New Japanese Society of Dialysis Therapy Guidelines for Peritoneal Dialysis.

Abstract

Background: The Japanese Society for Dialysis Therapy established 14 clinical practice guidelines (CPGs) for various fields of renal replacement therapy. About 10 years have passed since the previous peritoneal dialysis (PD) guidelines were established. We commenced the establishment of new PD guidelines in 2016. Recently, the methods for development of CPGs have changed dramatically.

Summary: The previous guidelines were described in a textbook-like format. However, these kinds of guidelines no longer meet the definition of CPGs as defined by the National Academy of Medicine in the USA, according to which "CPGs are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options." Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a systematic approach to rating the certainty of evidence in systematic reviews and other evidence syntheses. We have commenced the creation of new guidelines based on the same policy. The new guidelines are presented in 2 parts. Part 1 is described in a textbook-style format and includes 7 chapters, namely, Initiation of PD, Adequacy of PD, Adequate nutrition in PD patients, Evaluation of peritoneal membrane function, Discontinuation of PD for prevention of encapsulating peritoneal sclerosis, Management of peritonitis, and Management of the PD catheter and exit site. Part 2 comprises systematic reviews and recommendations on clinical questions (CQs) according to the GRADE system. Six CQs are included in Part 2: CQ1. Are renin-angiotensin inhibitors useful in the management of PD? CQ2. Is combination of icodextrin solution with glucose-based solution useful or not in the management of PD? CQ3. Is mupirocin or gentamicin ointment useful in the prevention of exit site infection? CQ4. Which method is more useful for the insertion of the PD catheter - open or laparoscopic surgery? CQ5. Intravenous or intraperitoneal administration, which route is more effective in the treatment of patients with PD-related peritonitis? CQ6. Which therapy is preferable for the management of diabetic end-stage renal failure, PD or HD? Key Messages: The new PD guidelines are under construction and will be completed by the beginning of 2019.