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Recent Advances in Peritoneal Dialysis
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Recent Advances in Peritoneal Dialysis

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

Deadline for manuscript submissions: closed (25 February 2023) | Viewed by 10627

Special Issue Editors

Dr. Claudia Torino

E-Mail Website
Guest Editor
National Research Council—Institute of Clinical Physiology, Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
Interests: epidemiology; CKD; ESKD; dialysis; outcomes; clinical trials; clinical studies
Special Issues, Collections and Topics in MDPI journals
Dr. Vincenzo Antonio Panuccio

E-Mail Website
Guest Editor
GOM “Bianchi-Melacrino-Morelli”, Via Vallone Petrara SNC, 89124 Reggio Calabria, Italy
Interests: hemodialysis; peritoneal dialysis; dialysis; hypertension; renal disease; clinical nephrology; chronic renal failure; acute kidney injury; kidney transplantation; renal biopsy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear colleagues,

Peritoneal dialysis (PD) stands out for the greater independence from the dialysis center, but, despite this, it is still scarcely widespread. It is estimated that only 11% of dialysis patients are on PD. One of the main limitations to the long-term use of PD is the side effects of high glucose content in the PD solutions, whose degradation products have adverse local and systemic consequences. Recently, new biocompatible solutions have been developed, but their benefits need to be confirmed in large studies. Furthermore, the clearance of small solutes is a challenge in PD. Continuous-flow PD may be useful to overcome this issue, but technological barriers need to be overcome before this technique can be implemented in clinical practice. Furthermore, the failure of PD may also be due to a malfunctioning of the PD catheter, so new catheter insertion techniques need to be implemented. Finally, in an era of a maximum spread of telemedicine, automated peritoneal dialysis has been proved to benefit from remote monitoring, and this was true especially during the COVID-19 pandemic. This issue aims to deepen knowledge in recent advances in PD, from technical innovations to new PD solutions and new frontiers of telemedicine.

Dr. Claudia Torino
Dr. Vincenzo Antonio Panuccio
Guest Editors

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

  • peritoneal dialysis
  • peritoneal solution
  • remote control
  • clinical outcomes
  • technique
  • catheter
  • insight
  • advances

Published Papers (5 papers)

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12 pages, 863 KiB  
Article
Home Pulse Pressure Predicts Death and Cardiovascular Events in Peritoneal Dialysis Patients
by Vincenzo Panuccio, Pasquale Fabio Provenzano, Rocco Tripepi, Maria Carmela Versace, Giovanna Parlongo, Emma Politi, Antonio Vilasi, Sabrina Mezzatesta, Domenico Abelardo, Giovanni Luigi Tripepi and Claudia Torino
J. Clin. Med. 2023, 12(12), 3904; https://doi.org/10.3390/jcm12123904 - 07 Jun 2023
Viewed by 957
Abstract
Increased arterial hypertension represents a prevalent condition in peritoneal dialysis patients that is often related to volume expansion. Pulse pressure is a robust predictor of mortality in dialysis patients, but its association with mortality is unknown in peritoneal patients. We investigated the relationship [...] Read more.
Increased arterial hypertension represents a prevalent condition in peritoneal dialysis patients that is often related to volume expansion. Pulse pressure is a robust predictor of mortality in dialysis patients, but its association with mortality is unknown in peritoneal patients. We investigated the relationship between home pulse pressure and survival in 140 PD patients. During a mean follow-up of 35 months, 62 patients died, and 66 experienced the combined event death/CV events. In a crude COX regression analysis, a five-unit increase in HPP was associated with a 17% increase in the hazard ratio of mortality (HR: 1.17, 95% CI 1.08–1.26 p < 0.001). This result was confirmed in a multiple Cox model adjusted for age, gender, diabetes, systolic arterial pressure, and dialysis adequacy (HR: 1.31, 95% CI 1.12–1.52, p = 0.001). Similar results were obtained considering the combined event death–CV events as an outcome. Home pulse pressure represents, in part, arterial stiffness, and it is strongly related to all-cause mortality in peritoneal patients. In these high cardiovascular risk populations, it is important to maintain optimal blood pressure control, but it is fundamental to consider all the other cardiovascular risk indicators, such as pulse pressure. Home pulse pressure measurement is easy and feasible and can add important information for the identification and management of high-risk patients. Full article
(This article belongs to the Special Issue Recent Advances in Peritoneal Dialysis)
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10 pages, 266 KiB  
Article
Increased Peritoneal Protein Loss and Diabetes: Is There a Link?
by Ana Bontić, Selena Gajić, Danka Bjelić, Jelena Pavlović, Verica Stanković-Popović, Milan Radović and Aleksandra Kezić
J. Clin. Med. 2023, 12(7), 2670; https://doi.org/10.3390/jcm12072670 - 03 Apr 2023
Viewed by 1185
Abstract
Increased peritoneal protein loss has been associated with the fast transport of small molecules, diabetes mellitus (DM), and a reduced survival in patients on peritoneal dialysis (PD), although some studies did not confirm the association with survival. In this single-center retrospective study, we [...] Read more.
Increased peritoneal protein loss has been associated with the fast transport of small molecules, diabetes mellitus (DM), and a reduced survival in patients on peritoneal dialysis (PD), although some studies did not confirm the association with survival. In this single-center retrospective study, we investigated the relationship of baseline peritoneal albumin and protein loss with transport status, comorbidities including DM, and survival in 106 incident PD patients during the period of July 2005–June 2014. Five-year survival rate was determined using Cox-regression analysis. There were not significant differences in D/Pcr or peritoneal protein and albumin loss between diabetics and non-diabetics. In the group of 66 non-diabetics, high and high-average transporters for creatinine had higher values for both peritoneal protein (11.85 ± 6.77 vs. 7.85 ± 4.36 g/day; p = 0.002) and albumin (5.03 ± 2.32 vs. 3.72 ± 1.54 g/day; p = 0.016) loss as compared to slow transporters. However, in the group of 40 diabetics, this association was not observed. Upon multivariable regression analysis, the independent association of D/PCr with peritoneal albumin (β = 0.313; p = 0.008) and protein (β = 0.441; p = 0.001) loss was found only in non-diabetics in whom ultrafiltration also appeared as a significant predictor of peritoneal protein loss (β = 0.330; p = 0.000). A high comorbidity grade, older age, and low serum albumin were associated with mortality, but both peritoneal protein and albumin loss as well as D/Pcr were not determinants of survival. Baseline peritoneal protein and albumin loss was not associated with DM and did not predict survival. The clinical significance of the absence of association between fast peritoneal transport status and peritoneal protein flux in diabetics should be evaluated in a prospective study comprising a greater number of diabetics with evaluation of overhydration as a main inducing variable of protein leak. Full article
(This article belongs to the Special Issue Recent Advances in Peritoneal Dialysis)
10 pages, 414 KiB  
Article
Late Dialysis Modality Education Could Negatively Predict Peritoneal Dialysis Selection
by Takashin Nakayama, Ken Nishioka, Kiyotaka Uchiyama, Kohkichi Morimoto, Ei Kusahana, Naoki Washida, Shintaro Yamaguchi, Tatsuhiko Azegami, Tadashi Yoshida and Hiroshi Itoh
J. Clin. Med. 2022, 11(14), 4042; https://doi.org/10.3390/jcm11144042 - 13 Jul 2022
Viewed by 1518
Abstract
Patients with end-stage renal disease are less likely to choose peritoneal dialysis (PD) as renal replacement therapy (RRT). The reasons for this biased selection are still poorly understood. In this study, we evaluated the effect of the timing of RRT education on PD [...] Read more.
Patients with end-stage renal disease are less likely to choose peritoneal dialysis (PD) as renal replacement therapy (RRT). The reasons for this biased selection are still poorly understood. In this study, we evaluated the effect of the timing of RRT education on PD selection. This single-center retrospective observational study included patients who initiated maintenance dialysis at our hospital between April 2014 and July 2021. A logistic regression analysis was performed to investigate the association of RRT education timing with PD selection. Among the 355 participants (median age [IQR] 70 (59–79) years; 28.7% female), 53 patients (14.9%) and 302 patients (85.1%) selected PD and hemodialysis, respectively. Multivariate analysis demonstrated that high estimated glomerular filtration (eGFR) at RRT education positively predicted PD selection (p < 0.05), whereas old age (p < 0.01) and high Charlson comorbidity index (p < 0.05) were negative predictors of PD selection. Female sex (p = 0.44), welfare public assistance (p = 0.78), living alone (p = 0.25), high geriatric nutritional risk index (p = 0.10) and high eGFR at first visit to the nephrology department (p = 0.83) were not significantly associated with PD selection. Late RRT education could increase the biased selection of dialysis modality. Full article
(This article belongs to the Special Issue Recent Advances in Peritoneal Dialysis)
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16 pages, 1685 KiB  
Article
Does Far-Infrared Therapy Improve Peritoneal Function and Reduce Recurrent Peritonitis in Peritoneal Dialysis Patients?
by Yuanmay Chang, Jui-Ting Chang, Mei-Yi Lee, Mei-Zen Huang, Yann-Fen C. C. Chao, Yung-Luen Shih and Yao-Rong Hwang
J. Clin. Med. 2022, 11(6), 1624; https://doi.org/10.3390/jcm11061624 - 15 Mar 2022
Cited by 3 | Viewed by 2169
Abstract
The use of peritoneal dialysis in end-stage renal disease is increasing in clinical practice. The main purpose of this study was to evaluate the effect of far-infrared radiation therapy on inflammation and the cellular immunity of patients undergoing peritoneal dialysis. We recruited 56 [...] Read more.
The use of peritoneal dialysis in end-stage renal disease is increasing in clinical practice. The main purpose of this study was to evaluate the effect of far-infrared radiation therapy on inflammation and the cellular immunity of patients undergoing peritoneal dialysis. We recruited 56 patients undergoing peritoneal dialysis, and we included 32 patients for the experimental group and 24 patients from the control group in the final analysis. The experimental evaluation in our study was as follows: (1) We used abdominal computed tomography to explore the changes in abdominal blood vessels. (2) We compared the effects of peritoneal dialysis using blood glucose, HbAlC, albumin, urea nitrogen, creatinine, white blood cells, hs-CRP; peritoneal Kt/V of peritoneal function, and eGFR. (3) We compared the cytokines’ concentrations in the two groups while controlling for the other cytokines. Results and Discussion: (1) There was no significant difference in the abdominal blood vessels of the experimental group relative to the control group according to abdominal CT over the 6 months. (2) Our study demonstrates statistically significant effects of FIR therapy on the following parameters: creatinine (p = 0.039 *) and hs-CRP (p < 0.001 **) levels decreased significantly, and eGFR (p = 0.043 *), glucose (p < 0.001 **), and albumin (p = 0.048 *) levels increased significantly. Our study found that in the experimental group, creatinine and hs-CRP levels decreased significantly due to FIR therapy for 6 months. However, our study also found that the glucose level was significantly different after FIR therapy for 6 months. Peritoneal dialysis combined with FIR can reduce the side effects of the glucose in the dialysis buffer, which interferes with peritoneal inflammation and peritoneal mesothelial cell fibrosis. (3) In addition, we also found that no statistically significant difference in any inflammatory cytokine after FIR therapy. IFN-γ (p = 0.124), IL-12p70 (p = 0.093), IL-18 (p = 0.213), and TNF-α (p = 0.254) did not exhibit significant improvements after peritoneal dialysis with FIR treatment over 6 months. Conclusions: We found that the effectiveness of peritoneal dialysis was improved significantly with FIR therapy, and significant improvements in the peritoneal permeability and inflammatory response were observed. Full article
(This article belongs to the Special Issue Recent Advances in Peritoneal Dialysis)
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10 pages, 431 KiB  
Case Report
Chyloperitoneum in Peritoneal Dialysis Secondary to Calcium Channel Blocker Use: Case Series and Literature Review
by Luca Piscitani, Gianpaolo Reboldi, Angelo Venanzi, Francesca Timio, Annamaria D’Ostilio, Vittorio Sirolli and Mario Bonomini
J. Clin. Med. 2023, 12(5), 1930; https://doi.org/10.3390/jcm12051930 - 01 Mar 2023
Cited by 1 | Viewed by 3191
Abstract
Chyloperitoneum (chylous ascites) is a rare complication of peritoneal dialysis (PD). Its causes may be traumatic and nontraumatic, associated with neoplastic disease, autoimmune disease, retroperitoneal fibrosis, or rarely calcium antagonist use. We describe six cases of chyloperitoneum occurring in patients on PD as [...] Read more.
Chyloperitoneum (chylous ascites) is a rare complication of peritoneal dialysis (PD). Its causes may be traumatic and nontraumatic, associated with neoplastic disease, autoimmune disease, retroperitoneal fibrosis, or rarely calcium antagonist use. We describe six cases of chyloperitoneum occurring in patients on PD as a sequel to calcium channel blocker use. The dialysis modality was automated PD (two patients) and continuous ambulatory PD (the rest of the patients). The duration of PD ranged from a few days to 8 years. All patients had a cloudy peritoneal dialysate, characterized by a negative leukocyte count and sterile culture tests for common germs and fungi. Except for in one case, the cloudy peritoneal dialysate appeared shortly after the initiation of calcium channel blockers (manidipine, n = 2; lercanidipine, n = 4), and cleared up within 24–72 h after withdrawal of the drug. In one case in which treatment with manidipine was resumed, peritoneal dialysate clouding reappeared. Though turbidity of PD effluent is due in most cases to infectious peritonitis, there are other differential causes including chyloperitoneum. Although uncommon, chyloperitoneum in these patients may be secondary to the use of calcium channel blockers. Being aware of this association can lead to prompt resolution by suspension of the potentially offending drug, avoiding stressful situations for the patient such as hospitalization and invasive diagnostic procedures. Full article
(This article belongs to the Special Issue Recent Advances in Peritoneal Dialysis)
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