Anorexia nervosa (AN) is an eating disorder characterized by restriction of energy intake leading to a significantly low body weight, and intense fear of gaining weight. Severe electrolyte changes such as hypokalemia and hypophosphatemia; and alterations in water metabolism such as hyponatremia and edema, can occur in patients with AN. Hypokalemia and chronic volume depletion may lead to acute kidney injury (AKI) and chronic kidney disease (CKD). There are few reports of patients with AN who require maintenance dialysis. Therefore, it is unclear whether hemodialysis (HD) or peritoneal dialysis (PD) is suitable for such patients. We report a case of kidney failure that developed in the patient with AN who received successful psychiatric treatment aimed at weight gain while performing PD. The safety of PD may be improved in patients who also undergo cognitive behavioral psychotherapeutic intervention.
{"title":"Impact of peritoneal dialysis on weight gain in a patient with anorexia nervosa.","authors":"Misa Iimori, Takashi Kitani, Yayoi Shiotsu, Yasuto Sunahara, Mari Morimoto, Kanako Asai, Noriko Urata, Junko Ono, Tetsuro Kusaba, Keiichi Tamagaki","doi":"10.1177/08968608241307825","DOIUrl":"https://doi.org/10.1177/08968608241307825","url":null,"abstract":"<p><p>Anorexia nervosa (AN) is an eating disorder characterized by restriction of energy intake leading to a significantly low body weight, and intense fear of gaining weight. Severe electrolyte changes such as hypokalemia and hypophosphatemia; and alterations in water metabolism such as hyponatremia and edema, can occur in patients with AN. Hypokalemia and chronic volume depletion may lead to acute kidney injury (AKI) and chronic kidney disease (CKD). There are few reports of patients with AN who require maintenance dialysis. Therefore, it is unclear whether hemodialysis (HD) or peritoneal dialysis (PD) is suitable for such patients. We report a case of kidney failure that developed in the patient with AN who received successful psychiatric treatment aimed at weight gain while performing PD. The safety of PD may be improved in patients who also undergo cognitive behavioral psychotherapeutic intervention.</p>","PeriodicalId":19969,"journal":{"name":"Peritoneal Dialysis International","volume":" ","pages":"8968608241307825"},"PeriodicalIF":2.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-01-05DOI: 10.1177/08968608231209850
Benjamin Talbot, Simon Davies, Jenny Burman, Angus Ritchie, Paul Snelling, Sue Lynch, Youn Park, Brian Jones, Vincent Garvey, Allison Jaure, Meg Jardine, Vlado Perkovic, Martin Gallagher, Arthur Brandwood, Navneet Kaur, John Knight
The global unmet need for kidney replacement therapy means that millions of people die every year as they cannot afford treatment. Peritoneal dialysis (PD) offers comparable survival to haemodialysis and is often more affordable, but one barrier to increasing access is that conventional manufacturing and distribution of PD fluid is costly. Here we report the results from a pilot proof-of-principal study demonstrating for the first time that the Ellen Medical Devices Point-of-Care system can be used by patients to produce sterile PD fluid at the point-of-care. With further development, this low-cost system could offer a solution to the many millions of people around the world who currently cannot afford treatment for kidney failure.
全球对肾脏替代疗法的需求尚未得到满足,这意味着每年有数百万人因负担不起治疗费用而死亡。腹膜透析(PD)可提供与血液透析相当的存活率,而且通常更经济实惠,但增加腹膜透析机会的一个障碍是腹膜透析液的传统制造和配送成本高昂。在此,我们报告了一项试验性原理验证研究的结果,该研究首次证明了患者可以使用 Ellen 医疗设备护理点系统在护理点生产无菌腹膜透析液。随着进一步的发展,这种低成本系统可以为全球数百万目前无力负担肾衰竭治疗费用的患者提供解决方案。
{"title":"The Point-of-Care Peritoneal Dialysis System Early Evaluation Study (POC-PDEE): A pilot proof-of-principal study of the Ellen Medical Devices Point-of-Care affordable peritoneal dialysis system.","authors":"Benjamin Talbot, Simon Davies, Jenny Burman, Angus Ritchie, Paul Snelling, Sue Lynch, Youn Park, Brian Jones, Vincent Garvey, Allison Jaure, Meg Jardine, Vlado Perkovic, Martin Gallagher, Arthur Brandwood, Navneet Kaur, John Knight","doi":"10.1177/08968608231209850","DOIUrl":"10.1177/08968608231209850","url":null,"abstract":"<p><p>The global unmet need for kidney replacement therapy means that millions of people die every year as they cannot afford treatment. Peritoneal dialysis (PD) offers comparable survival to haemodialysis and is often more affordable, but one barrier to increasing access is that conventional manufacturing and distribution of PD fluid is costly. Here we report the results from a pilot proof-of-principal study demonstrating for the first time that the Ellen Medical Devices Point-of-Care system can be used by patients to produce sterile PD fluid at the point-of-care. With further development, this low-cost system could offer a solution to the many millions of people around the world who currently cannot afford treatment for kidney failure.</p>","PeriodicalId":19969,"journal":{"name":"Peritoneal Dialysis International","volume":" ","pages":"52-56"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139098494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1177/08968608241297861
Johann Morelle, Carl M Öberg
{"title":"Will Xylocore<sup>®</sup> be the magic ELIXIR for peritoneal dialysis?","authors":"Johann Morelle, Carl M Öberg","doi":"10.1177/08968608241297861","DOIUrl":"https://doi.org/10.1177/08968608241297861","url":null,"abstract":"","PeriodicalId":19969,"journal":{"name":"Peritoneal Dialysis International","volume":"45 1","pages":"3-6"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-08-01DOI: 10.1177/08968608241266130
Ryan Ting, Megan Borkum, Lian Ting Ni, Adeera Levin
Background: Home dialysis therapies have limited uptake in most regions despite recognized benefits such as increasing patients' independence, and several domains of quality of life with cost savings in some systems.
Objective: To perform a scoping review of published literature to identify tools and guides used in systematically screening and assessing patient suitability for home dialysis. A secondary objective was to explore barriers and enablers associated with the home dialysis assessment process. It is important to identify gaps in current research to pose pertinent questions for future work in the field.
Design: Online databases Embase, Medline (Ovid), and CINAHL were used to identify articles published between January 2007 to May 2023. A total of 23 peer-reviewed primary and secondary studies that investigated screening or selection for patients > 18 years old with kidney failure for home dialysis met the study inclusion criteria.
Results: The studies consisted of secondary studies (n = 10), observational studies (n = 8), and survey-based studies (n = 5). The major themes identified that influence patient screening and assessment for home dialysis candidacy included: screening tools and guidelines (n = 8), relative contraindications (n = 4), patient or program education (n = 9), and socioeconomic factors (n = 2).
Limitations: Consistent with the scoping review methodology, the methodological quality of included studies was not assessed. The possible omission of evidence in languages other than English is a limitation.
Conclusion: This scoping review identified tools and factors that potentially guide the assessment process for home dialysis candidacy. Patient screening and assessment for home dialysis requires a comprehensive evaluation of clinical, psychosocial, and logistical factors. Further research is required to validate and refine existing tools to establish standardized patient screening criteria and evaluation processes. Up-to-date training and education for healthcare providers and patients are needed to improve the utilization of home dialysis and ensure optimal outcomes.
{"title":"Patient screening and assessment for home dialysis therapies: A scoping review.","authors":"Ryan Ting, Megan Borkum, Lian Ting Ni, Adeera Levin","doi":"10.1177/08968608241266130","DOIUrl":"10.1177/08968608241266130","url":null,"abstract":"<p><strong>Background: </strong>Home dialysis therapies have limited uptake in most regions despite recognized benefits such as increasing patients' independence, and several domains of quality of life with cost savings in some systems.</p><p><strong>Objective: </strong>To perform a scoping review of published literature to identify tools and guides used in systematically screening and assessing patient suitability for home dialysis. A secondary objective was to explore barriers and enablers associated with the home dialysis assessment process. It is important to identify gaps in current research to pose pertinent questions for future work in the field.</p><p><strong>Design: </strong>Online databases Embase, Medline (Ovid), and CINAHL were used to identify articles published between January 2007 to May 2023. A total of 23 peer-reviewed primary and secondary studies that investigated screening or selection for patients > 18 years old with kidney failure for home dialysis met the study inclusion criteria.</p><p><strong>Results: </strong>The studies consisted of secondary studies (n = 10), observational studies (n = 8), and survey-based studies (n = 5). The major themes identified that influence patient screening and assessment for home dialysis candidacy included: screening tools and guidelines (n = 8), relative contraindications (n = 4), patient or program education (n = 9), and socioeconomic factors (n = 2).</p><p><strong>Limitations: </strong>Consistent with the scoping review methodology, the methodological quality of included studies was not assessed. The possible omission of evidence in languages other than English is a limitation.</p><p><strong>Conclusion: </strong>This scoping review identified tools and factors that potentially guide the assessment process for home dialysis candidacy. Patient screening and assessment for home dialysis requires a comprehensive evaluation of clinical, psychosocial, and logistical factors. Further research is required to validate and refine existing tools to establish standardized patient screening criteria and evaluation processes. Up-to-date training and education for healthcare providers and patients are needed to improve the utilization of home dialysis and ensure optimal outcomes.</p>","PeriodicalId":19969,"journal":{"name":"Peritoneal Dialysis International","volume":" ","pages":"7-16"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-08-28DOI: 10.1177/08968608241274106
Mario Bonomini, Simon Davies, Werner Kleophas, Mark Lambie, Gianpaolo Reboldi, Lorenzo Di Liberato, Josè Carolino Divino-Filho, Olof Heimburger, Alberto Ortiz, Johan Povlsen, Massimo Iacobelli, Tommaso Prosdocimi, Arduino Arduini
Peritoneal dialysis adoption and technique survival is affected by limitations related to peritoneal membrane longevity and metabolic alterations. Indeed, almost all peritoneal dialysis fluids exploit glucose as an osmotic agent that rapidly diffuses across the peritoneal membrane, potentially resulting in metabolic abnormalities such as hyperglycemia, hyperinsulinemia, obesity, and hyperlipidemia. Moreover, glucose-degradation products generated during heat sterilization, other than glucose itself, induce significant morphological and functional changes in the peritoneum leading to ultrafiltration failure. The partial substitution of glucose with osmotic agents characterized by a better local and systemic biocompatibility has been suggested as a potential strategy to innovate peritoneal dialysis fluids. The approach aims to minimize glucose-associated toxicity, preserving the peritoneal membrane welfare and counteracting common comorbidities. In this work, we report the clinical trial design of ELIXIR, a phase III randomized, controlled, blinded outcome assessment study comparing Xylocore®, an innovative formulation based on Xylitol and l-carnitine, to standard glucose-based regimens, in end-stage kidney disease patients treated with continuous ambulatory peritoneal dialysis; 170 patients will be randomized (1:1) to receive XyloCore® or to continue their pre-randomization peritoneal dialysis (PD) therapy with glucose-only PD solutions, for 6 months. The primary study's objective is to demonstrate the noninferiority of XyloCore® in terms of Kt/V urea, for which a clinically acceptable noninferiority margin of -0.25 has been determined, assuming that all patients will be treated aiming to a minimum target of 1.7 and an optimal target of 2.0.
{"title":"Rationale and design of ELIXIR, a randomized, controlled trial to evaluate efficacy and safety of XyloCore, a glucose-sparing solution for peritoneal dialysis.","authors":"Mario Bonomini, Simon Davies, Werner Kleophas, Mark Lambie, Gianpaolo Reboldi, Lorenzo Di Liberato, Josè Carolino Divino-Filho, Olof Heimburger, Alberto Ortiz, Johan Povlsen, Massimo Iacobelli, Tommaso Prosdocimi, Arduino Arduini","doi":"10.1177/08968608241274106","DOIUrl":"10.1177/08968608241274106","url":null,"abstract":"<p><p>Peritoneal dialysis adoption and technique survival is affected by limitations related to peritoneal membrane longevity and metabolic alterations. Indeed, almost all peritoneal dialysis fluids exploit glucose as an osmotic agent that rapidly diffuses across the peritoneal membrane, potentially resulting in metabolic abnormalities such as hyperglycemia, hyperinsulinemia, obesity, and hyperlipidemia. Moreover, glucose-degradation products generated during heat sterilization, other than glucose itself, induce significant morphological and functional changes in the peritoneum leading to ultrafiltration failure. The partial substitution of glucose with osmotic agents characterized by a better local and systemic biocompatibility has been suggested as a potential strategy to innovate peritoneal dialysis fluids. The approach aims to minimize glucose-associated toxicity, preserving the peritoneal membrane welfare and counteracting common comorbidities. In this work, we report the clinical trial design of ELIXIR, a phase III randomized, controlled, blinded outcome assessment study comparing Xylocore<sup>®</sup>, an innovative formulation based on Xylitol and l-carnitine, to standard glucose-based regimens, in end-stage kidney disease patients treated with continuous ambulatory peritoneal dialysis; 170 patients will be randomized (1:1) to receive XyloCore<sup>®</sup> or to continue their pre-randomization peritoneal dialysis (PD) therapy with glucose-only PD solutions, for 6 months. The primary study's objective is to demonstrate the noninferiority of XyloCore<sup>®</sup> in terms of Kt/V urea, for which a clinically acceptable noninferiority margin of -0.25 has been determined, assuming that all patients will be treated aiming to a minimum target of 1.7 and an optimal target of 2.0.</p>","PeriodicalId":19969,"journal":{"name":"Peritoneal Dialysis International","volume":" ","pages":"17-25"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-02-15DOI: 10.1177/08968608231224612
Lijuan Zhao, Zixian Yu, Xiayin Li, Jin Zhao, Yunlong Qin, Meilan Zhou, Ming Bai, Guoshuang Xu, Shiren Sun
Background: This network meta-analysis (NMA) aimed to compare the clinical advantage of four commonly used peritoneal dialysis catheters (PDCs) including the Swan neck segment with straight tip (Swan neck + S), Tenckhoff segment with straight tip (Tenckhoff + S), Swan neck segment with coiled tip (Swan neck + C) and Tenckhoff segment with coiled tip (Tenckhoff + C).
Methods: Randomised clinical trials were searched from PubMed, Embase, the Cochrane Register of clinical trials, China National Knowledge Infrastructure (CNKI) and ChinaInfo from their inception until July 31, 2022. Meta-analysis was performed using Stata 14.0 and RevMan 5.3.5 software to evaluate the four commonly used PDCs.
Results: Seventeen studies involved 1578 participants were included. NMA showed that compared with Swan neck + C, Swan neck + S significantly reduced catheter tip migration (OR 0.47 95% CI 0.22-0.99). Tenckhoff + S was more effective in reducing catheter dysfunction (OR 0.42, 95% CI 0.23-0.79), catheter tip migration with dysfunction (OR 0.19, 95% CI 0.05-0.78) and catheter removal (OR 0.56, 95% CI 0.34-0.93) which were consistent with the pairwise meta-analysis. According to the surface under the cumulative ranking curve, Swan neck + S emerged as the best PDC in the reduction of catheter tip migration (83.3%), followed by Tenckhoff + S (79.4%). Moreover, Tenckhoff + S (86.5%, 76.3%) and Swan neck + S (72.3, 86.9%) ranked as the first and second PDC for 1 and 2-year technique survival which was significantly higher than those of the other two PDCs.
Conclusion: Our NMA showed Swan neck + S and Tenckhoff + S tended to be more efficacious than Swan neck + C and Tenckhoff + C in lowering the mechanical dysfunction and prolonging the technique survival, which may contribute to better clinical decisions. More randomised controlled trials with larger scales and higher quality are needed in order to obtain more credible evidence.
背景:本网络荟萃分析(NMA)旨在比较四种常用腹膜透析导管(PDC)的临床优势,包括天鹅颈段带直头(Swan neck + S)、Tenckhoff段带直头(Tenckhoff + S)、天鹅颈段带螺旋头(Swan neck + C)和Tenckhoff段带螺旋头(Tenckhoff + C):从 PubMed、Embase、Cochrane 临床试验注册中心、中国国家知识基础设施(CNKI)和 ChinaInfo 中检索了从开始到 2022 年 7 月 31 日的随机临床试验。使用Stata 14.0和RevMan 5.3.5软件进行了元分析,以评估四种常用的PDCs:结果:共纳入 17 项研究,涉及 1578 名参与者。NMA显示,与天鹅颈+C相比,天鹅颈+S可显著减少导管尖端移位(OR 0.47 95% CI 0.22-0.99)。Tenckhoff + S 在减少导管功能障碍(OR 0.42,95% CI 0.23-0.79)、导管尖端移位与功能障碍(OR 0.19,95% CI 0.05-0.78)和导管移除(OR 0.56,95% CI 0.34-0.93)方面更为有效,这与成对荟萃分析结果一致。根据累积排名曲线的表面积,在减少导管尖端移位方面,Swan neck + S 是最好的 PDC(83.3%),其次是 Tenckhoff + S(79.4%)。此外,Tenckhoff + S(86.5%,76.3%)和 Swan neck + S(72.3%,86.9%)在 1 年和 2 年技术存活率方面排名第一和第二,明显高于其他两种 PDC:我们的 NMA 显示,在降低机械功能障碍和延长技术存活期方面,Swan neck + S 和 Tenckhoff + S 比 Swan neck + C 和 Tenckhoff + C 更有效,这可能有助于做出更好的临床决策。为了获得更可信的证据,需要更多规模更大、质量更高的随机对照试验。
{"title":"Comparison of different peritoneal dialysis catheters on complications and catheter survival: A network meta-analysis of randomised controlled trials.","authors":"Lijuan Zhao, Zixian Yu, Xiayin Li, Jin Zhao, Yunlong Qin, Meilan Zhou, Ming Bai, Guoshuang Xu, Shiren Sun","doi":"10.1177/08968608231224612","DOIUrl":"10.1177/08968608231224612","url":null,"abstract":"<p><strong>Background: </strong>This network meta-analysis (NMA) aimed to compare the clinical advantage of four commonly used peritoneal dialysis catheters (PDCs) including the Swan neck segment with straight tip (Swan neck + S), Tenckhoff segment with straight tip (Tenckhoff + S), Swan neck segment with coiled tip (Swan neck + C) and Tenckhoff segment with coiled tip (Tenckhoff + C).</p><p><strong>Methods: </strong>Randomised clinical trials were searched from PubMed, Embase, the Cochrane Register of clinical trials, China National Knowledge Infrastructure (CNKI) and ChinaInfo from their inception until July 31, 2022. Meta-analysis was performed using Stata 14.0 and RevMan 5.3.5 software to evaluate the four commonly used PDCs.</p><p><strong>Results: </strong>Seventeen studies involved 1578 participants were included. NMA showed that compared with Swan neck + C, Swan neck + S significantly reduced catheter tip migration (OR 0.47 95% CI 0.22-0.99). Tenckhoff + S was more effective in reducing catheter dysfunction (OR 0.42, 95% CI 0.23-0.79), catheter tip migration with dysfunction (OR 0.19, 95% CI 0.05-0.78) and catheter removal (OR 0.56, 95% CI 0.34-0.93) which were consistent with the pairwise meta-analysis. According to the surface under the cumulative ranking curve, Swan neck + S emerged as the best PDC in the reduction of catheter tip migration (83.3%), followed by Tenckhoff + S (79.4%). Moreover, Tenckhoff + S (86.5%, 76.3%) and Swan neck + S (72.3, 86.9%) ranked as the first and second PDC for 1 and 2-year technique survival which was significantly higher than those of the other two PDCs.</p><p><strong>Conclusion: </strong>Our NMA showed Swan neck + S and Tenckhoff + S tended to be more efficacious than Swan neck + C and Tenckhoff + C in lowering the mechanical dysfunction and prolonging the technique survival, which may contribute to better clinical decisions. More randomised controlled trials with larger scales and higher quality are needed in order to obtain more credible evidence.</p>","PeriodicalId":19969,"journal":{"name":"Peritoneal Dialysis International","volume":" ","pages":"35-43"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139741738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-02-20DOI: 10.1177/08968608231225013
Robert R Quinn, Matthew J Oliver, Alix Clarke, Farah Mohamed, Scott W Klarenbach, Braden J Manns, Danielle E Fox, Nairne Scott-Douglas, Louise Morrin, Anita Kozinski, Tracy Schwartz, Robert Pauly
Background: Peritoneal dialysis (PD) is actively promoted, but increasing PD utilisation is difficult. The objective of this study was to determine if the Starting dialysis on Time, At Home, on the Right Therapy (START) project was associated with an increase in the proportion of dialysis patients receiving PD within 6 months of starting therapy.
Methods: Consecutive patients over age 18, with end-stage kidney failure, who started dialysis between 1 April 2015 and 31 March 2018 in the province of Alberta, Canada. Programmes were provided with high-quality data about the individual steps in the process of care that drive PD utilisation that were used to identify problem areas, design and implement interventions to address them, and then evaluate whether those interventions had impact. The primary outcome was the proportion of patients receiving PD within 6 months of starting dialysis. Secondary outcomes included hospitalisation, death or probability of transfer to haemodialysis (HD). Interrupted time series methodology was used to evaluate the impact of the quality improvement initiative on the primary and secondary outcomes.
Results: A total of 1962 patients started dialysis during the study period. Twenty-seven per cent of incident patients received PD at baseline, and there was a 5.4% (95% confidence interval: 1.5-9.2) increase in the use of PD in the province immediately after implementation. There were no changes in the rates of hospitalisation, death or probability of transfer to HD after the introduction of START.
Conclusions: The approach used in the START project was associated with an increase in the use of PD in a setting with high baseline utilisation.
{"title":"The impact of the Starting dialysis on Time, At home on the Right Therapy (START) project on the use of peritoneal dialysis.","authors":"Robert R Quinn, Matthew J Oliver, Alix Clarke, Farah Mohamed, Scott W Klarenbach, Braden J Manns, Danielle E Fox, Nairne Scott-Douglas, Louise Morrin, Anita Kozinski, Tracy Schwartz, Robert Pauly","doi":"10.1177/08968608231225013","DOIUrl":"10.1177/08968608231225013","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis (PD) is actively promoted, but increasing PD utilisation is difficult. The objective of this study was to determine if the Starting dialysis on Time, At Home, on the Right Therapy (START) project was associated with an increase in the proportion of dialysis patients receiving PD within 6 months of starting therapy.</p><p><strong>Methods: </strong>Consecutive patients over age 18, with end-stage kidney failure, who started dialysis between 1 April 2015 and 31 March 2018 in the province of Alberta, Canada. Programmes were provided with high-quality data about the individual steps in the process of care that drive PD utilisation that were used to identify problem areas, design and implement interventions to address them, and then evaluate whether those interventions had impact. The primary outcome was the proportion of patients receiving PD within 6 months of starting dialysis. Secondary outcomes included hospitalisation, death or probability of transfer to haemodialysis (HD). Interrupted time series methodology was used to evaluate the impact of the quality improvement initiative on the primary and secondary outcomes.</p><p><strong>Results: </strong>A total of 1962 patients started dialysis during the study period. Twenty-seven per cent of incident patients received PD at baseline, and there was a 5.4% (95% confidence interval: 1.5-9.2) increase in the use of PD in the province immediately after implementation. There were no changes in the rates of hospitalisation, death or probability of transfer to HD after the introduction of START.</p><p><strong>Conclusions: </strong>The approach used in the START project was associated with an increase in the use of PD in a setting with high baseline utilisation.</p>","PeriodicalId":19969,"journal":{"name":"Peritoneal Dialysis International","volume":" ","pages":"26-34"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Is cloudy peritoneal dialysate associated with adverse drug reactions to benidipine?","authors":"Yun Lin, Shumin Huang, Xiaorui Cai, Xiaoling Tang, Haohao Chen","doi":"10.1177/08968608241307829","DOIUrl":"https://doi.org/10.1177/08968608241307829","url":null,"abstract":"<p><p>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 (<i>p</i> < 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.</p>","PeriodicalId":19969,"journal":{"name":"Peritoneal Dialysis International","volume":" ","pages":"8968608241307829"},"PeriodicalIF":2.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-09DOI: 10.1177/08968608241301688
Ryan J Chan, Robert R Quinn, Joanne M Bargman
Peritoneal dialysis (PD) was historically the initial kidney replacement modality of choice for patients admitted to the intensive care unit, and there are several advantages to maintaining critically ill PD patients on their usual dialysis therapy. However, in this patient population, there are two contentious questions: how are the respiratory dynamics of mechanical ventilation impacted by the presence of dialysate within the abdomen, and what can be done to mitigate these potential effects? This review discusses the theoretical impact of PD on intra-abdominal pressure (IAP) and evidence for the effect of IAP on respiratory mechanics in mechanically ventilated PD patients.
{"title":"Peritoneal dialysis and its impact on intra-abdominal pressure and respiratory mechanics in the critically ill patient: Can PD take the pressure?","authors":"Ryan J Chan, Robert R Quinn, Joanne M Bargman","doi":"10.1177/08968608241301688","DOIUrl":"https://doi.org/10.1177/08968608241301688","url":null,"abstract":"<p><p>Peritoneal dialysis (PD) was historically the initial kidney replacement modality of choice for patients admitted to the intensive care unit, and there are several advantages to maintaining critically ill PD patients on their usual dialysis therapy. However, in this patient population, there are two contentious questions: how are the respiratory dynamics of mechanical ventilation impacted by the presence of dialysate within the abdomen, and what can be done to mitigate these potential effects? This review discusses the theoretical impact of PD on intra-abdominal pressure (IAP) and evidence for the effect of IAP on respiratory mechanics in mechanically ventilated PD patients.</p>","PeriodicalId":19969,"journal":{"name":"Peritoneal Dialysis International","volume":" ","pages":"8968608241301688"},"PeriodicalIF":2.7,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}