Long-term exposure to bioincompatible peritoneal dialysis(PD) solutions frequently results in peritoneal fibrosis and ultrafiltration failure,which limits the life-long use of and leads to the cessation of PD therapy....Long-term exposure to bioincompatible peritoneal dialysis(PD) solutions frequently results in peritoneal fibrosis and ultrafiltration failure,which limits the life-long use of and leads to the cessation of PD therapy.Therefore,it is important to elucidate the pathogenesis of peritoneal fibrosis in order to design therapeutic strategies to prevent its occurrence.Peritoneal fibrosis is associated with a chronic inflammatory status as well as an elevated oxidative stress(OS) status.Beyond uremia per se,OS also results from chronic exposure to high glucose load,glucose degradation products,advanced glycation end products,and hypertonic stress.Therapy targeting the cannabinoid(CB) signaling pathway has been reported in several chronic inflammatory diseases with elevated OS.We recently reported that the intra-peritoneal administration of CB receptor ligands,including CB_1 receptor antagonistsand CB_2 receptor agonists,ameliorated dialysis-related peritoneal fibrosis.As targeting the CB signaling pathway has been reported to be beneficial in attenuating the processes of several chronic inflammatory diseases,we reviewed the interaction among the cannabinoid system,inflammation,and OS,through which clinicians ultimately aim to prolong the peritoneal survival of PD patients.展开更多
AIMTo study the relationship between overhydration （OH） in peritoneal dialysis （PD） patients and cardiac mortality.METHODSOH, as measured by body composition monitor （BCM）, is associated with increased mortality...AIMTo study the relationship between overhydration （OH） in peritoneal dialysis （PD） patients and cardiac mortality.METHODSOH, 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 20.0.RESULTSThere 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; median （IQR） hydration at baseline was ＋2.7 （2.3 to 3.7） L. They were followed up for a minimum of 6 mo. Reduction in OH values in these patients over 6 mo correlated with lowering of cTnT levels （Spearman r value 0.29, P 〈 0.02）. CONCLUSIONPatients that were overhydrated had higher cTnT, and had deaths that were more likely to be cardiac related. Reduction in OH correlated with lowering of cTnT.展开更多
AIM： To examine all skin changes in peritoneal dialysis （PD） patients followed up in our unit.METHODS： Patients on PD program for at least three months without any known chronic skin disease were included in the s...AIM： To examine all skin changes in peritoneal dialysis （PD） patients followed up in our unit.METHODS： Patients on PD program for at least three months without any known chronic skin disease were included in the study. Patients with already diagnosed skin disease, those who have systemic diseases that may cause skin lesions, patients with malignancies and those who did not give informed consent were excluded from the study. All patients were examined by the same predetermined dermatologist with all fndings recorded. The demographic, clinical and laboratory data including measures of dialysis adequacy of patients were recorded also. Statistical Package for Social Sciences （SPSS） for Windows 16.0 standard version was used for statistical analysis.RESULTS： Among the patients followed up in our PD unit, those without exclusion criteria who gave informed consent, 38 patients were included in the study with male/female ratio and mean age of 26/12 and 50.3 ± 13.7 years, respectively. The duration of CKD was 7.86 ± 4.16 years and the mean PD duration was 47.1 ± 29.6 mo. Primary kidney disease was diabetic nephropathy in 11, nephrosclerosis in six, uropathologies in four, chronic glomerulonephritis in three, chronic pyelonephritis in three, autosomal dominant polycystic kidney disease in three patients while cause was unknown in eight patients. All patients except for one patient had at least one skin lesion. Loss of lunula, onychomycosis and tinea pedis are the most frequent skin disorders recorded in the study group. Diabetic patients had tinea pedis more frequently （ P = 0.045）. No relationship of skin findings was detected with primary renal diseases, comorbidities and medications that the patients were using.CONCLUSION： Skin abnormalities are common in in PD patients. The most frequent skin pathologies are onychomycosis and tinea pedis which must not be overlooked.展开更多
Epiploic appendagitis(EA)is rare cause of acute or subacute abdominal pain in patients on peritoneal dialysis(PD),where the diagnosis can be challenging as the clinical features,laboratory markers and imaging characte...Epiploic appendagitis(EA)is rare cause of acute or subacute abdominal pain in patients on peritoneal dialysis(PD),where the diagnosis can be challenging as the clinical features,laboratory markers and imaging characteristics have not been described previously in this group of patients.Here,we present the management of a case of EA in a patient on PD and review published literature pertinent to the subject.The importance of establishing the diagnosis early by laparoscopy is emphasised.展开更多
基金Supported by The Ministry Of Science and Technology,Taiwan,Nos.NSC 96-2628-B-075-003-MY3,MOST 104-2314-B-075-031,and MOST 105-2628-B-075-008-MY3Taipei Veterans General Hospital,Taipei,Taiwan,No.V106D25-003-MY3-1Taipei Veterans General Hospital,National Yang-Ming University Excellent Physician Scientists Cultivation Program,No.103-V-B-024
文摘Long-term exposure to bioincompatible peritoneal dialysis(PD) solutions frequently results in peritoneal fibrosis and ultrafiltration failure,which limits the life-long use of and leads to the cessation of PD therapy.Therefore,it is important to elucidate the pathogenesis of peritoneal fibrosis in order to design therapeutic strategies to prevent its occurrence.Peritoneal fibrosis is associated with a chronic inflammatory status as well as an elevated oxidative stress(OS) status.Beyond uremia per se,OS also results from chronic exposure to high glucose load,glucose degradation products,advanced glycation end products,and hypertonic stress.Therapy targeting the cannabinoid(CB) signaling pathway has been reported in several chronic inflammatory diseases with elevated OS.We recently reported that the intra-peritoneal administration of CB receptor ligands,including CB_1 receptor antagonistsand CB_2 receptor agonists,ameliorated dialysis-related peritoneal fibrosis.As targeting the CB signaling pathway has been reported to be beneficial in attenuating the processes of several chronic inflammatory diseases,we reviewed the interaction among the cannabinoid system,inflammation,and OS,through which clinicians ultimately aim to prolong the peritoneal survival of PD patients.
文摘AIMTo study the relationship between overhydration （OH） in peritoneal dialysis （PD） patients and cardiac mortality.METHODSOH, 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 20.0.RESULTSThere 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; median （IQR） hydration at baseline was ＋2.7 （2.3 to 3.7） L. They were followed up for a minimum of 6 mo. Reduction in OH values in these patients over 6 mo correlated with lowering of cTnT levels （Spearman r value 0.29, P 〈 0.02）. CONCLUSIONPatients that were overhydrated had higher cTnT, and had deaths that were more likely to be cardiac related. Reduction in OH correlated with lowering of cTnT.
文摘AIM： To examine all skin changes in peritoneal dialysis （PD） patients followed up in our unit.METHODS： Patients on PD program for at least three months without any known chronic skin disease were included in the study. Patients with already diagnosed skin disease, those who have systemic diseases that may cause skin lesions, patients with malignancies and those who did not give informed consent were excluded from the study. All patients were examined by the same predetermined dermatologist with all fndings recorded. The demographic, clinical and laboratory data including measures of dialysis adequacy of patients were recorded also. Statistical Package for Social Sciences （SPSS） for Windows 16.0 standard version was used for statistical analysis.RESULTS： Among the patients followed up in our PD unit, those without exclusion criteria who gave informed consent, 38 patients were included in the study with male/female ratio and mean age of 26/12 and 50.3 ± 13.7 years, respectively. The duration of CKD was 7.86 ± 4.16 years and the mean PD duration was 47.1 ± 29.6 mo. Primary kidney disease was diabetic nephropathy in 11, nephrosclerosis in six, uropathologies in four, chronic glomerulonephritis in three, chronic pyelonephritis in three, autosomal dominant polycystic kidney disease in three patients while cause was unknown in eight patients. All patients except for one patient had at least one skin lesion. Loss of lunula, onychomycosis and tinea pedis are the most frequent skin disorders recorded in the study group. Diabetic patients had tinea pedis more frequently （ P = 0.045）. No relationship of skin findings was detected with primary renal diseases, comorbidities and medications that the patients were using.CONCLUSION： Skin abnormalities are common in in PD patients. The most frequent skin pathologies are onychomycosis and tinea pedis which must not be overlooked.
文摘Epiploic appendagitis(EA)is rare cause of acute or subacute abdominal pain in patients on peritoneal dialysis(PD),where the diagnosis can be challenging as the clinical features,laboratory markers and imaging characteristics have not been described previously in this group of patients.Here,we present the management of a case of EA in a patient on PD and review published literature pertinent to the subject.The importance of establishing the diagnosis early by laparoscopy is emphasised.
