Residual renal function in patients on peritoneal dialysis: effect of peritonitis episodes
Función renal residual en enfermos tratados con diálisis peritoneal: repercusión de los episodios de peritonitis
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Teruel-Briones, Nuria Rodríguez-Mendiola, Martha Díaz-Domínguez, Gloria Ruiz-Roso, Carlos Quereda-Rodríguez-Navarro" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Maite" "apellidos" => "Rivera-Gorrin" "email" => array:1 [ 0 => "mriverag.hrc@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "José L." "apellidos" => "Teruel-Briones" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "Nuria" "apellidos" => "Rodríguez-Mendiola" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Martha" "apellidos" => "Díaz-Domínguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "nombre" => "Gloria" "apellidos" => "Ruiz-Roso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "nombre" => "Carlos" "apellidos" => "Quereda-Rodríguez-Navarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => " Servicio de Nefrología, Hospital Universitario Ramón y Cajal. IRYCIS. Universidad de Alcalá, Madrid, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Función renal residual en enfermos tratados con diálisis peritoneal: repercusión de los episodios de peritonitis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12389_16025_64437_en_t112389.jpg" "Alto" => 478 "Ancho" => 2137 "Tamanyo" => 305288 ] ] "descripcion" => array:1 [ "en" => "Clinical and laboratory data at the start of treatment with peritoneal dialysis" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor,</span></p><p class="elsevierStylePara">Residual renal function (RRF) has prognostic value in patients treated with peritoneal dialysis (PD) due to its beneficial effect on patient survival and technique<span class="elsevierStyleSup">1,2</span>.<span class="elsevierStyleSup"> </span>One of the objectives of treatment is control and prevention of factors that can cause a decrease in RRF<span class="elsevierStyleSup">3</span>. Peritonitis episodes may contribute to deterioration of RRF both due to the inflammatory reaction and possible nephrotoxicity of antibiotics used. However, it is a subject not frequently addressed and the limited results available are controversial<span class="elsevierStyleSup">4,5</span>.</p><p class="elsevierStylePara">In the present study we analyse the impact on RRF of episodes of peritonitis occurring during the first 12 months on PD.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">From 2007 to 2011, 70 patients began PD consecutively in our unit. According to our clinical protocol, RRF is measured routinely in all patients treated with dialysis by determining the glomerular filtration rate estimated as the arithmetic mean of urinary urea and creatinine clearances. The first determination is usually done in the first week of renal replacement therapy and is considered the baseline glomerular filtration rate. It is then repeated every two months until diuresis is less than 100ml/day. From that moment the patient is considered anuric and RRF is zero. The rate of decline in glomerular filtration rate (ml/min/month) was established as follows: the difference between the value of baseline glomerular filtration rate and last value of glomerular filtration rate obtained before considering this had disappeared (less than 100ml/day urine output), or the value of glomerular filtration prior to the end of PD treatment (due to transplant, death, recovery of renal function or referral to haemodialysis [HD]), or the value of glomerular filtration rate at the time this study ended (30 June 2012). This difference was divided by the number of months of the period analysed.</p><p class="elsevierStylePara">Nineteen patients had at least one episode of peritonitis during the first twelve months (11 patients: 1 episode; 5 patients: 2 episodes; 3 patients: 3 episodes), and these constitute the study group. The remaining 51 patients did not experience any episodes of peritonitis in the first year and constitute the control group. All received as empirical treatment, until culture results were available, and according to the unit protocol: vancomycin (2g every 4 days) and intraperitoneal tobramycin (150mg loading dose + 16mg x exchange).</p><p class="elsevierStylePara">Results are expressed as mean ± standard deviation for normally distributed data. The decrease in glomerular filtration has a normal distribution and the results are expressed as median and 25th and 75th percentiles (interquartile range). Quantitative variables were compared with Student's or Mann-Whitney tests. Qualitative variables were compared with Fisher's test.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara">At baseline there were no differences between both groups in relation to age (52 vs. 54 years), sex, comorbidity (Charlson 4.5 vs. 4.7), origin of non-functioning transplant or glomerular filtration rate (6.28 vs. 6.87ml/min). The prevalence of diabetic nephropathy was higher in the group of patients with peritonitis (21%) compared to the group without peritonitis (12%), but the difference was not statistically significant (Table 1).</p><p class="elsevierStylePara">Follow-up time on PD was similar in both groups, with no differences in mortality. Episodes of peritonitis had no effect on the rate of decline of glomerular filtration rate, glomerular filtration rate after one year of treatment, or the rate of anuric patients. However, the exit from the PD programme due to renal transplant was lower in the study group. Five patients were referred to HD after suffering 1 episode of peritonitis (2 patients), 2 episodes (2 patients) and 3 episodes (1 patient). The referral to HD was 18% in patients who had 1 episode of peritonitis (2 of 11) and 38% (3 of 8) in those which had more than 1 episode. The reasons for referral to HD were catheter removal in two cases and loss of independence in three patients. None of the patients referred to HD subsequently returned to PD. Obviously, the referral to HD was higher in the group that suffered at least one episode of peritonitis with regards to the control group (Table 2).</p><p class="elsevierStylePara">On average, patients with peritonitis received two doses of vancomycin of 2g each and 5 days of tobramycin.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Maintenance of RRF on dialysis has an important prognostic value. Diabetes mellitus, obesity, high initial transport, high protein intake and coronary disease are risk factors associated with rapid loss of residual function<span class="elsevierStyleSup">5,6</span>. In our series, the number of diabetic patients in the group with episodes of peritonitis was double than among those without peritonitis. However, only 1 diabetic patient with peritonitis was referred to HD (5.2%), compared to 4 (7.8%) with non-diabetic peritonitis. Therefore, the presence of diabetes was not significant, although the small sample size precludes definitive conclusions. Aminoglycoside nephrotoxicity is well known. Nonetheless, aminoglycosides are still used as empirical treatment in peritonitis due to their bactericidal properties, activity against gram-negative bacteria, low price, low allergenic profile and low resistance. According to our experience, and that of other authors<span class="elsevierStyleSup">6</span>, empirical treatment of peritonitis episodes with aminoglycosides did not affect renal function. On the one hand, peritonitis meant less time on PD, since 26% of patients had to migrate to HD. On the other hand, they had less chances of receiving a transplant, since patients are excluded from the transplant list during peritonitis and kept off it for a minimum of one month after peritonitis is considered cured.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">In our study we did not observe that peritonitis during the first year of PD treatment has a deleterious effect on RRF, despite using potentially nephrotoxic antibiotics, but it decreases the likelihood of kidney transplant and continuation on PD.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article.</p><p class="elsevierStylePara"><a href="grande/12389_16025_64437_en_t112389.jpg" class="elsevierStyleCrossRefs"><img src="12389_16025_64437_en_t112389.jpg" alt="Clinical and laboratory data at the start of treatment with peritoneal dialysis "></img></a></p><p class="elsevierStylePara">Table 1. Clinical and laboratory data at the start of treatment with peritoneal dialysis </p><p class="elsevierStylePara"><a href="grande/12389_16025_64438_en_t212389.jpg" class="elsevierStyleCrossRefs"><img src="12389_16025_64438_en_t212389.jpg" alt="Progression data "></img></a></p><p class="elsevierStylePara">Table 2. Progression data </p>" "pdfFichero" => "P1-E577-S4809-A12389-EN.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12389_16025_64437_en_t112389.jpg" "Alto" => 478 "Ancho" => 2137 "Tamanyo" => 305288 ] ] "descripcion" => array:1 [ "en" => "Clinical and laboratory data at the start of treatment with peritoneal dialysis" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12389_16025_64438_en_t212389.jpg" "Alto" => 544 "Ancho" => 2162 "Tamanyo" => 395365 ] ] "descripcion" => array:1 [ "en" => "Progression data" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Liao CT, Chen YM, Shiao CC, Hu FC, Huang JW, Kao TW, et al. 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Perit Dial Int 2003;23:276-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12938830" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S1525861012004070" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville NC, Wiggins KJ, et al. Use of aminoglycosides for peritoneal dialysis-associated peritonitis does not affect residual renal function. Nephrol Dial Transplant 2012;27(1):381-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21633101" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003400000006/v0_201502091558/X2013251414054742/v0_201502091558/en/main.assets" "Apartado" => array:4 [ "identificador" => "35438" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief papers about basic research or clinical experiences" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003400000006/v0_201502091558/X2013251414054742/v0_201502091558/en/P1-E577-S4809-A12389-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414054742?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 8 | 16 |
| 2024 October | 81 | 35 | 116 |
| 2024 September | 71 | 36 | 107 |
| 2024 August | 67 | 54 | 121 |
| 2024 July | 62 | 28 | 90 |
| 2024 June | 69 | 43 | 112 |
| 2024 May | 77 | 37 | 114 |
| 2024 April | 70 | 38 | 108 |
| 2024 March | 50 | 26 | 76 |
| 2024 February | 53 | 40 | 93 |
| 2024 January | 51 | 30 | 81 |
| 2023 December | 38 | 25 | 63 |
| 2023 November | 49 | 35 | 84 |
| 2023 October | 93 | 28 | 121 |
| 2023 September | 54 | 36 | 90 |
| 2023 August | 63 | 21 | 84 |
| 2023 July | 55 | 31 | 86 |
| 2023 June | 54 | 26 | 80 |
| 2023 May | 77 | 35 | 112 |
| 2023 April | 56 | 19 | 75 |
| 2023 March | 62 | 21 | 83 |
| 2023 February | 46 | 25 | 71 |
| 2023 January | 50 | 19 | 69 |
| 2022 December | 86 | 28 | 114 |
| 2022 November | 60 | 26 | 86 |
| 2022 October | 89 | 36 | 125 |
| 2022 September | 98 | 25 | 123 |
| 2022 August | 72 | 48 | 120 |
| 2022 July | 70 | 45 | 115 |
| 2022 June | 67 | 28 | 95 |
| 2022 May | 72 | 36 | 108 |
| 2022 April | 43 | 53 | 96 |
| 2022 March | 68 | 50 | 118 |
| 2022 February | 80 | 53 | 133 |
| 2022 January | 101 | 36 | 137 |
| 2021 December | 58 | 35 | 93 |
| 2021 November | 64 | 39 | 103 |
| 2021 October | 84 | 44 | 128 |
| 2021 September | 72 | 40 | 112 |
| 2021 August | 81 | 52 | 133 |
| 2021 July | 115 | 33 | 148 |
| 2021 June | 70 | 37 | 107 |
| 2021 May | 89 | 48 | 137 |
| 2021 April | 233 | 58 | 291 |
| 2021 March | 75 | 54 | 129 |
| 2021 February | 72 | 16 | 88 |
| 2021 January | 75 | 23 | 98 |
| 2020 December | 61 | 13 | 74 |
| 2020 November | 54 | 18 | 72 |
| 2020 October | 38 | 23 | 61 |
| 2020 September | 56 | 19 | 75 |
| 2020 August | 53 | 13 | 66 |
| 2020 July | 60 | 15 | 75 |
| 2020 June | 54 | 15 | 69 |
| 2020 May | 64 | 30 | 94 |
| 2020 April | 57 | 17 | 74 |
| 2020 March | 42 | 10 | 52 |
| 2020 February | 41 | 25 | 66 |
| 2020 January | 55 | 24 | 79 |
| 2019 December | 74 | 23 | 97 |
| 2019 November | 54 | 28 | 82 |
| 2019 October | 52 | 7 | 59 |
| 2019 September | 77 | 21 | 98 |
| 2019 August | 51 | 20 | 71 |
| 2019 July | 31 | 30 | 61 |
| 2019 June | 52 | 24 | 76 |
| 2019 May | 41 | 26 | 67 |
| 2019 April | 118 | 38 | 156 |
| 2019 March | 72 | 24 | 96 |
| 2019 February | 36 | 19 | 55 |
| 2019 January | 54 | 30 | 84 |
| 2018 December | 94 | 39 | 133 |
| 2018 November | 97 | 14 | 111 |
| 2018 October | 101 | 21 | 122 |
| 2018 September | 77 | 13 | 90 |
| 2018 August | 57 | 17 | 74 |
| 2018 July | 57 | 10 | 67 |
| 2018 June | 75 | 19 | 94 |
| 2018 May | 77 | 21 | 98 |
| 2018 April | 89 | 9 | 98 |
| 2018 March | 67 | 9 | 76 |
| 2018 February | 55 | 6 | 61 |
| 2018 January | 58 | 6 | 64 |
| 2017 December | 74 | 9 | 83 |
| 2017 November | 70 | 14 | 84 |
| 2017 October | 68 | 7 | 75 |
| 2017 September | 58 | 8 | 66 |
| 2017 August | 59 | 10 | 69 |
| 2017 July | 73 | 9 | 82 |
| 2017 June | 69 | 19 | 88 |
| 2017 May | 81 | 17 | 98 |
| 2017 April | 74 | 17 | 91 |
| 2017 March | 62 | 29 | 91 |
| 2017 February | 84 | 5 | 89 |
| 2017 January | 52 | 9 | 61 |
| 2016 December | 52 | 4 | 56 |
| 2016 November | 74 | 7 | 81 |
| 2016 October | 103 | 8 | 111 |
| 2016 September | 162 | 2 | 164 |
| 2016 August | 206 | 5 | 211 |
| 2016 July | 214 | 6 | 220 |
| 2016 June | 128 | 0 | 128 |
| 2016 May | 130 | 0 | 130 |
| 2016 April | 106 | 0 | 106 |
| 2016 March | 107 | 0 | 107 |
| 2016 February | 149 | 0 | 149 |
| 2016 January | 109 | 0 | 109 |
| 2015 December | 118 | 0 | 118 |
| 2015 November | 104 | 0 | 104 |
| 2015 October | 108 | 0 | 108 |
| 2015 September | 78 | 0 | 78 |
| 2015 August | 76 | 0 | 76 |
| 2015 July | 93 | 0 | 93 |
| 2015 June | 54 | 0 | 54 |
| 2015 May | 66 | 0 | 66 |
| 2015 April | 9 | 0 | 9 |
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