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Clinical Medicine (London, England) May 2023Home dialysis therapies offer a significant benefit to patients in respect of quality of life and autonomy, as compared with in-centre haemodialysis. There is...
Home dialysis therapies offer a significant benefit to patients in respect of quality of life and autonomy, as compared with in-centre haemodialysis. There is significant unwarranted variation across the world in the availability of both peritoneal dialysis (PD) and home haemodialysis, which has led in the UK to a recommendation of a minimum 20% prevalent rate of dialysis patients at home. Key advances in PD have included changes in the approach to prescribing PD and the use of assisted dialysis. Peritonitis remains a significant complication which may present to general physicians and needs prompt recognition and treatment. The development of novel small dialysis machines has led to a resurgence of interest in home haemodialysis.
Topics: Humans; Hemodialysis, Home; Renal Dialysis; Quality of Life; Kidney Failure, Chronic; Peritoneal Dialysis
PubMed: 37236788
DOI: 10.7861/clinmed.2023-RM4 -
Annals of the Academy of Medicine,... Mar 2022
Topics: Humans; Peritoneal Dialysis; Renal Dialysis
PubMed: 35373234
DOI: 10.47102/annals-acadmedsg.202255 -
La Tunisie Medicale Oct 2023Peritoneal dialysis (PD) is the method of choice for extra-renal replacement therapy (ERT) for children with end-stage renal disease (ESRD), because of its various...
INTRODUCTION
Peritoneal dialysis (PD) is the method of choice for extra-renal replacement therapy (ERT) for children with end-stage renal disease (ESRD), because of its various advantages. However, it presents different infectious and non-infectious complications, causes of important morbidity and mortality.
AIM
To determine the mechanical complications of PD in our center and to identify risk factors of their occurrence.
METHODS
We retrospectively collected the records of 99 patients who were treated with PD within the past eleven years in the department of pediatrics of the University Hospital Charles Nicolle of Tunis. Analysis examining possible risque factors were performed using parametric and non-parametric tests.
RESULTS
A total of 63 patients had mechanical complications with an incidence of peritoneal dialysis catheter revision of 1 procedure every 38 months. The causes were dominated by catheter migration (27.5%) and obstruction by fibrin or blood clotting (19.8%). A history of peritonitis (p=0.046) and the presence of comorbidity (p=0.008) were the two independent risk factors for catheter revision. Inguinal hernia was noted in six patients. No patient presented with a hydrothorax. Seven patients presented an episode of hemoperitoneum.
CONCLUSION
Our results lead us to focus our efforts on preventing peritonitis and controlling morbidity. Prospective studies will enable us to confirm our results.
Topics: Humans; Child; Retrospective Studies; Prospective Studies; Peritoneal Dialysis; Kidney Failure, Chronic; Peritonitis
PubMed: 38465752
DOI: No ID Found -
Wounds : a Compendium of Clinical... Jun 2019Many patients with end-stage kidney disease prefer peritoneal dialysis (PD) to hemodialysis to replace kidney function1 but avoid PD due to fears of serious... (Review)
Review
Many patients with end-stage kidney disease prefer peritoneal dialysis (PD) to hemodialysis to replace kidney function1 but avoid PD due to fears of serious complications, such as peritonitis or catheter exit site and tunnel infections, which often have higher incidences than those recommended by the International Society for Peritoneal Dialysis (ISPD). Factors that increase the risk of PD-related peritonitis include patient nasal Staphylococcus aureus carriage, diabetes, advanced age, obesity, depression, cardiovascular disease, and catheter connection methods or exit site infection (ESI). A 2004 Cochrane systematic review reported 2 different significant effects of antimicrobial agents on patients receiving PD. One randomized clinical trial (RCT) on 2716 patients reported that, compared with placebo, intranasal mupirocin, bactericidal to S aureus, reduced PD catheter ESI and tunnel infections but not peritonitis rates. A meta-analysis of 4 RCTs on 335 patients revealed preoperative intravenous antibiotics reduced the incidence of early peritonitis, but it did not affect catheter ESI or tunnel infections. These results suggest peritonitis and ESI or tunnel infections are independent outcomes potentially responsive to different interventions. Herein, this Evidence Corner examines what can be learned about these 2 different PD-related infectious outcomes from an update3 to the earlier Cochrane review and a study of topical antimicrobial agents.
Topics: Administration, Topical; Anti-Infective Agents; Catheter-Related Infections; Female; Humans; Kidney Failure, Chronic; Male; Peritoneal Dialysis; Peritonitis; Primary Prevention; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Treatment Outcome
PubMed: 31215869
DOI: No ID Found -
Nefrologia : Publicacion Oficial de La... 2017The measure of intraperitoneal pressure in peritoneal dialysis is easy and provides clear therapeutic benefits. However it is measured only rarely in adult peritoneal... (Review)
Review
The measure of intraperitoneal pressure in peritoneal dialysis is easy and provides clear therapeutic benefits. However it is measured only rarely in adult peritoneal dialysis units. This review aims to disseminate the usefulness of measuring intraperitoneal pressure. This measurement is performed in supine before initiating the drain of a manual exchange with "Y" system, by raising the drain bag and measuring from the mid-axillary line the height of the liquid column that rises from the patient. With typical values of 10-16 cmHO, intraperitoneal pressure should never exceed 18 cmHO. With basal values that depend on body mass index, it increases 1-3 cmHO/L of intraperitoneal volume, and varies with posture and physical activity. Its increase causes discomfort, sleep and breathing disturbances, and has been linked to the occurrence of leaks, hernias, hydrothorax, gastro-esophageal reflux and enteric peritonitis. Less known and valued is its ability to decrease the effectiveness of dialysis significantly counteracting ultrafiltration and decreasing solute clearance to a smaller degree. Because of its easy measurement and potential utility, should be monitored in case of ultrafiltration failure to rule out its eventual contribution in some patients. Although not yet mentioned in the clinical practice guidelines for PD, its clear benefits justify its inclusion among the periodic measurements to consider for prescribing and monitoring peritoneal dialysis.
Topics: Adult; Ascitic Fluid; Body Mass Index; Dialysis Solutions; Humans; Hydrostatic Pressure; Kidney Failure, Chronic; Manometry; Peritoneal Dialysis; Pressure; Reference Values; Supine Position; Ultrafiltration
PubMed: 28739249
DOI: 10.1016/j.nefro.2017.05.014 -
Kidney360 May 2022
Topics: Dialysis Solutions; Icodextrin; Peritoneal Dialysis
PubMed: 36128486
DOI: 10.34067/KID.0001902022 -
Renal Failure 2023Peritoneal dialysis (PD) requires high patient conscientiousness. Therefore, we aimed to investigate the relationship between conscientiousness score and prognosis in...
Peritoneal dialysis (PD) requires high patient conscientiousness. Therefore, we aimed to investigate the relationship between conscientiousness score and prognosis in PD patients. The ten-item Big Five Personality Inventory's Chinese version was used to assess the conscientiousness score. Basic clinical information, prior medical history, hematological examination results, the occurrence of the first peritonitis and catheter-related infection, the start of hemodialysis, and the time of renal transplantation were collected. The patients were split into two groups, high and low conscientiousness groups, based on the mean value of the conscientiousness score. The differences in prognostic indicators were compared between groups, and the association between conscientiousness score and prognostic indicators in PD patients was assessed. Enrolled PD patients were divided into low conscientiousness group 103 and high conscientiousness group 98. There were significant differences in serum albumin ( = 0.021) and iPTH ( = 0.045) between the two groups. Multivariate Cox regression analysis identified conscientiousness score as an independent risk factor for the development of first peritonitis ( = 0.558, 0.400-0.779, = 0.001) and first catheter-related infection ( = 0.544, 0.308-0.962, = 0.036) in PD patients. Conscientiousness score ( = 2.377, 1.109-5.095, = 0.026) was independently associated with renal transplantation. Conscientiousness personality is closely related to the prognosis of PD patients.
Topics: Humans; Catheter-Related Infections; Retrospective Studies; Peritoneal Dialysis; Renal Dialysis; Prognosis; Risk Factors; Peritonitis; Kidney Failure, Chronic
PubMed: 37846973
DOI: 10.1080/0886022X.2023.2264935 -
Peritoneal Dialysis International :... Nov 2015Heart failure (HF) is a common and important cause of morbidity and mortality in the elderly, imposing a significant burden on healthcare systems. Better management of... (Comparative Study)
Comparative Study Review
Heart failure (HF) is a common and important cause of morbidity and mortality in the elderly, imposing a significant burden on healthcare systems. Better management of ischemic heart disease has resulted in increased survival and growth in the number of prevalent heart failure patients, but co-existing renal impairment complicates management and limits traditional therapeutic options. Ultrafiltration (UF) techniques have shown promise in the treatment of diuretic-resistant HF, but the early successes of extracorporeal treatments has not been confirmed by randomized trials. Peritoneal dialysis (PD) may be cheaper and provide more effective UF therapy in selected patients and this review examines the issues surrounding the use of PD for such patients. Whist many nephrologists are enthusiastic about the use of this technique, making a more cogent case for PD in this setting for cardiologists is likely to need a combined strategy of demonstrating improvement in individual cases and further study of potential medicoeconomic benefits.
Topics: Age Factors; Aged; Aged, 80 and over; Australia; Cause of Death; Comorbidity; Cost Savings; Female; Geriatric Assessment; Heart Failure; Hemofiltration; Humans; Male; Patient Selection; Peritoneal Dialysis; Prognosis; Renal Insufficiency, Chronic; Risk Assessment; Severity of Illness Index; Survival Analysis; Treatment Outcome
PubMed: 26702006
DOI: 10.3747/pdi.2014.00340 -
Kidney & Blood Pressure Research 2017Chronic inflammation and angiogenesis are the most common complications in patients undergoing maintenance peritoneal dialysis (PD), resulting in progressive peritoneum... (Review)
Review
Chronic inflammation and angiogenesis are the most common complications in patients undergoing maintenance peritoneal dialysis (PD), resulting in progressive peritoneum remolding and, eventually, utrafiltration failure. Contributing to the deeper tissue under the peritoneal membrane, adipocytes play a neglected role in this process. Some adipokines act as inflammatory and angiogenic promoters, while others have the opposite effects. Adipokines, together with inflammatory factors and other cytokines, modulate inflammation and neovascularization in a coordinated fashion. This review will also emphasize cellular regulators and their crosstalk in long-term PD. Understanding the molecular mechanism, targeting changes in adipocytes and regulating adipokine secretion will help extend therapeutic methods for preventing inflammation and angiogenesis in PD.
Topics: Adipocytes; Humans; Inflammation; Neovascularization, Pathologic; Peritoneal Dialysis
PubMed: 28478435
DOI: 10.1159/000476017 -
Peritoneal Dialysis International :...Being aware of controversies and lack of evidence in peritoneal dialysis (PD) training, the Nursing Liaison Committee of the International Society for Peritoneal... (Review)
Review
Being aware of controversies and lack of evidence in peritoneal dialysis (PD) training, the Nursing Liaison Committee of the International Society for Peritoneal Dialysis (ISPD) has undertaken a review of PD training programs around the world in order to develop a syllabus for PD training. This syllabus has been developed to help PD nurses train patients and caregivers based on a consensus of training program reviews, utilizing current theories and principles of adult education. It is designed as a 5-day program of about 3 hours per day, but both duration and content may be adjusted based on the learner. After completion of our proposed PD training syllabus, the PD nurse will have provided education to a patient and/or caregiver such that the patient/caregiver has the required knowledge, skills and abilities to perform PD at home safely and effectively. The course may also be modified to move some topics to additional training times in the early weeks after the initial sessions. Extra time may be needed to introduce other concepts, such as the renal diet or healthy lifestyle, or to arrange meetings with other healthcare professionals. The syllabus includes a checklist for PD patient assessment and another for PD training. Further research will be needed to evaluate the effect of training using this syllabus, based on patient and nurse satisfaction as well as on infection rates and longevity of PD as a treatment.
Topics: Caregivers; Education, Nursing; Female; Humans; Internationality; Male; Nurse-Patient Relations; Outcome Assessment, Health Care; Patient Education as Topic; Peritoneal Dialysis; Practice Guidelines as Topic; Program Evaluation; Societies, Medical; Teaching
PubMed: 26917664
DOI: 10.3747/pdi.2015.00277