Search

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]

During the last decades, various strategies have been optimized to enhance clearance of a variable spectrum of retained molecules to ensure hemodynamic tolerance to fluid removal and improve long-term survival in patients affected by kidney failure. Treatment effects are the result of the interaction of individual patient characteristics with device characteristics and treatment prescription. Historically, the nephrology community aimed to provide adequate treatment, along with the best possible quality of life and outcomes. In this article, we analyzed blood purification techniques that have been developed with their different characteristics. [ABSTRACT FROM AUTHOR]

Introduction: The impact of coronavirus disease 2019 (COVID‐19) infection control on other infections in patients with dialysis has not received sufficient consideration. Methods: We compared hospitalization and mortality rates among patients who underwent hemodialysis (HD) at three dialysis centers before (March 2018–February 2020) and during (March 2020–February 2022) the COVID‐19 pandemic. Results: This study included 1696 patients undergoing HD (mean age, 70 years; 1099 men). Compared to before the COVID‐19 pandemic, the emergency hospitalization rate (per 100 dialysis patient‐years) for non‐severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) respiratory infectious diseases (IDs) (7.0 vs. 4.1, p < 0.001) significantly decreased during the COVID‐19 pandemic, whereas the hospitalization rates for other IDs were comparable. The mortality rates for non‐SARS‐CoV‐2 respiratory IDs were comparable before and during the COVID‐19 pandemic. Conclusions: Hospitalizations for non‐SARS‐CoV‐2 respiratory IDs among patients undergoing HD may have decreased owing to the implementation of infection control measures for COVID‐19. [ABSTRACT FROM AUTHOR]

Introduction: Predictive markers and prognosis remain unclear in hospitalized hemodialysis (HD) patients with coronavirus disease 2019 (COVID‐19) during the Omicron epidemic. Methods: We evaluated characteristics, laboratory parameters, and outcomes in hospitalized HD patients with COVID‐19 (n = 102) at two centers between January and April 2022. Results: The 30‐day mortality rate was higher in moderate–critical group (n = 43) than mild group (n = 59) (16.3% vs. 1.7%; p = 0.007), and higher in patients with lower CC chemokine ligand 17 (CCL17) levels (<95.0 pg/mL) compared with normal CCL17 levels (19.0% versus 4.9%; p = 0.03). In multivariate analyses, a low CCL17 level (p = 0.003) was associated with moderate–critical conditions, and moderate–critical conditions (p = 0.04) were associated with 30‐day mortality, whereas CCL17 was not associated with 30‐day mortality. Conclusions: COVID‐19 remains a fatal complication, and CCL17 was a predictive marker of severity in hospitalized HD patients during the Omicron epidemic. [ABSTRACT FROM AUTHOR]

Progress in the identification and characterization of uremic retention solutes has refined our understanding of the pathophysiology of the uremic syndrome. Furthermore, the evolution of dialysis and other techniques designed to remove uremic retention solutes offers opportunities to provide a more personalized and targeted treatment for patients with chronic kidney disease (CKD) with an aim to improve outcomes. Considering these developments, a consensus report was recently published that readdressed the 2003 definition and classification of uremic toxins and formulated recommendations for future research to enhance the understanding of uremic retention solutes. In the present work, the authors of a work group that contributed to the consensus report provide a more detailed rationale for the recommendations related to their theme "Critical appraisal of limitations in the current definition/classification of uremic toxins." In summary, the authors propose that the current definition of uremic toxins should remain organized on hemodialysis strategies, membranes, and removal patterns since hemodialysis is the most frequently applied therapeutic strategy to reduce their concentration in advanced CKD. Nevertheless, the work group also acknowledges that any classification based on cutoff values and/or molecular spatial configurations is arbitrary and will likely need to be changed with therapeutic advancements. Furthermore, the current physicochemical classification might be extended to reflect the degree of toxicity of a specific toxin that is likely to support more personalized and targeted dialysis prescriptions and improve the outcomes for patients with CKD. [ABSTRACT FROM AUTHOR]