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New Insights into Peritoneal Dialysis and Hemodialysis
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New Insights into Peritoneal Dialysis and Hemodialysis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: 25 May 2024 | Viewed by 3549

Special Issue Editor

Dr. Grazia Maria Virzì

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Guest Editor
Department of Nephrol Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
Interests: dialysis; uremia; cardiorenal syndrome; organ crosstalk; kidney; biomarkers; chronic kidney disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The incidence of end-stage renal disease is increasing year by year, and it is one of the most commonly fatal diseases in patients. Kidney replacement therapy (KRT) has made significant progress over the past few decades, with about 70% of people receiving KRT undergoing dialysis, of whom about 10% undergo peritoneal dialysis and 90% undergo hemodialysis.

Nephrologists will face significant challenges in the future as the number of patients requiring KRT increases. In addition, some important pathophysiological features of patients, including accelerated systemic atherosclerosis, vascular calcification, inflammation, frailty, cognitive impairment, etc., have recently been revealed. The daily lives of dialysis patients are also restricted by fatigue, depression, and comorbidities. These disease states have complex effects on adverse events and prognosis in hemodialysis patients.

This Special Issue of the Journal of Clinical Medicine will explore the current state of dialysis, including hemodialysis and peritoneal dialysis. Future challenges and current research will be noted, including, but not limited to, the clinical application of hemodialysis and peritoneal dialysis, dialysis preparation, vascular access function, complications, dialysis membranes and techniques, unfavorable adverse effects, and other topics to related diagnosis, treatment, and management in patients. We welcome you to submit your latest original articles or reviews to provide clinicians with the latest insights related to this field.

Dr. Grazia Maria Virzì
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hemodialysis
  • peritoneal dialysis
  • end-stage renal disease
  • kidney replacement therapy (KRT)
  • pathophysiology
  • dialysis membranes
  • dialysis preparation
  • dialysis modality
  • cardiovascular events
  • vascular access
  • PD-related peri-tonitis
  • unfavorable adverse effects
  • complications
  • challenges

Published Papers (5 papers)

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Research

10 pages, 1410 KiB  
Article
Immunomodulation Driven by Theranova Filter during a Single HD Session
by Carlotta Caprara, Grazia Maria Virzì, Katia Chieregato, Nicola Marchionna, Valentina Corradi, Alessandra Brendolan, Claudio Ronco and Monica Zanella
J. Clin. Med. 2024, 13(7), 2147; https://doi.org/10.3390/jcm13072147 - 08 Apr 2024
Viewed by 393
Abstract
Background: Patients with end-stage kidney disease (ESKD) have altered immunity. Patients on hemodialysis (HD) present a coexistence of immunodeficiency and activation of the immune system. We evaluated the immunophenotypic profile induced by the medium cut-off of Theranova filter during a single HD [...] Read more.
Background: Patients with end-stage kidney disease (ESKD) have altered immunity. Patients on hemodialysis (HD) present a coexistence of immunodeficiency and activation of the immune system. We evaluated the immunophenotypic profile induced by the medium cut-off of Theranova filter during a single HD session in the same individual. Methods: This pilot observational study explored 11 patients (75 ± 8 years and 73% male). Blood samples were collected prior to (predialytic, PRE) and after 4 h (postdialytic, POST) standard HD session with a medium cut-off, polyarylethersulfone and polyvinylpyrrolidone blend, BPA-free membrane. We performed an immunophenotyping characterization by using flow cytometry. We evaluated eryptosis RBCs and HLA-DR expression on monocytes and Treg cells. Results: The percentages of eryptosis in lymphocytes (CD3+), lymphocyte T helper (CD3+ and CD4+) cells, and monocytes (CD45+ and CD14+) were similar pre- and post-HD. On the contrary, HLA-DR expression and Treg cell numbers significantly decreased after HD. Conclusions: Many studies have focused on the comparison between healthy volunteers and HD patients, but very few have focused on the changes that occur after an HD session in the same individual. With this pilot observational study, we have revealed an immunomodulation driven by HD treatment with Theranova filter. Our preliminary results can be considered to be a hypothesis, generating and stimulating further studies with better designs and larger populations. Full article
(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)
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12 pages, 1578 KiB  
Article
Relationship between Permanent Catheter Patency and Nutrient Score in Patients Aged >75 Years Requiring Renal Replacement Therapy
by Moo Jun Kim, Yunkyeong Hwang, Jae Wan Jeon, Hae Ri Kim, Suyeon Han, Heewon Park, Eu Jin Lee, Young Rok Ham, Ki Ryang Na, Hyerim Park and Dae Eun Choi
J. Clin. Med. 2024, 13(6), 1562; https://doi.org/10.3390/jcm13061562 - 08 Mar 2024
Viewed by 518
Abstract
Background: Malnutrition is common in patients undergoing hemodialysis and is a powerful predictor of morbidity and mortality. This study aimed to investigate the effect of nutritional status on permanent catheter patency in elderly patients aged >75 years of age undergoing dialysis using tunneled [...] Read more.
Background: Malnutrition is common in patients undergoing hemodialysis and is a powerful predictor of morbidity and mortality. This study aimed to investigate the effect of nutritional status on permanent catheter patency in elderly patients aged >75 years of age undergoing dialysis using tunneled dialysis catheters; Methods: Records of 383 patients whose nutritional factors and body cell mass (BCM) were measured simultaneously at the start of dialysis between 14 January 2020 and 30 September 2023, at Chungnam National University Hospital, were retrospectively reviewed. The relationships between permanent catheter patency at 180 days and BCM parameters and clinical parameters were studied using Kaplan–Meier survival curves and multivariate Cox proportional hazards analysis. Results: Age and sexual differences were significant (p ≤ 0.05), and most of the BCM parameters and BCM were not significant (p ≤ 0.05), except for intracellular water. Permanent catheter patency was superior at low controlling nutritional status (CONUT) scores (p < 0.05). After adjustment for covariates, the CONUT score remained an independent factor associated with permanent catheter-patency survival; Conclusions: CONUT scores measured before the start of dialysis are expected to play an important role in predicting the prognosis of permanent catheter-patency survival in patients aged >75 years. Full article
(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)
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11 pages, 1182 KiB  
Article
Metabolically Abnormal Non-Obese Phenotype Is Significantly Associated with All-Cause Mortality in Hemodialysis Patients
by Jin Hyeog Lee, Hae-Ryong Yun, Hyung Woo Kim, Jung Tak Park, Seung Hyeok Han, Yong-Lim Kim, Yon Su Kim, Chul Woo Yang, Nam-Ho Kim, Shin-Wook Kang and Tae-Hyun Yoo
J. Clin. Med. 2024, 13(4), 1059; https://doi.org/10.3390/jcm13041059 - 13 Feb 2024
Viewed by 678
Abstract
The association between obesity and all-cause mortality in patients undergoing kidney failure with replacement therapy (KFRT) has shown conflicting results. This study aimed to evaluate whether metabolic abnormalities (MA) increase the risk of all-cause mortality in these patients. Between 2009 and 2015, 1141 [...] Read more.
The association between obesity and all-cause mortality in patients undergoing kidney failure with replacement therapy (KFRT) has shown conflicting results. This study aimed to evaluate whether metabolic abnormalities (MA) increase the risk of all-cause mortality in these patients. Between 2009 and 2015, 1141 patients undergoing KFRT were recruited from the Clinical Research Center for End-Stage Renal Disease dataset. Patients were divided into four groups according to the presence of obesity and MA. Multivariate Cox proportional hazard analysis was performed to determine the association between the phenotypes and all-cause mortality. During a mean follow-up of 4.2 years, all-cause mortality was observed in 491 (43.0%) patients. Obesity had a 24% decreased risk of all-cause mortality compared with non-obesity. In contrast, the presence of MA showed a 1.53-fold increased risk of all-cause mortality. There was a significant interaction between obesity and MA (p = 0.006). In Cox proportional hazard analyses after adjustment of confounding factors, the metabolically abnormal non-obesity (MANO) phenotype showed a 1.63-fold increased risk of all-cause mortality compared with the metabolically healthy non-obesity phenotype. In subgroup analysis, the risk of all-cause mortality was higher in the MANO phenotype; this phenotype was significantly associated with a higher all-cause mortality in patients undergoing KFRT. Full article
(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)
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10 pages, 784 KiB  
Article
Ongoing Peritoneal Dialysis Training at Home Allows for the Improvement of Patients’ Empowerment: A Single Center Experience
by Sabrina Milan Manani, Grazia Maria Virzì, Niccolò Morisi, Davide Marturano, Ilaria Tantillo, Anna Giuliani, Nunzia Miranda, Alessandra Brocca, Gaetano Alfano, Gabriele Donati, Claudio Ronco and Monica Zanella
J. Clin. Med. 2024, 13(2), 411; https://doi.org/10.3390/jcm13020411 - 11 Jan 2024
Viewed by 592
Abstract
Introduction: Peritoneal dialysis (PD), as a home treatment, ensures better patient autonomy and lower intrusiveness compared to hemodialysis. However, choosing PD comes with an increased burden of responsibility that the patient may not always be able to bear, due to advanced age and [...] Read more.
Introduction: Peritoneal dialysis (PD), as a home treatment, ensures better patient autonomy and lower intrusiveness compared to hemodialysis. However, choosing PD comes with an increased burden of responsibility that the patient may not always be able to bear, due to advanced age and deteriorating health condition. Various approaches have been explored to address this issue and mitigate its primary complications. In this study, we aim to present the ongoing PD training at-home program implemented by the Vicenza PD Center, and evaluate its impact on patients’ prognoses. Material and Methods: We enrolled 210 patients who underwent PD at Vicenza Hospital between 1 January 2019 and 1 January 2022 for a minimum of 90 days. Each patient was observed retrospectively for one year. We categorized the patients into three groups based on their level of autonomy regarding their PD management: completely independent patients; patients able to perform some parts of the PD method on their own, while the remaining aspects were carried out by a caregiver; and patients who required complete assistance from a caregiver, like in the assisted PD program (asPD). Results: A total of 70% of the PD population were autonomous regarding their PD therapy, 14% had an intermediate degree of autonomy, and 16% were entirely dependent on caregivers. The PD nurses performed a median of four home visits per patient per year, with a tendency to make more visits to patients with a lower degree of autonomy. All the groups achieved similar clinical outcomes. At the end of the year of observation, only 6% of the patients witnessed a decline in their autonomy level, whereas 7% demonstrated an enhancement in their level of autonomy, and 87% remained stable. Conclusions: A home care assistance program ensures clinical support to a household with the purpose of improving the empowerment of the PD population and reducing the prevalence of assisted PD. Ongoing PD training at home helps patients to maintain a stable degree of autonomy and stay in their home setting, even though they present with relative attitudinal or social barriers. Full article
(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)
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9 pages, 1805 KiB  
Article
Self-Reported Physical Inactivity and Mood Disturbances in End-Stage Kidney Disease (ESKD) Patients on Chronic Dialysis Treatment
by Michela Musolino, Pierangela Presta, Paola Cianfrone, Maria Antonietta Errante, Michele Andreucci, Giuseppe Coppolino and Davide Bolignano
J. Clin. Med. 2023, 12(22), 7160; https://doi.org/10.3390/jcm12227160 - 18 Nov 2023
Cited by 1 | Viewed by 963
Abstract
Background: Physical inactivity and mood disturbances are key issues in individuals with end-stage kidney disease (ESKD) and may lead to poor clinical outcomes. Methods: We performed a pilot, observational study to explore the possible relationships between the self-reported level of physical activity (IPAQ) [...] Read more.
Background: Physical inactivity and mood disturbances are key issues in individuals with end-stage kidney disease (ESKD) and may lead to poor clinical outcomes. Methods: We performed a pilot, observational study to explore the possible relationships between the self-reported level of physical activity (IPAQ) and the severity of mood disturbances (BDI score) in a cohort of 58 ESKD patients undergoing chronic hemodialysis (HD; n = 30) or peritoneal dialysis (PD; n = 28). Results: Overall, ESKD patients were severely inactive (median METs: 590 [460–1850]) and the intensity of overall and walking physical activity was mostly low to moderate. HD individuals appeared less active than PD (METs 550 [250–1600] vs. 1080 [750–1730]; p = 0.003) and were also less prone to walking (METs 180 ± 90 vs. 320 ± 100; p = 0.01), while a barely statistical difference was noticed for the time spent sitting. ESKD individuals displayed a median BDI score of 17 [12–21], which indicated, on average, the presence of borderline depression, which was apparently more evident among HD individuals. A strong, inverse correlation was found between self-reported METs and BDI scores (R = −0.78; p < 0.0001), while such scores paralleled the time spent sitting during a weekday (R = 0.45; p = 0.0004) and a weekend day (R = 0.40; p = 0.002). Conclusions: In ESKD patients on chronic dialysis, physical inactivity and mood disturbances might be significantly inter-connected, thereby amplifying their relative impact on quality of life, dysautonomia and long-term outcomes. Future studies on larger populations are recommended to confirm these preliminary observations. Promoting strategies to improve fitness, along with greater attention to physiological aspects, should be incorporated into the clinical management of ESKD patients. Full article
(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)
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