Improvement in uremic symptoms after increasing daily dialysate volume in patients on chronic peritoneal dialysis with declining renal function

Liakopoulos, Vassilios; Krishnan, Murali; Stefanidis, Ioannis; Savaj, Shokoufeh; Ghareeb, Sumaya; Musso, Carlos G.; Vas, Stephen I.; Bargman, Joanne M.; Jassal, Sarbjit V.; Oreopoulos, Dimitrios G.

doi:10.1007/s11255-004-8788-9

Cited by 27 publications

(14 citation statements)

References 26 publications

(20 reference statements)

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“…A spectacular correction of sleep apnea was recorded in this small-scale study [44]. Furthermore, increasing the dialysis dose was associated with an improvement in sleep in 50% of peritoneal dialysis patients [45]. Finally, the impact of uremic toxins is highlighted by the fact that sleep disorders are more frequent and more severe in dialyzed patients compared with subjects with pre-dialysis CKD [18].…”

Section: Uremic Toxinsmentioning

confidence: 68%

Sleep disorders: a systematic review of an emerging major clinical issue in renal patients

et al. 2007

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The prevalence of sleep disorders is significantly higher (up to 80%) in patients with chronic uremia compared to the general population. Sleep disorders appear even in the early stages of chronic kidney disease. These disturbances are complex, including difficulties in falling asleep and awakening, interrupted sleep, nightmares, restless legs syndrome, sleep apnea syndrome, etc. There are still disagreements on the major etiological factors of sleep disorders in the uremic patient. Older age, long dialysis vintage, alcohol and tobacco abuse and, particularly, the presence of significant comorbidities are major determinants of sleep disorders in dialysis patients. Proper assessment of sleep disorders in the renal population is still under investigation; recent studies have mostly addressed patients' perception based on questionnaires. More precise polysomnographic assessments are less studied in renal patients. Sleep disorders significantly affect quality of life in dialysis patients. An accurate and early identification of such disturbances would lead to a significant improvement in quality of life, and probably also in outcome, in uremic patients. Sleep apnea syndrome is extremely frequent in dialysis patients, with obvious consequences for cardiovascular morbidity and mortality. Proper diagnosis and therapy of sleep apnea syndrome could significantly reduce cardiovascular risk. Although sleep quality improves after renal transplantation, allograft recipients still have significantly more sleep disorders than healthy individuals. Here, we review recent data on sleep disturbances in renal patients, focusing on the end-stage renal disease patient treated by dialysis.

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Section: Uremic Toxinsmentioning

confidence: 68%

Sleep disorders: a systematic review of an emerging major clinical issue in renal patients

et al. 2007

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“…Previously, Graf et al [28] reported that lowering the dialysate magnesium concentration can restore nerve conduction velocity towards normal in patients receiving HD, and this could be the reason for the complete disappearance of pruritus in the study by Hiroshige et al [24]. In contrast, Carmichael et al [29] failed to demonstrate a beneficial effect of reduction in magnesium on pruritus.…”

Section: Modification Of Dialysis Techniquesmentioning

confidence: 97%

“…However, it still remains uncertain whether alterations in dialysis therapy including changes in dialysis membrane can reduce pruritus [24] [25] or not [26]. Hiroshige et al [27] analyzed data on 59 HD patients, who did not have disorders in calcium and phosphate metabolism, and found that more than 60% of them suffered from disabling pruritus possibly related to chronic uremia.…”

Section: Modification Of Dialysis Techniquesmentioning

confidence: 99%

Recent Advances in Treatment for Uremic Pruritus

Suzuki¹,

Omata²,

Kumagai³

2015

OJNeph

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This review highlights recent advances in pathophysiology and treatment for uremic pruritus, especially focusing on various interventions. Pruritus in patients on hemodialysis (HD) and peritoneal dialysis (PD) still remains an unresolved issue. Recently, the efficacy and safety of nalfurafine hydrochloride have been reported in Japan, and at present, more than thirty thousand patients receive this new drug. In comparison with the efficacy of this new drug, acupuncture, a form of traditional Japanese therapy, has been validated for relief of symptoms of pruritus. In this review, various interventions for relief of symptoms of pruritus as well as recent studies on its pathophysiology will be introduced. This review will be helpful for treatment of pruritus in patients on dialyzed therapy in clinical practice.

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“…In PD, one study also reported an improvement in appetite scales through applying increased daily dialysate volume [89]. In fact, the increase in the number of dialysis sessions through short daily HD or nocturnal HD has been shown to improve appetite and food intake [85e88].…”

Section: Treatment Of Anorexia In Ckdmentioning

confidence: 99%