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Renal Failure Dec 2021Peritoneal dialysis (PD) was introduced in China more than 60 years ago and has grown continuously since then. Now China leads the first of the world in number of...
Peritoneal dialysis (PD) was introduced in China more than 60 years ago and has grown continuously since then. Now China leads the first of the world in number of patients on PD. In this manuscript a brief review of the history of peritoneal dialysis in China is presented; this includes a description of pioneers and their important contributions, discussion of peritoneal dialysate, the technique of the use of Tenckhoff catheter, the use of continuous ambulatory peritoneal dialysis (CAPD) and dialysis registration. Current ongoing PD research activities among Chinese PD academicians are also discussed. Finally, we present four areas of future focus: 1) the promotion of PD in rural areas where PD use is still very limited due to the lack of PD awareness and education; 2) PD quality management and continuous quality improvement (CQI) program particularly focusing on PD adequacy and patient rehabilitation; 3) development and enforcement of national standards on PD management; 4) multi-center studies to compare the benefits of PD and hemodialysis (HD) that should include survival, rehabilitation and cost-effectiveness.
Topics: China; History, 20th Century; History, 21st Century; Humans; Nephrology; Peritoneal Dialysis
PubMed: 34865609
DOI: 10.1080/0886022X.2021.2011316 -
Peritoneal Dialysis International :... Jul 2022
Topics: Appendix; Cystostomy; Humans; Laparoscopy; Peritoneal Dialysis; Urologic Surgical Procedures
PubMed: 35380068
DOI: 10.1177/08968608221090792 -
Renal Failure Dec 2023Gut dysbiosis in peritoneal dialysis (PD) patients causes chronic inflammation and metabolic disorders which result in a series of complications, probably playing an...
BACKGROUND
Gut dysbiosis in peritoneal dialysis (PD) patients causes chronic inflammation and metabolic disorders which result in a series of complications, probably playing an important role in PD technique failure. The reduction in gut microbial diversity was a common feature of gut dysbiosis. The objective was to explore the relationship between gut microbial diversity and technique failure in PD patients.
METHODS
The gut microbiota was analyzed by 16s ribosomal RNA gene amplicon sequencing. Cox proportional hazards models were used to identify association between gut microbial diversity and technique failure in PD patients.
RESULTS
In this study, a total of 101 PD patients were enrolled. During a median follow-up of 38 months, we found that lower diversity was independently associated with a higher risk of technique failure (hazard ratio [HR], 2.682; 95% confidence interval [CI], 1.319-5.456; = 0.006). In addition, older age (HR, 1.034; 95% CI, 1.005-1.063; = 0.020) and the history of diabetes (HR, 5.547; 95% CI, 2.218-13.876; < 0.001) were also independent predictors for technique failure of PD patients. The prediction model constructed on the basis of three independent risk factors above performed well in predicting technique failure at 36 and 48 months (36 months: area under the curve [AUC] = 0.861; 95% CI, 0.836-0.886; 48 months: AUC = 0.815; 95% CI, 0.774-0.857).
CONCLUSION
Gut microbial diversity was independently correlated with technique failure in PD patients, and some specific microbial taxa may serve as a potential therapeutic target for decreasing PD technique failure.
Topics: Humans; Gastrointestinal Microbiome; Dysbiosis; Peritoneal Dialysis; Proportional Hazards Models; Risk Factors; Kidney Failure, Chronic
PubMed: 37009921
DOI: 10.1080/0886022X.2023.2195014 -
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 -
Seminars in Dialysis Mar 2017The future growth of peritoneal dialysis (PD) will be directly linked to the shift in US healthcare to a value-based payment model due to PD's lower yearly cost, early... (Review)
Review
The future growth of peritoneal dialysis (PD) will be directly linked to the shift in US healthcare to a value-based payment model due to PD's lower yearly cost, early survival advantage over in-center hemodialysis, and improved quality of life for patients treating their kidney disease in the home. Under this model, nephrology practices will need an increased focus on managing the transition from chronic kidney disease to end-stage renal disease (ESRD), providing patient education with the aim of accomplishing modality selection and access placement ahead of dialysis initiation. Physicians must expand their knowledge base in home therapies and work toward increased technique survival through implementation of specific practice initiatives that highlight PD catheter placement success, preservation of residual renal function, consideration of incremental PD, and competence in urgent start PD. Avoidance of both early and late PD technique failures is also critical to PD program growth. Large dialysis organizations must continue to measure and improve quality metrics for PD, expand their focus beyond the sole provision of PD to holistic patient care, and initiate programs to reduce PD hospitalization rates and encourage physicians to consider the benefits of PD as an initial modality for appropriate patients. New and innovative strategies are needed to address the main reasons for PD technique failure, improve the connectivity of the patient in the home, leverage home biometric data to improve overall outcomes, and develop PD cycler devices that lower patient treatment burden and reduce both treatment fatigue and treatment-dependent complications.
Topics: Cost-Benefit Analysis; Delivery of Health Care; Female; Forecasting; Health Care Costs; Hospitalization; Humans; Kidney Failure, Chronic; Male; Medicare; Peritoneal Dialysis; Practice Patterns, Physicians'; Quality Improvement; Risk Assessment; Survival Analysis; United States
PubMed: 28144977
DOI: 10.1111/sdi.12576 -
Peritoneal Dialysis International :... Nov 2015Selecting peritoneal dialysis (PD) in older individuals is a complex, multi-step process. At each step, older individuals may not have the opportunity to receive PD... (Review)
Review
Selecting peritoneal dialysis (PD) in older individuals is a complex, multi-step process. At each step, older individuals may not have the opportunity to receive PD unless care is optimized. Older individuals are less likely to complete a PD assessment, because of unstable medical conditions, consideration of palliative care, or reluctance to approach frail patients once they are established on hemodialysis (HD). Older individuals are also more likely to have medical or social conditions that contraindicate PD or to have barriers to self-care PD that may not be overcome with support. Older individuals who are eligible for PD may be reluctant to choose it, leaving HD as the default modality. Finally, receipt of PD may be compromised by urgent HD or PD catheter-related complications at the time of insertion. Despite all these challenges, older patients can do very well on PD, so each step should be well understood and optimized in renal programs to maximize PD use in older patients.
Topics: Age Factors; Aged; Aged, 80 and over; Cause of Death; Comorbidity; Female; Geriatric Assessment; Humans; Kidney Failure, Chronic; Male; Patient Compliance; Patient Selection; Peritoneal Dialysis; Prognosis; Risk Assessment; Survival Analysis; Treatment Outcome
PubMed: 26702000
DOI: 10.3747/pdi.2014.00346 -
Renal Failure Dec 2023Excessive daytime sleepiness (EDS) is associated with quality of life and all-cause mortality in the end-stage renal disease population. This study aims to identify...
Excessive daytime sleepiness (EDS) is associated with quality of life and all-cause mortality in the end-stage renal disease population. This study aims to identify biomarkers and reveal the underlying mechanisms of EDS in peritoneal dialysis (PD) patients. A total of 48 nondiabetic continuous ambulatory peritoneal dialysis patients were assigned to the EDS group and the non-EDS group according to the Epworth Sleepiness Scale (ESS). Ultra-high-performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry (UHPLC-Q-TOF/MS) was used to identify the differential metabolites. Twenty-seven (male/female, 15/12; age, 60.1 ± 16.2 years) PD patients with ESS ≥ 10 were assigned to the EDS group, while twenty-one (male/female, 13/8; age, 57.9 ± 10.1 years) PD patients with ESS < 10 were defined as the non-EDS group. With UHPLC-Q-TOF/MS, 39 metabolites with significant differences between the two groups were found, 9 of which had good correlations with disease severity and were further classified into amino acid, lipid and organic acid metabolism. A total of 103 overlapping target proteins of the differential metabolites and EDS were found. Then, the EDS-metabolite-target network and the protein-protein interaction network were constructed. The metabolomics approach integrated with network pharmacology provides new insights into the early diagnosis and mechanisms of EDS in PD patients.
Topics: Humans; Male; Female; Adult; Middle Aged; Aged; Quality of Life; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Kidney Failure, Chronic; Disorders of Excessive Somnolence
PubMed: 37051665
DOI: 10.1080/0886022X.2023.2190815 -
Peritoneal Dialysis International :... Mar 2023We conducted a systematic review and meta-analysis to determine the effect of the peritoneal dialysis (PD) modality, automated peritoneal dialysis (APD) or continuous... (Meta-Analysis)
Meta-Analysis
We conducted a systematic review and meta-analysis to determine the effect of the peritoneal dialysis (PD) modality, automated peritoneal dialysis (APD) or continuous ambulatory peritoneal dialysis (CAPD), on all-cause mortality (ACM) and PD failure. Studies were identified in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure, Weipu and Wanfang databases from database inception until April 1, 2021. The inclusion and exclusion criteria were based on the Population, Intervention, Comparison, Outcome, and Study (PICOS) design. Adjusted hazard ratios (HRs) with 95% confidence intervals (CI) were used to pool outcome estimates. Seventeen studies (more than 230,000 patients) were included. Our meta-analysis showed that compared with CAPD, APD demonstrated a significantly lower ACM risk (HR 0.87 [95% CI 0.77-0.99], = 0.04), especially in studies involving an as-treated analysis (HR 0.75 [95% CI, 0.63-0.90], = 0.00), published in Asia (HR 0.76 [95% CI, 0.67-0.86], < 0.001) or Europe (HR 0.81 [95% CI, 0.74-0.89], < 0.00), or published after 2012 (HR 0.82 [95% CI, 0.68-0.99], = 0.04). However, APD was as effective as CAPD for PD survival (HR, 0.87 [95% CI, 0.75 to 1.00], = 0.05 or HR, 0.90 [95% CI, 0.60 to 1.35], = 0.61). Our results demonstrate a significant survival benefit for APD and provide evidence for increasing the global use of APD, especially in developing nations, where APD use has been hampered by a lack of reimbursement for care.
Topics: Humans; Automation; China; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Proportional Hazards Models
PubMed: 36476184
DOI: 10.1177/08968608221140788 -
Contributions To Nephrology 2018As an effective renal replacement therapy, peritoneal dialysis (PD) is as important as hemodialysis (HD) and renal transplantation. PD is beneficial for social... (Review)
Review
BACKGROUND
As an effective renal replacement therapy, peritoneal dialysis (PD) is as important as hemodialysis (HD) and renal transplantation. PD is beneficial for social rehabilitation and home medical care. However, in Japan, there are fewer PD patients than HD patients.
SUMMARY
According to the JSDT 2015 registry, PD patients accounted for only 2.9% of all dialysis patients, and they have been gradually decreasing since 2009. One of the reasons why PD is not widely used in Japan is that there is insufficient evidence supporting its use. In this review, some recent reports about changes and challenges of PD, including survival rates, residual renal function, peritonitis, encapsulating peritoneal sclerosis (EPS), and combination therapy are summarized. These also indicate some problems and strategies related to PD treatment in Japan. According to the PDOPPS study, the incidence of peritonitis and culture-negative peritonitis was higher in Japan than in other countries. Further, the International Society of Peritoneal Dialysis (ISPD) Recommendation about peritonitis and catheter-related infection that topical application of antibiotic cream or ointment to the catheter exit site should be used daily could be a strategy for decreasing the incidence of peritonitis. The prevention and treatment of EPS are other challenges in PD. An EPS recommendation was published by the ISPD in 2017. Although the Next PD study showed that the occurrence of EPS is now decreasing compared to the time when acidic dialysates were used, the predictors for the development of EPS and strategies to reduce EPS have not been established. Peritoneal pathological parameters of groups that did and did not develop EPS were compared using peritoneal biopsy tissues at the time of cessation of PD, and it was found that the L/V ratio could be an independent predictor of EPS development. In Japan, 20% of PD patients are receiving combination therapy, which shows promising results. However, some problems, such as the risk of EPS, still limit long-term PD. Key Messages: PD treatment is changing as patients' situations change and with advances in technology. It is necessary to translate evidence to Japan from overseas reports and ISPD guidelines.
Topics: Humans; Incidence; Japan; Kidney Failure, Chronic; Peritoneal Dialysis; Peritoneal Fibrosis; Peritonitis; Survival Rate
PubMed: 30041216
DOI: 10.1159/000485711 -
Seminars in Dialysis Sep 2018Coping with the transition from end-stage kidney disease to dialysis can be challenging for patients and their care partners. Introducing incident dialysis patients to...
Coping with the transition from end-stage kidney disease to dialysis can be challenging for patients and their care partners. Introducing incident dialysis patients to incremental forms of dialysis is associated with better quality of life and reduced cost. Incremental hemodialysis (HD) has generated significant interest over the last decade with treatments that focus on clinical criteria rather than prespecified Kt/V targets. Incremental peritoneal dialysis (PD) has traditionally focused on the sum of residual renal and peritoneal clearances to achieve a specific Kt/V value. Gradual increases in the PD dose were prescribed as the residual kidney function declined. Adopting a new approach to incremental PD similar to what has been done for incremental HD would obviate the need for Kt/V and focus exclusively on clinical criteria. New incremental PD may be considered less disruptive to incident dialysis patients, and may be more likely to be accepted as treatment. It will also reduce our obsession with small solute kinetics and enhance encounters with patients by focusing instead on the holisitc clinical assessment.
Topics: Humans; Kidney; Kidney Failure, Chronic; Kidney Function Tests; Peritoneal Dialysis
PubMed: 29806970
DOI: 10.1111/sdi.12712