Oxidative stress (OxSt) and inflammation are common in end-stage renal disease and dialysis patients; they are known risk factors for cardiovascular disease and mortality. In peritoneal dialysis (PD), OxSt and inflammation are even further increased compared to the already increased oxidative stress of their pre-dialysis phase. This is due to the high glucose-based solutions currently used, whose continuous contact with the peritoneal membrane can induce significant long-term morphological and functional changes (mesothelial to mesenchymal transition, thickening, neo-angiogenesis and fibrosis) of the peritoneal membrane. Oxidative stress plays a very important role in these processes, which may compromise the peritoneal dialysis procedure. There is, therefore, the need for more biocompatible dialysis fluids with polymers other than glucose to prevent and treat OxSt and inflammation. The most known and used of such glucose-free and more biocompatible peritoneal dialysis solutions is icodextrin, which has shown a protective effect from oxidative stress. This has supported the consideration of the use of glucose-free-based peritoneal dialysis fluids in order to reduce oxidative stress and improve peritoneal membrane survival. Studies investigating peritoneal dialysis with the use of osmo-metabolic agents (L-carnitine, xylitol and their combination) in peritoneal fluids replacing glucose-based fluids are, in fact, ongoing. They represent a promising strategy to reduce OxSt, preserve the peritoneal membrane’s integrity and improve patients’ outcome.

Managing mineral bone disease (MBD) could reduce cardiovascular risk and improve the survival of dialysis patients. Our study focuses on the impact of calcium bath exposure in dialysis patients by comparing peritoneal dialysis patients (PD, intervention group) and hemodialysis patients (HD, control group). We assessed various factors, including calcium, phosphorus, magnesium, PTH, vitamin D 25-OH, C-terminal telopeptide (CTX), and FGF-23 levels, as well as the calcium bath six hours before the blood sample and the length of daily calcium exposure. We enrolled 40 PD and 31 HD patients with a mean age of 68.7 ± 13.6 years. Our cohort had median PTH and FGF-23 levels of 194 ng/L (Interquartile range [IQR] 130-316) and 1296 pg/mL (IQR 396-2698), respectively. We identified the length of exposure to a 1.25 mmol/L calcium bath, phosphate levels, and CTX as independent predictors of PTH (OR 0.279, p = 0.011; OR 0.277, p = 0.012; OR 0.11, p = 0.01, respectively). In contrast, independent predictors of FGF-23 were phosphate levels (OR 0.48, p < 0.001) and serum calcium levels (OR 0.25, p = 0.015), which were affected by the calcium bath. These findings suggest that managing dialysate calcium baths impacts phosphaturic hormones and could be a critical factor in optimizing CKD-MBD treatment in PD patients, sparking a new avenue of research and potential interventions.

Peritoneal catheter dysfunction is one of the most frequent complications of peritoneal dialysis. The malposition of a peritoneal catheter may cause one- or two-way obstruction with fluid outflow or inflow problems, large residual volumes, and, therefore, reduced ultrafiltration and sometimes abdominal pain. Standard procedures may often fail to solve the dysfunction. Catheterography is an interventional radiologic procedure based on the infusion under aseptic conditions of iodated contrast into the peritoneal catheter, followed by the introduction of a guidewire into the catheter for guidewire manipulation. The available literature about catheterography is quite scarce and mainly based on case reports, case series, and small retrospective studies. In this minireview, we describe the guidewire manipulation techniques explored so far and their pros and cons. In addition, four interesting cases of catheterography performed in our center are also reported. In conclusion, in this minireview, the pros and cons of catheterography have been outpointed. Radiologic manipulation of peritoneal catheters may represent an effective and safe solution for malfunctioning peritoneal catheters and may also be exploited as “bridge therapy” to laparotomy in patients temporarily unsuitable for surgery. The advantages of this procedure are that it does not require long-term hospitalization and allows immediate resume of peritoneal dialysis.

Background/Objectives: Phosphate level is a critical factor in the health of dialysis patients, as it is linked to cardiovascular risk. In peritoneal dialysis (PD), phosphate removal is related to residual kidney function, dietary intervention, and the ability of the visceral peritoneum to transport phosphate. The role of dialysis prescriptions in phosphate management is not sufficiently enhanced. Standardizing a phosphate removal propensity marker could optimize the peritoneal dialytic program. Our preliminary report aims to evaluate a simple model of phosphate handling and to assess which marker during the peritoneal equilibration test (PET) could better describe the propensity of phosphate removal through the peritoneal membrane. Methods: We hypothesized a simple two-compartment model to describe phosphate removal driven by diffusion. We performed an explorer study on 10 PD patients to assess the reliability of the two-compartment model. In each patient, we evaluated the basal condition and performed a PET with 2 L of 3.86% glucose exchange to assess phosphate handling. We collected blood and peritoneal effluent samples at the beginning of the test (t0), after 1 h (t1), and after 4 h (t4). We proposed and examined the following biomarkers: the ratio between dialysis effluent phosphate and plasma at t4 (PHO-D/P4); the difference between dialysis effluent phosphate at t0 and t4 (PHOΔd0-d4); and phosphate permeability–area product at t4 (PHO-PxA4). Results: 9 men and one woman with a mean age of 58.7 ± 16.7 years and a mean dialysis vintage of 25 ± 18.3 months were enrolled. The PHO-D/P4 mean was 0.68 ± 0.18, the PHO-Δd0-d4 median was 0.89 mmol/L [0.7–1.19], and the PHO-PxA4 mean was 1.7 ± 0.85. PHO-D/P4was significantly related to creatinine D/P4 (beta 1.49, p < 0.001), PHO-Δd0-d4 was significantly influenced by plasma phosphate at t0 (beta 0.56, p < 0.001), and the PHO-PxA4 was significantly influenced by ultrafiltration (beta 0.003, p < 0.001). Conclusions: In our two-compartment model, we observed the independence of the PHO-D/P4marker, which could serve as a potential marker for standardizing phosphate handling. However, PHO-Δd0-d4 and PHO-PxA4 normalized by plasma phosphate at t0 and ultrafiltration rate were able to reserve a potential good performance as markers in phosphate handling standardization.

Background: Hyperuricemia is a well-known problem in end-stage kidney disease. Currently, the end-stage kidney disease patients may be treated with comprehensive conservative management, hemodialysis, or peritoneal dialysis, which impact uric acid levels distinctly. We assessed the impact of these strategies on uric acid control and identified the factors that influence it. Methods: We conducted a preliminary case–control study comparing patients in comprehensive conservative management, hemodialysis and peritoneal dialysis. For each patient, we evaluated demographic characteristics, comorbidities, body mass index, protein intake, urine output and blood test results. Results: In the entire population, uric acid levels were slightly higher in the comprehensive conservative management group. Furthermore, uric acid control was influenced primarily by body mass index (β = −0.005, p = 0.03) and treatment modality (β = −0.0026, p = 0.05). In comprehensive conservative management, body mass index (β = −0.007, p = 0.02) and urine urea excretion (β = 0.014, p = 0.04) were independent predictors of uric acid level. Conversely, only the suggested protein intake (β = 0.16, p = 0.05), potassium levels (β = −0.046, p = 0.04) and allopurinol therapy (β = −0.073, p = 0.03) were independent predictors of uric acid in hemodialysis patients. Finally, only the recommended protein intake (B = −0.005, p = 0.03) was associated with uric acid levels in patients undergoing peritoneal dialysis. Conclusions: In our series, uric acid control correlates with the treatment modality used for end-stage kidney disease and dietary protein intake.

Background/Objectives: Rituximab is widely used in primary glomerular diseases, but treatment may fail for several reasons, including primary non-response, incomplete response, relapse, intolerance or anti-rituximab antibodies. We assessed within-patient efficacy and safety after switching to another anti-CD20 antibody, considering the reason for switching. Methods: PubMed and Scopus were searched from inception to 15 May 2026 without language restrictions. Eligible reports included adults with primary glomerular disease treated with a non-rituximab anti-CD20 antibody after rituximab and reporting within-patient outcomes. Risk of bias was assessed with design-specific JBI tools and certainty with GRADE. Heterogeneity precluded meta-analysis, and findings were synthesized narratively. Results: A total of 309 patients were included across 43 studies: 283 had membranous nephropathy (MN), 18 had minimal change disease (MCD), 6 had focal segmental glomerulosclerosis (FSGS), and 2 had IgA nephropathy (IgAN). Obinutuzumab was the principal drug used, and the main reasons for switching were primary non-response, with immunization, relapse, or intolerance occurring less frequently. In MN, among the 262 patients with available response data, 217 achieved complete or partial remission, and relapse was rare. For MCD, 17 of 18 patients with active disease attained remission, and only one relapsed during follow-up. On the other hand, five out of the six FSGS patients responded, but three of them relapsed. The two patients with IgAN achieved either complete or partial remission. Notably, these results may not apply to conventional IgAN, since one biopsy showed contextually MCD and the other was proliferative and crescentic. Infusion-related reactions were the most frequent adverse events and were generally mild, while infections were the main issue during the follow-up. Evidence certainty for all outcomes was very low. Conclusions: Switching to a non-rituximab anti-CD20 antibody may be a feasible rescue strategy, most convincingly after intolerance, rituximab immunization, or relapse. The uncontrolled, very-low-certainty evidence precludes firm recommendations, and controlled studies are warranted.