Peritoneal Dialysis International最新文献

A 69-year-old male with end-stage kidney disease secondary to ischemic cardiomyopathy and peripheral arterial disease presented with early peritoneal dialysis (PD) catheter dysfunction, 14 weeks after laparoscopic insertion of a Di Paolo catheter. The patient experienced slow and incomplete effluent drainage (800 mL out of 1000 mL instilled). Clinical examination revealed a reducible, non-painful right incisional hernia at the site of a prior aortofemoral vascular bypass. Abdominal imaging, including X-ray and CT scan, identified catheter malposition in the right iliac fossa, with the catheter tip trapped in the right incisional hernia sac containing small bowel. Laparoscopic exploration confirmed adhesions and catheter entrapment. After adhesiolysis and repositioning of the catheter into the pouch of Douglas, a functional peroperative test confirmed excellent catheter function. Hernia repair was performed on both sides, with prosthetic mesh on the right and Lichtenstein repair on the left to prevent contralateral hernia development. Postoperative recovery was uneventful, and PD resumed after 3 weeks. This case illustrates a rare cause of PD catheter malfunction due to hernia entrapment. The weight of the catheter may have contributed to its migration into the pre-existing hernia. Systematic screening for abdominal wall hernias in patients with prior vascular or abdominal surgery should be part of pre-PD evaluation to avoid such complications.

IntroductionIncremental peritoneal dialysis (PD) may confer environmental benefits compared to full-dose PD due to reduced resource use. We aimed to quantify and compare carbon emissions, water consumption, and waste generation between incremental and full-dose PD in a cohort of incident PD patients.MethodsWe compared environmental metrics, including carbon emissions, water consumption, and waste generation between incremental and full-dose PD, using prospectively collected data between June 2019 and May 2024 at the Western Renal Service, Sydney, Australia. Carbon emissions were quantified using standardized coefficients from a published life-cycle analysis, while water and waste volumes were estimated using literature-based assumptions. Group comparisons were conducted using the Mann-Whitney U test, with a two-sided p-value <0.05 considered statistically significant.ResultsAmong 365 incident patients (187 incremental, 178 full-dose), followed for a median of 20 months (interquartile range 13-37), incremental PD had lower median annual per-patient carbon dioxide equivalent emissions (1016 vs. 1360 kg), blue water consumption (24,090 vs. 25,548 L), landfill waste (212 vs. 271 kg), gray water generation (8213 vs. 10,549 L), and recycling volume (73 vs. 131 kg), compared to full-dose PD (all p < 0.001). Incremental PD yielded estimated savings of 201,087 kg carbon dioxide equivalent emissions, over 5 million liters of blue water, 1.8 million liters of gray water, 27,223 kg of landfill waste, and 16,219 kg of recyclable materials.ConclusionIncremental PD was associated with a lower environmental impact than full-dose PD, highlighting its potential contribution to environmentally sustainable dialysis care.

Peritoneal dialysis-associated peritonitis (peritoneal dialysis (PD) peritonitis) is a common complication of peritoneal dialysis associated with adverse events and mortality. Outcomes are poorer when two or more organisms are isolated in the dialysis effluent culture, known as polymicrobial PD peritonitis, which can be caused by an underlying secondary process, such as gastrointestinal tract pathology and, rarely, a foreign body. Here, we report a case of polymicrobial PD peritonitis due to a vegetable matter foreign body perforating the colon. The patient was conservatively managed with antibiotic treatment and subsequent colonoscopic removal of the foreign body without the need for peritoneal dialysis catheter removal. She continues to remain on peritoneal dialysis 18 months after the PD peritonitis episode.

BackgroundProtein-energy-wasting (PEW) is a prevalent condition in patients undergoing peritoneal dialysis (PD) associated with poor outcomes and anthropometry assessment is necessary for its diagnosis. The aim of this study was to compare whether anthropometry or bioimpedance spectroscopy (BIS) in the diagnosis of PEW differ in predicting all-cause mortality in PD patients.MethodsProspective, multicenter and observational study. The diagnosis of PEW was performed using the criteria of the International Society of Renal Nutrition and Metabolism (ISRNM). The measurement of muscle and fat mass was done using both anthropometry and BIS. Patients were followed for up to two years for adverse events. The survival rates of the patients identified with PEW according to both methods were compared. Patient survival was analyzed using a competing risk approach as proposed by Fine and Gray.ResultsWe included 121 patients with mean age of 58.9 ± 14.2 years, almost half of them with diabetes as the primary kidney disease (48.4%) and 52.5% were males. We identified 16 (13.2%) patients with PEW using anthropometry and 25 (20.7%) using BIS. In 92 (76%) patients there was no diagnosis of PEW independent of the method used to measure muscle mass and fat. PEW was a strong predictor of death. After adjustments for confounders the diagnosis of PEW using anthropometry was a better predictor of patient survival comparing to BIS.ConclusionPEW was associate with all-cause mortality either using anthropometry or BIS. Both assessment tools have clinical utility; however, in this study, anthropometry demonstrated greater effectiveness in identifying patients at increased risk of mortality.

Peritoneal dialysis (PD) is a preferred dialysis modality in many patients and healthcare settings, as it enables patient independence, reduces hospital visits, and health costs when compared to center-based hemodialysis (HD). However, PD technique failure due to loss of residual kidney function and/or loss of peritoneal membrane function may require patients to transition to HD, where hybrid dialysis (combining PD and HD) may be a viable alternative to thrice-weekly HD, while also promoting patient-centered care. However, hybrid dialysis is not advocated in current clinical practice guidelines, potentially due to a lack of clinician experience or high certainty evidence on the benefits, safety, and cost of combining PD and HD. In this narrative review, we summarize the existing data on health and economic outcomes in patients transitioning from PD alone to combined PD and HD, which may inform patient selection, dialysis prescription, and evaluation of dialysis quality for clinicians and patients considering hybrid dialysis.

Peritoneal dialysis (PD) catheter dysfunction is an important mechanical complication in patients undergoing PD. Although there are many causes of mechanical obstruction causing PD catheter dysfunction, very rarely the obstruction can be caused by fallopian tubes. We report a case of a 42-year-old female who experienced PD catheter dysfunction at 6 weeks post-PD catheter insertion from fallopian tube invasion of the PD catheter. Diagnosis was confirmed using laparoscopy with intraoperative interventions to release the fimbriae from the drainage holes and no further recurrence at 3 months of follow up. Right fallopian tube involvement was more commonly seen in previous reports however our case was the first to be reported to involve both fallopian tubes.

Increasingly, nephrologists struggle with providing care to patients with complex diseases who are heading towards the end of life. In this vignette, we illustrate how to recognize and acknowledge disease progression, tailor treatments to frailty status, and extend high-quality kidney care through to the time of death. Questions answered include how to discuss prognosis while retaining feelings of hope, and tips on how to recognize that the end-of-life may be approaching are included as part of the case discussion. We advocate for modest changes to nephrology care guidelines that promote integration of both high clinical standards and holistic and practical kidney care.

BackgroundThe impact of peritoneal filling on hepato-splanchnic perfusion during peritoneal dialysis has not been fully elucidated yet.MethodsMeasurements were done in 20 prevalent peritoneal dialysis patients during a peritoneal equilibration test (PET) with 2L of standard dialysate. Data were obtained in the drained state at baseline (T₀), after instillation (T₁), and after 2 h of dwell time (T₂). Intra-abdominal pressure (IAP) was measured by Durand's approach. The hepatic clearance index (KI) of indocyanine-green (ICG) was determined as an indirect measure of hepato-splanchnic blood flow. Cardiac index (CI), heart rate (HR), and total peripheral resistance index (TPRI) were derived from continuous arterial pulse analysis. Fluid volume overload (VO) was evaluated by multifrequency bioimpedance analysis. Ejection fraction (EF) was obtained from echocardiographic examination.ResultsIAP was 5.8 ± 3.5 mmHg at baseline (T₀), rose to 9.4 ± 2.8 mmHg after instillation of dialysate (T₁), and further to 9.7 ± 2.8 mmHg after 2 h of dwell time (p < 0.001). KI slightly declined from 0.60 ± 0.22 L/min/m² at T₀ to 0.53 ± 0.15 L/min/m² at T₁ (p = 0.075), and returned to 0.59 ± 0.22 L/min/m² at T₂ (p = 0.052). CI, HR, and TPRI did not change significantly. In five patients with an EF < 40% KI was significantly lower at T₁ (0.42 ± 0.12 L/min/m²; p = 0.039), and further decreased at T₂ (0.40 ± 0.04 L/min/m²; p = 0.016) compared to patients with normal EF (T₁: 0.58 ± 0.15 L/min/m² and T₂: 0.67 ± 0.22 L/min/m²).ConclusionsOverall, hepatic clearance of ICG as a marker of hepato-splanchnic blood flow is not affected by the filling of the peritoneal cavity.

BackgroundVentral hernia is a common surgical problem among patients with end-stage kidney disease (ESKD), while the optimal repair technique for small ventral hernias is controversial. This study aimed to compare the outcomes of open suture repair versus biological mesh repair of small ventral hernias with defect size ≤2 cm in ESKD patients.MethodData from consecutive ESKD patients who underwent elective ventral hernia repair with defect size ≤2 cm at a single institution from January 2012 to January 2022 were retrospectively reviewed. Outcomes of open suture repair were compared to Permacol^TM mesh repair. The primary outcome was recurrence rate. Secondary outcomes included post-operative complications, peri-operative and post-operative dialysis regimen.ResultsForty-seven ventral hernia repairs were included, with 20 being suture repairs and 27 being Permacol^TM mesh repairs. Median age at hernia repair was 60 (range 32-81) years old. Pre-operatively, 42 patients (89.4%) were on peritoneal dialysis (PD). Paraumbilical hernia (59.6%) was most common. Median hernia defect size was 15 mm (range 2-20 mm). Upon median follow-up of 56 (range 9-119) months, more patients in the suture repair group developed recurrence (30% vs. 0%, p = 0.004). Median time to recurrence was 10 (range 5-16) months. There was no wound or mesh infection. The majority of patients underwent intermittent PD peri-operatively and were able to resume on PD in the long run.ConclusionVentral hernia repair is indicated in ESKD patients even for small defects; repair with Permacol^TM mesh was associated with a lower recurrence rate when compared to suture repair and post-operative morbidity was low.

Peritoneal dialysis (PD) provides independence and quality of life comparable to in-center hemodialysis, but its long-term success depends on comprehensive training and sustained support. This editorial underscores the pivotal role of PD nurses as educators, partners, and motivators in empowering patients and caregivers. Beyond clinical skills, effective training must also address psychosocial stressors, as patient and caregiver burnout is an overlooked barrier to technique survival and adherence. Drawing on ISPD and NKF-KDOQI guidance, we highlight strategies such as early education, routine assessment of well-being, peer mentorship, retraining, and remote patient monitoring to foster resilience, prevent isolation, and reduce dropout. By prioritizing holistic, patient-centered training, healthcare systems can strengthen outcomes, enhance sustainability, and ensure PD remains a lifestyle-enabling therapy.