Application of Dorzagliatin in peritoneal dialysis patients with type 2 diabetes mellitus:A case report

BACKGROUND Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female patient with a 30-year history of type 2 diabetes(T2DM)who had struggled to control her blood sugar for more than a year.She had a history of high blood pressure for 30 years,had undergone continuous ambulatory peritoneal dialysis for more than two years,was 163 cm tall,weighed 77 kg,and had a body mass index of 28.98 kg/m2.Despite intensive insulin therapy at a daily dose of 150 units,adding Dorzagliatin at a dosage of 75 mg orally twice daily led to immediate blood sugar improvement and a gradual reduction in insulin dosage.After one month of follow-up,the fasting plasma glucose was 6-8 mmol/L,and the 2-hour postprandial glucose was 8-12 mmol/L.CONCLUSION To our knowledge,this report is the first to use Dorzagliatin to treat type 2 diabetes peritoneal dialysis patients with challenging glucose control.Dorzagliatin,a novel glucokinase activator primarily metabolized by the liver,exhibits no pharmacokinetic differences among patients with varying degrees of chronic kidney disease.It has a high plasma protein binding rate and may not be cleared by peritoneal dialysis,potentially offering a new glycemic control option for Type 2 diabetic patients on peritoneal dialysis.

Anaesthesia in chronic dialysis patients:A narrative review

The provision of anaesthesia for individuals receiving chronic dialysis can be challenging.Sedation and anaesthesia are frequently managed by critical care clinicians in the intensive care unit or operating room.This narrative review summarizes the important principles of sedation and anaesthesia for individuals on long-term dialysis,with reference to the best available evidence.Topics covered include the pharmacology of anaesthetic agents,the impacts of patient characteristics upon the pre-anaesthetic assessment and critical illness,and the fundamentals of dialysis access procedures.

Selection of dialysis methods for end-stage kidney disease patients with diabetes

The increasing prevalence of diabetes has led to a growing population of endstage kidney disease(ESKD)patients with diabetes.Currently,kidney transplantation is the best treatment option for ESKD patients;however,it is limited by the lack of donors.Therefore,dialysis has become the standard treatment for ESKD patients.However,the optimal dialysis method for diabetic ESKD patients remains controversial.ESKD patients with diabetes often present with complex conditions and numerous complications.Furthermore,these patients face a high risk of infection and technical failure,are more susceptible to malnutrition,have difficulty establishing vascular access,and experience more frequent blood sugar fluctuations than the general population.Therefore,this article reviews nine critical aspects:Survival rate,glucose metabolism disorder,infectious complications,cardiovascular events,residual renal function,quality of life,economic benefits,malnutrition,and volume load.This study aims to assist clinicians in selecting individualized treatment methods by comparing the advantages and disadvantages of hemodialysis and peritoneal dialysis,thereby improving patients’quality of life and survival rates.

Single self-leading suture technique for iridodialysis repairment

Dear Editor,We described an innovative“single self-leading suture technique”for repairing iridodialysis.Instead of moving the needle forth and back,our method is easier to manipulate in the narrow surgical space between the cornea and lens,which will decrease the unnecessary complications related to iatrogenic injury.We provide an economical friendly and less time-taking method,which improves the suture accuracy.

Effectiveness of Ultrasound-Guided Arteriovenous Fistulas Cannulation in Difficult Hemodialysis Arteriovenous Access: A Meta-Analysis of Randomised Controlled Trials

Aim(s): Complex Arteriovenous fistula (AVF) poses challenges to cannulation. Ultrasound (US)-guided cannulation may promote successful cannulation and prevent AVF-related complications. Renal nurses performing US-guided cannulation may improve successful cannulation and reduce complications associated with unnecessary punctures. The study aims to conduct the meta-analyze to examine the effectiveness of renal nurse-performed US-guided cannulation to improve successful cannulation and reduce AVF-related complications in difficult AVF access. Design: A meta-analysis of randomised controlled trials. Methods: A systemic search was performed on electronic databases including CINAHL Plus, Web of Science, and PubMed from inception to October 2023. Risk ratios (RR) and standardized mean differences (SMD) were estimated using random-effect models for considerable homogeneity, and the Scottish Intercollegiate Guidelines Network (SIGN) methodology was adopted for critical appraisal. Results: Four RCTs were included. The results showed US-guided AVF cannulation had a significant effect in improving successful cannulation (RR: 0.19, 95% CI: 0.06 to 0.63, p = 0.007), and was favorable in reducing cannulation-associated complications (RR: 0.44, 95% CI: 0.10 to 1.93, p = 0.28), compared with blind needle cannulation. Conclusion: US-guided cannulation performed by renal nurses has the potential to improve successful cannulation, and fewer complications in hemodialysis patients with difficult arteriovenous access. Relevance to Clinical Practice: The results suggest the value of further training for renal nurses in US-guided cannulation, and broader implementation of US-guided cannulation to improve patient outcomes. Future studies could explore the optimal nursing training and longer-term benefits of US-guided cannulation by renal nurses in difficult AVF access. Patient or Public Contribution: No Patient or Public Contribution as this is a meta-analysis using the secondary data published in the RCTs.

Return to Dialysis after Kidney Graft Failure

Introduction: The transition period from renal transplantation to dialysis is associated with high morbidity and mortality. The aim of this study is to describe the clinical and paraclinical characteristics, therapeutic management and evolutionary profile of patients returning to dialysis after kidney graft failure. Material and Methods: This was a retrospective, descriptive study conducted in the Nephrology-Dialysis-Renal Transplant Department at university hospital IbnSina between January 1998 and December 2021. We included all renal transplant recipients who had experienced kidney graft dysfunction and returned to dialysis. Patients with a follow-up after return to dialysis of less than 1 year were excluded. Results: Among 166 renal transplant recipients, 20 returned to dialysis after a median renal graft life of 85.5 months [42 - 186], corresponding to a prevalence of 12%. The mean age of our patients was 38.7 ± 11.9 years, with a M/F sex ratio of 2.3. Dialysis was initiated urgently in 10 patients (50%). Hemodialysis was the most commonly used modality (75%). Central venous catheterization was used in 35% of cases, including tunneled catheters. General condition is impaired in all patients, with persistent hypertension in 70% of cases. Mean uremia was 2.35 ± 0.8 g/l, mean creatinine 116 ± 48.3 mg/l, giving a mean GFR of 5.1 ± 2.2 ml/min. Mean albuminemia was 32.9 ± 6 g/l and mean hemoglobinemia 8.6 ± 1.9 g/dl. During the first year of follow-up, none of the patients died. However, 13 patients required hospitalization, with a mean length of stay of 15 days. Eight patients were hospitalized for infections and 5 for renal graft intolerance syndrome. After a mean follow-up of 22 months, 6 patients were detransplanted following graft necrosis. Conclusion: Return to dialysis after RT is fraught with a high rate of complications. The management of these patients must be optimized to improve their vital prognosis and quality of life.

Hyperkalemia in Patients on Peritoneal Dialysis: Clinical Use Experience with New Potassium-Binders

Background: Patients with end-stage kidney disease (ESKD) on maintenance dialysis have a high risk of developing hyperkalemia. In addition to traditional approaches, a new option for the management of patients on dialysis includes the use of a potassium binder, sodium zirconium cyclosilicate (SZC). We evaluated the effect and safety of SZC in patients with chronic PD. Objective: To present a case series that illustrates the real-world use of new potassium-binders in hyperkalemic patients on peritoneal dialysis. Methods: This case series collected 9 patients on PD with baseline potassium values > 5.5 mmol/l and who were treated with SZC 5 g once a day. Data were collected at baseline and at 1, 2, and 3 months after initiation of treatment. Results: The median age of patients was 64.5 years and the median duration of observation was 90 ± 5 days. It was observed that median serum potassium decreased (5.8 mmol/l at baseline with a range of 5.8 mmol/L - 6.8 mmol/L versus 4.5 in the third month with a range of 3.6 mmol/L - 5.3 mmol/L) after SZC treatment. Adverse events were observed in 2 (22.2%). The unique adverse event was constipation and presented in 2 patients (22.2%). Constipation was mild and transient during the observation period. No adverse events of special interest were reported. Conclusion: Normokalemia was established and maintained in this series of patients treated with SZC. No episodes of hyper- or hypo-kalemia were observed. SCZ had a good safety profile and was well tolerated over 3 months.

Peritoneo-Vaginal Leaks in Peritoneal Dialysis: A Report of 3 Cases

Introduction: Peritoneal dialysis (PD) is an extra-renal purification technique indicated for patients with end-stage kidney disease (ESKD). Although it has many advantages, it also has a number of complications, such as peritoneo-vaginal leakage of dialysate. Cases Reports: Three male patients, aged 70, 50 and 77 respectively, with ESKD were placed on PD. All three patients presented with inadequate drainage and the progressive appearance of bilateral hydrocele, which occurred one year (late leakage), two and four days (early leakage) respectively after the initiation of exchanges. The etiological investigation led to the conclusion of a peritoneo-vaginal leak associated with an inguinal hernia in only one case. The two cases of early leakage were treated by temporary suspension of PD, with a good response in one case and failure in the second, leading to hisdefinitive transfer to hemodialysis (HD);however, the hernia repair enabled immediate resumption of PD in the third patient. Discussion and Conclusion: Peritoneo-vaginal leakage is a rare mechanical complication in PD. The clinical examination plays an essential role in confirming the diagnosis and in the therapeutic decision. If the diagnosis is uncertain, or if there is a clinical need to show the anatomy of the leak, an imaging approach becomes desirable. This complication should not prevent the progression of PD in the management of patients with ESKD.

Secondary Hyperparathyroidism in Dialysis Patients: Short- and Long-Term Outcomes of Conservative Parathyroidectomy

Secondary hyperparathyroidism (HPT) is frequent in dialysis patients. Parathyroidectomy (PTX) is indicated for patients who failed medical therapy. We reviewed the data from 184 dialysis patients who underwent PTX between January 2015 and January 2023. We aimed to evaluate the short and long term outcomes of PTX in dialysis patients, comparing the conservative 3/4 versus 7/8 techniques in this population.166 dialysis patients with secondary HPT were included. A conservative subtotal PTX (sPTX) 7/8 was performed in 72% of patients and sPTX 3/4 in 28% of them. Severe postoperative hypocalcaemiaocurred in 45 patients (27%). Hypocalcaemia was significantly more frequent in the sPTX 7/8 group (p = 0.012). One case of persistent HPT (0.6%) and 20 cases of recurrence (12%) were diagnosed. Recurrence was more frequent in the sPTX 3/4 group (15%). No deaths were reported during the perioperative period.

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.

Spontaneous dislodgment of a peritoneal dialysis catheter inserted using the Seldinger technique:A case report

BACKGROUND Peritoneal dialysis(PD)is an important renal replacement therapy in patients with end-stage renal disease.PD catheters remain the lifeline for patients undergoing PD.The catheter technique survival rate is considered a core PD outcome domain.CASE SUMMARY The PD catheter spontaneously dislodged in a patient undergoing PD during regular fluid exchange without pain.Abdominal computed tomography showed a tunnel infection.A double-cuff straight Tenckhoff catheter had been inserted using the Seldinger technique.Before this incident,the patient had a history of tunnel infections.We speculate that recurrent tunnel infections and catheter insertion using the Seldinger technique may have led to catheter dislodgement.CONCLUSION The present case suggests that clinicians should more rigorously assess the persistence of catheter-related infections concerning the potential complications arising from catheter dislodgement associated with the Seldinger technique.

Impact of anxiety symptoms on dialysis adherence and complication rates:A longitudinal observational study

BACKGROUND Anxiety is a common psychological comorbidity in patients undergoing dialysis,yet its impact on treatment adherence and complication rates remains understudied.We designed a longitudinal observational study to investigate these relationships,based on the hypothesis that higher anxiety symptoms would be associated with increased complication rates and negatively associated with adherence to the dialysis regimen.AIM To investigate the relationship between anxiety symptoms,dialysis adherence,and complication rates in patients undergoing dialysis over a 24-month period.METHODS This observational study analyzed data from 250 adult patients who underwent hemodialysis or peritoneal dialysis at three Affiliated Hospitals of Youjiang Medical University for Nationalities over a period of 24 months.Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale at baseline and every 6 months.Dialysis adherence was evaluated through attendance records,interdialytic weight gain,and patientreported medication adherence.We recorded complications(infections,cardiovascular events,and hospitalizations)and used mixed-effects models and survival analyses to infer associations between anxiety symptoms,adherence measures,and complication rates.RESULTS Higher anxiety symptoms were significantly associated with poorer dialysis adherence,including increased missed sessions[incidence rate ratio=1.32,95%confidence interval(CI):1.18-1.47,P<0.001],greater interdialytic weight gain(β=0.24,95%CI:0.15-0.33,P<0.001),and lower medication adherence(odds ratio=0.85,95%CI:0.78-0.93,P<0.001).Patients with clinically significant anxiety(Hospital Anxiety and Depression Scale-Anxiety subscale≥8)had a higher risk of complications[hazard ratio(HR)=1.68,95%CI:1.32-2.14,P<0.001],particularly infections(HR=1.89,95%CI:1.41-2.53,P<0.001)and cardiovascular events(HR=1.57,95%CI:1.18-2.09,P=0.002).The relationship between anxiety and complications was partially mediated by adherence measures.CONCLUSION Anxiety symptoms in patients undergoing dialysis are associated with poorer treatment adherence and increased complication rates.Regular screening and targeted interventions to address symptoms may improve adherence and clinical outcomes.

Study on the occurrence and influencing factors of gastrointestinal symptoms in hemodialysis patients with uremia

BACKGROUND Gastrointestinal symptoms are common in patients with uremia undergoing hemodialysis,and these symptoms seriously affect patients'prognosis.AIM To assess the occurrence and factors influencing gastrointestinal symptoms in patients with uremia undergoing hemodialysis.METHODS We retrospectively selected 98 patients with uremia who underwent regular hemo-dialysis treatment in the blood purification center of our hospital from December 2022 to December 2023.The gastrointestinal symptoms and scores of each dimension were evaluated using the Gastrointestinal Symptom Grading Scale(GSRS).Patients were divided into gastrointestinal symptoms and no gastrointestinal symptom groups according to whether they had gastrointestinal symptoms.The factors that may affect gastrointestinal symptoms were identified by single-factor analysis.Multiple logistic regression analysis was performed to identify independent risk factors for gastrointestinal symptoms.RESULTS Gastrointestinal symptoms included indigestion,constipation,reflux,diarrhea,abdominal pain,and eating disorders,and the total average GSRS score was 1.35±0.47.This study showed that age,number of tablets,dialysis time,glucocorticoid,parathyroid hormone(PTH),combined diabetes mellitus and C-reactive protein(CRP)were independent risk factors for gastrointestinal symptoms in patients with uremia undergoing hemodialysis,whereas body mass index(BMI),hemoglobin(Hb),and urea clearance index were independent protective factors(P<0.05).CONCLUSION Gastrointestinal symptoms are mostly mild in patients with uremia undergoing hemodialysis,most commonly including dyspepsia,eating disorders,and gastroesophageal reflux.The independent influencing factors mainly include the BMI,age,number of pills taken,dialysis time,urea clearance index,Hb,use of glucocorticoids,and thyroid hormone level.PTH,CRP,and diabetes are clinically related factors influencing the occurrence of gastrointestinal symptoms,and targeted prevention can be performed.

Analysis of current status of and barriers to exercise participation among patients on maintenance hemodialysis

Objective:The objective of this study was to analyze the current status of barriers to exercise participation(EP)among patients on maintenance hemodialysis(MHD).Materials and Methods:A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method.The data of patients on MHD were collected using the general information questionnaire,Physical Activity Rating Scale,Exercise Benefits/Barriers Scale(EBBS),and Exercise Self-Efficacy Scale(ESES).The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models.Results:Patients on MHD had a low exercise volume score of 13.71±0.68 points and a medium EBBS score of 63.36±0.40 points.Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects,including low monthly household income per capita(odds ratio[OR]=86.741,95%confidence interval[CI][1.164-6.465],P=0.042),primary underlying disease of diabetic nephropathy(OR=45.993,95%CI[1.353-1.564],P=0.033),the belief that“fatigue in lower extremities hinders exercise”(OR=4.697,95%CI[1.127-19.585],P=0.034),and the belief that“physical exercise bringing optimistic and positive life attitude”(OR=0.074,95%CI[0.007-0.830],P=0.035).Conclusions:Since patients on MHD had low physical exercise volume,the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD.Therefore,feasible and effective intervention measures can be formulated based on ESES in clinical nursing.

Probiotic interventions in peritoneal dialysis:A review of underlying mechanisms and therapeutic potentials

Peritoneal dialysis(PD)is a commonly used modality for kidney replacement therapy for patients with end-stage kidney disease(ESKD).PD offers many benefits,including home-based care,greater flexibility,and preservation of residual kidney function compared to in-center hemodialysis.Nonetheless,patients undergoing PD often face significant challenges,including systemic inflammation,PD-related peritonitis,metabolic disorders,and cardiovascular issues that can negatively affect their quality of life and treatment outcomes.Recent studies have demonstrated the crucial role of the gut microbiome in overall health and treatment results,supporting the hypothesis that probiotics may bring potential benefits to the general population of ESKD patients.However,specific data on probiotic use in PD patients are limited.This opinion review aims to summarize the current knowledge on the relationship between PD and the gut microbiome and offers a novel perspective by specifically exploring how probiotic interventions could improve the outcomes of PD treatment.The review also outlines some clinical data supporting the effectiveness of probiotics in patients undergoing PD and considers the difficulties and restrictions in their application.Based on the current knowledge gaps,this study seeks to explore future research directions and their implications for clinical practice.

Systemic oncological therapy in breast cancer patients on dialysis

The advancement of renal replacement therapy has significantly enhanced the survival rates of patients with end-stage renal disease(ESRD)over time.How-ever,this prolonged survival has also been associated with a higher likelihood of cancer diagnoses among these patients including breast cancer.Breast cancer treatment typically involves surgery,radiation,and systemic therapies,with ap-proaches tailored to cancer type,stage,and patient preferences.However,renal replacement therapy complicates systemic therapy due to altered drug clearance and the necessity for dialysis sessions.This review emphasizes the need for opti-mized dosing and administration strategies for systemic breast cancer treatments in dialysis patients,aiming to ensure both efficacy and safety.Additionally,ch-allenges in breast cancer screening and diagnosis in this population,including soft-tissue calcifications,are highlighted.

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.

What is the optimal dialysis method for diabetic patients with end stage kidney disease?

Diabetes is one of the most catastrophic diseases ruling every corner of the world,and this has led to elevated incidents of end-stage kidney disease(ESKD).The standard treatment for ESKD is kidney transplantation/replacement,which is limited due to a deficiency of donors.Hence,dialysis has become the second-best option for treating patients with ESKD.Patients with ESKD with underlying diabetes have an additional risk of complications and infections over non-diabetic ESKD patients.Furthermore,these patients also experience variations in blood glucose levels and are more liable to develop malnutrition.This article elaborates on the different dialysis methods for ESKD patients.This editorial highlights the evidence-based studies that include randomized clinical trials,cohort studies,retrospective studies and case-control studies and suggests the most suitable type of dialysis under the following components.

Vitamin B12 deficiency in dialysis patients:risk factors,diagnosis,complications,and treatment:A comprehensive review

Vitamin B12 deficiency is a significant concern among patients with end-stage renal disease undergoing dialysis.However,there hasn’t been extensive research conducted on this particular patient group.The reported incidence rates vary widely,ranging from 20%to 90%,reflecting the complexity of its diagnosis.Dialysis patients often face multiple nutritional deficiencies,including a lack of essential vitamins,due to factors such as dietary restrictions,impaired absorption,and nutrient loss during dialysis.Diagnosing vitamin B12 deficiency in these patients is challenging,and addressing it is crucial to prevent complications and improve their overall quality of life.This review paper delves into the available body of evidence on vitamin B12 deficiency in dialysis patients,examining the contributing risk factors,diagnostic challenges,potential complications,and available treatment options.It provides a well-rounded perspective on the topic,making it a valuable resource for researchers,healthcare practitioners,and policymakers interested in addressing the nutritional needs of dialysis patients.