Peritoneal Dialysis International最新文献

Peritoneal dialysis (PD)-associated peritonitis commonly arises from touch contamination events, however, it is important to be mindful of alternative etiologies and to take a detailed history and perform a root cause analysis for each episode. In fact, the PD effluent can be a window into intra-abdominal pathologies which may require surgical management. We present an unusual case of secondary enteric peritonitis due to foreign body bowel perforation from ingestion of a fish bone.

Peritoneal dialysis effluent should be clear and any changes in aspect require further investigation. We report a case of a spontaneous milky white effluent (chyloperitoneum) associated with calcium channel blockers in a peritoneal dialysis patient. Our case is a 43-year-old man that presents with milky white peritoneal dialysis effluent 9 days after starting peritoneal dialysis. He didn't have any other complaints and he wasn't prescribed any new medications. In the effluent sample we found high triglycerides (1.8 mmol/L) thus confirming the chyloperitoneum. We suspended lercanidipine and within a few days the peritoneal dialysis effluent was clear. Currently the patient is well adjusted to the technique and had no further episodes of chyloperitoneum.

Chronic kidney disease (CKD) may be associated with dysbiosis which may increase the risk of gastrointestinal infections. Patients with kidney failure have a predominance of bacteria responsible for the exacerbation of chronic inflammation through the production of ureases, uricase, and uremic toxins and a reduction of bacteria-producing protective molecules as short-chain fatty acids. Patients with CKD have an increased risk of Clostridioides difficile infection. Currently, besides antibiotic therapy, fecal microbiota transplantation (FMT) is the only effective gut microbiota-targeted therapy for treating this infection. Scant evidence is available on FMT in those receiving peritoneal dialysis (PD). In this case, we report a successful FMT performed by colonoscopy in a patient receiving PD for polycystic kidney disease suffering from recurrent Clostridioides difficile infections. The FMT was repeated to enhance microbiota engraftment. The role of FMT in treating Clostridioides difficile in individuals receiving PD may be an important and promising therapeutic strategy but requires further prospective study.

Background: Assisted peritoneal dialysis (PD), where trained health care providers assist individuals with PD in their home, allows individuals, who would otherwise be ineligible, to pursue home dialysis. Alberta Kidney Care South started an assisted PD program in 2011 using licensed practical nurses (LPNs) and switched to health care aids (HCA) July 2018.

Methods: A retrospective chart review to describe characteristics of assisted PD patients and their outcomes for each of the models of health care. The primary outcome was the duration of assisted PD from initiation to exit. Secondary outcomes included reasons for exit and the proportion of patients who performed independent PD.

Results: A total of 135 patients received assisted PD, mean age 70.7 ± 11.2 years and 44.4% (60/135) women. The average time to exit from assisted PD was 366.2 ± 378.1 days. There was no difference between time in PD between LPN (1.89 [1.02, 3.85] years) and HCA (2.09 [0.89, 3.26] years), p = 0.98. Main reasons for exit from assisted PD included death 30.4% (41/135) and switching to hemodialysis 26.7% (36/135). Total of 29 patients (21.5%) continued PD independently for an additional 495 ± 399 days. There was no difference in reasons for exit, p = 0.90 or peritonitis rates between the two care models, p = 0.60.

Conclusion: Assisted PD allows patients to maintain independence in the community and facilitates the uptake of independent PD in a significant proportion. Utilizing an HCA model offers a cost-effective alternative while still providing high-quality care.

Background: High-quality and timely peritoneal access is essential for effective peritoneal dialysis (PD). Existing comparisons of medical compared to surgical catheter insertion have focused on the incidence of catheter events, but the cost-effectiveness of providing medical in addition to surgical catheter insertion in a dual pathway, compared to providing surgical insertion alone has not been evaluated.

Methods: Data from the UK Catheter study, exploring how patient, service and insertion technique factors interact was used to estimate the comparative rates of catheter events between medical and surgical catheter insertion. A cost-effectiveness model estimates the health benefits and costs of providing medical in addition to surgical catheter insertion, compared to surgical insertion alone. Parametric modelling estimated time to catheter events, haemodialysis and transplantation to populate the model.

Results: Data on 769 first catheter insertions informs the model (325 medical and 444 surgical). Fewer catheter events were observed with medical insertion. The dual insertion pathway (69% medical, 31% surgical) was therefore associated with lower lifetime catheter events (3.18 vs. 3.34) and longer time on PD (3.07 vs. 3.00 years) than a purely surgical insertion pathway. The lifetime mean differences in quality-adjusted life years (7.12 vs. 7.00) and near identical costs (£226,549 vs. £226,764) meant dual insertion pathway was likely to be cost-effective, a finding robust to a series of sensitivity analyses.

Conclusion: Offering medical in addition to surgical catheter insertion techniques has the potential to improve clinical outcomes and is likely to be highly cost-effective compared to surgical insertion alone.

Peritoneal dialysis (PD) and kidney transplantation are important therapeutic options in patients with advanced kidney disease. This article delineates the relationship between PD and kidney transplantation in several key domains, including: (1) Comparative merits and limitations of PD versus center-based hemodialysis prior to kidney transplantation, (2) Patient outcomes after kidney transplantation in individuals receiving PD prior to kidney transplantation, (3) Perioperative management strategies of patients receiving PD at the time of kidney transplantation, and (4) The relative advantages and clinical outcomes of PD use following kidney allograft failure compared to other modalities. This article aims to provide comprehensive guidance for optimizing care across the PD-kidney transplant transitions continuum.

There is growing emphasis on increasing utilization of peritoneal dialysis (PD) in patients with end stage kidney disease (ESKD); however, use in patients with severe obesity has still been fraught for various reasons. We aim to assess the viability of PD in patients with severe obesity (BMI > 40 Kg/m²). We conducted a retrospective chart review of patients admitted at the home dialysis center of an academic center between 2014 and 2020 (n = 99). Patients with a BMI>40 kg/m² at the time of PD initiation (n = 9) were selected. We extracted and examined the data for these nine patients till March 2023. The mean age at baseline was 47.8 ± 12.6 year, 56% were males, 67% were Hispanic, 33% were white, and mean BMI was 43.3 ± 3.4 kg/m². By the end of the follow-up of this report, five (56%) patients were still active on PD (mean duration 27.8 ± 4.5 months). PD therapy was terminated in 3 (33%) patients (17.7 ± 6.8 months) due to refractory peritonitis, burnout, transfer to rehabilitation facility, respectively. One patient transferred out to another facility after 10.6 months. Rates of access and mechanical complications as well as peritonitis in these nine patients were similar to center's overall rates. All the patients had elimination of uremic symptoms using incremental prescription and met weekly Kt/V targets of >1.7 using adjusted weight. Overall, patients' weight and glycemic control remained stable. In conclusion, PD can be an effective long-term high-quality dialysis option for patients with ESKD and severe obesity. Further studies in a larger population are required to confirm our findings.

Background: Few studies have evaluated the predictive capability of equations for residual kidney function (RKF) in patients undergoing peritoneal dialysis (PD). Moreover, the applicability of each equation remains unclear. Therefore, we aimed to evaluate the performances of the estimated RKF (eRKF) equations of Shafi, Steubl, and Jaques in Chinese patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

Methods: This was a retrospective study. We enrolled patients who underwent CAPD and RKF measurements (via 24-h urine collection) in our hospital between November 2021 and May 2022. Using the measured RKF (mRKF) as the reference, we derived the bias, precision and accuracy of each equation.

Results: We enrolled 174 participants. The mean β2-microglobulin and median mRKF were 29.00 ± 8.69 mg/L and 2.94 (1.26, 4.65) mL/min/1.73 m², respectively. The Steubl equation had the least bias (MD [95% confidence interval, CI]: -0.52 [-0.77 to -0.38]), higher precision (interquartile range: 1.43 [1.16, 1.76]), and highest accuracy (83%). It also had a high diagnostic accuracy for identifying patients with an mRKF of > 2.5 mL/min/1.73 m², area under the curve of 0.936 95% CI [0.903-0.970], p < 0.001), cut-off value of 1.80 mL/min/1.73 m², specificity of 0.895, and sensitivity of 0.847.

Conclusion: Although no equation was fully accurate, the Steubl equation identified patients suitable for an incremental PD prescription more accurately than the Shafi and Jaques versions. It may be useful for monitoring the RKF of Chinese patients undergoing CAPD who are unable to reliably collect urine.

Peritoneopericardial leakage is a rare but important complication of peritoneal dialysis. Peritoneal scintigraphy is reported to be effective in diagnosing the peritoneopericardial communication. Although switching to hemodialysis is commonly recommended, reducing exchange volumes and performing peritoneal dialysis in an upright sitting position may also be considered particularly in pediatric patients. Here we presented a 10-year-old girl in whom peritoneopericardial leakage was demonstrated with peritoneal scintigraphy and was successfully managed by conservative approach.

Baclofen is a gamma-aminobutyric acid agonist that is commonly and widely used for the treatment of muscle spasticity. Given its predominant kidney excretion, patients with reduced kidney function are at particular risk of drug accumulation and toxicity, with neurotoxicity in the form of drowsiness, encephalopathy, seizures, and coma being the most reported clinical features. In addition to the importance of early identification of baclofen toxicity and drug discontinuation, dialysis can effectively accelerate baclofen elimination given its small molecule weight, and the relatively low volume of distribution and weak protein binding. While several cases of baclofen-induced toxicity have been reported in hemodialysis patients, the literature on baclofen toxicity in individuals receiving peritoneal dialysis (PD) is limited. Here, we present a case of baclofen-induced encephalopathy in a PD patient following a single dose of baclofen. In this case, our patient was managed by continuous (24 h) automated PD, with complete recovery of neurological status within three days.