Association between self‐reported appetite and clinical outcomes of peritoneal dialysis patients: Findings from a low middle‐income country

Boonyakrai, Chanchana; Kanjanabuch, Talerngsak; Puapatanakul, Pongpratch; Halue, Guttiga; Johnson, David W.; Lorvinitnun, Pichet; Tangjittrong, Kittisak; Kittiskulnam, Piyawan; Pongpirul, Krit; Bieber, Brian; Tungsanga, Kriang

doi:10.1111/nep.13859

Cited by 5 publications

(4 citation statements)

References 33 publications

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“…Patient-reported poor appetite and lower albumin are associated with risk for peritonitis, PD drop-out and mortality. 27,28 Prescriptions that increase fill volumes or add additional exchanges may achieve a target Kt/Vurea but may also have unintended negative consequences. The recent shift away from small solute clearance and toward person-centered assessment of dialysis quality may provide support for clinicians and patients reconciling fill volumes and frequencies needed for effective dialysis with the need for optimal nutrition.…”

Section: Discussionmentioning

confidence: 99%

Patient perspectives on peritoneal dialysis (PD) and the PD catheter: Strategies and Solutions

et al. 2023

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Introduction: Peritoneal dialysis (PD) catheter complications reduce quality of life and increase risks for hospitalizations, for unplanned transitions to haemodialysis and for death. Patient PD catheter management is crucial for safe, sustained PD. Patient perspectives on strategies for living with PD and using a PD catheter may inform efforts to reduce PD catheter complications, increase individual patient PD modality persistence, and thus increase overall home dialysis prevalence. Methods: We interviewed 32 adult PD patients in Nashville, Tennessee. Qualitative analyses included (1) isolation of themes, (2) development of a coding system and (3) creation of a conceptual framework using an inductive–deductive approach. Results: Challenges identified by patients as important included drain pain, difficulty eating and sleeping, and fear of peritonitis. Coping strategies included repositioning while draining, adjusting eating patterns, and development of PD patient and helper knowledge and confidence, especially at home after initial training. Patients described a trial-and-error iterative process of trying multiple strategies with input from multiple sources, which led to individualised solutions. Conclusions: The trial-and-error process may be crucial for maintaining PD. Individual patient success with PD may be promoted by creating expectations during training that a solution may require multiple attempts, and by a reimbursement policy that supports robust nursing support for safe progression through the trial-and-error process, particularly in the first few months for incident patients. Interventions to support patient motivation and optimal coping behaviour may also support an increase in PD modality duration for individual patients, and thus increase overall PD prevalence.

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Section: Discussionmentioning

confidence: 99%

Patient perspectives on peritoneal dialysis (PD) and the PD catheter: Strategies and Solutions

et al. 2023

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“…Inadequate nutrition compromises patients' immune function and increases their susceptibility to infections. 29 Constipation itself can cause discomfort, bloating, and a sense of fullness, which can reduce appetite and dietary intake. 30 Furthermore, chronic constipation can disrupt the balance of the gut microbiota, which plays a crucial role in digestion and nutrient metabolism.…”

Section: Discussionmentioning

confidence: 99%

“…In the context of malnutrition, constipation may have a significant impact. Inadequate nutrition compromises patients' immune function and increases their susceptibility to infections 29 . Constipation itself can cause discomfort, bloating, and a sense of fullness, which can reduce appetite and dietary intake 30 .…”

Section: Discussionmentioning

confidence: 99%

Constipation and clinical outcomes in peritoneal dialysis: Results from Thailand PDOPPS

Halue,

Tharapanich,

Phannajit

et al. 2023

Nephrology

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BackgroundPatient‐reported outcome measures (PROMs) are widely recognized as valuable predictors of clinical outcomes in peritoneal dialysis (PD). Our study aimed to explore the connections between patient‐reported constipation and clinical outcomes.MethodsWe assessed constipation in patients across 22 facilities participating in the Thailand Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) from 2014 to 2017. Constipation diagnosis utilized objective assessment tools such as the Bristol stool form scale (BSFS) and a self‐reported questionnaire known as the constipation severity score (CSS). The BSFS is a 7‐level scale that visually inspects feces based on texture and morphology, while the CSS measures constipation duration and severity using a 5‐point Likert scale for various factors. We employed Cox proportional hazards model regression to determine the associations between constipation and clinical outcomes, including mortality, hemodialysis (HD) transfer and peritonitis.ResultsAmong 975 randomly selected PD patients from 22 facilities, 845 provided written informed consent, and 729 completed CSS questionnaire. Constipation was prevalent in the PD population (13%), particularly among older patients, those who were caregiver dependent, had diabetes and poorer nutritional status (indicated by lower time‐averaged serum albumin, potassium, creatinine and phosphate concentrations). Twenty‐seven percent of which experiencing symptoms of constipation for over a year. Notably, self‐reported constipation at baseline was significantly associated with a shorter time to first peritonitis and higher rates of peritonitis and death. However, no significant association was found between constipation and HD transfer after adjusting for various factors, including age, gender, PD vintage, comorbidities, shared frailty by study sites and serum albumin.ConclusionPatient‐reported constipation independently correlated with increased risks of peritonitis and all‐cause mortality, though no such correlation was observed with HD transfer. These findings underscore the need for further investigation to identify effective interventions for constipation in PD patients.

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“…Our in-house analysis showed that from 1995–1999 to 2015–2019, the prevalence of obesity or overweight at the initiation of PD increased from 21.9% to 47.3% in our center [7]. To complicate the matter, patients tend to gain weight after started on PD, presumably due to the improvement in appetite and glucose load in PD solutions [8, 9]. A previous study at our center showed that the mean weight gain after the first year of PD was 1.3 kg and around 25% patients had weight gain over 3 kg [10].…”

Section: Introductionmentioning

confidence: 99%

Impact of Weight Gain on the Subsequent Survival of New Peritoneal Dialysis Patients

Than¹,

Ng²,

Chan³

et al. 2023

Kidney Dis

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Introduction: Obesity at the initiation of dialysis was reported to adversely affect the clinical outcome of peritoneal dialysis (PD) patients, and weight gain is common after started on PD. However, there are few studies on the prognostic implications of weight gain after PD. Methods: We reviewed the change in body weight of 954 consecutive patients during the first 2 years of PD in a single Hong Kong center. Their subsequent clinical outcomes, including patient and technique survival rates, hospitalization, and peritonitis rates, were analyzed. Results: The mean age was 60.3 ± 12.2 years; 535 patients (56.1%) were men, and 504 (52.8%) had diabetes. From 1995-1999 to 2015-2019, the percentage of body weight gain during the first 2 years of PD was 1.0 ± 7.9%, 1.6 ± 7.1%, 1.6 ± 7.2%, 3.9 ± 9.5%, to 4.0 ± 10.3% for each 5-year period, respectively (p for linearity <0.0001). The subsequent 5-year patient survival rates were 29.9%, 43.3%, 40.5%, 43.6%, and 43.3% for patients with weight loss >5%, weight loss 2-5%, weight change with 2%, weight gain 2-5%, and weight gain >5% during the first 2 years on PD, respectively (log-rank test, p = 0.035). With multi-variable Cox regression model to adjust for clinical confounders, weight loss >5% during the first 2 years of PD was associated with a worse patient survival rate subsequently (adjusted hazard ratio 4.118, 95% confidence interval 1.040-16.313, p = 0.044), while weight gain was not associated with the subsequent patient survival. Weight change during the first 2 years of PD does not appear to affect subsequent technique survival, hospitalization, decline in residual renal function, or peritonitis rate. Discussion and Conclusions: Weight gain is common during the first two years of PD, but weight gain does not appear to have any significant impact on the subsequent outcome. In contrast, weight loss >5% was significantly associated a worse patient survival subsequently.

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Association between self‐reported appetite and clinical outcomes of peritoneal dialysis patients: Findings from a low middle‐income country

Cited by 5 publications

References 33 publications

Patient perspectives on peritoneal dialysis (PD) and the PD catheter: Strategies and Solutions

Patient perspectives on peritoneal dialysis (PD) and the PD catheter: Strategies and Solutions

Constipation and clinical outcomes in peritoneal dialysis: Results from Thailand PDOPPS

Impact of Weight Gain on the Subsequent Survival of New Peritoneal Dialysis Patients

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