Kyu-Hyang Cho

Effect of icodextrin dialysis solution on body weight and fat accumulation over time in CAPD patients

BACKGROUND The purpose of this study was to analyse the changes of body composition and the effects of icodextrin dialysis solution over time on peritoneal dialysis (PD) in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS Among 183 incident patients, 75 patients finished a complete 36-month protocol. Clinical indices including daily glucose absorption and body composition, by bioelectrical impedance analysis (BIA), were measured in both groups (icodextrin group: 36 patients, non-icodextrin group: 39 patients) at the 1st (baseline), 12th, 24th and 36th months. RESULTS There were significant increases in body weight and fat mass during the 36 months after initiation of CAPD. It was found that 78% of 3 years of weight gain occurred during the first year and 88% of weight gain at the end of the first year was fat mass gain. The icodextrin group showed a significantly lower percent of fat mass during the first 36 months (P < 0.05) and also less changes in body weight, fat mass, percent (%) fat mass, visceral fat area and waist/hip ratio at 1, 2 and 3 years than the non-icodextrin group. There were no significant changes in total body water (TBW), extra cellular fluid (ECF), oedema index and lean body mass (LBM) through comparable daily and ultrafiltration volume (UFV) between the two groups during the initial 3 years. Factors associated with the higher percent of fat mass gain over time on peritoneal dialysis were age, diabetes, gender (female) and non-icodextrin group (all, P < 0.01, generalized estimating equation). CONCLUSION The application of icodextrin solution may be a better option to alleviate excessive fat gain over time for patients on PD.

Low glucose degradation products dialysis solution modulates the levels of surrogate markers of peritoneal inflammation, integrity, and angiogenesis: preliminary report

SUMMARY:  The presence of glucose degradation products (GDPs) in peritoneal dialysis (PD) fluids has many adverse effects, namely clinically significant abdominal pain or discomfort during infusion, inhibition of cell proliferation, impairment of inflammatory cell function, cytotoxicity, and the induction of vascular endothelial growth factor (VEGF). In a prospective, randomized, controlled trial comparing a low GDP PD solution (pH 7.0, two compartment bag: low GDP) to conventional PD solution (pH 5.5: high GDP), the overnight dialysate levels of the markers of inflammation/wound healing (hyaluronic acid (HA)), mesothelial cell mass/membrane integrity (cancer antigen 125 (CA125)), and angiogenesis (VEGF) were assessed over a 12‐month period. Twenty‐six newly commencing continuous ambulatory peritoneal dialysis (CAPD) patients were randomly assigned to either the Low GDP group (n = 16) or the High GDP group (n = 10). Standard peritoneal permeability analysis for membrane transport characteristics and dialysis adequacy with nutritional status (serum albumin, nPCR) were evaluated at 1, 6, and 12 months. In patients treated with high GDP solution, there was significant increase in VEGF with time (time = 1 month, 67.2 ± 10.8; time = 6 months, 189.8 ± 90.2; and time = 12 months, 169.3 ± 83.1 pg/mg of protein; P < 0.05). There was no significant change of VEGF with time in the low GDP group. Significantly higher concentrations of CA125 (65.5 ± 10.4 vs. 19.7 ± 2.6 at 1 month, P < 0.0001; 66.6 ± 9.8 vs. 29.7 ± 5.0 at 6 months, P < 0.01; 68.7 ± 10.5 vs. 30.7 ± 10.0 U/mL at 12 months, P < 0.01) and lower concentrations of HA (114.6 ± 18.8 vs. 254.3 ± 69.2 at 1 month, P < 0.05; 417.5 ± 57.2 vs. 1277.5 ± 367.9 ng/mg of protein at 12 month, P < 0.05) were observed in the low GDP group compared with the high GDP group. In conclusion, continuous therapy with the low GDP solution modulates the levels of surrogate markers of peritoneal inflammation, integrity and angiogenesis. The results strongly suggest that the use of a low GDP solution would be beneficial to maintain the function and structural integrity of the peritoneal membrane.

Immunoglobulin E-mediated hypersensitivity reaction after intraperitoneal administration of vancomycin

Intraperitoneal (IP) vancomycin is widely used to treat Gram-positive peritonitis associated with peritoneal dialysis. There have been two cases of red man syndrome (RMS), a vancomycin-specific nonimmunologic reaction, associated with IP vancomycin. However, immune-mediated hypersensitivity reaction to IP vancomycin has not yet been reported. A 49 year old woman on continuous ambulatory peritoneal dialysis developed her first peritonitis episode. The patient was treated with IP vancomycin once/wk for 4 weeks. She experienced mild itching and flushing throughout her body for 1 day after the second treatment. Whenever vancomycin was administered, generalized urticaria and a prickling sensation developed, and the intensity increased gradually; however, these symptoms improved after vancomycin was discontinued. An allergic skin test was performed 6 weeks after the previous urticarial episode, and an intradermal skin test revealed a positive response to vancomycin. To our knowledge, this is the first case report of immunoglobulin E-mediated hypersensitivity reaction to IP vancomycin administration.

Catheter revision for the treatment of intractable exit site infection/tunnel infection in peritoneal dialysis patients: A single centre experience

Aim:  Catheter‐related infection is a major cause of catheter loss in peritoneal dialysis (PD). We evaluated the effect of catheter revision on the treatment of intractable exit site infection (ESI)/tunnel infection (TI) in PD patients who required catheter removal.

Impact of dialysis modality on the incidence of 2009 pandemic H1N1 influenza in end-stage renal disease patients.

Patients with end-stage renal disease are among the groups at high risk for influenza-related complications (1), but few data are available about the incidence and clinical characteristics of pandemic H1N1 influenza in these patients (2). Here, we compare the incidence of pandemic H1N1 influenza in peritoneal dialysis (PD) and hemodialysis (HD) groups, describe the clinical characteristics of dialysis patients with pandemic H1N1 influenza, and identify risk factors for hospitalization attributable to pandemic H1N1 influenza.

Obstructive uropathy after inguinal herniorrhaphy with a mesh in a renal transplant patient

A 67-year-old male renal transplant patient presented with a right inguinal bulging mass, and was diagnosed with a right indirect inguinal hernia. The day following inguinal herniorrhaphy, serum creatinine became elevated. The patient was oliguric and had abdominal pain on the first day after inguinal herniorrhaphy with a mesh. We diagnosed him with acute renal failure and subsequently performed acute hemodialysis. The kidney computed tomography showed hydronephroureter, with distal ureter obstruction. With urgent percutaneous nephrostomy, we were able to relieve the obstructive uropathy with distal ureteral stenosis. Subsequently, hernia repair was performed with removal of the mesh, followed by the antegrade ureteral stent insertion. Renal function was recovered after ureteral stent insertion. This case shows that acute renal failure can occur due to ureteral obstruction, complicated by an inguinal hernia repair, and this can be successfully treated with percutaneous nephrostomy and inguinal hernia repair with mesh removal.