Peritoneal Dialysis International最新文献

Sorbent peritoneal dialysis (SPD) removes a tidal volume of spent dialysate, passing it through sorbent layers before infusing replacement electrolytes and dextrose to regenerate dialysate. We examine the five devices using SPD in published literature, reviewing their design, dialysis clearance, and ultrafiltration (UF) capacity-Automated Wearable Artificial Kidney (AWAK), now called Viva Kompact since 2024, Carry Life System PD/Carry Life UF, Wearable Artificial Kidney (WEAKID), Vicenza Wearable Artificial Kidney (ViWAK), and Renart-PD. Carry Life devices and Viva Kompact have reported on human trials, WEAKID and Renart-PD on animal studies, while ViWAK has published in vitro data. All devices have published data on dialysis clearance capabilities. WEAKID and Carry Life PD achieved a high dialysate:plasma concentration gradient for small solutes. Viva Kompact and Renart-PD reported stable or lower serum concentrations of urea, creatinine, phosphate, and β2-microglogulin following treatments. ViWAK demonstrated removal of creatinine, B2 microglobulin, and angiogenin to <10% of pre-treatment levels. UF capacity remains unknown for many devices. In human trials, Carry Life UF has achieved 863 mL UF in a 5-h treatment with the addition of 20 g/h of glucose to 1.5% dextrose dialysate. Viva Kompact has demonstrated 877 mL UF in a 9-h treatment using 1.5% dextrose dialysate in an animal model, comparable to 10-h APD, with the addition of 6.6 g/h glucose. Both devices have demonstrated improved UF per gram of glucose used. The expected use of these devices varies greatly, from an adjunct to currently available treatments to a complete replacement for current modalities. Large-scale, human studies are needed to determine their role in the future of PD delivery.

BackgroundChronic kidney disease and end-stage renal disease (ESRD) significantly burden the U.S. healthcare system. Despite its benefits, such as cost savings and increased autonomy, peritoneal dialysis (PD) is underutilized. This study examines how state and ESRD network-level variations impact PD utilization across the United States, addressing a gap in previous investigations that have not fully disentangled the effects of measurable patient-level factors from harder-to-capture influences.MethodsWe analyzed publicly available data from the United States Renal Data System, Centers for Medicare and Medicaid Services, and the U.S. Census Bureau covering 50 states and two territories (2015-2020). Multi-level Beta regression models assessed how state-level predictors are associated with PD utilization, accounting for state and network-level variations. Ranked random effects were compared to 2020 PD rates to identify overperforming or underperforming regions.ResultsBetween 2015 and 2020, PD utilization rose from 9.6% to 12.8%. The proportions of incident dialysis patients who were male, ≥ 65 years, and White, respectively, and dialysis facilities per 100,000 people did not significantly affect PD utilization, whereas population density was significantly negatively associated. The final model revealed that unmeasured variations in PD utilization were significantly explained by both state (intraclass correlation coefficient (ICC) = 0.47) and network (ICC = 0.53) factors.ConclusionThe chosen demographic, provider, and geographical factors explain only 18.5% of PD utilization. About half of the remaining variation resides at the state level and half at the ESRD network level, verifying the importance of unmeasured factors at both levels. We provide adjusted PD utilization rankings-identifying overperforming and underperforming states and networks-where future research can identify disparate effective and ineffective regional policies with the aim of optimizing PD uptake.

Mycobacterium tuberculosis (MTB)-related peritonitis is a rare but serious complication in patients receiving maintenance peritoneal dialysis (PD). Early diagnosis is difficult due to the low sensitivity and delayed results of conventional microscopy and culture methods. MTB polymerase chain reaction (PCR) testing in PD effluent is recommended as a diagnostic adjunct, but real-world data remain limited. We conducted a 20-year single-centre retrospective study in a tuberculosis-endemic region to evaluate the diagnostic accuracy and clinical utility of MTB-PCR in PD effluent. Among 372 tests, MTB-PCR demonstrated sensitivity 50%, specificity 100%, negative-predictive value 94.6% and positive-predictive value 100%, using diagnoses based on a composite of clinical and laboratory criteria as the reference standard. Sensitivity showed a numerical trend of improvement from 33.3% with earlier assays to 50-85.7% with newer assays. Of 72 patients with culture-confirmed MTB-PD peritonitis, 13 (18.1%) were diagnosed via MTB-PCR. Compared to those diagnosed by non-PCR methods, MTB-PCR-diagnosed patients had shorter time to anti-tuberculosis treatment initiation (median 8 vs. 22 days, p ≤ 0.001) and shorter hospital stay from presentation to treatment (median 8 vs. 17 days, p = 0.008). They also had a numerically lower rate of PD catheter removal prior to treatment initiation [0/13 (0%) vs. 9/53 patients (17.0%), p = 0.186]. Rates of permanent transfer to haemodialysis and all-cause mortality at 1 year were similar among the two groups. These findings suggest a role for early MTB-PCR testing in suspected MTB-PD peritonitis. Further studies are needed to confirm the findings and optimize diagnostic strategies.

Identifying risk factors that pre-dispose people on peritoneal dialysis (PD) to develop exit site infections (ESIs) may help improve prevention and treatment. Given the differences anatomically, hormonally and of the microbiota profile between males and females, we hypothesised that there is a difference in ESI incidence, outcomes, and the epidemiology of organism-specific ESI between males and females. This study was a retrospective case note review of all PD patients at our centre between 2012 and 2024. Of the 486 patients on PD, 202 (42%) were female and 273 positive swabs from 151 patients were identified (0.18 patient episodes/year). We found no statistically significant difference in the incidence of ESI between sexes in our cohort. Gram-positive organisms accounted for 126/273 (46.2%) of all ESI swabs, suggesting that current empiric antibiotic therapy potentially offers effective treatment for less than half of ESI only. We found significant morbidity from ESI: 39 (14%) patients developed peritonitis and 40 (15%) required catheter removal. Sex had no influence on ESI incidence, microbiology of infection or outcome.

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.

BackgroundPeritoneal dialysis (PD) is an increasingly common modality for end-stage kidney disease patients. Laparoscopic peritoneal dialysis catheter placement (LPDC) may allow for successful outcomes in patients considered to have difficult abdomens for PD.MethodsThis was a retrospective review of 505 consecutive patients who underwent attempted LPDC between July 2009 and May 2024 by a single surgeon. Intraoperative decision making and rate of complications were evaluated in patients with/without comorbidities. Hazard ratio calculations using Cox regression and P-values were calculated using SPSS.ResultsAverage age of the study population is 53.4 ± 14.8 years, 45.1% (n = 228) were female, and 60.2% (n = 304) were Black. Average BMI was 31.7 ± 7.3. Two hundred ninety-two patients (57.8%) had previous abdominal surgery. LPDC could not be done safely in 13 patients (2.6%). Lysis of adhesions at initial placement was needed in 186 patients (36.8%). BMI > 35 kg/m² did not increase the risk of revision with a hazard ratio (HR) of 0.9 (0.6-1.4). Adhesiolysis did not increase the risk of revision (HR 1.3 (0.9-1.9)). Catheter-related complications required revision in 122 patients (24.7%). Catheter-related complications did not vary significantly between those who had (n = 104, 21.1%) and had not had adhesiolysis (n = 91, 18.5%, P > .05). Two or more revisions were required in 35/492(7.1%) patients. One-year modified patency rate was 94.1% (446/474).ConclusionThis represents one of the largest reported single surgeon experiences in LPDC. Laparoscopic techniques can help provide a feasible option for long-term dialysis in patients with a difficult abdomen and the disease of obesity.

Background: Varying peritoneal dialysis (PD)-related clinical outcomes have been reported in different countries. As a participant of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), this study investigated the characteristics of Korean PD patients, PD facilities and the incidence rates of clinical outcomes including mortality and PD-related outcomes.

Methods: From July 2019 to December 2021, a total of 766 Korean PD patients were included for analysis. Poisson regression analysis was used to explore the incidence rates of various clinical events including mortality, modality transfer, exit site or catheter tunnel infection and peritonitis.

Results: Among the 766 patients (median age 55.5 years, males 59.5%), 276 were incident and 490 were prevalent PD patients. The incidence rates of events were as follows: all-cause mortality (0.048), modality transfer (0.051), exit site or catheter tunnel infection (0.054) and peritonitis (0.136) events per person year. The most common causative organism for exit site or tunnel infection was staphylococcus species (47%) and that for peritonitis was streptococcus (28%) followed by staphylococcus (27%) species.

Conclusions: Up to now, PDOPPS Korea has recruited 766 Korean PD patients and started documentation of major PD-related outcomes which occurred during the follow-up period. The overall incidence rates of clinical outcomes in Korean PD patients were relatively favourable. There was no statistically significant difference in the incidence rates of clinical outcomes according to both facility and patient factors.

BackgroundVariation in residual volume between peritoneal dialysis dwells creates uncertainty in ultrafiltration determination, dialysis efficiency, and poses a risk of overfill if the residual volume is large. Measuring the dilution of a marker molecule during fluid fill offers a convenient approach, however, estimation accuracy depends on the choice of dilution marker. We here evaluate the feasibility of creatinine and urea as dilution markers compared to albumin-based residual volumes and three-pore model estimations.MethodThis clinical, retrospective analysis comprises 56 residual volume estimations from 20 individuals, based on the dilution of pre-fill dialysate creatinine, urea and albumin concentrations during the dialysis fluid fill phase. Outcomes were compared individually. Bias induced by ultrafiltration, marker molecule mass-transfer and influence of fluid glucose contents was quantified using the three-pore model. Linear regression established conversion factors enabling conversion between the various marker molecules.ResultsCreatinine-based calculations overestimated residual volumes by 115 mL (IQR 89-149) in 1.5% dwells and 252 mL (IQR 179-313) in 4.25% glucose dwells. In hypertonic dwells, ultrafiltration was 52 mL (IQR 38-66), while intraperitoneal creatinine mass increased by 67% during fluid fill, being the leading cause of overestimation. Albumin-based volumes conformed strongly with three-pore model estimates. Correction factors effectively enabled marker molecule interchangeability.ConclusionsMass-transfer of low molecular weight marker molecules is associated with residual volume overestimation. However, by applying correction factors, creatinine and urea dilution can still provide reasonable estimates, particularly when the purpose is to exclude the presence of a very large residual volume.

There is growing emphasis on increasing utilization of peritoneal dialysis (PD) in patients with end stage kidney disease (ESKD); however, use in patients with severe obesity has still been fraught for various reasons. We aim to assess the viability of PD in patients with severe obesity (BMI > 40 Kg/m²). We conducted a retrospective chart review of patients admitted at the home dialysis center of an academic center between 2014 and 2020 (n = 99). Patients with a BMI>40 kg/m² at the time of PD initiation (n = 9) were selected. We extracted and examined the data for these nine patients till March 2023. The mean age at baseline was 47.8 ± 12.6 year, 56% were males, 67% were Hispanic, 33% were white, and mean BMI was 43.3 ± 3.4 kg/m². By the end of the follow-up of this report, five (56%) patients were still active on PD (mean duration 27.8 ± 4.5 months). PD therapy was terminated in 3 (33%) patients (17.7 ± 6.8 months) due to refractory peritonitis, burnout, transfer to rehabilitation facility, respectively. One patient transferred out to another facility after 10.6 months. Rates of access and mechanical complications as well as peritonitis in these nine patients were similar to center's overall rates. All the patients had elimination of uremic symptoms using incremental prescription and met weekly Kt/V targets of >1.7 using adjusted weight. Overall, patients' weight and glycemic control remained stable. In conclusion, PD can be an effective long-term high-quality dialysis option for patients with ESKD and severe obesity. Further studies in a larger population are required to confirm our findings.

Peritoneal dialysis effluent should be clear and any changes in aspect require further investigation. We report a case of a spontaneous milky white effluent (chyloperitoneum) associated with calcium channel blockers in a peritoneal dialysis patient. Our case is a 43-year-old man that presents with milky white peritoneal dialysis effluent 9 days after starting peritoneal dialysis. He didn't have any other complaints and he wasn't prescribed any new medications. In the effluent sample we found high triglycerides (1.8 mmol/L) thus confirming the chyloperitoneum. We suspended lercanidipine and within a few days the peritoneal dialysis effluent was clear. Currently the patient is well adjusted to the technique and had no further episodes of chyloperitoneum.