Peritoneal Dialysis International最新文献

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.

BackgroundLack of data on the accuracy of continuous glucose monitoring systems currently limits their usage in people with diabetes on peritoneal dialysis (PD).AimWe aimed to assess the analytical and clinical accuracy of the FreeStyle Libre (FSL) continuous glucose monitoring system in people with diabetes on PD.Methods12 participants using Icodextrin in their PD regime were recruited to a single-centre observational study. They wore a blinded research model of the FSL for 10 days. Results from the FSL were compared with venous glucose measured on a Yellow Springs Instrument (YSI) and self-monitored capillary blood glucose (SMBG) recorded five times per day over the 10-day study.ResultsThe mean absolute relative difference from 84 FSL-YSI matched pairs was 9.8% (95% CI 8.6-11.1) and from 416 FSL-SMBG matched pairs, it was 17.3% (95% CI 16.24-18.43). The systematic error for the FSL as determined by Bland-Altman analysis was -0.6 ± 1.0 mmol/l compared with YSI and -1.4 ± 1.9 mmol/l compared with SMBG. With regard clinical accuracy, compared with YSI and SMBG, respectively, 100% and 99.9% of sensor values were in clinically acceptable zones A and B of Parkes consensus error grid.ConclusionWe demonstrated satisfactory performance of the FSL monitoring system by both analytical and clinical metrics in this cohort of PD patients using treatment prescriptions including Icodextrin-based fluids. Larger studies are now needed to provide clinicians with appropriate reassurance if this technology is to be used with confidence in people on PD.

As humanity's marked effects on Earth's natural systems become increasingly apparent, we witness with alarm the impact on health and healthcare delivery. In this review, interrelationships between climate change, kidney health, and peritoneal dialysis (PD) therapies are described, and expansion of duty of care to the environment while maintaining the highest-quality healthcare is explored. Practical, high-yield actions that can be undertaken by patients and providers through the principles of sustainable care are introduced, including medication and single-use plastic consumables optimization, incremental PD, remote health monitoring, innovative PD effluent drainage, waste optimization, and importantly, patient empowerment as partners in sustainability. To ensure sustainable practices are embedded in clinical care, creation of a network of green champions, alignment with low carbon sustainable health systems more broadly, and appropriate uptake of emerging innovations in PD therapy that may be offered through sustainable procurement and regional or point of care dialysate production are crucial.

BackgroundAt low levels of kidney function, uremic symptoms prompt the initiation of dialysis. Peritoneal dialysis can continue to relieve these symptoms even when patients become anuric. To accomplish this, dialysis must maintain the plasma levels of solutes which cause symptoms lower than they were when dialysis was initiated. This study examined kinetic properties that solutes must possess for peritoneal dialysis to accomplish this. We sought further to identify solutes that possess these properties.MethodsMathematical modeling analyzed kinetic properties that determine a solute's plasma level in an anuric dialysis patient relative to its level when symptoms prompt dialysis initiation. The predictions of modeling were compared to the observed behavior of the solutes methylurea, guanidine, and phenylacetylglutamine measured in 22 patients on peritoneal dialysis and 22 patients with advanced chronic kidney disease using liquid chromatography tandem mass spectrometry.ResultsModeling showed that peritoneal dialysis can effectively control the plasma levels only of solutes which have a high dialytic clearance relative to their native kidney clearance. Chemical measurements showed that the dialytic clearance of methylurea was close to that of urea while the dialytic clearances of guanidine and phenylacetylglutamine were lower. Comparison of these dialytic clearances with residual native kidney clearances suggested that if their generation rates remained stable, peritoneal dialysis could control the levels of methylurea but not guanidine or phenylacetylglutamine in anuric patients.ConclusionA search for solutes whose properties include a high dialytic clearance and a relatively low native kidney clearance could identify solutes that contribute to uremic symptoms.

BackgroundThe proportion of dialysis patients performing PD in Australia is decreasing over time.¹ Understanding the trends in population, the rates and causes of peritonitis and haemodialysis (HD) transfer over time is critical towards understanding this trend.MethodsStudy Design: Registry-based cohort study using Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data. Inclusion criteria: All Australian patients starting PD older than 18 years, starting PD within 90 days of KRT entry from 1 January 2013 through 31 December 2022.AnalysisPeritonitis rates were analysed using Poisson regression, while time to first peritonitis and HD transfer were assessed using Cox Proportional Hazards and competing-risks regression models.ResultsThe demographic profile of PD patients has remained relatively stable. Peritonitis rates declined from 0.40 to 0.33 infections per patient-year between 2013 and 2022. Over time, peritonitis-associated HD transfer reduced, HR 0.96 [95% CI: 0.93-0.98], p < .001. Despite this, there was a deterioration in overall HD transfer, HR 1.03 [95% CI: 1.02-1.04] per year, p < .001 and worse adjusted non-infective HD transfer HR 1.02 [95% CI: 1.01-1.04] per year, p = .006.ConclusionPD utilisation in Australia has declined over the past decade, despite improvements in peritonitis rates and peritonitis-associated HD transfer. The demographic profile of PD patients has remained relatively stable, suggesting systemic rather than patient-level factors are driving these trends. The apparent disconnect between infection control improvements and overall HD transfer highlights the growing importance of non-infective contributors such as access, psychosocial factors, and clinical support.

We share an unusual presentation of fungal (Aspergillus) peritoneal dialysis catheter infection diagnosed by a color change in a patient's PD transfer set. Recognizing and sharing uncommon presentations of fungal infection is important to help others diagnose and intervene early, which may reduce the development of fungal peritonitis, which is associated with high rates of mortality and technique failure.