Metabolic Syndrome in Peritoneal Dialysis Patients

Szeto, Cheuk‐Chun; Kwan, Bonnie Ching‐Ha; Chow, Kai‐Ming; Leung, Chi‐Bon; Cheng, Mei-Shan; Law, Man-Ching; Li, Philip Kam-Tao

doi:10.2215/cjn.06620613

Cited by 25 publications

(25 citation statements)

References 36 publications

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“…A previous study also reported that visceral fat content, as measured by bioimpedance analysis, is a simple method for predicting the risk of chronic kidney disease and metabolic syndrome in the general population [23]. Since the primary objective of our study was to determine the prevalence and contributing factors of frailty, we did not perform extensive analysis on the possible clinical implications of central obesity in PD patients, which has been examined in detail in another study by our group [24].…”

Section: Discussionmentioning

confidence: 99%

Frailty in Chinese Peritoneal Dialysis Patients: Prevalence and Prognostic Significance

Kwan

Chow

et al. 2016

Kidney Blood Press Res

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Background/Aims: 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. Methods: 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. Results: 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. Conclusions: 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.

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Section: Discussionmentioning

confidence: 99%

Frailty in Chinese Peritoneal Dialysis Patients: Prevalence and Prognostic Significance

Kwan

Chow

et al. 2016

Kidney Blood Press Res

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“…For example, the greater weight gain with PD compared with HD is unclear. 114,125,126 Again the role of treatment modality varies, as new-onset diabetes is less common in Chinese patients treated with PD than HD, and in either dialysis modality much less than for newly transplanted patients. However, in many circumstances this weight gain reflects catch-up of the predialysis loss.…”

Section: Cardiovascular Risk Modification In Pd Patientsmentioning

confidence: 99%

The Current State of Peritoneal Dialysis

Mehrotra

Devuyst

Davies

et al. 2016

JASN

416

344

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Technical innovations in peritoneal dialysis (PD), now used widely for the long-term treatment of ESRD, have significantly reduced therapy-related complications, allowing patients to be maintained on PD for longer periods. Indeed, the survival rate for patients treated with PD is now equivalent to that with in-center hemodialysis. In parallel, changes in public policy have spurred an unprecedented expansion in the use of PD in many parts of the world. Meanwhile, our improved understanding of the molecular mechanisms involved in solute and water transport across the peritoneum and of the pathobiology of structural and functional changes in the peritoneum with long-term PD has provided new targets for improving efficiency and for intervention. As with hemodialysis, almost half of all deaths on PD occur because of cardiovascular events, and there is great interest in identifying modality-specific factors contributing to these events. Notably, tremendous progress has been made in developing interventions that substantially reduce the risk of PD-related peritonitis. Yet the gains have been unequal among individual centers, primarily because of unequal clinical application of knowledge gained from research. The work to date has further highlighted the areas in need of innovation as we continue to strive to improve the health and outcomes of patients treated with PD.

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“…While some of the traditional risk factors for cardiovascular diseases, like DM and smoking, increased cardiovascular disease mortality in ESRD patients just like in the normal population, other traditional factors such as BMI, serum cholesterol and blood pressure showed a reverse epidemiology in long-term dialysis patients in that obesity, hypercholesterolemia and hypertension may appear to be protective features that are associated with a greater survival among dialysis patients [33,35]. Less data were available concerning Asian PD patients.…”

Section: Issues Related To Peritoneal Dialysis In Asian Countriesmentioning

confidence: 99%

“…However, different outcomes were observed in obese patients. Some reasons for the difference in outcomes in obese PD patients may be due to a different definition of obesity, variable duration of the study period, wide variability in patient characteristics in different studies and the fact that BMI is unable to distinguish between fat mass and muscle mass, which obviously affects survival outcomes [35]. …”

Section: Issues Related To Peritoneal Dialysis In Asian Countriesmentioning

confidence: 99%

Peritoneal Dialysis in Asia

Kwong¹,

Li²

2015

Kidney Dis

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Background: There is a growing demand of dialysis in Asia for end-stage renal failure patients. Diabetes mellitus is the leading cause of end-stage renal failure in many countries in Asia. Summary: The growth of peritoneal dialysis (PD) in Asia is significant and seeing a good trend. With the enhanced practices of PD, the quality of care in PD in Asia is also improved. Overall, PD and hemodialysis (HD) are comparable in clinical outcome. There is a global trend in the reduction of peritonitis rates and Asian countries also witness such improvement. The socio-economic benefits of PD for end-stage renal failure patients in both urban and rural areas in the developed and developing regions of Asia are an important consideration. This can help to reduce the financial burden of renal failure in addressing the growing demand of patients on dialysis. Initiatives should be considered to further drive down the cost of PD in Asia. Key Messages: Growing demand for dialysis by an increasing number of end-stage renal failure patients requires the use of a cost-effective quality dialysis modality. PD is found to be comparable to HD in outcome and quality. In most countries in Asia, PD should be more cost-effective than HD. A ‘PD-first' or a ‘PD as first considered therapy' policy can be an overall strategy in many countries in Asia in managing renal failure patients, taking the examples of Hong Kong and Thailand. Facts from East and West: (1) PD is cheaper than HD and provides a better quality of life worldwide, but its prevalence is significantly lower than that of HD in all countries, with the exception of Hong Kong. Allowing reimbursement of PD but not HD has permitted to increase the use of PD over HD in many Asian countries like Hong Kong, Vietnam, Taiwan, Thailand, as well as in New Zealand and Australia over the last years. In the Western world, however, HD is still promoted, and the proportion of patients treated with PD decreases. Japan remains an exception in Asia where PD penetration is very low. Lack of adequate education of practitioners and information of patients might as well be reasons for the low penetration of PD in both the East and West. (2) Patient survival of PD varies between and within countries but is globally similar to HD. (3) Peritonitis remains the main cause of morbidity in PD patients. South Asian countries face specific issues such as high tuberculosis and mycobacterial infections, which are rare in developed Asian and Western countries. The infection rate is affected by climatic and socio-economic factors and is higher in hot, humid and rural areas. (4) Nevertheless, the promotion of a PD-first policy might be beneficial particularly for remote populations in emerging countries where the end-stage renal disease rate is increasing dramatically.

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Metabolic Syndrome in Peritoneal Dialysis Patients

Cited by 25 publications

References 36 publications

Frailty in Chinese Peritoneal Dialysis Patients: Prevalence and Prognostic Significance

Frailty in Chinese Peritoneal Dialysis Patients: Prevalence and Prognostic Significance

The Current State of Peritoneal Dialysis

Peritoneal Dialysis in Asia

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