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  • 1
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    Online Resource
    Depression does not predict clinical outcome of Chinese peritoneal Dialysis patients after adjusting for the degree of frailty
    Springer Science and Business Media LLC ; 2020
    In:  BMC Nephrology Vol. 21, No. 1 ( 2020-12)
    Details
    In: BMC Nephrology, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2020-12)
    Abstract: Depression and frailty contribute to the adverse clinical outcome of peritoneal dialysis (PD) patients. However, the interaction between depression and frailty in PD patients remains uncertain. We determined the prevalence of depression and frailty in prevalent Chinese PD patients, dissected the internal relationship between depression and frailty, and determined their relative contribution to the adverse clinical outcome in PD patients. Methods In a prospective observational study, we recruited 267 prevalent PD patients. Depression was identified by Patient Health Questionnaire (PHQ-9). Frailty was identified by a validated Frailty Score. All cases were followed for one year. Outcome measures included number and duration of hospitalization, peritonitis rate, and all-cause mortality. Results Of the 267 patients, 197 patients (73.8%) were depressed, and 157 (58.8%) were frail. There was a substantial overlap between depression and frailty. Although depression and frailty were associated the number and duration of hospitalization by univariate analysis, the association became insignificant after adjusting for confounding factors by multivariate analysis. Both depression and frailty were associated with one-year mortality by univariate analysis. One-year patient survival was 95.9, 86.5, 82.4 and 71.0% for patients with nil, mild, moderate and severe frailty, respectively ( p  = 0.001). Frailty was an independent predictor of patient survival by multivariate analysis (adjusted hazard ratio 1.424, 95% confidence interval 1.011–2.005. p  = 0.043), while the prognostic effect of depression disappears after adjusting for frailty score. Conclusion Depression and frailty were common among Chinese PD patients. Frailty, but not depression, was an independent predictor of one-year mortality.
    Type of Medium: Online Resource
    ISSN: 1471-2369
    URL: Article
    DOI: 10.1186/s12882-020-01994-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2041348-8
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  • 2
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    Excessive risk and poor outcome of hospital-acquired peritoneal dialysis-related peritonitis
    Oxford University Press (OUP) ; 2022
    In:  Clinical Kidney Journal Vol. 15, No. 11 ( 2022-10-28), p. 2107-2115
    Details
    In: Clinical Kidney Journal, Oxford University Press (OUP), Vol. 15, No. 11 ( 2022-10-28), p. 2107-2115
    Abstract: Peritoneal dialysis (PD) is a home-based renal replacement therapy. Since hospital staff are not often familiar with PD and its complications, PD patients may have an excess risk of developing PD-related peritonitis during hospital admission for unrelated reasons, and the outcome may be affected. Methods We reviewed 371 episodes of hospital-acquired PD peritonitis in our center from 2000 to 2019. Their clinical characteristics and outcomes were compared with 825 episodes that required hospital admission and 1964 episodes that were treated as outpatient. Results Hospitalized PD patients had a significantly higher risk of developing peritonitis than outpatients [incident rate ratio 4.41 (95% confidence interval 3.95–4.91]. Hospital-acquired peritonitis episodes were more commonly culture negative. Bacterial isolates from the hospital-acquired episodes were more likely resistant to ceftazidime (P & lt; .0001) than the other groups. The primary response rate, complete cure rate and overall mortality of the hospital-acquired episodes were 66.6%, 62.0%, and 23.2%, respectively, all worse than episodes that developed outside the hospital (P & lt; .0001 for all). Conclusion PD patients admitted to the hospital had a 4-fold increase in the risk of developing peritonitis. Hospital-acquired peritonitis episodes were more likely culture negative and resistant to antibiotics. They also had a lower primary response rate, a lower complete cure rate and higher mortality than episodes that developed outside the hospital.
    Type of Medium: Online Resource
    ISSN: 2048-8505 , 2048-8513
    URL: Article
    DOI: 10.1093/ckj/sfac164
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2656786-6
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  • 3
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    Online Resource
    Impact of frailty and its inter-relationship with lean tissue wasting and malnutrition on kidney transplant waitlist candidacy and delisting
    Elsevier BV ; 2021
    In:  Clinical Nutrition Vol. 40, No. 11 ( 2021-11), p. 5620-5629
    Details
    In: Clinical Nutrition, Elsevier BV, Vol. 40, No. 11 ( 2021-11), p. 5620-5629
    Type of Medium: Online Resource
    ISSN: 0261-5614
    URL: Article
    DOI: 10.1016/j.clnu.2021.09.023
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2009052-3
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  • 4
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    Online Resource
    Helper-assisted continuous ambulatory peritoneal dialysis: Does the choice of helper matter?
    SAGE Publications ; 2020
    In:  Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis Vol. 40, No. 1 ( 2020-01), p. 34-40
    Details
    In: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, SAGE Publications, Vol. 40, No. 1 ( 2020-01), p. 34-40
    Abstract: There is an increasing number of elderly patients on continuous ambulatory peritoneal dialysis (CAPD) who could not perform dialysis exchange themselves and require assistance. We examine the outcome of Chinese CAPD patients who required helper-assisted dialysis and compare the outcome between different types of helper. Methods: We reviewed 133 incident patients on helper-assisted CAPD and 266 incident patients who performed self-CAPD exchanges (self-peritoneal dialysis (PD) group). Outcome measures included patient survival, peritonitis-free survival, and overall peritonitis rate. Results: At 24 months, patient survival of the helper-assisted and self-PD groups were 56.0% and 80.6%, respectively ( p 〈 0.0001). Within the helper-assisted group, patient survival at 24 months was 55.5%, 63.2%, and 27.2% for the patients with domestic helper, family member, and nursing home staff as their helpers, respectively ( p = 0.037). Peritonitis-free survival of the helper-assisted and self-PD groups were 54.2% and 64.9%, respectively ( p = 0.039). Within the helper-assisted group, peritonitis-free survival at 24 months was 59.4%, 55.4%, and 37.2% for the patients with domestic helper, family member, and nursing home staff as their helpers, respectively ( p = 0.06). There was no significant difference in peritonitis rate between patients with domestic helper, family member, and nursing home staff as their helpers (0.54, 0.57, and 0.94 episodes per patient-year, respectively, p = 0.2). Conclusions: Helper-assisted CAPD patients had worse patient survival and peritonitis-free survival than the self-PD group. Assistance by nursing home staff was associated with worse patients’ survival and peritonitis-free survival than assistance by family members or domestic maids.
    Type of Medium: Online Resource
    ISSN: 0896-8608 , 1718-4304
    URL: Article
    DOI: 10.1177/0896860819879873
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2075957-5
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  • 5
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    Online Resource
    Frailty in Chinese Peritoneal Dialysis Patients: Prevalence and Prognostic Significance
    S. Karger AG ; 2016
    In:  Kidney and Blood Pressure Research Vol. 41, No. 6 ( 2016), p. 736-745
    Details
    In: Kidney and Blood Pressure Research, S. Karger AG, Vol. 41, No. 6 ( 2016), p. 736-745
    Abstract: 〈 b 〉 〈 i 〉 Background/Aims: 〈 /i 〉 〈 /b 〉 Previous studies showed that frailty is prevalent in both pre-dialysis and dialysis patients. However, the prevalence and prognostic implication of frailty in Chinese peritoneal dialysis (PD) patients remain unknown. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We used a validated questionnaire to determine the Frailty Score of 193 unselected prevalent PD patients. All patients were then followed for 2 years for their need of hospitalization and mortality. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Amongst the 193 patients, 134 (69.4%) met the criteria of being frail. Frailty Score significantly correlated with Charlson's comorbidity score (r = 0.40, p 〈 0.0001), Malnutrition Inflammation Score (r = 0.59, p 〈 0.0001), and inversely with Subjective Global Assessment score (r = -0.44, p 〈 0.0001). Frailty was closely associated with the need of hospitalization. Patients with nil, mild, moderate, and severe frailty required 2.4 ± 6.0, 1.6 ± 1.6, 2.7 ± 2.5, 5.2 ± 4.8 hospital admissions per year, respectively (p 〈 0.0001), and they stayed in hospital for 6.4 ± 9.2, 5.3 ± 6.2, 10.0 ± 10.4, 12.9 ± 20.1 days per hospital admission, respectively (p 〈 0.0001). However, Frailty Score was not an independent predictor of patient or technique survival. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Frailty is prevalent among Chinese PD patients. Frail PD patients have a high risk of requiring hospitalization and their hospital stay tends to be prolonged. Early identification may allow timely intervention to prevent adverse health outcomes in this group of patients.
    Type of Medium: Online Resource
    ISSN: 1420-4096 , 1423-0143
    URL: Article
    DOI: 10.1159/000450563
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
    detail.hit.zdb_id: 1482922-8
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  • 6
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    The Impact of Volume Overload on the Longitudinal Change of Adipose and Lean Tissue Mass in Incident Chinese Peritoneal Dialysis Patients
    MDPI AG ; 2022
    In:  Nutrients Vol. 14, No. 19 ( 2022-09-30), p. 4076-
    Details
    In: Nutrients, MDPI AG, Vol. 14, No. 19 ( 2022-09-30), p. 4076-
    Abstract: Patients treated with peritoneal dialysis (PD) experience complex body composition changes that are not adequately reflected by traditional anthropometric parameters. While lean and adipose tissue mass can be readily assessed by bioimpedance spectroscopy (BIS), there is concern about the potential confounding effect of volume overload on these measurements. This study aimed to assess the influence of fluid status (by echocardiography) on body composition parameters measured by BIS and to describe the longitudinal changes in adipose and lean tissue mass. We conducted a prospective observational study in a tertiary hospital. Incident Chinese PD patients underwent baseline echocardiography and repeated BIS measurements at baseline and 12 months later. Among 101 PD patients, lean tissue index (LTI) or fat tissue index (FTI) was not associated with echocardiographic parameters that reflected left ventricular filling pressure (surrogate of volume status). Sixty-eight patients with repeated BIS had a significant increase in body weight and FTI, while LTI remained similar. Gains in fat mass were significantly associated with muscle wasting (beta = −0.71, p 〈 0.0001). Moreover, progressive fluid accumulation independently predicted decrease in FTI (beta = −0.35, p 〈 0.0001) but not LTI. Body composition assessments by BIS were not affected by fluid status and should be considered as part of comprehensive nutrition assessment in PD patients.
    Type of Medium: Online Resource
    ISSN: 2072-6643
    URL: Article
    DOI: 10.3390/nu14194076
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2518386-2
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  • 7
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    Progression in Physical Frailty in Peritoneal Dialysis Patients
    S. Karger AG ; 2021
    In:  Kidney and Blood Pressure Research Vol. 46, No. 3 ( 2021), p. 342-351
    Details
    In: Kidney and Blood Pressure Research, S. Karger AG, Vol. 46, No. 3 ( 2021), p. 342-351
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Physical frailty contributes to adverse clinical outcomes in peritoneal dialysis (PD) patients. Little has been reported about frailty transitions in this population. We aimed to describe the transitions of frailty in PD patients and identify factors that predicted changes in frailty state. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 In a prospective observational study, we recruited 267 PD patients. Frailty was assessed by a validated frailty score. Depression was graded by PHQ-9 score, and nutritional status was evaluated by serum albumin, Subjective Global Assessment (SGA), and comprehensive Malnutrition Inflammation Score (MIS). The primary outcome was the change in frailty score at follow-up compared to baseline. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 At baseline, 194 (72.7%) patients were classified as frail. With time, their frailty scores significantly increased ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), and 93 of the surviving subjects (78.2%) were classified as frail. There was a modest significant correlation between change in MIS ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), change in SGA score ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), and change in PHQ-9 score ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001) with change in frailty score. An increase in PHQ-9 score ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001) and MIS ( 〈 i 〉 p 〈 /i 〉 = 0.001), as well as longer duration of hospitalization ( 〈 i 〉 p 〈 /i 〉 = 0.001), was independently associated with a greater change in frailty score after adjustment for confounding factors. Frailty score was also improved in patients who were converted to hemodialysis ( 〈 i 〉 p 〈 /i 〉 = 0.048) and received renal transplantation ( 〈 i 〉 p 〈 /i 〉 = 0.005). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Our findings suggested that frailty transitions were common in PD patients. Worsening in nutrition and depression, together with a longer duration of hospitalization, were associated with worsening in frailty.
    Type of Medium: Online Resource
    ISSN: 1420-4096 , 1423-0143
    URL: Article
    DOI: 10.1159/000515635
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 1482922-8
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  • 8
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    Online Resource
    The efficacy of managing fluid overload in chronic peritoneal dialysis patients by a structured nurse-led intervention protocol
    Springer Science and Business Media LLC ; 2019
    In:  BMC Nephrology Vol. 20, No. 1 ( 2019-12)
    Details
    In: BMC Nephrology, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2019-12)
    Abstract: Extracellular volume overload is a common problem in peritoneal dialysis (PD) patients and is associated with excessive mortality. We determine the effectiveness of treating PD patients with extracellular volume overload by a structured nurse-led intervention program. Methods The hydration status of PD patients was screened by bioimpedance spectroscopy (BIS). Fluid overload was defined as overhydration volume ≥ 2 L. Patients were classified into Symptomatic and Asymptomatic Groups and were managed by a structured nurse-led intervention protocol that focused on education and motivation. Hypertonic cycles were given for short term symptom relief for the Symptomatic group. Patients were followed for 12 weeks for the change in volume status, blood pressure, knowledge and adherence as determined by standard questionnaires. Results We recruited 103 patients (53 Symptomatic, 50 Asymptomatic Group. There was a significant reduction in overhydration volume 4 weeks after intervention, which was sustained by week 12; the overall reduction in overhydration volume was 0.96 ± 1.43 L at 4 weeks, and 1.06 ± 1.70 L at 12 weeks ( p   〈  0.001 for both). The improvement was significant for both Symptomatic and Asymptomatic Groups. There was a concomitant reduction in systolic blood pressure in the Asymptomatic (146.9 ± 20.7 to 136.9 ± 19.5 mmHg, p  = 0.037) but not Symptomatic group. The scores of knowledge, adherence to dietary control and advices on daily habit at week 4 were all significantly increased, and the improvement was sustained at week 12. Conclusions The structured nurse-led intervention protocol has a lasting benefit on the volume status of PD patients with extracellular volume overload. BIS screening allows prompt identification of volume overload in asymptomatic patients, and facilitates a focused effort on this high risk group.
    Type of Medium: Online Resource
    ISSN: 1471-2369
    URL: Article
    DOI: 10.1186/s12882-019-1596-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2041348-8
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  • 9
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    Online Resource
    Peritoneal Dialysis Catheter Revision and Replacement by Nephrologist for Peritoneal Dialysis Catheter Malfunction
    S. Karger AG ; 2018
    In:  Nephron Vol. 138, No. 3 ( 2018), p. 214-219
    Details
    In: Nephron, S. Karger AG, Vol. 138, No. 3 ( 2018), p. 214-219
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Catheter malfunction is an important cause of technique failure for peritoneal dialysis (PD) patients, and is commonly managed by surgeons or intervention radiologists. We reviewed our experience in catheter revision or replacement by nephrologists. 〈 b 〉 〈 i 〉 Method: 〈 /i 〉 〈 /b 〉 We reviewed the clinical outcome and complication rate of 95 consecutive patients who had PD catheter malfunction, with catheter revision or replacement by nephrologist. 〈 b 〉 〈 i 〉 Result: 〈 /i 〉 〈 /b 〉 Amongst the 95 patients, 32 had catheter revision, 24 catheter replacement via the original wound, and 39 catheter replacement via a new mini-laparotomy wound. Catheter survival was 71.6% at 1 month and 48.4% at 6 months; technique survival was 88.4% at 1 month and 77.4% at 6 months. When the 3 types of procedure were analyzed separately, technique survival at 1 month was 96.8, 75.0, and 89.7%, respectively, for patients who received catheter revision, catheter replacement via the original wound, and catheter replacement via a new mini-laparotomy wound ( 〈 i 〉 p 〈 /i 〉  = 0.0002), although their catheter survival rates were not significantly different. Also, 2 patients had bleeding that required urgent surgical exploration, 2 had wound infection, and 8 had peritonitis within 4 weeks after the surgery. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 PD catheter revision and replacement by nephrologist has an acceptable catheter survival and a reasonable complication rate. Given that prompt intervention is an important consideration, catheter revision and replacement by nephrologist is a suitable method for the management of catheter malfunction.
    Type of Medium: Online Resource
    ISSN: 1660-8151 , 2235-3186
    URL: Article
    DOI: 10.1159/000485643
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
    detail.hit.zdb_id: 2810853-X
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