Mineral bone disorders (MBD) in patients on peritoneal dialysis

Nitta, Kosaku; Hanafusa, Norio; Tsuchiya, Ken

doi:10.1186/s41100-019-0200-4

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…These complications increase the risk of fractures, CVD and mortality in patients receiving dialysis 187 – 189 . Despite physiological differences in mineral metabolism between patients treated with PD and those treated with HD 190 , most studies have focused on HD populations, with relatively few studies including PD patients 191 – 193 .…”

Section: Global Surrogate Pd Outcomesmentioning

confidence: 99%

Epidemiology of peritoneal dialysis outcomes

et al. 2022

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Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring.

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Section: Global Surrogate Pd Outcomesmentioning

confidence: 99%

Epidemiology of peritoneal dialysis outcomes

et al. 2022

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“…Among patients on hemodialysis, the predialysis serum phosphate level is 30% higher than the corresponding time-averaged serum phosphate level [35]. This dynamic change is mitigated with frequent dialysis modalities such as HHD and more so with PD, leading to lower serum phosphate even with the same phosphate clearance [36]. It may partly explain our findings of lower serum phosphate levels and paradoxically higher PTH levels in HHD and PD than in conventional in-center hemodialysis; time-averaged serum phosphate levels may be actually higher in HHD and PD within our cohort.…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Dialysis Modality on Laboratory Parameters of Mineral Metabolism

et al. 2022

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Introduction: Chronic kidney disease-mineral and bone disorders (CKD-MBD) are prevalent in patients undergoing maintenance dialysis. Yet, there are limited and mixed evidence on the effects of different dialysis modalities involving longer treatment times or higher frequencies on CKD-MBD markers. Methods: This cohort study used data from 132,523 incident dialysis patients treated with any of the following modalities: conventional thrice-weekly in-center hemodialysis, nocturnal in-center hemodialysis (NICHD), home hemodialysis (HHD), or peritoneal dialysis (PD) from 2007 to 2011. We used marginal structural models fitted with inverse probability weights to adjust for fixed and time-varying confounding and informative censoring. We estimated the average effects of treatments with different dialysis modalities on time-varying serum concentrations of CKD-MBD markers: albumin-corrected calcium, phosphate, parathyroid hormone (PTH), and alkaline phosphatase (ALP) using pooled linear regression. Results: Most of the cohort were exclusively treated with conventional in-center hemodialysis, while few were ever treated with NICHD or HHD. At the baseline, PD patients had the lowest mean and median values of PTH, while NICHD patients had the highest median values. During follow-up, compared to hemodialysis patients, patients treated with NICHD had lower mean serum PTH (19.8 pg/mL [95% confidence interval: 2.8, 36.8] lower), whereas PD and HHD patients had higher mean PTH (39.7 pg/mL [31.6, 47.8] and 51.2 pg/mL [33.0, 69.3] higher, respectively). Compared to hemodialysis patients, phosphate levels were lower for patients treated with NICHD (0.44 mg/dL [0.37, 0.52] lower), PD (0.15 mg/dL [0.12, 0.19] lower), or HHD (0.33 mg/dL [0.27, 0.40] lower). There were no clinically meaningful associations between dialysis modalities and concentrations of calcium or ALP. Conclusion: In incident dialysis patients, compared to treatment with conventional in-center hemodialysis, treatments with other dialysis modalities with longer treatment times or higher frequency were associated with different patterns of serum phosphate and PTH. Given the recent growth in the use of dialysis modalities other than hemodialysis, the associations between the treatment and the CKD-MBD markers warrant additional study.

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