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Article ; Online: Relationship between sodium removal, hydration and outcomes in peritoneal dialysis patients.

Mok, Natalie M-Y / Fan, Nicholas / Finney, Hazel / Fan, Stanley L-S

2021 Volume 26, Issue 8, Page(s) 676–683

Abstract: Background: Fluid overload (FO) in peritoneal dialysis (PD) patients is associated with mortality. We explore if low daily sodium removal is an independent risk factor for mortality. We examined severely FO PD patients established for >1 year in ... ...

Abstract	Background: Fluid overload (FO) in peritoneal dialysis (PD) patients is associated with mortality. We explore if low daily sodium removal is an independent risk factor for mortality. We examined severely FO PD patients established for >1 year in expectation that PD prescription would have been optimized for solute clearance and ultrafiltration. We also wish to determine the relationship between kt/v and sodium removal. Methods: Retrospective analysis of 231 PD patients with FO ≥2.0 L and compared with 218 PD patients who were euvolaemic throughout their PD treatment. Patients were followed up until death censored for transplantation. Results: Mean daily sodium removal in overhydrated patients was only 75 mmoles (=1.7 g). CAPD usage was more common in patients with the highest sodium removal. Achievement of UK guidelines for solute clearance and daily fluid removal were not independent predictors of mortality. Markers of sarcopenia (low serum albumin and high CRP) were associated with increased mortality, but these parameters were not independent predictors in a model that included functional assessment (Karnofsky score). Daily sodium removal was not predictive of mortality but the imprecision of clinically used sodium assay should be noted. The correlation between Na and kt/v is statistically significant but R Conclusion: While diabetic males were more likely to become overhydrated, these factors did not increase mortality further. Traditional targets of 'dialysis adequacy' did not predict survival. Kt/v is not a good indicator of sodium removal which can be surprisingly low. Measuring sodium clearance may help clinicians optimize PD modality (CAPD vs. APD).
MeSH term(s)	Adult ; Aged ; Cohort Studies ; Female ; Humans ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Peritoneal Dialysis ; Retrospective Studies ; Risk Factors ; Sodium ; Treatment Outcome ; Water-Electrolyte Imbalance/complications
Chemical Substances	Sodium (9NEZ333N27)
Language	English
Publishing date	2021-04-30
Publishing country	Australia
Document type	Journal Article ; Observational Study
ZDB-ID	1303661-0
ISSN	1440-1797 ; 1320-5358
ISSN (online)	1440-1797
ISSN	1320-5358
DOI	10.1111/nep.13885
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Article ; Online: Should we use biocompatible PD solutions for all patients?

Fan, Stanley L S

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis

2009 Volume 29, Issue 6, Page(s) 630–633

MeSH term(s)	Hemodialysis Solutions ; Humans ; Peritoneal Dialysis
Chemical Substances	Hemodialysis Solutions
Language	English
Publishing date	2009-11-10
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	645010-6
ISSN	1718-4304 ; 0896-8608
ISSN (online)	1718-4304
ISSN	0896-8608
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Article: Is intermittent peritoneal dialysis still a valid treatment option?

Dreyer, Gavin / Fan, Stanley L S

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis

2008 Volume 28, Issue 5, Page(s) 484–486

MeSH term(s)	Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic/physiopathology ; Kidney Failure, Chronic/therapy ; Palliative Care ; Peritoneal Dialysis/methods ; Quality of Life
Language	English
Publishing date	2008-07-30
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	645010-6
ISSN	0896-8608
ISSN	0896-8608
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Article ; Online: Long-term follow-up of patients randomized to biocompatible or conventional peritoneal dialysis solutions show no difference in peritonitis or technique survival.

Srivastava, Shalabh / Hildebrand, Sarah / Fan, Stanley L-S

Kidney international

2011 Volume 80, Issue 9, Page(s) 986–991

Abstract: Peritonitis remains a common clinical problem for patients on peritoneal dialysis (PD). There are, however, retrospective studies with historical controls that suggest that biocompatible PD solutions may reduce the rates of peritonitis. We conducted a ... ...

Abstract	Peritonitis remains a common clinical problem for patients on peritoneal dialysis (PD). There are, however, retrospective studies with historical controls that suggest that biocompatible PD solutions may reduce the rates of peritonitis. We conducted a randomized controlled study comparing the use of biocompatible and conventional solutions, accumulating over 7000 patient-months experience. We included peritonitis episodes from patients who discontinued PD during the follow-up period. The study was powered to detect a reduction in the peritonitis rate of over half in the 267 randomized patients in demographically similar groups. There were no intergroup differences in PD technique survival irrespective of whether the outcome was censored for death. Peritonitis-free survival was 26.7 months using conventional compared to 23.1 months using biocompatible PD solutions. The peritonitis rates were also not statistically different when measured in patient-months. Thus, despite the finding of non-randomized studies suggesting benefits of the biocompatible PD solutions, we could not detect any clinically significant advantages in terms of technique survival or peritonitis. Although our study is the largest randomized study comparing different PD solutions to date, we do not exclude the possibility that our results are a consequence of the lack of statistical power. Meta-analysis of randomized control trials in this field is essential.
MeSH term(s)	Biocompatible Materials/administration & dosage ; Biocompatible Materials/adverse effects ; Chi-Square Distribution ; Dialysis Solutions/administration & dosage ; Dialysis Solutions/adverse effects ; Disease-Free Survival ; Female ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/therapy ; London ; Male ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory/adverse effects ; Peritoneal Dialysis, Continuous Ambulatory/methods ; Peritoneal Dialysis, Continuous Ambulatory/mortality ; Peritonitis/etiology ; Peritonitis/mortality ; Peritonitis/prevention & control ; Proportional Hazards Models ; Prospective Studies ; Renal Dialysis ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
Chemical Substances	Biocompatible Materials ; Dialysis Solutions
Language	English
Publishing date	2011-11
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial
ZDB-ID	120573-0
ISSN	1523-1755 ; 0085-2538
ISSN (online)	1523-1755
ISSN	0085-2538
DOI	10.1038/ki.2011.244
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Zs.A 797: Show issues

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Article ; Online: Comparing automated peritoneal dialysis with continuous ambulatory peritoneal dialysis: survival and quality of life differences?

Balasubramanian, Gowrie / McKitty, Khadija / Fan, Stanley L-S

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

2011 Volume 26, Issue 5, Page(s) 1702–1708

Abstract: Background: There is a wide disparity in the use of automated peritoneal dialysis (APD) or continuous ambulatory peritoneal dialysis (CAPD) in the UK. This may be due to a perceived quality of life and technique survival advantage with APD, although ... ...

Abstract	Background: There is a wide disparity in the use of automated peritoneal dialysis (APD) or continuous ambulatory peritoneal dialysis (CAPD) in the UK. This may be due to a perceived quality of life and technique survival advantage with APD, although evidence is lacking. Methods: We conducted a single-centre retrospective study of incident end-stage renal disease initiating APD and CAPD with data collected prospectively over 5 years. PD modality was based on patient preference. Health status was assessed using SF-36 questionnaires at initial and 1-year follow-up appointments. Results: Three hundred and seventy-two patients were included: 194 patients chose APD, and 178 patients chose CAPD. CAPD patients were generally older and more dependent than APD patients. Univariate analysis for technique survival was inferior for CAPD (relative risk for failure 1.46, 95% CI 1.08-1.97). But on multivariate analysis when comorbidity was added into the model, PD modality was no longer a significant predictor of technique survival. There was no difference in decline in residual renal function. Baseline CAPD patients had worse health status (HS); mean (SEM) physical and social composite scores were 32.3 (0.9) vs 36.5 (0.9) and 33.3 (1.2) vs 40.3 (1.2). After 1 year, HS scores for CAPD and APD patients were similar, but the improvement in HS scores correlated with baseline scores (PD modality was not an independent predictor of the change in HS). Conclusions: This study did not show any advantages of APD over CAPD in terms of technique survival or HS. There is no evidence to support physician bias towards one PD modality, and both should be available to allow patient choice.
MeSH term(s)	Automation ; Female ; Follow-Up Studies ; Humans ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis/diagnosis ; Prognosis ; Quality of Life ; Retrospective Studies ; Survival Rate
Language	English
Publishing date	2011-05
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/gfq607
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Zs.A 2198: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Tackling Dialysis Burden around the World: A Global Challenge.

Li, Philip Kam-Tao / Chan, Gordon Chun-Kau / Chen, Jianghua / Chen, Hung-Chun / Cheng, Yuk-Lun / Fan, Stanley L-S / He, John Cijiang / Hu, Weixin / Lim, Wai-Hon / Pei, York / Teo, Boon Wee / Zhang, Ping / Yu, Xueqing / Liu, Zhi-Hong

Kidney diseases (Basel, Switzerland)

2021 Volume 7, Issue 3, Page(s) 167–175

Abstract: CKD is a global problem that causes significant burden to the healthcare system and the economy in addition to its impact on morbidity and mortality of patients. Around the world, in both developing and developed economies, the nephrologists and ... ...

Abstract	CKD is a global problem that causes significant burden to the healthcare system and the economy in addition to its impact on morbidity and mortality of patients. Around the world, in both developing and developed economies, the nephrologists and governments face the challenges of the need to provide a quality and cost-effective kidney replacement therapy for CKD patients when their kidneys fail. In December 2019, the 3rd International Congress of Chinese Nephrologists was held in Nanjing, China, and in the meeting, a symposium and roundtable discussion on how to deal with this CKD burden was held with opinion leaders from countries and regions around the world, including Australia, Canada, China, Hong Kong, Singapore, Taiwan, the UK, and the USA. The participants concluded that an integrated approach with early detection of CKD, prompt treatment to slow down progression, promotion of home-based dialysis therapy like peritoneal dialysis and home HD, together with promotion of kidney transplantation, are possible effective ways to combat this ongoing worldwide challenge.
Language	English
Publishing date	2021-04-29
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2817963-8
ISSN	2296-9357 ; 2296-9381
ISSN (online)	2296-9357
ISSN	2296-9381
DOI	10.1159/000515541
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Article ; Online: Do oral aluminium phosphate binders cause accumulation of aluminium to toxic levels?

Roberts Norman B / Yaqoob Magdi M / Campbell Neil / Pepper Ruth / Fan Stanley L-S

BMC Nephrology, Vol 12, Iss 1, p

2011 Volume 55

Abstract: Abstract Background Aluminium (Al) toxicity was frequent in the 1980s in patients ingesting Al containing phosphate binders (Alucaps) whilst having HD using water potentially contaminated with Al. The aim of this study was to determine the risk of Al ... ...

Abstract	Abstract Background Aluminium (Al) toxicity was frequent in the 1980s in patients ingesting Al containing phosphate binders (Alucaps) whilst having HD using water potentially contaminated with Al. The aim of this study was to determine the risk of Al toxicity in HD patients receiving Alucaps but never exposed to contaminated dialysate water. Methods HD patients only treated with Reverse Osmosis(RO) treated dialysis water with either current or past exposure to Alucaps were given standardised DFO tests. Post-DFO serum Al level > 3.0 μmol/L was defined to indicate toxic loads based on previous bone biopsy studies. Results 39 patients (34 anuric) were studied. Mean dose of Alucap was 3.5 capsules/d over 23.0 months. Pre-DFO Al levels were > 1.0 μmol/L in only 2 patients and none were > 3.0 μmol/L. No patients had a post DFO Al levels > 3.0 μmol/L. There were no correlations between the serum Al concentrations (pre-, post- or the incremental rise after DFO administration) and the total amount of Al ingested. No patients had unexplained EPO resistance or biochemical evidence of adynamic bone. Conclusions Although this is a small study, oral aluminium exposure was considerable. Yet no patients undergoing HD with RO treated water had evidence of Al toxicity despite doses equivalent to 3.5 capsules of Alucap for 2 years. The relationship between the DFO-Al results and the total amount of Al ingested was weak (R 2 = 0.07) and not statistically significant. In an era of financial prudence, and in view of the recognised risk of excess calcium loading in dialysis patients, perhaps we should re-evaluate the risk of using Al-based phosphate binders in HD patients who remain uric.
Keywords	Diseases of the genitourinary system. Urology ; RC870-923 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Urology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	616 ; 610
Language	English
Publishing date	2011-10-01T00:00:00Z
Publisher	BioMed Central
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Are we underestimating the problem of ultrafiltration in peritoneal dialysis patients?

McCafferty, Kieran / Fan, Stanley L S

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis

2006 Volume 26, Issue 3, Page(s) 349–352

Abstract: Background: Accurate measurement of ultrafiltration (UF) is important to improve the morbidity and mortality of peritoneal dialysis (PD) patients. The introduction of "flush-before-fill" PD systems has led to improved peritonitis rates. Partly to ... ...

Abstract	Background: Accurate measurement of ultrafiltration (UF) is important to improve the morbidity and mortality of peritoneal dialysis (PD) patients. The introduction of "flush-before-fill" PD systems has led to improved peritonitis rates. Partly to compensate for dialysate lost during flush-before-fill, extra dialysate was added to each PD bag. A 2-L PD bag now contains a mean volume of 2.225 L. That overfill volume might be erroneously measured as UF. We previously studied how this confounding factor might be affecting the diagnosis of UF failure and found that almost all units were overestimating daily UF by 900 mL. We now repeat the study to determine if the accuracy of UF estimation has improved. Methods: We conducted a telephone survey of PD units in the UK to determine how drain bags are weighed and how UF is calculated during formal assessment of adequacy and the peritoneal equilibrium test (PET). We also retrospectively analyzed our last 100, 24-hour dialysate collections and PET results to determine the potential clinical impact of overestimating UF. Results: There has been an improvement since our last study, but 70% of PD units in the UK are still overestimating daily UF in patients on continuous ambulatory PD (CAPD). Half the surveyed units also inaccurately calculate UF during the PET, and 85% were reporting results of PET and 24-hour dialysate collections through the software provided by Baxter Healthcare. By including the overfill volume, 73% of patients with daily UF <750 mL would not be diagnosed as having inadequate daily UF (assuming that all were fluid overloaded and anuric). Similarly, 73% with potential UF failure during the PET (4-hour UF <100 mL) would be missed if overfill volume was misrepresented as UF. Conclusion: For patients undergoing CAPD, there requires standardization on when drain bags are weighed. Awareness that calculation of UF must exclude overfill volumes has improved but remains poor. The PD Adequest software (Baxter Healthcare, Compton, UK) is widely adopted in the UK and perhaps it could draw attention of users to the potential of UF overestimation in CAPD patients.
MeSH term(s)	Hemofiltration/adverse effects ; Hemofiltration/methods ; Humans ; Interviews as Topic ; Patient Education as Topic ; Peritoneal Cavity/physiology ; Peritoneal Dialysis/methods ; Peritoneal Dialysis, Continuous Ambulatory ; Reproducibility of Results ; Software ; Telephone ; United Kingdom
Language	English
Publishing date	2006-05-11
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	645010-6
ISSN	0896-8608
ISSN	0896-8608
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Article ; Online: New prospects for the management of renal bone disease.

Steddon, Simon J / Fan, Stanley L S / Cunningham, John

Nephron. Clinical practice

2005 Volume 99, Issue 1, Page(s) c1–7

Abstract: The last decade has been a remarkably productive one in the field of bone biology. New insights into the maintenance of a normal bone microenvironment have led to significant advances in our understanding of many important skeletal disorders, including ... ...

Abstract	The last decade has been a remarkably productive one in the field of bone biology. New insights into the maintenance of a normal bone microenvironment have led to significant advances in our understanding of many important skeletal disorders, including renal osteodystrophy. Novel targets for therapeutic manipulation have been exposed and encouraging progress made towards new treatments. In addition, just as clinical studies have alerted us to the potential hazards of vascular calcification, basic science has unearthed the intimate nature of the relationship between the previously separate disciplines of bone and vascular biology. The clinical nephrologist, however, may be forgiven a little cynicism at this point. If such progress has been made, why do the same proverbial difficulties confront us in day-to-day practice? Control of phosphate remains inadequate, despite a literature which constantly reaffirms its crucial importance, and parathyroid hyperplasia seems inevitable in many patients. Furthermore, even the satisfaction of successful control of serum parathyroid hormone concentration must now be tempered by disquiet regarding the skeletal and cardiovascular consequences of oversuppression. This review aims to provide an update of the latest developments in relevant skeletal research and to assess how recently acquired knowledge may improve clinical nephrological practice over the next five years.
MeSH term(s)	Animals ; Bone Remodeling/physiology ; Calcium/blood ; Carrier Proteins/physiology ; Chronic Kidney Disease-Mineral and Bone Disorder/diagnostic imaging ; Chronic Kidney Disease-Mineral and Bone Disorder/physiopathology ; Chronic Kidney Disease-Mineral and Bone Disorder/therapy ; Cinacalcet Hydrochloride ; Humans ; Hyperparathyroidism/drug therapy ; Hyperplasia ; Membrane Glycoproteins/physiology ; Naphthalenes/therapeutic use ; Osteoclasts/physiology ; Parathyroid Glands/pathology ; Parathyroid Hormone/blood ; Parathyroidectomy ; RANK Ligand ; Radiography ; Receptor Activator of Nuclear Factor-kappa B ; Vitamin D/analogs & derivatives
Chemical Substances	Carrier Proteins ; Membrane Glycoproteins ; Naphthalenes ; Parathyroid Hormone ; RANK Ligand ; Receptor Activator of Nuclear Factor-kappa B ; TNFRSF11A protein, human ; TNFSF11 protein, human ; Vitamin D (1406-16-2) ; Cinacalcet Hydrochloride (1K860WSG25) ; Calcium (SY7Q814VUP)
Language	English
Publishing date	2005
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	207121-6
ISSN	1660-2110 ; 1423-0186 ; 2235-3186 ; 1660-8151 ; 0028-2766
ISSN (online)	1660-2110 ; 1423-0186 ; 2235-3186
ISSN	1660-8151 ; 0028-2766
DOI	10.1159/000081787
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Article ; Online: Accelerated decline of GFR in diabetic nephropathy predicted by interferon release assay to tuberculosis antigens.

Lane, Catherine / Ashcroft, Anthony / Bothamley, Graham / Yaqoob, Magdi M / Fan, Stanley L-S

Nephron. Clinical practice

2011 Volume 117, Issue 3, Page(s) c266–9

Abstract: Background: The QuantiFERON® test (QFT) is a diagnostic tool for active and latent tuberculosis (TB) infections. High rates of positivity to QuantiFERON® have been demonstrated in patients with chronic kidney disease (CKD) and diabetic patients. We ... ...

Abstract	Background: The QuantiFERON® test (QFT) is a diagnostic tool for active and latent tuberculosis (TB) infections. High rates of positivity to QuantiFERON® have been demonstrated in patients with chronic kidney disease (CKD) and diabetic patients. We performed a pilot study to investigate if QFT positivity in diabetic CKD patients predicted the rate of renal function decline. Methods: QFT was performed in 38 diabetic patients with CKD 4-5 not on dialysis. The rate of decline in estimated glomerular filtration rate (eGFR) was calculated. Results: 18/38 patients had a positive QFT. Patients with a positive QFT had a steeper decline in eGFR, compared with patients with a negative QFT. Ethnicity (a marker of risk of previous TB exposure), urine protein/creatinine ratio, use of ACE inhibitors/angiotensin II receptor blockers and statins, serum C-reactive protein, vitamin D levels, HbA1c concentration and presenting GFR did not differ significantly. Conclusions: The finding in this small cohort needs to be replicated in a larger study because our study is susceptible to both type I and type II statistical error. We found that QFT positivity was associated with a more rapid rate of decline in GFR, but this association may be coincidental (with the difference in decline attributed to differences in the blood pressure or proteinuria of the two groups). Moreover, an association does not necessarily mean causality, although it would be interesting to speculate if we are identifying patients with latent TB who have an active interstitial nephritis. Another intriguing possibility is that this assay identifies patients with an immunological phenotype that predisposes to eGFR loss.
MeSH term(s)	Aged ; Antigens, Bacterial/blood ; Cohort Studies ; Diabetic Nephropathies/diagnosis ; Diabetic Nephropathies/metabolism ; Diabetic Nephropathies/physiopathology ; Female ; Follow-Up Studies ; Glomerular Filtration Rate/physiology ; Humans ; Interferon-gamma/secretion ; Kidney Failure, Chronic/blood ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/metabolism ; Male ; Middle Aged ; Pilot Projects ; Predictive Value of Tests ; Prospective Studies
Chemical Substances	Antigens, Bacterial ; Interferon-gamma (82115-62-6)
Language	English
Publishing date	2011
Publishing country	Switzerland
Document type	Comparative Study ; Journal Article
ZDB-ID	207121-6
ISSN	1660-2110 ; 1423-0186 ; 2235-3186 ; 1660-8151 ; 0028-2766
ISSN (online)	1660-2110 ; 1423-0186 ; 2235-3186
ISSN	1660-8151 ; 0028-2766
DOI	10.1159/000320753
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