Peritoneal Dialysis International最新文献

A peritoneal mesothelial cyst is a rare entity, commonly asymptomatic, which is usually detected as an incidental radiological finding and needs surgical intervention for complete removal. We present a unique case of a peritoneal simple mesothelial cyst that was removed accidentally during peritoneal dialysis in a pediatric patient.

Introduction: Despite 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.

Methods: The 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.

Results: Fifty-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.

Conclusions: The 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.

Background: Although both hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) are covered by national healthcare insurance, 98% of kidney failure disease patients are treated with hemodialysis. This study compared the health-related quality of life (HRQoL) and utility scores of patients receiving hemodialysis and CAPD in Indonesia and determined factors associated with HRQoL and utility scores.

Methods: A cross-sectional study was performed using the Kidney Disease Quality of Life-36 and EQ-5D-5L instruments at six hospitals. Utility scores were presented as SF-6D and EQ-5D scores. Factors associated with the EQ-5D were evaluated using Tobit regressions due to ceiling effects, while the SF-6D and HRQoL were assessed using generalized linear models since the data were not normally distributed.

Results: Among the 613 patients, 76% were treated with hemodialysis. After adjusting for sociodemographic characteristics and clinical parameters, CAPD patients reported better HRQoL compared to hemodialysis patients in terms of the SF-6D (p = .038), mental component summary (p = .020), symptoms (p = .005), and effects of kidney disease (p<.001), but no significant differences were reported in EQ-5D (p = .083), physical component summary (p = .323), burden of kidney disease (p = .111), and kidney summary scores (p = .068). Poorer HRQoL and utility scores were likely experienced by older patients who were male, married, with diabetes, treated in Class A hospitals, and with lower education, hemoglobin, and albumin levels.

Conclusion: In Indonesia, patients treated with CAPD had better HRQoL and utility scores compared to patients undergoing hemodialysis. Therefore, CAPD should be promoted by healthcare professionals as the first treatment option for patients who are eligible for both hemodialysis and CAPD.

Peritoneal dialysis (PD) has become an established treatment modality for end-stage kidney disease (ESKD) in recent years, though catheter dysfunction remains a common issue, often due to adhesions or migration. Laparoscopic surgery is an effective method for addressing these problems with precision and minimal trauma. A rare cause of catheter dysfunction is fimbriae adhesions, where the fimbriae of the fallopian tubes obstruct the catheter. We present a case of a 23-year-old woman with ESKD who transitioned to PD, complicated by catheter blockage within days. Radiographs suggested adhesions and diagnostic laparoscopy revealed fimbriae entangling the catheter. Laparoscopic adhesiolysis and catheter replacement were performed, with the fallopian tubes secured to the ipsilateral ovary to prevent recurrence. Post-surgery, catheter function was restored, and an 18-month follow-up showed no complications. This case highlights the importance of considering fertility preservation in cases of fimbrial adhesions and underscores the value of laparoscopic intervention.

Background: Frailty is associated with poor outcomes for patients on dialysis; however, dedicated studies among incident peritoneal dialysis (PD) patients are lacking. This study aims to determine the association between frailty and mortality/transfer to hemodialysis (HD) among incident PD patients and identify whether dialysis modality (PD vs. HD) modifies the association of frailty and mortality following dialysis initiation.

Methods: A single center retrospective cohort of incident PD and HD patients was analyzed from 2009 to 2020 (last follow-up December 2021). The first version of the clinical frailty scale (CFS) ranging from 1, very fit, to 7, severely frail, was used to characterize patient frailty at dialysis initiation. Time to death/transfer to HD was analyzed using multivariable Cox Survival analyses. Patients were censored at transplant/last follow-up. Dialysis modality was evaluated as a potential effect modifier on the impact of frailty on mortality.

Results: Of 253 patients who initiated PD, 182 had completed CFS scores. Mean age at dialysis initiation was 63 ± 13 years and mean CFS score was 3 ± 1. There were 42 deaths and 69 instances of transfer to HD over 379 patient-years at risk. Vulnerable/frail patients (CFS ≥ 4) had a two-fold increase in the adjusted relative hazard for death/transfer to HD (HR 2.04, 95% CI [1.10-3.77]). Incident dialysis modality did not modify the association between frailty and mortality.

Conclusions: A higher severity of frailty at PD initiation is associated with both mortality/transfer to HD and mortality alone, and the association between frailty and mortality is not modified by dialysis modality.

Background: Children with severe chronic kidney disease receiving maintenance peritoneal dialysis (PD) are often malnourished and may require nutritional supplementation. Recent PD guidelines address laparoscopic and open surgical gastrostomy as safe approaches in children established on PD, while existing evidence on percutaneous endoscopic gastrostomy (PEG) is still lacking; as well as the role of perioperative antibiotic and antifungal prophylaxis. Hence, this study aimed to report our experience with PEG placement in patients on PD and compare it with the available literature.

Methods: We retrospectively reviewed the medical records from patients on PD, who underwent PEG placement at a tertiary referral centre between 2000 and 2020. Data on perioperative management, complications and outcomes were retrieved. An extensive literature search was performed; studies describing PEG placement and perioperative prophylaxis in patients on PD were used as a comparison. Descriptive statistical analysis was conducted.

Results: Seven patients (five males) were included. Perioperative antibiotic and antifungal prophylaxis were standard practice. At a median follow-up of 27 months (10-75), the peritonitis rate was 0.2 patient/years. No statistical significance was found between the peritonitis rate before and after PEG placement (p = 0.2). Patients' demographics and postoperative complications were comparable to the reported studies.

Conclusions: Based on our experience, our technique of PEG insertion with antimicrobial prophylaxis is feasible and associated with an acceptable complication risk in patients on PD. Further multicentric studies about surgical technique in patients on PD will be necessary to verify the feasibility of PEG and standardise the perioperative protocol.

Introduction: In South Africa, only children considered eligible for transplantation are offered dialysis as bridge to kidney transplantation. Maintenance peritoneal dialysis (PD) is preferred and has several advantages over hemodialysis (HD). While awaiting transplantation, PD may be discontinued due to permanent transfer to HD or death while on PD, of which the occurrence and burden is not known in our setting. We investigated the rate of discontinuation of maintenance PD, and associated factors among children awaiting a kidney transplant under challenging socio-economic circumstances in a low resource setting.

Methods: Single center retrospective analysis of children receiving maintenance PD. Outcomes included the proportion of children who discontinued PD before transplantation, associated factors and timing of discontinuation, and the proportion transplanted. Time to discontinuation or transplantation was displayed using a Kaplan-Meier curve.

Results: Sixty-seven children who received maintenance automated PD as initial dialysis modality were identified from the kidney transplant waiting list between January 2009 and December 2018. Complete data was available for 52 of the 67 children. Four children had prior failed kidney transplants. The median age was 11 years (interquartile range 6.0, 13.1). Overall, 17/52 (32.7%) children discontinued PD, with 13 (25%) transfers to HD and 4 deaths (7.7%), whereas 29/52 (55.8%) received a kidney transplant. Three of the deaths were PD related. Six children remained on maintenance PD at the end of the study period. Over a half of our patients discontinued PD by 12 months, and 80% by 30 months. Most PD discontinuations were associated with peritonitis.

Conclusions: The proportion discontinuing PD was high, highlighting the need to optimize measures to improve retention rates, especially through prevention of peritonitis.

Background: Exit site infections are a risk factor for the development of peritonitis in patients on long-term peritoneal dialysis. Visual assessments of an exit site utilising currently available tools (Twardowski and Mid-European Pediatric Peritoneal Dialysis Study Group (MEPPS)) are necessary to objectively characterise the appearance of an exit site. The aim of this study was to assess the interobserver agreement of exit site evaluations utilising both exit site scoring tools.

Methods: Exit site evaluations were independently performed by two evaluators during outpatient visits at 13 sites within the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease collaborative. The frequency and percentage of evaluations where both reviewers agreed were calculated. A sub-analysis was performed looking at evaluations where disagreement occurred.

Results: A total of 371 paired exit site evaluations were collected over 6 months. For the majority of evaluations (range: 78%-97% Twardowski, 78%-97% MEPPS), both reviewers agreed that no abnormality was present across all domains. When the analysis was restricted to evaluations where at least one reviewer noted an abnormality, interobserver agreement fell across all domains (range: 31%-61% Twardowski, 56%-66% MEPPS). Disagreements more commonly occurred regarding the presence versus absence of an abnormality, rather than a difference in the severity of an abnormality.

Conclusions: Whereas interobserver agreement is high when the appearance of a peritoneal dialysis catheter exit site is characterised as 'normal', interobserver disagreement is common when the appearance of the exit site is 'abnormal'. Further work is warranted to improve interobserver agreement of exit site assessments and to identify domains conferring an increased risk of infection.