Efficacy of Potassium Supplementation in Hypokalemic Patients Receiving Peritoneal Dialysis: A Randomized Controlled Trial

Pichitporn, Watthikorn; Kanjanabuch, Talerngsak; Phannajit, Jeerath; Puapatanakul, Pongpratch; Chuengsaman, Piyatida; Parapiboon, Watanyu; Treamtrakanpon, Worapot; Boonyakrai, Chanchana; Matayart, Saraporn; Katavetin, Pisut; Perl, Jeffrey; Praditpornilpa, Kearkiat; Eiam‐Ong, Somchai; Tungsanga, Kriang; Johnson, David W.

doi:10.1053/j.ajkd.2022.03.013

Cited by 20 publications

(15 citation statements)

References 17 publications

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“…In this study, we analyzed the relationship between different non-specific ECG changes and CVM and all-cause mortality, and the results showed that patients who presented with NSSTTAs tended to have higher hemoglobin levels. This seems to be contrary to the results of a previous study, which reported that lower hemoglobin levels are an independent risk factor for CVD and mortality in patients with CKD ( 29 ). We suppose that this result may be related to the greater proportion of men with NSSTTAs, as previous studies have reported that male dialysis patients typically have higher hemoglobin levels than their female counterparts ( 30 ).…”

Section: Discussioncontrasting

confidence: 99%

“…Although the underlying pathophysiology mechanism remains unknown, we suspect that non-specific ST-segment or ST-T abnormalities may reflect subclinical cardiovascular changes, as many factors—such as anemia, a micro-inflammatory state, uremic toxin accumulation, fluid overload, secondary hyperparathyroidism, hypertension, altered lipid metabolism, and the accumulation of gut microbiota–derived uremic toxins like trimethylamine N-oxidase—may affect cardiovascular function in the context of renal failure ( 31 ). Nevertheless, T-waves are more susceptible to electrolyte disturbances, especially changes in potassium, which are common in patients undergoing PD ( 29 , 32 ) and may eventually mitigate the T-wave’s effect on the prognosis of PD patients.…”

Section: Discussionmentioning

confidence: 99%

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Non-specific electrocardiographic ST-T abnormalities predict mortality in patients on peritoneal dialysis

Zhan

Zeng

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThis study aimed to evaluate the predictive value of non-specific ST-segment and/or T-wave abnormalities in electrocardiography (ECG) for all-cause and cardiovascular mortality (CVM) in peritoneal dialysis (PD) patients.MethodsAll patients who started PD between November 1, 2005, and February 28, 2017, at the First Affiliated Hospital of Nanchang University were enrolled. The primary outcomes were all-cause mortality and CVM. The Kaplan–Meier method and a log-rank test were used for the survival analysis. Multivariate Cox proportional hazards models were used to investigate the risk factors for all-cause mortality and CVM.ResultsA total of 724 eligible PD patients were enrolled, including 401 (55.4%) men. In total, 153 (21.1%) patients died during a mean follow-up period of 27 (interquartile range, 13–41) months, and cardiovascular death was responsible for 84 of these deaths. The patients with non-specific ST-T abnormalities (NSSTTAs) had lower overall and cardiovascular survival rates compared to those free from any ECG abnormalities. According to the multivariate Cox proportional hazards models, (NSSTTAs) are independent risk factors for all-cause mortality and CVM, the hazard ratios are 1.81 (95% confidence interval, 1.11–2.95; p = 0.017) and 2.86 (95% confidence interval, 1.52–5.37; p = 0.001), respectively.ConclusionNon-specific ST-T abnormalities can serve as risk markers of all-cause and CVM in PD patients.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Non-specific electrocardiographic ST-T abnormalities predict mortality in patients on peritoneal dialysis

Zhan

Zeng

et al. 2022

Front. Cardiovasc. Med.

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“…Andererseits beschreiben klinische Studien einen Zusammenhang zwischen Hypokaliämie, bakterieller Überwucherung im Darm und erhöhter Peritonitishäufigkeit durch Enterobakterien 27 , 28 . Eine rezente randomisierte Studie zeigt, dass eine standardisierte Kaliumsubstitution mit dem Ziel, das Serum-Kalium zwischen 4 und 5 mmol/l zu halten, im Vergleich zu einer Kontrollgruppe, bei der Kalium nur im Falle einer Hypokaliämie temporär substituiert wurde, das Peritonitisrisiko an der PD signifikant senken konnte 29 . Der derzeitige Evidenzgrad zur Empfehlung, eine Hypokaliämie bei PD-Patienten zu vermeiden (2C-Empfehlung), wird sich in den künftigen Guidelines nach Berücksichtigung dieser Studie sicherlich verbessern.…”

Section: Prophylaxe Der Peritonitisunclassified

Peritonealdialyse assoziierte Peritonitis

Vychytil

2023

Nephrologie aktuell

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ZUSAMMENFASSUNGIm Jahr 2022 wurden die neuen Leitlinien der International Society for Peritoneal Dialysis (ISPD) zur Diagnostik, Prophylaxe und Therapie der Peritonitis publiziert. Die maximal tolerierbare Peritonitisrate pro Zentrum wurde auf 0,4 Episoden/ Jahr herabgesenkt, wobei weniger als 15 % der Peritonitisfälle kulturnegativ sein sollten. Es wird empfohlen, auch die Peritonitisfälle, die vor Beginn der Peritonealdialyse (PD) auftreten, separat zu analysieren. Eine antibiotische Prophylaxe wird vor Katheterimplantation sowie vor Kolonoskopien und invasiven gynäkologischen Prozeduren empfohlen. Besondere hygienische Maßnahmen sind erforderlich, wenn Haustiere vorhanden sind. Anstelle einer Kombinationstherapie kann zur Abdeckung des gramnegativen und grampositiven Keimspektrums auch eine Monotherapie mit einem Cephalosporin der 4. Generation verwendet werden. Bei Wahl eines Aminoglykosids wird eine additive Therapie mit N-Azetylcystein zur Verhinderung der Ototoxizität empfohlen. Sollte 48 h nach Therapiebeginn keine Besserung eintreten, müssen weitere diagnostische Maßnahmen wie etwa die Abnahme neuerlicher Kulturen und Computertomografie des Abdomens durchgeführt werden.

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“…Data from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) 8 has demonstrated that persistent hypokalaemia (<3.5 mmol/L) is associated with increased peritonitis rates (hazard ratio (HR) = 1.15; 95% confidence interval (CI) = 0.96–1.37). Furthermore, a recent randomized controlled trial showed that in patients on PD with hypokalaemia, oral potassium supplementation to maintain the serum potassium concentration in the range of 4–5 mmol/L was associated with a 53% reduced risk of developing peritonitis 9 Invasive procedures near the abdominal cavity (gastrointestinal and gynecological) : Polypectomy and endoscopic mucosal resection are common invasive gastrointestinal procedures associated with a higher risk of peritonitis in patients on PD 10 .…”

Section: Figurementioning

confidence: 99%

Hospital‐acquired peritonitis in patients on peritoneal dialysis: A call to action

Ling

Castelino

Sud

2023

Seminars in Dialysis

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Peritonitis remains a significant complication of peritoneal dialysis (PD), and severe episodes of peritonitis lead to structural and functional alterations of the peritoneal membrane, which can result in a permanent transfer to hemodialysis. Although PD is designed primarily to be delivered in the community setting, patients on PD get hospitalized for a number of reasons. In this commentary, we highlight the enormous risks each hospitalization has on the occurrence of peritonitis in patients on PD and the need to understand factors that predispose patients to hospital-acquired peritonitis. Furthermore, we suggest directions on several strategies that could not only reduce the risks of developing peritonitis but also improve outcomes of patients on PD who get hospitalized for an unrelated illness.Peritonitis remains a significant complication of peritoneal dialysis (PD), and severe episodes of peritonitis lead to structural and functional alterations of the peritoneal membrane, which can result in a permanent transfer to hemodialysis. While PD is designed primarily to

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Efficacy of Potassium Supplementation in Hypokalemic Patients Receiving Peritoneal Dialysis: A Randomized Controlled Trial

Cited by 20 publications

References 17 publications

Non-specific electrocardiographic ST-T abnormalities predict mortality in patients on peritoneal dialysis

Non-specific electrocardiographic ST-T abnormalities predict mortality in patients on peritoneal dialysis

Peritonealdialyse assoziierte Peritonitis

Hospital‐acquired peritonitis in patients on peritoneal dialysis: A call to action

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