Peritoneal Dialysis International最新文献

Background: Although the impact of aerobic exercise (AE) and resistance training (RT) on peritoneal dialysis (PD) patients is well established, the impact of exercise programs on residual kidney function (RKF) has not been elucidated.

Methods: Patients were randomly assigned to either the exercise (n = 25) or control groups (n = 30). Patients in the exercise group performed AE three times a week and RT twice a week at home for 24 weeks. The control group did not receive any specific intervention. The primary outcome was RKF, assessed by residual glomerular filtration rate (rGFR). Secondary outcomes included urinary protein levels, distance covered in the incremental shuttle walking test (ISWT), and glycated hemoglobin (HbA1c) percentages.

Results: Linear mixed-effects models showed no significant changes in mean rGFR between the exercise and control groups at 12 weeks (-0.40; 95% confidence interval (CI): -2.17, 1.36; p = 0.65) and at 24 weeks (0.65; 95% CI: -1.15, 2.45; p = 0.48). There was a trend toward improvement in mean urinary protein level and ISWT results, and a significant decrease in mean HbA1c percentage at 24 weeks in the exercise group (-1.07, 95% CI: -2.29, 0.15, p = 0.09; 37.7, 95% CI: -10.1, 85.5, p = 0.12; -0.57, 95% CI: -0.97, -0.18, p = 0.005, respectively) compared to the control group.

Conclusion: The 24-week home-based exercise program did not demonstrate beneficial effects on RKF in incident PD patients. Nonetheless, it may have an impact on reducing urinary protein levels and HbA1c percentages.

Introduction: Larger fill volumes in peritoneal dialysis (PD) typically improve small solute clearance and water removal, and vice versa-but the relationship between intraperitoneal volume and the capacities for solute and water transport in PD has been little studied. Here, it is proposed that this relative relationship is described by a simple ratio (Volume_new/Volume_old)^2/3 up to a critical break-point volume, beyond which further volume increase is less beneficial in terms of solute and water removal.

Method: To scrutinize this hypothesis, experiments were conducted in a rat model of PD alongside a retrospective analysis of data from a prior clinical study. Rats underwent PD with either three consecutive fills of 8 + 8 + 8 mL (n = 10) or 12 + 12 + 12 mL (n = 10), with 45-minute dwell time intervals. This approach yielded 60 estimations of water and solute transport, characterized by osmotic conductance to glucose and solute diffusion capacities, respectively.

Results: Comparative analysis of the predictive efficacy of the two models-the simple ratio versus the break-point model-was performed using Monte Carlo cross-validation. The break-point model emerged as a superior predictor for both water and solute transfer, demonstrating its capability to characterize both experimental data from rats and clinical data from patients.

Conclusion: The present analysis indicates that relatively simple calculations can be used to approximate clinical effects on solute and water removal when prescribing a lower or higher fill volume to patients with PD.

Background: The stability of antimicrobials in peritonitis during peritoneal dialysis (PD) solutions is a critical factor influencing treatment success. This study investigated the stability of daptomycin (DAP) when combined with icodextrin-based PD solution, by measuring DAP concentrations and observing any structural changes.

Methods: A dose of DAP (350 mg) was dissolved in 7 mL of saline in a clean bench. The solution was then injected into the large compartment (1,260 mL) of NICOPELIQ^® Peritoneal Dialysis Solution and thoroughly mixed. Samples were collected at intervals ranging from 0 to 336 h (7 points in total). The concentration of DAP was quantified using high-performance liquid chromatography (HPLC). The structure of any unidentified peaks was determined using HPLC coupled with electrospray ionization tandem mass spectrometry.

Results: DAP maintained 90% of the initial concentration in NICOPELIC^® for 72 h at room temperature and 12 h at 37 °C. Unidentified peaks, distinct from DAP, were detected during analysis. Further investigation indicated that these peaks corresponded to anhydrated DAP.

Conclusions: The findings from this stability study are expected to enhance the effectiveness of outpatient management and preparation for treating peritonitis using DAP.

Exercise and physical activity have been shown to improve health outcomes among people receiving peritoneal dialysis (PD), however, little is known about PD clinicians' perceptions and practices regarding exercise counselling. To inform exercise program design and implementation, we distributed a cross-sectional online questionnaire to PD clinicians between July and December 2021 through professional nephrology societies and networks. As part of this survey, participants were asked, "What are the most important aspects you would like to see incorporated in an exercise program for PD patients?" Six hundred and nine respondents provided 1249 unique perspectives. Responses were coded using summative content analysis and grouped into themes. The overarching theme identified was the need for individualized and accessible programming. Under this umbrella, the four main sub-themes identified were: promotion of specific exercises, overcoming common barriers to exercise, perceived cornerstones of exercise prescriptions, and program design to address patient-relevant outcomes. Overall, PD clinicians believed that PD does not preclude exercise participation and recognized the potential for exercise to improve physical, mental, and social well-being. The involvement of exercise professionals was valued in PD clinical programs. However, additional education for practitioners and patients regarding safety and the benefits of exercise is required to assist in widespread implementation and acceptance of exercise programming in the PD population.

A peritoneal mesothelial cyst is a rare entity, commonly asymptomatic, which is usually detected as an incidental radiological finding and needs surgical intervention for complete removal. We present a unique case of a peritoneal simple mesothelial cyst that was removed accidentally during peritoneal dialysis in a pediatric patient.

Background: Although both hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) are covered by national healthcare insurance, 98% of kidney failure disease patients are treated with hemodialysis. This study compared the health-related quality of life (HRQoL) and utility scores of patients receiving hemodialysis and CAPD in Indonesia and determined factors associated with HRQoL and utility scores.

Methods: A cross-sectional study was performed using the Kidney Disease Quality of Life-36 and EQ-5D-5L instruments at six hospitals. Utility scores were presented as SF-6D and EQ-5D scores. Factors associated with the EQ-5D were evaluated using Tobit regressions due to ceiling effects, while the SF-6D and HRQoL were assessed using generalized linear models since the data were not normally distributed.

Results: Among the 613 patients, 76% were treated with hemodialysis. After adjusting for sociodemographic characteristics and clinical parameters, CAPD patients reported better HRQoL compared to hemodialysis patients in terms of the SF-6D (p = .038), mental component summary (p = .020), symptoms (p = .005), and effects of kidney disease (p<.001), but no significant differences were reported in EQ-5D (p = .083), physical component summary (p = .323), burden of kidney disease (p = .111), and kidney summary scores (p = .068). Poorer HRQoL and utility scores were likely experienced by older patients who were male, married, with diabetes, treated in Class A hospitals, and with lower education, hemoglobin, and albumin levels.

Conclusion: In Indonesia, patients treated with CAPD had better HRQoL and utility scores compared to patients undergoing hemodialysis. Therefore, CAPD should be promoted by healthcare professionals as the first treatment option for patients who are eligible for both hemodialysis and CAPD.

Introduction: Despite being an effective home-based kidney replacement therapy, peritoneal dialysis (PD) remains underutilized. The aim of the Renality-CASE training program was to assess its impact on nephrologists by expanding their knowledge of PD therapy and enhancing their catheter placement skills to better offer the PD option.

Methods: The Renality-CASE program provided two days of training, including theoretical lectures, virtual reality sessions, and hands-on practice of PD catheter placement on live pigs. Eighty-eight participants attended four sessions. An anonymized online questionnaire collected demographic data, self-assessments of knowledge and skills, and feedback. Pre- and post-training comparisons were analyzed using paired samples t-tests and the Wilcoxon signed-rank test, with significance at p < 0.05.

Results: Fifty-seven out of 88 participants responded to the survey one-year post-training. Post-training, 94.7% felt at least moderately knowledgeable compared to 61.4% pre-training (p < 0.001). Confidence in skills increased to 73.6% post-training from 26% pre-training (p < 0.001). The number of PD catheters placed by participants also rose significantly (p = 0.012). The program received positive feedback and high satisfaction rates.

Conclusions: The Renality-CASE program significantly improved nephrologists' PD catheter placement skills through comprehensive training. Despite limitations such as sample size and response bias, the study highlights the need for standardized PD training to enhance clinical practice and increase PD utilization in CKD management.

Peritoneal dialysis (PD) has become an established treatment modality for end-stage kidney disease (ESKD) in recent years, though catheter dysfunction remains a common issue, often due to adhesions or migration. Laparoscopic surgery is an effective method for addressing these problems with precision and minimal trauma. A rare cause of catheter dysfunction is fimbriae adhesions, where the fimbriae of the fallopian tubes obstruct the catheter. We present a case of a 23-year-old woman with ESKD who transitioned to PD, complicated by catheter blockage within days. Radiographs suggested adhesions and diagnostic laparoscopy revealed fimbriae entangling the catheter. Laparoscopic adhesiolysis and catheter replacement were performed, with the fallopian tubes secured to the ipsilateral ovary to prevent recurrence. Post-surgery, catheter function was restored, and an 18-month follow-up showed no complications. This case highlights the importance of considering fertility preservation in cases of fimbrial adhesions and underscores the value of laparoscopic intervention.