Peritoneal Dialysis International最新文献

Cloudiness in peritoneal dialysate is a key clinical indicator of peritonitis. However, distinguishing between turbidity caused by peritonitis and that induced by drug administration can be challenging. To better understand this phenomenon, data were collected between April 2020 and March 2023 from 287 peritoneal dialysis (PD) patients undergoing benidipine-controlled blood pressure management in our PD center. Among these patients, 25 cases (8.71%) developed non-infectious chyloperitoneum as an adverse reaction to benidipine. Turbidity appeared, on average, 25.28 ± 60.55 days after starting benidipine. Switching to another antihypertensive drug cleared the dialysate within 12 to 36 hours. Laboratory results, including smears and cultures, were consistent with a non-infectious state. Elevated triglyceride (TG) levels were observed in the turbid dialysate (p < 0.0001), with a mean TG of 0.28 ± 0.17 mmol/L in cloudy samples, compared to 0.07 ± 0.03 mmol/L in clear samples. No significant changes in cholesterol or peripheral blood TG levels were found before or after the occurrence of turbidity. This study confirms that benidipine can cause non-infectious chyloperitoneum, underscoring the need for attention to adverse drug reactions to avoid unnecessary resource use. Further investigation is required to guide antihypertensive medication choices in PD patients.

A nurse new to home peritoneal dialysis (PD) undoubtedly has to learn all the steps for continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) procedures, along with basics such as hand hygiene, ordering supplies, disposing of supplies, recognizing signs and symptoms of peritonitis. However, it is not always clear what else the new PD nurse needs to know in order to successfully teach a patient all that a patient (and care partner) starting home PD training need to know, as well as to support that patient overtime once the patient is performing PD at home. To answer this question, using a modified Delphi technique, members of the International Society for Peritoneal Dialysis (ISPD) Nursing and Allied Health Professional Committee identified the top 10 practice advice (tips) these nurse members thought all new home PD nurses should know and be aware of. For each tip, we justified the importance of the tip and how it could be implemented. The 10 tips were quite varied and highlighted both the breadth and the depth of knowledge a new PD nurse needs to acquire over and above basic knowledge and skills such as performing CAPD and APD and recognizing signs and symptoms of peritonitis. The members of the ISPD Nursing and Allied Health Professional Committee who compiled this list of the top 10 tips, believe that through understanding the importance, justification, and implementation of each of these tips, the nurse new to a home PD program can, in turn, appreciate more how to individualize home PD training sessions, improve the quality of life for patients on PD, as well as extend the patients' time on PD.

Women with kidney failure have impaired fertility challenges due to disruption of the hypothalamic gonadal axis and hormonal dysregulation, with pregnancy rates on home dialysis being much lower than those with normal kidney function. Pregnant women on dialysis are at high risk of hypertensive disorders, preterm birth, and fetal growth restriction, but intensified dialysis can mitigate these risks. Home dialysis offers advantages like flexibility, better hemodynamic stability, and improved fetal outcomes, but logistical and training challenges remain. Hybrid approaches combining hemodialysis and peritoneal dialysis may benefit select women during pregnancy. Effective management of pregnancy on dialysis requires treatment of anemia, optimized nutrition, close obstetric monitoring, and multi-disciplinary care. Postpartum care should focus on breastfeeding support, home dialysis prescription adjustment, and contraception counseling. Systematic capacity-building in home dialysis can lead to better pregnancy outcomes while alleviating in-center dialysis burdens.

BackgroundInfections can make it difficult to continue peritoneal dialysis (PD). Nontuberculous mycobacteria-associated PD (NTM-PD) infections, while rare, frequently pose a treatment challenge due to their intractable nature and the lack of established therapeutic guidelines. As a result, we aimed to investigate the clinical characteristics of NTM infections in patients undergoing PD.MethodsWe retrospectively examined consecutive patients with NTM-PD infections from 2012 to 2022. The cases were identified through microbiological records. The primary outcomes were all-cause mortality and transition to hemodialysis. Secondary outcomes included treatment duration and antimicrobial regimens. Outcomes were compared across different NTM species and between cases with and without infectious disease (ID) consultation.ResultsAmong 177 patients undergoing PD, we identified 22 NTM infections in 20 patients. The predominant species were M. chelonae (36%), M. fortuitum (36%), and M. abscessus (23%). Twelve patients were transitioned to hemodialysis, with no mortality. All M. abscessus infections (n = 5) required transition to hemodialysis, compared to 46% in other species. ID consultation (n = 15) was linked to more frequent antimicrobial susceptibility testing (60% vs. 0%, p < .05), longer treatment duration (5.7 vs. 1.2 months, p < .05), and increased use of combination therapies (100% vs. 43%, p < .05). However, ID consultation did not affect the frequency of transition to hemodialysis.ConclusionEarly identification of NTM species and timely ID consultation can help optimize management strategies for these challenging infections.

BackgroundThe impact of incremental peritoneal dialysis (PD) on outcomes is poorly understood, and there is a paucity of evidence informing best practices regarding the dialysis dose at the commencement of PD. This international prospective cohort study aimed to compare PD prescription practices at dialysis commencement and their subsequent association with clinical outcomes.MethodsAdult patients who started PD for less than three months at the time of enrolment in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) between 1 January 2014 and 31 December 2017 were included. Patients were defined as initiating incremental PD if prescribed a total of <4 exchanges/day for continuous ambulatory peritoneal dialysis (CAPD) or, with dry days or having PD less than seven days per week for automated peritoneal dialysis (APD). All other prescriptions were considered standard PD. The primary outcome was the transfer to haemodialysis (HD). Secondary outcomes included peritonitis rate, time to first peritonitis and mortality. Logistic regression analysed PD uptake and the Cox proportional hazards regression model analysed HD transfer, peritonitis and patient survival.ResultsOverall, 1365 PD patients from 128 facilities across seven countries were included. Fewer individuals started on incremental PD than standard PD (37% vs 63%, p < 0.001). Higher incremental PD uptake was associated with receiving treatment in Japan (odds ratio [OR] 2.35, 95% CI 1.05-5.26, p = 0.04; ref: Canada), age >75 years (OR 1.51, 95% CI 1.02-2.24, p = 0.04), icodextrin use (OR 8.54, 95% CI 6.26-11.64, p < 0.001), lower serum creatinine concentration at PD start (OR 1.01, 95% CI 1.01-1.01, p = 0.007) and higher number of PD patients at a facility (OR 1.01, 95% CI 1.00-1.01, p = 0.02). Crude HD transfer rates for the incremental and standard PD groups were 0.14 (95% CI, 0.12-0.16) and 0.15 (95% CI, 0.13-0.17) per patient-year of follow-up, respectively (incidence rate ratio [IRR], 0.93; 95% CI, 0.75-1.15; p = 0.49). There was no significant difference in the hazard of HD transfer between the incremental and standard PD groups (hazard ratio [HR] 0.87, 95% CI 0.68-1.12, p = 0.29). There were also no differences between the two groups concerning peritonitis and mortality.ConclusionsIncremental PD start was prescribed in approximately one-third of patients and, in low certainty evidence, was associated with comparable risks of HD transfer, peritonitis and death.

IntroductionThe clinical outcomes of starting peritoneal dialysis (PD) in kidney failure patients according to different break-in periods are not well established. Our aim was to assess whether the strategy of PD initiation interferes with clinical outcomes over the initial 180 days.MethodsThis retrospective study included incident kidney failure patients starting PD at a single center (November 2016-July 2022). Patients were divided into three groups: (1) Urgent-start (US-PD), initiated within 3 days after catheter insertion without prior hemodialysis (HD); (2) Early-start (ES-PD), initiated between 3-14 days, including those with ≤30 days of prior HD; (3) Planned-start (Plan-PD), initiated after 15 days without prior HD. Mechanical and infectious complications, hospitalizations, mortality, and time on PD were compared at 180 days. Patient dropout was defined as the discontinuation of PD due to death or transfer to HD.ResultsA total of 211 patients were included: 118 (55.9%) US-PD, 46 (21.9%) ES-PD, and 47 (22.2%) Plan-PD. Among ES-PD patients, 15 (32.6%) had prior HD (<30 days - median time 19 days). Catheter insertion was mostly performed by nephrologists (60.6%) using the modified Seldinger technique (59.2%). Early complications included catheter dysfunction, which occurred in 12.7% of the overall cohort (17.8% in US-PD vs. 4.3% in ES-PD vs. 8.5% in Plan-PD; p = 0.04), and leakage, observed in 7.1% of the overall cohort (9.3% in US-PD vs. 6.5% in ES-PD vs. 2.1% in Plan-PD; p = 0.26). Later complications, hospitalizations, mortality, and time on PD did not differ significantly between groups. Peritonitis, poor education, and hospitalization were associated with dropout.ConclusionAlthough initiating PD within 72 h of catheter insertion was associated with more mechanical complications in our study, it resulted in similar clinical outcomes to Planned-start PD patients within the first 6 months of therapy, making it a viable option for urgent dialysis initiation in kidney failure patients.

This case report describes a 66-year-old male on continuous cycling peritoneal dialysis (PD) with polycythemia vera and type 2 diabetes. He presented with culture-negative PD-associated peritonitis secondary to splenic infarcts and further accompanied by a splenic vein thrombosis and posterior brain circulation infarcts. His abdominal pain was atypical for peritonitis, being mild and localized to the left side, with an unremitting course despite several treatment attempts with appropriate antimicrobial coverage. An extensive workup for thromboembolic causes was unremarkable. Initially, the patient was started on aspirin and later treated with hydroxyurea and long-term warfarin. His PD catheter was removed due to concerns about an underlying biofilm, and a new one was inserted one month later, while on temporary hemodialysis, without recurrence. This case highlights that non-infectious, culture-negative PD peritonitis related to splenic infarction should be considered in patients with left-sided abdominal pain, poor clinical response to appropriate antibiotics and significant risk factors for thromboembolic events, such as hematologic disorders like polycythemia vera and splenomegaly. Maintaining a high clinical suspicion can prevent unnecessary antibiotic use and reduce repeated exposure to intravenous contrast for imaging studies. Early initiation of long-term anticoagulation might also prevent futile PD catheter removal if subsequent clinical improvement is obtained.

We appreciate Dr Akcay's insightful comments. His observations provide valuable context and highlight important considerations for future research. We hope our work will serve as a foundation for further investigation into sex-associated risks in peritoneal dialysis and contribute to optimizing high-quality patient care for all individuals. Looking ahead, future studies should integrate dialysis-specific measures, explore mechanistic pathways, and incorporate patient-centered outcomes to better characterize sex-associated differences in peritoneal dialysis.