of the week, but was clear if data were analyzed by the day of dialysis. There is weekly BP variability probably due to volume status, not due to the day of the week. The range of variability of morning SBP in a week was almost 16 mm Hg in HD patients. But continuous ambulatory PD patients' home morning SBP variability in a week was only 3 mm Hg. Comparing data of PD patients and HD patients, weekly BP variability is much wider in HD, which might increase CV event risk. PD patients should undertake physical activity and salt restriction compatible with CV health and tolerance, which might reduce BP as some reports suggested. Keeping good volume status is crucial for the treatment of BP. Using the bioelectrical impedance device is a good method to measure dry weight. Conventionally, we should check dry weight confirming no edema on body, normal BP and normal heart rate, cardiothoracic ratio, plasma concentration of human atrial natriuretic peptide, diameter of inferior vena cava, etc. Before starting or increasing antihypertensive medications, PD patients with HT should have volume status optimized. Although the utility of hypertonic glucose PD solutions for volume removal in PD is not disputed, the minimization of PD glucose exposure by salt restriction, diuretic use among those with residual renal function, and use of glucose-sparing solutions like icodextrin to optimize volume control are important. PD patients whose BP is consistently >140/90 mm Hg should be treated to maintain SBP at <140 mm Hg and DBP at <90 mm Hg. There are no randomized studies examining different BP targets in relation to clinical outcomes in PD patients. As a perspective, evidence for BP control in PD patients is awaited., (© 2018 S. Karger AG, Basel.)

Background Peritoneal dialysis (PD)-related peritonitis is a major complication of PD. Wide variations in peritonitis prevention, treatment strategies and consequences are seen between countries. These between-country differences may result from modifiable risk factors and clinical practices. Methods A total of 1225 Japanese PD patients were included and prospectively followed in the Peritoneal Dialysis Outcomes and Practice Patterns Study phase 1 (2014–2018) and phase 2 (2018–2022). Associations between PD-related peritonitis and various risk factors were assessed by Cox proportional hazards survival models. Results During follow-up (median 1.52 years), 539 peritonitis episodes were experienced by 364 patients. The country crude peritonitis rate was 0.27 episodes/patient-year. In the fully adjusted model, noticeable patient-level factors associated with experiencing any peritonitis included age {hazard ratio [HR] 1.07 per 5-year increase [95% confidence interval (CI) 1.01–1.14]}, serum albumin level [HR 0.63 per 1 g/dl higher (95% CI 0.48–0.82)] and continuous ambulatory peritoneal dialysis (PD) [HR 1.31 versus automated PD (95% CI 1.05–1.63)]. The adoption of antibiotic prophylaxis practice at the time of PD catheter insertion [HR 0.63 (95% CI 0.51–0.78)] or when having complicated dental procedures [HR 0.74 (95% CI 0.57–0.95)] or lower endoscopy [HR 0.69 (95% CI 0.54–0.89)] were associated with lower hazards of any peritonitis, while a routine facility practice of having more frequent regular medical visits was associated with a higher hazard. Conclusion Identification of risk factors in Japan may be useful for developing future versions of guidelines and improving clinical practices in Japan. Investigation of country-level risk factors for PD-related peritonitis is useful for developing and implementing local peritonitis prevention and treatment strategies [ABSTRACT FROM AUTHOR]

Peritonitis is one of the most important complications in patients with peritoneal dialysis (PD). Appropriate antibiotic treatment against PD-associated peritonitis is necessary to prevent PD catheter removal and withdrawal from PD. Chryseobacterium indologenes is a Gram-negative rod that occurs in the natural environment. C. indologenes is thought to acquire resistance to β-lactam drugs through the production of metallo-β-lactamase and to become resistant to antibiotic therapy through the formation of biofilms. Only a few cases of PD-associated peritonitis caused by C. indologenes have been reported to date, and appropriate treatment strategies have not been clarified. In the past, 5 cases of PD-associated peritonitis caused by C. indologenes have been reported and 2 patients required catheter removal because of recurrence or refractoriness. In this case, a 51-year-old man with PD-associated peritonitis caused by C. indologenes was treated with 2 susceptible antibiotics, including fluoroquinolones to prevent acquired resistance and biofilm formation. There was no recurrence, and catheter removal was not necessary in this case. Collectively, the present case highlighted that PD-associated peritonitis caused by C. indologenes should be treated with 2 susceptible antibiotics including fluoroquinolones for 3 weeks. [ABSTRACT FROM AUTHOR]