Factors Associated with Mortality in Diabetic Patients with End-Stage Renal Failure Starting Emergency Hemodialysis

Background: Diabetic nephropathy is the leading cause of end-stage chronic kidney disease with poor prognosis in resource-limited settings. This study aimed to determine factors associated with mortality in patients starting dialysis treatment for end-stage chronic renal disease in an emergency context. Patients and Methods: This was a retrospective study from January 2020 to December 2022 at CHU-B. Data from 79 diabetic patients requiring emergency dialysis were compared with those of 79 non-diabetic patients with an end-stage renal disease requiring emergency dialysis. Data were collected from the Nephrology Department registry. We studied their initial clinical and biological profiles and factors related to mortality. Results: Out of 545 compiled records, 79 diabetic chronic kidney disease patients needing dialysis were included (group 1). A control group of 79 non-diabetic chronic kidney disease patients requiring emergency dialysis was also included (group 2). The average age of patients was 53.5 ± 17 years, and the duration of diabetes at dialysis initiation was 14.8 ± 4.3 years. Twenty-three percent were hypertensive. Fifty-two percent of patients experienced intra-dialytic hypotension. Death occurred in 22% of patients. Results show that age (adjusted OR 1.955;CI: 1.025 - 1.086;p-value: Conclusion: Emergency dialysis in diabetics is associated with unfavorable outcomes in terms of mortality. Despite follow-up, renal involvement remains poorly explored, emphasizing the need for physician awareness.

Relationship of demoralization with anxiety,depression,and demographics of Chinese dialysis patients:Erratum

In the article entitled“Relationship of demoralization with anxiety,depression,and demographics of Chinese dialysis patients”by Zhuang CL,Zheng JL,Gao L,Huang YL,and Hu WJ(J Integr Nurs 2021;3(4):155-160.DOI:10.4103/jin.jin_46_21),[1]the ethical statement was not provided.

Continuous ambulatory peritoneal dialysis telemonitoring and education:A scoping review

The risk of peritonitis complications in continuous ambulatory peritoneal dialysis(CAPD)can be prevented or reduced by providing proper education and continuous monitoring.Telemedicine and telemonitoring are methods that enable remote monitoring and patient care.This study aimed to determine the success and factors affecting telemonitoring in CAPD patient care.This study is a scoping review(ScR)using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR method.Article searches were carried out on ProQuest,PubMed,and ScienceDirect with a time range of 2018-2023.Data extraction was performed regarding knowledge level,quality of life,clinical outcomes(peritonitis),and risk of hospitalization.Of the 12 articles and studies included,6 articles were related to the effect of telemonitoring on CAPD patient outcomes,and 6 articles were associated with the effect of education on CAPD patient outcomes.Education provided to patients can improve patient understanding of therapeutic modalities for renal disorders,reduce the potential for peritonitis and dialysis complications,and improve the quality of life of patients with CAPD.CAPD patients who received telemonitoring had a better quality of life,good clinical outcomes,and a lower risk of hospitalization than those who did not receive telemonitoring and had fewer health-care visits.In summary,the implementation of telemonitoring and education in chronic kidney disease patients with CAPD modality therapy has been proven effective in improving quality of life and reducing dialysis-related risks.

A Cross-Sectional Study on The Prevalence of Anemia in Maintenance Hemodialysis and Peritoneal Dialysis Patients and Its Related Factors

Objective:To study the prevalence of anemia,the proportion of hemoglobin(Hb)levels,the treatment methods,and the influencing factors of Hb levels in maintenance hemodialysis(MHD)and peritoneal dialysis patients.Methods:In this study,602 patients with maintenance hemodialysis and continuous ambulatory peritoneal dialysis were enrolled from December 2020 to December 2022 in our hospital,and their medical records were collected and summarized.The main contents included the patient’s gender,age,primary disease,dialysis duration,dialysis method,the use of erythropoietic stimulating agents(ESA),intravenous iron,and laboratory tests.A Hb index exceeding 110 g/L was set as the standard for the prevalence of anemia.Results:The rate of anemia in patients undergoing blood purification was 83%.The proportion of ESA use was 84.1%,and the proportion of iron use was 76.7%,of which the proportion of intravenous iron used was 17.0%,and the proportion of folic acid used was 28.3%.Conclusion:The incidence of anemia in MHD patients was relatively high,with a low proportion of patients reaching the standard Hb levels.Risk factors include albumin(ALB)levels,iron storage,white blood cells,C-reactive protein,cholesterol,etc.Nutritional support,iron supplementation,and prevention of micro-inflammatory reactions can effectively promote the improvement of Hb indicators in dialysis patients to prevent anemia.

Psychological review of hemodialysis patients and kidney transplant recipients during the COVID-19 pandemic

BACKGROUND Kidney transplantation(KT)and end-stage renal disease(ESRD)requiring hemodialysis(HD)increase the incidence of morbidity and mortality associated with coronavirus disease 2019(COVID-19)infection.The COVID-19 pandemic has had a negative effect on the psychological well-being of COVID-19 patients,especially those with a high-risk of infectious complications.The prevalence of anxiety and depression is known to be higher in ESRD patients undergoing HD than in the general population.On the other hand,KT recipients have different treatment requirements compared to HD patients,including adherence to complex immunosuppressive regimens and compliance with follow-up appointments.We hypothesized that psychosocial difficulties and stressors would differ between ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic.If so,each group may require different interventions to maintain their psychosocial well-being.AIM To measure and compare the levels of stress,anxiety,depression,concerns related to the pandemic,and coping skills in ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic.METHODS This cross-sectional study was performed at a training and research hospital.The study included ESRD patients undergoing HD(HD group)and KT recipients(with stable graft function for≥6 mo prior to the study)(KT group).Patients completed a demographics form,the impact of events scale,the hospital anxiety and depression scale,and the Connor-Davidson resilience scale.Laboratory findings at the last clinical follow-up were recorded.Theχ^(2)test was used to assess the relationship between the HD and KT groups and the categorical variables.The relationships between the scale scores were analyzed using Pearson’s correlation test,and differences between the groups were analyzed using the independent groups t-test.RESULTS The study included 125 patients,of which 89(71.2%)were in the HD group and 36(28.8%)were in the KT group.The levels of anxiety and depression were higher in the HD group than in the KT group[9.36±4.38 vs 6.89±4.06(P=0.004)and 8.78±4.05 vs 6.42±4.26(P=0.004),respectively],whereas the post-traumatic stress score was higher in the KT group[46.75±13.98 vs 37.66±18.50(P=0.009)].The concern with the highest intensity in the HD group was transmission of COVID-19 to family and friends(93.3%)and in the KT group was loss of caregiver and social support(77.8%).Concerns regarding financial hardship,stigmatization,loneliness,limited access to health care services,failure to find medical supplies,and transmission of COVID-19 to family and friends were more prevalent in the HD group.Connor-Davidson resilience scale tenacity and personal competence,tolerance,and negative affect scores were higher in the KT group than in the HD group[43.47±11.39 vs 33.72±12.58,15.58±4.95 vs 11.45±5.05,and 68.75±17.39 vs 55.39±18.65(P<0.001),respectively].Biochemical parameters,such as creatine,urea,phosphorus,parathyroid hormone,and calcium,were lower,and the albumin and hemoglobin values were higher in the KT group than in the HD group(P<0.001).CONCLUSION Psychosocial difficulties and the level of stress differ in ESRD patients undergoing HD and KT recipients;therefore,psychosocial interventions should be tailored for each patient group.

Neisseria mucosa-A rare cause of peritoneal dialysis-related peritonitis:A case report

BACKGROUND Neisseria mucosa is a gram negative diplococcus belonging to the genus Neisseria found commonly in the upper respiratory tract.It is typically a commensal organism when it is parasitic on oral and nasal mucosa.To our knowledge,it does not cause disease in healthy individuals with normal immunity,but can be pathogenic in those with impaired immune function or change in bacterial colonization site.Neisseria mucosa has been reported to cause bacterial meningitis,conjunctivitis,pneumonia,endocarditis,peritonitis and urethritis.However,peritoneal dialysis-related peritonitis caused by Neisseria mucosa is extremely rare in clinical practice,which has not previously been reported in China.CASE SUMMARY A 55-year-old female presented to the nephrology clinic with upper abdominal pain without apparent cause,accompanied by nausea,vomiting and diarrhea for two days.The patient had a history of Stage 5 chronic kidney disease for five years,combined with renal hypertension and renal anemia,and was treated with peritoneal dialysis for renal replacement therapy.The patient was subsequently diagnosed with peritoneal dialysis-related peritonitis.Routine examination of peritoneal dialysis fluid showed abdominal infection,and the results of microbial culture of the peritoneal dialysis fluid confirmed Neisseria mucosa.Imi-penem/cilastatin 1.0 g q12h was added to peritoneal dialysis fluid for anti-infection treatment.After 24 d,the patient underwent upper extremity arteriovenous fistulation.One month later,the patient was discharged home in a clinically stable state.CONCLUSION Peritonitis caused by Neisseria mucosa is rare.Patients with home-based self-dialysis cannot guarantee good medical and health conditions,and require education on self-protection.

Impact of Dialysis Coverage on the Provision of Universal Health Insurance in the Republic of the Congo

Introduction: The launch of health insurance in the Republic of the Congo took place against a backdrop of extremely high costs for dialysis, which was not one of the services financed within this framework. The aim of this study is to assess the impact of including dialysis in the health insurance package in Congo. Methodology: This is a descriptive cross-sectional study with an evaluative aim, analyzing the impact of dialysis on the financing capacity of health insurance and health facilities to provide this type of care. Results: The results show that including dialysis in the universal health insurance package will require an additional financial effort of 6.20% of the current total financing capacity of the care basket. Most dialysis sessions are provided by the private health sector (87.5%), whose health facilities are unevenly distributed across the country, and concentrated in the country’s two major cities. This problem is the dual consequence of the very high cost of a dialysis session (average cost 140,234,375 FCFA or 229 US Dollars) and the number of patients under care, which will increase in the absence of effective and ongoing prevention efforts against chronic diseases in general and end-stage renal failure in particular. Conclusion: Dialysis is a high-impact public health intervention. The impact of its inclusion in the universal health insurance care package is difficult to bear financially. For dialysis to be covered by universal health insurance, additional funding and improved technical facilities are needed.

Global research trends and mapping knowledge structure of depression in dialysis patients

BACKGROUND Depression is one of the most common and important psychological issues faced by dialysis patients.It can make it more difficult for them to adhere to their treatment regimen,which,in turn,can worsen their physical symptoms and lead to poorer health outcomes.AIM To examine the evolution and growth of publications related to dialysis and depression.The objectives were to identify the number of publications,the top active countries,the contributed institutions,funding agencies and journals,as well as to perform citation and research theme analysis.METHODS The search was conducted using the Scopus database for publications related to dialysis and depression between 1970 and 2022.Subsequently,bibliometric analysis was carried out on the data obtained using VOSviewer software,version 1.6.9.This analysis included visualization analysis,co-occurrence analysis and examination of publication trends in dialysis and depression.RESULTS We identified 800 publications that met the search criteria.The number of publications related to dialysis and depression has increased significantly in the past two decades.The USA led the way with 144 publications,which is 18%of all publications on this topic.Turkey came second with 88 publications(11%),followed by China with 55 publications(6.88%)and Iran with 52 publications(6.5%).Analysis of the research theme identified three main clusters related to gender differences in prevalence,identification of depression as a risk factor,and effective interventions to relieve depression.Future research direction analysis shows a shift toward effective interventions to relieve depression in dialysis patients.CONCLUSION This study provides a comprehensive overview of growth,trends and research themes related to dialysis and depression that could help researchers identify gaps in the literature and develop future research.

Sequential treatment for diabetic foot ulcers in dialysis patients:A case report

BACKGROUND Diabetic foot ulcers(DFUs)are common in patients with diabetes,especially those undergoing hemodialysis.In severe cases,these ulcers can cause damage to the lower extremities and lead to amputation.Traditional treatments such as flap transposition and transfemoral amputation are not always applicable in all cases.Therefore,there is a need for alternative treatment methods.CASE SUMMARY This report describes a 62-year-old female patient who was admitted to the hospital with plantar and heel ulcers on her left foot.The patient had a history of renal failure and was undergoing regular hemodialysis.Digital subtraction angiography showed extensive stenosis and occlusion in the left superficial femoral artery,left peroneal artery and left posterior tibial artery.Following evaluation by a multidisciplinary team,the patient was diagnosed with type 2 DFUs(TEXAS 4D).Traditional treatments were deemed unsuitable,and the patient was treated with endovascular surgery in the affected area,in addition to supportive medical treatment,local debridement,and sequential repair using split-thickness skin and tissue-engineered skin grafts combined with negative pressure treatment.After four months,the wound had completely healed,and the patient was able to walk with a walking aid.CONCLUSION This study demonstrates a new treatment method for DFUs was successful,using angioplasty,skin grafts,and negative pressure.

Independent risk factors for depression in older adult patients receiving peritoneal dialysis for chronic kidney disease

BACKGROUND According to the trend of global population aging,the proportion of elderly patients with chronic kidney disease(CKD)is expected to increase.However,there are more than 20 million people in China with decompensated kidney function,of which 19.25%are elderly people.Therefore,special attention should be paid to the education years,sleep quality,anxiety status,comorbidities with diabetes,cardiovascular disease(CVD),and anemia as independent risk factors for depression in elderly CKD patients.This study explores the clinical management of elderly CKD patients that should address these risk factors to prevent depression and improve their prognosis.AIM To investigate depression risk factors in older patients receiving peritoneal dialysis,aiding future prevention of depression in these patients.METHODS This retrospective study included a primary study population of 170 patients with CKD who received peritoneal dialysis from January 2020 to December 2022.We assessed the patients’mental status using the Beck Depression Inventory Score-II(BDI-II),Self-Rating Anxiety Scale(SAS),Anxiety Inventory Score,and the Pittsburgh Sleep Quality Index(PSQI).Logistic regression was employed to identify depression independent risk factors among these patients.RESULTS The non-depressed group had a significantly longer education period than the depressed group(P<0.05).The depressed group exhibited significantly higher mental status scores than the non-depressed group(P<0.001).Patients with diabetes mellitus(DM)or CVD had a higher probability of developing depression.Patients with depression had significantly lower hemoglobin and albumin levels than patients without depression(P<0.05).Spearman correlation analysis of BDI-II scale scores,measuring depression,indicated positive correlations with BDI-II and SAS scores as risk factors for depression in patients with CKD.In contrast,years of education,hemoglobin levels,and peritoneal Kt/V were negatively correlated,serving as protective factors against depression.An analysis of variance for influences with significant differences in the univariate analysis revealed that years of schooling,BDI-II,SAS,PSQI,DM,CVD,and hemoglobin levels independently influenced depression in older patients with CKD.CONCLUSION Education,BDI-II,SAS,PSQI,DM,and CVD are independent risk factors for depression in older patients with CKD;therefore,post-treatment psychological monitoring of high-risk patients is crucial to prevent depression.

Analysis of the Short-Term Curative Effect of Roxadustat in Treating Renal Anemia in Patients with Peritoneal Dialysis

Objective:To analyze the short-term curative effect of roxadustat in the treatment of renal anemia in patients with peritoneal dialysis.Methods:70 patients with peritoneal dialysis renal anemia admitted to the dialysis department of our hospital from March 2021-March 2023 were selected as research objects,divided into a research group and a reference group according to random number drawing method,with each group consisting of 35 cases.The patients in the research group were treated with roxadustat,and those in the reference group were treated with recombinant human erythropoietin.The total efficacy,anemia index,iron metabolism index,and occurrence of adverse reactions were compared between the two groups.Results:The total efficacy of the treatment received in the research group was significantly higher than that in the reference group(P<0.05).In terms of anemia indicators,there was no statistically significant difference between the hemoglobin(Hb),the red blood cell(RBC),and the hematocrit(HCT)of both groups(P>0.05)before treatment.After treatment,the anemia indicators of the patients in the research group were significantly better than those in the reference group,(P<0.05).In terms of iron metabolism,before treatment,there was no significant difference between the total iron-binding capacity(TIBC),the transferrin(TRF),the ferritin(FER),and iron(Fe)of both groups(P>0.05).After treatment,the research group’s iron metabolism indicators were significantly better than those of the reference group(P<0.05).The incidence of adverse reactions in the research group was significantly lower than that in the reference group(P<0.05).Conclusion:The short-term curative effect of roxadustat in the treatment of peritoneal dialysis patients was demonstrated through this study,making it a viable treatment option.

Effect of different nursing interventions on the incidence of peritonitis in peritoneal dialysis patients at home: a network meta-analysis

Objective:Bayesian network meta-analysis was used to evaluate the effect of different nursing interventions on the incidence of peritonitis in peritoneal dialysis patients at home.Methods:Cochrane Library,PubMed,Embase,Web of Science,China Biology Medicine disc,CNKI and Wanfang data were searched to identify randomized controlled trials(RCTs)investigating the effects of different nursing interventions or health education on peritonitis in home peritoneal dialysis patients from the establishment of each database to March 2022.After literature screening,the Cochrane 5.1 evaluation tool was used to assess quality,Review Manager 5.4 software was used to generate a literature quality evaluation chart and R4.1.2 software,JAGS package,and GEMTC package were used for statistical analysis.Results:A total of 9 RCTs involving 8 different nursing interventions and a total of 1011 patients were included in the meta-analysis.The incidence of peritonitis for the eight nursing interventions,ranked from highest to lowest,were:systematic nursing,Omaha system case management intervention,routine care+health promotion mode,PD specialist nurse-led multi-disciplinary network platform management mode,5E rehabilitation nursing mode,routine care+Omaha extended nursing service,one-on-one coordinated family support intervention,and routine care.Conclusions:Systematic nursing was found to be the most effective intervention in reducing the incidence of peritonitis in peritoneal dialysis patients at home.However,this conclusion needs to be further verified by more high-quality,multicenter and large sample RCTs.

Bibliometric analysis of quality of life in peritoneal dialysis patients

Objective:Nowadays,the medical model is constantly changing,and the problem of how to improve the quality of life of peritoneal dialysis patients arises at a historic moment.This paper observes the publication and cooperation of research countries and institutions related to the quality of life of peritoneal dialysis patients,understands the research hotspots,explores the research trends,and provides a reference for further research by scholars.Methods:The search database was the Web of Science core collection,the search terms“peritoneal dialysis”and“quality of life”,the document type“Article or Review”,the language“English”and the period from 1985 to 2022.Results:A total of 1,597 literature were retrieved,and the number of documents showed an annual increase.The United States has the highest volume and centrality of publications and the most cooperation with other countries.The institution with the largest number of articles is the University of Toronto in Canada.The top three most highly cited documents were analyzed to derive the knowledge base of the research area.According to the analysis of keywords,there are high-frequency keywords such as“quality of life”and“peritoneal dialysis”and 11 keyword clusters.Understand the changing trends and frontiers in the research field through timeline maps and mutated words.Conclusion:The comparison of quality of life between peritoneal dialysis and haemodialysis and the study of factors influencing the quality of life is a hot research topic.With the gradual deepening of the research,it is suggested that future research should focus on the intervention research of influencing factors and clarify the intervention measures to improve patients’quality of life.

Progress of high-flux hemodialysis in clinical application, complications and treatment

Hemodialysis is the main method of clinical renal replacement therapy, and its effectiveness and safety have been widely confirmed. High-flux hemodialysis, as a constantly updating new mode in the field of blood purification, has effectively improved the efficiency of hemodialysis and reduced the incidence of hemodialysis complications. High-flux hemodialysis has been widely used in clinical practice, and mainly plays its role through adsorption, convection and dispersion. High-flux hemodialysis has some advantages not possessed by conventional hemodialysis, including protecting injured renal function, reducing the incidence of cardiovascular complications in hemodialysis patients, improving the patients' nutritional status, reducing the occurrence of renal osteopathy and delaying the occurrence time of dialysis-associated amyloidosis. However, high-flux hemodialysis also has some limitations, such as the elimination of drugs and nutrients, and the backfiltration caused by increased pressure on the dialysis membrane and dialysate side. In this review, the related progress of high-flux hemodialysis in clinical application, mechanism, complications and treatment are discussed in order to provide a reference for its more rational clinical use.

Effects of High-Flux Hemodialysis on Inflammatory Factors and Nutritional Status in Patients with Severe Renal Failure

Objective:To investigate the effects of high-flux hemodialysis on inflammatory factors and nutritional status in patients with severe renal failure.Methods:A total of 72 patients with severe renal failure who underwent dialysis treatment in the hospital from January 2017 to March 2019 were selected as the research subjects,and they were randomly divided into 2 groups with 36 patients each.The control group underwent low-flux hemodialysis,and the observation group underwent high-flux hemodialysis.The levels of inflammatory factors and nutritional status were compared between the two groups after treatment.Results:The levels of various inflammatory factors in the observation group were lower than those in the control group and the nutritional indexes were higher than those in the control group after 4 weeks of treatment(P<0.05).Conclusion:High-throughput hemodialysis in patients with severe renal failure can significantly reduce the levels of inflammatory factors and improve nutritional status.

Effect of high-flux and low-flux hemodialysis on the side metabolites and cytokines in patients with uremia

Objective:To study the effect of high-flux and low-flux hemodialysis on the side metabolites and cytokines in patients with uremia.Methods: A total of 50 patients with uremia who accepted high-flux hemodialysis and 140 patients with uremia who accepted low-flux hemodialysis in our hospital between March 2015 and March 2016 were selected and included in high-flux group and low-flux group respectively. Before and after dialysis, serum was collected respectively to determine the levels of side metabolites, calcium-phosphorus metabolism indexes and cytokines.Results: 3 months after dialysis, serum Ca levels of two groups of patients were not significantly different from those before dialysis while BUN, Scr,β2-MG, sTfR, P, PTH and AKP levels were significantly lower than those before dialysis;3 months after dialysis, serum BUN, Scr and Ca levels of high-flux group were not significantly different from those of low-flux group whileβ2-MG, sTfR, P, PTH, AKP, TNF-α, IL-1β, IL-6, IL-8 and IL-10 levels were significantly lower than those of low-flux group.Conclusion:Compared with low-flux hemodialysis, high-flux hemodialysis treatment of uremia can more effectively remove middle molecular and macromolecular toxins, correct calcium-phosphorus metabolism disorder and relieve micro-inflammatory state.

Gastrointestinal symptoms in patients undergoing peritoneal dialysis: Multivariate analysis of correlated factors

AIM: To investigate gastrointestinal (GI) symptoms in peritoneal dialysis (PD) patients and to explore related factors contributing to GI symptoms. METHODS: One hundred and twelve patients undergoing PD participated in the study. The gastrointestinal symptom rating scale was used for measuring GI symptoms. Information on age, height, weight, body mass index, disease leading to chronic renal failure, history of corticosteroid therapy, presence of predialytic GI symptoms, daily dosage of pills, and duration, type and daily dialysate volume of PD was obtained by interviewing patients and/or reviewing the medical records. Hemoglobin, albumin and Kt/V data were obtained from follow-up database. We used multiple regression analysis with stepwise backward variable selection to test for factors predicting GSRS scores with significance level of selection entry at 0.05 and selection of stay at 0.10. RESULTS: The prevalence of eating dysfunction, reflux and indigestion in the PD patients was 44.2%, 32.7%,32.7%, respectively. A history of corticosteroid therapy (b = 8.93, P < 0.001) and all pills daily intake (b = 0.16, P = 0.007) were positively correlated to GI symptoms, while residual renal Kt/V (b =-3.47, P = 0.009) was negatively correlated to GI symptoms. Other factors were proven to be not associated with GI symptoms, with P > 0.05. CONCLUSION: Eating dysfunction, reflux and indigestion were common in PD patients. Daily dosage of pills and corticosteroid history predicted GI symptoms, while residual renal function prevented them.

ACID RECOVERY FROM WASTE SULFURIC ACID BY DIFFUSION DIALYSIS

In the process of sulfuric acid production from pyrite, there is a lot of waste acid produced in fume washing with dilute acid. Acid recovery from this sort of waste sulfuric acid by diffusion dialysis is studied in the paper. The mass transfer dialysis coefficient of sulfuric acid of the membrane AFX is measured, the effect of the flowrate of the feed and ratio of feed to water is investigated, and the two kinds of membrane (AFX and S203) are compared. The results show that diffusion dialysis process can separate the metal cation from sulfuric acid effectively, but it is difficult to separate non cation impurities as As - and F -. The contrast tests of the two membranes show that the dialysis mass transfer coefficient of the membrane AFX is larger, while capacity of the removing impurities of membrane S203 is somewhat better.

Proton-pump inhibitors for prevention of upper gastrointestinal bleeding in patients undergoing dialysis

AIM:To investigate the preventive effects of low-dose proton-pump inhibitors(PPIs) for upper gastrointestinal bleeding(UGIB) in end-stage renal disease.METHODS:This was a retrospective cohort study that reviewed 544 patients with end-stage renal disease who started dialysis at our center between 2005 and 2013.We examined the incidence of UGIB in 175 patients treated with low-dose PPIs and 369 patients not treated with PPIs(control group).RESULTS:During the study period, 41 patients developed UGIB, a rate of 14.4/1000 person-years.The mean time between the start of dialysis and UGIB events was 26.3 ± 29.6 mo.Bleeding occurred in only two patients in the PPI group(2.5/1000 person-years) and in 39 patients in the control group(19.2/1000 person-years).Kaplan-Meier analysis of cumulative non-bleeding survival showed that the probability of UGIB was significantly lower in the PPI group than in the control group(log-rank test, P < 0.001).Univariate analysis showed that coronary artery disease, PPI use, anti-coagulation, and anti-platelet therapy were associated with UGIB.After adjustments for the potential factors influencing risk of UGIB, PPI use was shown to be significantly beneficial in reducing UGIB compared to the control group(HR = 13.7, 95%CI:1.8-101.6; P = 0.011).CONCLUSION:The use of low-dose PPIs in patients with end-stage renal disease is associated with a low frequency of UGIB.

Laparoscopic-assisted catheter insertion for continuous ambulatory peritoneal dialysis:A case report of simple technique for optimal placement

A 40-year-old male underwent tube placement surgery for continuous ambulatory peritoneal dialysis(CAPD).A2-cm skin incision was made,and the peritoneum was reflected enough to perform secure fixation.A swannecked,double-felted silicone CAPD catheter was inserted,and the felt cuff was sutured to the peritoneum to avoid postoperative leakage.An adequate gradient for tube fixation to the abdominal wall was confirmed.The CAPD tube was passed through a subcutaneous tunnel.Aeroperitoneum was induced to confirm that there was no air leakage from the sites of CAPD insertion.Two trocars were placed,and we confirmed that the CAPD tube led to the rectovesical pouch.Tip position was reliably observed laparoscopically.Optimal patency of the CAPD tube was confirmed during surgery.Placement of CAPD catheters by laparoscopic-assisted surgery has clear advantages in simplicity,safety,flexibility,and certainty.Laparoscopic technique should be considered the first choice for CAPD tube insertion.