Peritoneal Dialysis International最新文献

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.

BackgroundPeritoneal dialysis (PD) training and education for patients and their caregivers, provided by PD nurses, are crucial for effective PD programs. The goal is to impart sufficient knowledge, skills, training, and support to minimize complications. However, the evidence regarding effective educational interventions during training has been unclear and inconsistent. The review question was: How do PD training methods and educational interventions impact on PD outcomes in adult patients?MethodsA narrative review was undertaken with defined inclusion and exclusion criteria of articles published in the last 10 years. Databases were searched, followed by a selection process conducted with the project team. Quality appraisal and a final selection were uploaded to Excel, and data was extracted. A narrative description of the results was then completed.ResultsA total of 982 articles followed the selection process of these 21 studies, including mixed methods research design, but all met the inclusion criteria. The results were described under headings of training methods, educational interventions, patient characteristics, retraining, and outcomes reported.ConclusionsThe narrative review highlights gaps in robust evidence for educational interventions during training. However, some evidence supports adapting PD training methods to incorporate more individualized approaches, appropriate pre-training assessments, and consistent outcome measures.

IntroductionIncremental peritoneal dialysis (PD) prescriptions, tailored to individual patient needs and residual kidney function, may offer patients greater dialysis-free time than full-dose PD and has the potential to yield substantial cost savings. We aimed to quantify the direct healthcare costs and resource utilization associated with incremental and full-dose PD from a third-party health service payer's perspective and estimate dialysis-free time and dialysis waste saved.MethodsWe recruited patients from a large dialysis service provider in Australia. We retrospectively analysed prospectively collected hospital data from 203 incident patients receiving PD over a 24-month period. Incremental PD was compared to full dose, considering costs related to consumables, multidisciplinary reviews, pathology, and in-patient costs.ResultsOf the 204 incident patients recruited in the study, 123 (60%) were prescribed incremental PD, with mean age of 62 years, and 66% being male. The total mean monthly outpatient cost ($AUD) for any dose of incremental PD was $339 (95% CI $152, -$526, p< .001) less than full dose, with PD consumables as the greatest contributor to the cost difference. At the end of the study, the mean dwell and exchange procedure times were 5065 h (4222-5908) and 455 h (403-507) lower in incremental PD than full dose, respectively, and incremental PD prescriptions saved >2 million litres of water, >9000 kg plastic and >8000 kg cardboard.ConclusionCompared to full dose, incremental PD minimizes dialysis time and is associated with lower costs and dialysis waste, driven largely by reduction in consumables use.

IntroductionDespite 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.MethodsThe 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.ResultsFifty-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.ConclusionsThe 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.

Home-based peritoneal dialysis (PD) is less resource-intensive than in-center hemodialysis. When provided with a choice, many patients prefer home-based therapies. The Starting Dialysis on Time, At Home on the Right Therapy (START) project was a quality improvement initiative aiming to increase PD use in Alberta, Canada. The START project provided site-specific audit and feedback reports on the processes of care for PD and increased the use of PD. In this current study, we conducted a retrospective cost analysis of the START project. We used the perspective of a publicly funded healthcare system to compare the costs before and after the START intervention. We used a decision analytic model stratifying the patient cohort by age (under and over 65 years) and estimated the impact of the START intervention on the overall cost of care at 1, 3, 5, and 10 years. Sensitivity analyses were performed. We found cost savings of $CAD 1.2 million, $CAD 1.9 million, $CAD 2.4 million, and $CAD 2.7 million for the START intervention at 1, 3, 5, and 10 years, respectively. Results were robust to a variety of sensitivity and scenario analyses. Even modest increases in PD utilization led to cost savings. We found that the implementation of a quality improvement initiative to increase PD resulted in substantial cost savings over time.