Peritoneal Dialysis International最新文献

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.

Background: Clinical data supporting the target haemoglobin range in patients undergoing peritoneal dialysis (PD) are scarce. This study investigated the association between haemoglobin levels and all-cause mortality in Japanese patients undergoing PD using data from a nationwide dialysis registry.

Methods: A total of 4875 patients aged ≥18 years who were undergoing PD at the end of 2012 were analysed. Patients receiving combination therapy with haemodialysis or missing haemoglobin data were excluded. Haemoglobin values were categorised into six groups (<9.0, 9.0-9.9, 10.0-10.9, 11.0-11.9, 12.0-12.9 and ≥13.0 g/dL) and their association with mortality evaluated.

Results: Patients' mean age was 63 years, and 62% were men. The mean haemoglobin level was 10.7 g/dL, and 14% were anuric. Erythropoiesis-stimulating agents were used in 89%. During a median follow-up of 3.5 years, 1586 patients died. Haemoglobin levels <9.0 and ≥13.0 g/dL were significantly associated with mortality, as compared with levels of 10.0-10.9 g/dL (adjusted hazard ratios [95% confidence intervals]: 1.25 [1.06-1.48] and 1.45 [1.13-1.88], respectively). Restricted cubic spline analysis revealed a U-shaped association between haemoglobin levels and mortality. A haemoglobin level ≥12 g/dL was associated with mortality in patients with a history of cardiovascular disease (p interaction = 0.023).

Conclusion: We provide important insights into the target haemoglobin in patients undergoing PD. Our findings suggest that setting a lower upper limit for haemoglobin levels may be beneficial for patients with a history of cardiovascular disease.

Peritoneal dialysis (PD) is a well-established modality for kidney replacement therapy (KRT) globally, offering benefits such as better preservation of residual kidney function, improved quality of life, and reduced resource requirements. Despite these advantages, the global utilization of PD remains suboptimal, particularly in South Asia (SA), where a significant gap in PD delivery exists. This study aims to uncover the perceived barriers hindering PD utilization among nephrologists in SA. This is a cross-sectional survey involving 732 nephrologists from SA region. . The majority of respondents (44.7%) reported initiating less than six PD cases annually, reflecting low PD utilization. Cost and financial reimbursement policies emerged as major barriers, with 44.3% considering PD more expensive than haemodialysis (HD). Accessibility, negative attitudes toward PD, and fear of complications were identified as critical factors influencing PD adoption. The study also highlighted variations in PD costs among SA countries, emphasizing the need for tailored health economic strategies. This analysis provides insights into the multifaceted challenges faced by SA nephrologists in promoting PD and underscores the importance of targeted interventions.

BackgroundPeritonitis is a serious complication associated with risks of death and transfer to haemodialysis for patients receiving peritoneal dialysis (PD). To mitigate such risks, it is important to identify potentially reversible risk factors, such as hypokalaemia.MethodPatients who started PD at the Princess Alexandra Hospital, Australia from 1^st January 2013 to 31^st December 2022 were included. Hypokalaemia, defined as serum potassium <3.5 mmol/L, was assessed at the time of PD initiation and evaluated as categories (<3.5 mmol/L, 3.5-4.5 mmol/L and >4.5 mmol/L) based on 6-month average after PD commencement. Time to first peritonitis was examined using multi-variable Cox survival analyses censored for transplantation, recovery of kidney function or loss to follow up. Competing risk regression was conducted as sensitivity analysis. Peritonitis rates were compared using Poisson regression analysis.ResultsIn total, 486 patients were included. 6-Month average serum potassium level was <3.5 mmol/L in 30 patients (6.2%), 3.5-4.5 mmol/L in 301 patients (62%) and >4.5 mmol/L in 155 patients (32%). During the study period, 192 patients experienced peritonitis with comparable proportions across all three groups (35%, 40% and 40%, respectively). Using multi-variable regression modelling, we found that time to first peritonitis was not significantly associated with hypokalaemia based on 6-month average (hazard ratio 1.14, 95% confidence interval [CI] 0.67-1.95) or baseline hypokalaemia (hazard ratio 0.73, 95% CI 0.34-1.54). Using the categories based on 6-month average serum potassium level, mean peritonitis rate was higher among patients in the <3.5 mmol/L group (0.79 episodes/patient-year) compared to those in the 3.5-4.5 mmol/L (0.61 episodes/patient-year) and >4.5 mmol/L (0.47 episodes/patient-year), whilst the difference was not significant (p = 0.14).ConclusionIn this study, no significant association was identified between hypokalaemia and risk of peritonitis, although estimates were imprecise.

BackgroundFluid retention is a major complication of peritoneal dialysis (PD). Arginine vasopressin (AVP), an antidiuretic hormone, is known to be one of the important factors related to fluid management. However, the effect of the PD fluid (PDF) on AVP dynamics remains unclear.MethodsPlasma AVP levels and osmolality (direct measurement/calculation) were tested upon arrival. Next, we studied the effects of icodextrin-based PDF (I-PDF) and glucose-based PDF (G-PDF) on hypothalamic AVP synthesis in transgenic rats expressing AVP-enhanced green fluorescent protein (eGFP) under the AVP promoter.ResultsThe average plasma AVP levels in PD patients were higher than the normal range and patients with end-stage kidney disease (ESKD), however, the difference was not significant between PD and ESKD patients. In patients with PD, there is a significant correlation between plasma AVP levels and plasma osmolality (measured directly). In the G-PDF and I-PDF groups, eGFP fluorescence intensity increased in the paraventricular nucleus (PVN) and supraoptic nucleus (SON) of the hypothalamus, which are the main AVP synthesis sites. Immunohistochemical analysis revealed the expression of Fos protein, a useful indicator of neuronal activity, in eGFP-positive neurons in the PVN and SON after G-PDF administration.ConclusionTo the best of our knowledge, this is the first report demonstrating increased plasma AVP levels in patients with PD and upregulation of hypothalamic AVP after PDF administration in transgenic rats. This study revealed that osmotic changes during PD treatment strongly influence AVP dynamics. These findings provide new insights into fluid management in patients with PD.

Pleuroperitoneal communication affects 1.6%-10% of continuous ambulatory peritoneal dialysis (PD) patients and often leads to discontinuation of peritoneal dialysis. In pleuroperitoneal communication, an important aspect is not only the diagnosis but also the detection of the diaphragmatic defect. Traditional methods have often failed to detect small defects, which contributes to the recurrence of pleuroperitoneal communication. We present three cases of intractable diaphragmatic defects in pleuroperitoneal communication, successfully localized and treated using indocyanine green (ICG) fluorescence staining of peritoneal dialysate, visualized with an infrared camera. After detecting the defect, surgical repair involved defect plication and the application of talc for pleural adhesion. This approach enabled immediate and successful on-site repair, allowing all patients to resume peritoneal dialysis post-surgery. Even the smallest diaphragmatic defects were accurately identified using ICG fluorescence dye dissolved in peritoneal dialysate. This case series demonstrates that ICG fluorescence staining enhances the diagnosis and treatment of pleuroperitoneal communication by improving defect localization. Our protocol shows promise in increasing diagnostic accuracy, reducing recurrence rates, and helping patients maintain their preferred dialysis modality.

IntroductionAlthough the impact of air pollutants on infectious diseases is well-known, there is limited evidence regarding its effects on peritoneal dialysis (PD) patients. This study aimed to investigate the association between air pollutants and PD-related peritonitis.MethodsThis is an observational study affiliated to the PD Telemedicine-assisted Platform Cohort Study (PDTAP study), which is a national-level cohort study in China. The primary outcome was PD-related peritonitis, and the secondary outcomes were peritonitis-related death and transfer to hemodialysis. The pollution data were obtained from China High Air Pollutants according to the patients' place of residence. The association between pollutants and outcomes was evaluated by cause-specific Cox proportional hazard regression model. The patients were divided into the high-pollution group and low-pollution group according to the median value of PM_2.5 (53.90 μg/m³) and the WHO standard of PM_2.5 (35.00 μg/m³).ResultsA total of 7439 PD patients from all 7 geographical regions across China were enrolled between June 2016 and April 2019. There were 1585 patients who developed peritonitis during follow-up. The pollution was most severe in the north and central regions of China. Patients in the high-pollution group were characterized by older age, higher BMI, lower income, from rural and non-university affiliated hospitals, and had more comorbidities and better residual renal function. In multivariate analysis, PM_2.5 and its components (SO₄, NO₃, NH₄, OM, and BC), PM₁₀, NO₂, and CO were associated with increased peritonitis risk (P < 0.001-0.027). Additionally, following the propensity score matching to control for key individual-level covariates, the association between PM_2.5 and its components, NO₂, and CO with elevated peritonitis risk remained significant (P < 0.001).ConclusionIn this national large-scale Chinese PD cohort study, air pollutants were found to be associated with increased risk for peritonitis.

Rationale and ObjectiveCompared to in-center hemodialysis, home dialysis may better address the needs of some individuals with end-stage kidney disease (ESKD). However, home dialysis utilization is lower in African American and Hispanic individuals with ESKD. We sought to identify the factors that most influence dialysis modality choice, specifically home dialysis, in these individuals and their care partners.Study DesignQualitative research study using focus groups.Setting and ParticipantsFifty-seven participants, including African American and Spanish-speaking Mexican American individuals on dialysis (both in-center and home) and care partners, were recruited to in-person focus groups in five US metropolitan areas. Mexican American focus groups were held in Spanish language and translated in real time by a certified interpreter; recordings for all focus groups were transcribed verbatim for analyses.Analytical ApproachParticipant responses were analyzed using inductive thematic analysis techniques.ResultsPhysician guidance was cited as the most important factor in making the initial modality decision for all groups. African American respondents primarily relied on healthcare professionals for information, but also seek independent validation (e.g., "trust but verify"). Mexican American respondents stated that trust in physician recommendation is largely unquestioned, influenced by factors such as cultural respect for physician authority, limited literacy, and language barriers. African American respondents desire additional education about modalities, particularly when they feel ready to comprehend content (sequenced to recognize how overwhelming it can be at the initial diagnosis of kidney failure). Although most individuals on dialysis and their care partners acknowledged the clinical benefits of home dialysis, significant barriers to choosing a home modality included the fear of being solely responsible for a complex procedure and loss of social interaction and/or support from other individuals on dialysis and center staff.LimitationsAs the focus groups were all conducted in metropolitan areas, the transferability of the findings to other settings is uncertain.ConclusionsImproved educational programs on dialysis modality choice should build on the strong preference for physician-led health information to better address educational needs of African American and Mexican American individuals facing the choice of a dialysis modality. Tackling issues pertaining to understanding kidney disease pathogenesis and addressing trust in healthcare professionals is necessary in African American individuals. In Mexican American communities, specific emphasis should be placed on addressing literacy and language barriers. Home dialysis educational material for both groups should also incorporate content regarding concerns about safety and social isolation.

Modality transitions are very common in patients undergoing peritoneal dialysis (PD); they can either occur before the initiation of PD, following its termination, or as a temporary interruption during PD treatment. Transfers to and from facility hemodialysis represent the majority of these transitions. In addition to their impact on the quality of life of patients and their caregivers, modality transitions are often linked with hospitalizations, mortality, and increased health expenditures. Yet, some of these transfers are unavoidable and should be considered as part of the "dialysis life plan" for patients receiving PD. In this review, we will present the epidemiology, risk factors, and clinical impacts of the most frequent transitions that PD patients experience. We will also discuss strategies to optimize the outcomes of patients undergoing modality transfers. Finally, we will review the evidence underlying the integrated home dialysis paradigm, in which patients transition from PD to home hemodialysis.