Peritoneal Dialysis International最新文献

BackgroundThis study aims to describe patient and nurse trainer perspectives on a structured training programme for peritoneal dialysis (PD) as part of the Targeted Education ApproaCH to improve Peritoneal Dialysis outcomes (TEACH-PD) trial.MethodsTwo semi-structured interviews were conducted with 13 patients receiving PD and 10 PD nurses involved in training patients in PD before and after receiving training at 2 dialysis units. Transcripts were analysed thematically.ResultsFive themes were identified: (1) clear, comprehensive and culturally appropriate (clarity of content and wording to prevent disengagement, gauging patient progress, sufficiency, succinctness and flow); (2) competing priorities and burden (clinical emergencies and tasks taking priority, overwhelmed by amount of content, time pressure demands); (3) improving patient outcomes and safety (ability to assess safety, patient empowerment and personal responsibility, fostering trust and patient wellbeing, increasing technique survival, minimising risk of infection); (4) individualising the approach for patients (setting an appropriate pace, adapting to preferred learning styles, attuning to comprehension and literacy, symptoms and complications limiting capacity for learning) and (5) strengthening competence (motivation for continued learning, putting learning into practice, relevance to real-world practice, requiring structure and consistency, self-efficacy and confidence in problem solving).ConclusionPatients felt that their training was sufficient and reported feeling confident about doing PD themselves. The adult learning focus of the modules helped the nurse trainers to better adapt their teaching approaches to patients' individual needs. TEACH-PD training programmes were viewed as an opportunity to upskill nurses involved in patient training and as flexible enough to be adapted to the individual needs of patients. However, nurses also highlighted challenges related to the volume of content to be covered and time constraints due to competing clinical demands.

BackgroundGlucose and insulin blood levels are well known altering factors for 18F-fluoro-2-deoxy-2-d-glucose positron emission tomography-computed tomography ([18F]-FDG PET-CT) interpretability in peritoneal dialysis (PD) patients. A potential influence of glucose-based solutions and Icodextrin in PD patients has not been studied. The aim of this study was to assess PET-CT interpretability in PD patients according to the osmotic agent used in the dialysis fluid (Icodextrin vs. glucose) and the timing of dialysate infusion before imaging.MethodsWe searched for all PET-CT performed on individuals receiving PD between January 2020 and March 2024 at Cliniques universitaires Saint-Luc, Brussels, Belgium. Peritoneal membrane characteristics, data regarding dialysis solutions, PET-CT parameters and results were collected. We analyzed available data regarding insulinemia and glycemia during a PD exchange.ResultsFourteen PET-CTs were available for study of which four were performed on PD patients with a glucose-based solution dwell at imaging, six with Icodextrin, and three with an empty abdomen. Data regarding the presence or absence of PD fluid was missing for one patient. The only uninterpretable exam was performed on a patient injected with [18F]-FDG 86 min after an exchange with a glucose-based solution. All other exams in the glucose-based group were interpretable with a mean PD fluid infusion to [18F]-FDG injection time of 186 min. All PET-CTs in patients with an Icodextrin dwell were interpretable.ConclusionIn this small PD cohort, PET-CT interpretability appears preserved with Icodextrin dwells and may be adequate with glucose-based solutions if sufficient time elapses, requiring confirmation in larger studies.

BackgroundPeritoneal dialysis (PD) is commonly performed using either intermittent or tidal exchanges, whereas other exchange techniques such as continuous flow PD are little used. Previous research indicated that stirring the intra-peritoneal dialysate markedly increases small solute clearances. Here, we tested the hypothesis that stirring of the dialysate increases small solute clearances by using a novel exchange technique where the dialysate is pulsed back and forth during the treatment without addition of fresh fluid.MethodsPD was performed in anesthetized Sprague-Dawley rats with either no pulsations (20 mL fill volume), 2 mL (10%) pulses (21 mL fill volume), or 5 mL (25%) pulses (22.5 mL fill volume) utilizing a pulse flow rate of 5 mL/min. The higher fill volume for the pulsed treatments compensates for the fact that the average intra-peritoneal volume would otherwise be lower in pulsed treatments. Water and solute transport were closely monitored during the treatment.ResultsNet ultrafiltration decreased significantly during pulsed PD with the 25% pulse volume. The 60 min sodium dip was unaltered, whereas the fluid absorption rate was increased for the 25% group. Solute clearances did not significantly differ between groups, except for a slightly lower calcium clearance in the 25% group.ConclusionOur data indicate that stirring the dialysate using pulsed exchanges does not provide any advantage compared to conventional exchange techniques. In contrast, pulsed treatments had slightly lower ultrafiltration and small solute transport. The present findings may have implications regarding the choice of tidal volume in automated PD, favoring smaller tidal volumes.

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.

IntroductionLarger 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.MethodTo 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.ResultsComparative 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.ConclusionThe 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.

BackgroundHigh-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.MethodsData 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.ResultsData 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.ConclusionOffering 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.

Domestic animals are common in Australian households; however, there is little research into the potential risks these animals pose to patients undergoing in-home peritoneal dialysis (PD). Cats and dogs are known to carry many potential pathogens, including Pasteurella multocida. We reviewed the ANZDATA Peritoneal Dialysis Peritonitis Registry for cases of peritonitis due to Pasteurella multocida between 2011 and 2023. Cases identified were younger and more likely to be female compared with the Australian PD population who developed peritonitis due to other organisms. Of the total 32 episodes, 75% were using automated PD with glucose-based solutions. Two cases requiring removal of the PD catheter and transfer to haemodialysis and no deaths were reported. Whilst outcomes were largely favourable, it is likely that many of these cases could have been prevented. Education for people undergoing PD should include information about the potential infectious hazards of domestic animals.