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Increasing the use of biocompatible,glucose-free peritoneal dialysis solutions

World Journal of Nephrology 2015年第1期4卷 92-97页

作者： Ahad Qayyum elizabeth ley oei Klara Paudel Stanley L Fan Department of Renal Medicine and Transplantation The Royal London HospitalBarts Health NHS TrustLondon E1 1BBUnited Kingdom Department of Renal Medicine and Transplantation Singapore General HospitalSingapore 169608Singapore

A major concern inhibiting some clinicians from embracing peritoneal dialysis(PD) as the preferred first modality of dialysis is the effects of PD solutions on the peritoneal membrane. These anatomical and functional changes predispose to complications like peritonitis,encapsulating peritoneal sclerosis and ultrafiltration failure. In recent years, "biocompatible" and glucosesparing PD regimens have been developed to minimize damage to the peritoneal membrane. Can the use of these more expensive solutions be justified on current evidence? In this review of the literature, we explore how we may individualize the prescription of biocompatible PD fluid.

关键词： Individualized prescription Biocompatibility Peritoneal dialysis Glucose degradation products Peritonitis Ultrafiltration failure Residual renal function

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Is overhydration in peritoneal dialysis patients associated with cardiac mortality that might be reversible?

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World Journal of Nephrology 2016年第5期5卷 448-454页

作者： elizabeth oei Klara Paudel Annemarie Visser Hazel Finney Stanley L Fan Department of Renal Medicine and Transplantation Barts Health NHS Trust Department of Nutrition and Dietetics Barts Health NHS Trust Department of Clinical Biochemistry Barts Health NHS Trust

AIMTo study the relationship between overhydration （OH） in peritoneal dialysis （PD） patients and cardiac ***, as measured by body composition monitor （BCM）, is associated with increased mortality in dialysis pa-tients. BCM has been used to guide treatment on the assumption that correcting OH will improve cardiac morbidity and mortality although data demonstrating causality that is reversible is limited. We wished to determine if OH in PD patients predicted cardiac mor-tality, and if there was a correlation between OH and cardiac troponin-T （cTnT） levels. Finally, we wished to determine if improving OH values would lead to a decrement in cTnT. All prevalent PD patients over the study period of 57 mo who had contemporaneous BCM and cTnT measurements were followed irrespective of transplantation or PD technique failure. We also studied a cohort of patients with who had severe OH （〉＋2L）.The Fresenius Body Composition Monitor was used to obtain hydration parameters. cTnT levels were done as part of routine clinical care. Data was analysed using SPSS version *** were 48 deaths in the 336 patients. The patients that died from cardiac or non-cardiac causes were similar with respect to their age, incidence of diabetes mellitus, gender, ethnicity and cause of renal failure. However, the patients with cardiac causes of death had significantly shorter dialysis vintage （10.3 mo vs 37.0 mo, P 〈 0.0001） and were significantly more overhydrated by BCM measurement （2.95 L vs 1.35 L, P 〈 0.05）. The mean （standard error of the means） hydration status of the 336 patients was ＋1.15 （0.12） L and the median [interquartile range （IQR）] cTnT level was 43.5 （20-90） ng/L. The cTnT results were not normally distributed and were therefore transformed logarithmically. There was a statistically significant correlation between Log （cTnT） with the OH value （Spearman r value 0.425, P 〈 0.0001）. We identifed a sub-group of patients that were severely overhydrated; m

关键词： Bioimpedance Fluid status Peritoneal dialysis Mortality Overhydration Cardiac troponin

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