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BioMed Research International 2015Peritoneal dialysis is troubled with declining utilisation as a form of renal replacement therapy in developed countries. We review key aspects of therapy evidenced to... (Review)
Review
Peritoneal dialysis is troubled with declining utilisation as a form of renal replacement therapy in developed countries. We review key aspects of therapy evidenced to have a potential to increase its utilisation. The best evidence to repopulate PD programmes is provided for the positive impact of timely referral and systematic and motivational predialysis education: average odds ratio for instituting peritoneal dialysis versus haemodialysis was 2.6 across several retrospective studies on the impact of predialysis education. Utilisation of PD for unplanned acute dialysis starts facilitated by implantation of peritoneal catheters by interventional nephrologists may diminish the vast predominance of haemodialysis done by central venous catheters for unplanned dialysis start. Assisted peritoneal dialysis can improve accessibility of home based dialysis to elderly, frail, and dependant patients, whose quality of life on replacement therapy may benefit most from dialysis performed at home. Peritoneal dialysis providers should perform close monitoring, preventing measures, and timely prophylactic therapy in patients judged to be prone to EPS development. Each peritoneal dialysis programme should regularly monitor, report, and act on key quality indicators to manifest its ability of constant quality improvement and elevate the confidence of interested patients and financing bodies in the programme.
Topics: Catheters; Humans; Kidney Failure, Chronic; Peritoneal Dialysis; Quality of Life; Renal Dialysis; Renal Replacement Therapy
PubMed: 26640787
DOI: 10.1155/2015/431092 -
American Journal of Kidney Diseases :... Aug 2014Peritonitis is a common serious complication of peritoneal dialysis that results in considerable morbidity, mortality, and health care costs. It also significantly... (Review)
Review
Peritonitis is a common serious complication of peritoneal dialysis that results in considerable morbidity, mortality, and health care costs. It also significantly limits the use of this important dialysis modality. Despite its importance as a patient safety issue, peritonitis practices and outcomes vary markedly and unacceptably among different centers, regions, and countries. This article reviews peritonitis risk factors, diagnosis, treatment, and prevention, particularly focusing on potential drivers of variable practices and outcomes, controversial or unresolved areas, and promising avenues warranting further research. Potential strategies for augmenting the existing limited evidence base and reducing the gap between evidence-based best practice and actual practice also are discussed.
Topics: Humans; Peritoneal Dialysis; Peritonitis; Risk Factors; Treatment Outcome
PubMed: 24751170
DOI: 10.1053/j.ajkd.2014.02.025 -
Seminars in Dialysis 2015The success of peritoneal dialysis (PD) as renal replacement therapy is dependent upon the patient having a functional long-term peritoneal access. There are a number of...
The success of peritoneal dialysis (PD) as renal replacement therapy is dependent upon the patient having a functional long-term peritoneal access. There are a number of identified best practices that must be adhered to during PD catheter placement to achieve a durable and infection-resistant access. The clinical setting, available resources, and the employed catheter insertion method may not always permit complete adherence to these practices; however, an attempt should be made to comply with them as closely as possible. Although omission of any one of the practices can lead to catheter loss, departures from some are committed more frequently, manifesting as commonly occurring clinical problems, such as drain pain, catheter tip migration, omental entrapment, pericatheter leaks and hernias, and poor exit-site location. Understanding the technical pitfalls in PD catheter placement that lead to these problems, enable the provider to modify practice habits to avoid them and optimize outcomes.
Topics: Catheterization; Catheters, Indwelling; Equipment Design; Equipment Failure; Humans; Kidney Failure, Chronic; Peritoneal Dialysis
PubMed: 25338661
DOI: 10.1111/sdi.12299 -
Peritoneal Dialysis International :... Jul 2022
Topics: Appendix; Cystostomy; Humans; Laparoscopy; Peritoneal Dialysis; Urologic Surgical Procedures
PubMed: 35380068
DOI: 10.1177/08968608221090792 -
Blood Purification 2021Peritoneal dialysis (PD) is underutilized in many parts of the world despite pro-PD health policies. The physical and cognitive demands of PD means that over half of... (Review)
Review
BACKGROUND
Peritoneal dialysis (PD) is underutilized in many parts of the world despite pro-PD health policies. The physical and cognitive demands of PD means that over half of eligible patients require some form of assistance. As such, many countries now offer assisted PD (aPD) programs to help patients start or stay on PD as opposed to in-center hemodialysis (HD). In order to evaluate the potential scope of aPD, it is important to review the outcomes and cost considerations of aPD.
SUMMARY
We reviewed available data from different countries and regions for health outcomes between aPD and in-center HD, with a focus on quality of life (QoL), mortality, hospitalization, and technique survival. We also evaluated studies discussing the overall costs of delivering aPD, including training, operating costs, and indirect costs and compared these to in-center HD costs for the same regions. Key Messages: aPD patients are older and more frail than either self-care PD patients and many in-center HD patients. We found no evidence for any difference in QoL, mortality, or hospitalization between aPD and in-center HD after adjustment for these differences. There is some evidence for an association between nurse assistance and improved technique survival as compared to family assistance or self-care PD. Despite increased cost of providing assistance in PD, it is still significantly less expensive than in-center HD in Western Europe and Canada.
Topics: Hospitalization; Humans; Kidney Failure, Chronic; Outcome Assessment, Health Care; Peritoneal Dialysis; Quality of Life
PubMed: 33626546
DOI: 10.1159/000512839 -
Contributions To Nephrology 2017In 2013, 88.4% of all incident end-stage renal disease (ESRD) patients began renal replacement therapy with hemodialysis (HD) while 9.0% began with peritoneal dialysis... (Review)
Review
In 2013, 88.4% of all incident end-stage renal disease (ESRD) patients began renal replacement therapy with hemodialysis (HD) while 9.0% began with peritoneal dialysis (PD). The remaining 2.6% received a preemptive kidney transplant. In the US, outpatient HD units are widely distributed and economy of scale has resulted in HD being the most common ESRD modality. Use of PD and preemptive kidney transplant were relatively more common in younger groups and relatively less common among Black and Hispanic patients. Of note is that the new Medicare reimbursement system, known as the 'bundle', provides substantial financial incentives to do PD as opposed to in-center HD. By the end of 2013, 63.9% of all prevalent ESRD cases were receiving HD, 6.9% were being treated with PD, and 29.3% had a functioning kidney transplant. Distributions of modality use by patient characteristics generally mirror those for incident patients. PD and kidney transplant were more commonly used among patients who were younger and were more likely to be non-Hispanic Whites. Differences in the use of home dialysis (PD and HD) are largely driven by differences among individual dialysis centers or groups of centers, rather than by large-scale regional effects. Thus, the future use of PD or home HD will be driven by the proclivities of the largest dialysis providers, which, in turn, are driven by financial reimbursement.
Topics: Forecasting; Humans; Kidney Failure, Chronic; Kidney Transplantation; Peritoneal Dialysis; Renal Dialysis; United States
PubMed: 27951550
DOI: 10.1159/000450672 -
Journal of Nephrology Sep 2023This systematic review summarises the stability of less commonly prescribed antibiotics in different peritoneal dialysis solutions that could be used for... (Review)
Review
BACKGROUND
This systematic review summarises the stability of less commonly prescribed antibiotics in different peritoneal dialysis solutions that could be used for culture-directed therapy of peritonitis, which would be especially useful in regions with a high prevalence of multidrug antibiotic-resistant strains.
METHODS
A literature search of Medline, Scopus, Embase and Google Scholar for articles published from inception to 25 January, 2023 was conducted. Only antibiotic stability studies conducted in vitro and not recently reviewed by So et al. were included. The main outcomes were chemical, physical, antimicrobial and microbial stability. This protocol was registered in PROSPERO (registration number CRD42023393366).
RESULTS
We screened 1254 abstracts, and 28 articles were included in the study. In addition to those discussed in a recent systematic review (So et al., Clin Kidney J 15(6):1071-1078, 2022), we identified 18 antimicrobial agents. Of these, 9 have intraperitoneal dosing recommendations in the recent International Society for Peritoneal Dialysis (ISPD) peritonitis guidelines, and 7 of the 9 had stability data applicable to clinical practice. They were cefotaxime, ceftriaxone, daptomycin, ofloxacin, and teicoplanin in glucose-based solutions, tobramycin in Extraneal solution only and fosfomycin in Extraneal, Nutrineal, Physioneal 1.36% and 2.27% glucose solutions.
CONCLUSIONS
Physicochemical stability has not been demonstrated for all antibiotics with intraperitoneal dosing recommendations in the ISPD peritonitis guidelines. Further studies are required to determine the stability of antibiotics, especially in icodextrin-based and low-glucose degradation products, pH-neutral solutions.
Topics: Humans; Anti-Bacterial Agents; Dialysis Solutions; Glucose; Icodextrin; Peritoneal Dialysis; Peritonitis
PubMed: 37548827
DOI: 10.1007/s40620-023-01716-7 -
The Journal of Vascular Access May 2019Peritoneal access surgery is the first step to achieve successful peritoneal dialysis. It is important to perform easy, safe, and less invasive surgery of peritoneal...
Peritoneal access surgery is the first step to achieve successful peritoneal dialysis. It is important to perform easy, safe, and less invasive surgery of peritoneal dialysis catheter insertion. Secure peritoneal dialysis catheter insertion will lead to less infection, that is, exit site, tunnel infection, and peritonitis, which sometimes result in peritoneal dialysis discontinuation. To avoid these undesirable results, we should perform good and proper peritoneal dialysis insertion surgery. In this article, we describe peritoneal dialysis catheter insertion surgery and its management.
Topics: Catheter-Related Infections; Catheterization; Catheters, Indwelling; Clinical Decision-Making; Equipment Design; Humans; Peritoneal Dialysis; Peritonitis; Renal Insufficiency, Chronic; Risk Factors; Treatment Outcome
PubMed: 29591533
DOI: 10.1177/1129729818762989 -
Therapeutic Apheresis and Dialysis :... Jun 2023Recent evidence suggests that automated peritoneal dialysis (APD) might be a feasible alternative to hemodialysis (HD) in urgent-start peritoneal dialysis.
BACKGROUND
Recent evidence suggests that automated peritoneal dialysis (APD) might be a feasible alternative to hemodialysis (HD) in urgent-start peritoneal dialysis.
METHODS
This prospective study enrolled end-stage renal disease (ESRD) patients who had started APD as an urgent-start dialysis modality at a single center. Dialysis-related complications were recorded. Dialysis adequacy and electrolytes imbalance were compared between baseline, 14 and 42 days after catheter insertion. Technique survival and patient survival were also recorded.
RESULTS
A total of 36 patients were included in the study. Mean follow-up duration was 22 months. During the follow-up, 11 PD patients (30.6%) developed dialysis-related complications. Only two patients (5.6%) required re-insertion and one patients (2.8%) transfer to HD. The 2-year technique survival rate and patient survival rate were 94.4% and 97.2%, respectively.
CONCLUSION
In considering safety and dialysis adequacy, APD could be a feasible dialysis modality for urgent-start dialysis in ESRD patients, using a standard procedure.
Topics: Humans; Renal Dialysis; Prospective Studies; Time Factors; Kidney Failure, Chronic; Peritoneal Dialysis
PubMed: 36263921
DOI: 10.1111/1744-9987.13943 -
Revue Medicale Suisse Feb 2016Peritoneal dialysis is a dialysis modality used worldwide. Despite offering several advantages, its prevalence in Switzerland in end stage renal disease population is... (Review)
Review
Peritoneal dialysis is a dialysis modality used worldwide. Despite offering several advantages, its prevalence in Switzerland in end stage renal disease population is dramatically lower than hemodialysis (7.3% vs 92.7% in 2014) although its incidence has recently progressed. Technically, a catheter is inserted into the Douglas' pouch, enabling dialysate to be infused into the peritoneal cavity. The peritoneum acts as a semi-permeable membrane allowing for the removal of toxic substances and excess water. In the following article we will give an overview of peritoneal dialysis including its technical modalities, indications and main advantages as well as its contraindications and complications.
Topics: Contraindications; Dialysis Solutions; Humans; Kidney; Kidney Failure, Chronic; Peritoneal Dialysis; Renal Insufficiency, Chronic; Switzerland
PubMed: 27039607
DOI: No ID Found