Peritoneal Dialysis International最新文献

BackgroundDespite the exceptional quality of peritoneal dialysis (PD) care in Taiwan and the country's globally high PD patient survival rates, PD utilization has declined. This trend is likely due to limited patient awareness and disparities in financial incentives between hemodialysis (HD) and PD. To address this issue, a new initiative has been launched to rebalance these incentives and promote PD adoption, with the goal of reversing the declining trend.MethodsEnforcing a policy to encourage PD therapy among specific patient populations is crucial, given its benefits for proactive patients and fewer hospital visits. To address these trends, Taiwan's National Health Insurance Administration launched a reimbursement initiative in July 2023, guided by the expertise of the Peritoneal Dialysis Working Committee of the Taiwan Society of Nephrology. This initiative encourages the setup of new PD units, education for new staff, and an integrative care approach provided by medical centers and their collaborative community clinics. Additionally, this initiative encourages comprehensive SDM on KRT modality choice and reimburses telemedicine video consultations.ResultsIn this reimbursement initiative, our primary focus is on improving PD quality rather than solely increasing the quantity of new PD patients. As of the end of 2023, the short-term outcomes of this initiative are promising, including the reopening of six previously closed PD units, the establishment of 68 new units, and an increase in the crude PD prevalence rates from 7.5% to 7.9% (p = 0.006). Since the implementation began, the adherence rate at medical centers, as measured by a scoring system evaluating the high standard of PD care quality, has reached 100%, while regional hospitals have reached nearly 90%.ConclusionsThe short-term outcomes of this initiative are promising, and it is still ongoing, with plans to continue for at least three years. We look forward to sharing the long-term outcomes and insights gained from this initiative in the near future. While healthcare systems differ across countries, Taiwan's model may offer valuable insights for other nations by showing how such initiatives can mobilize healthcare teams, empower patients, and ultimately support long-term expansion of PD.

Chronic kidney disease (CKD) may be associated with dysbiosis which may increase the risk of gastrointestinal infections. Patients with kidney failure have a predominance of bacteria responsible for the exacerbation of chronic inflammation through the production of ureases, uricase, and uremic toxins and a reduction of bacteria-producing protective molecules as short-chain fatty acids. Patients with CKD have an increased risk of Clostridioides difficile infection. Currently, besides antibiotic therapy, fecal microbiota transplantation (FMT) is the only effective gut microbiota-targeted therapy for treating this infection. Scant evidence is available on FMT in those receiving peritoneal dialysis (PD). In this case, we report a successful FMT performed by colonoscopy in a patient receiving PD for polycystic kidney disease suffering from recurrent Clostridioides difficile infections. The FMT was repeated to enhance microbiota engraftment. The role of FMT in treating Clostridioides difficile in individuals receiving PD may be an important and promising therapeutic strategy but requires further prospective study.

This case report discusses the complex management of a 46-year-old man with poorly controlled type 1 diabetes mellitus, stage 5 chronic kidney disease, and severe neuropathic complications, which led to bilateral leg amputations. The patient experienced persistent diarrhea due to diabetic neuropathy, significantly impairing his daily functioning. Despite transitioning from hemodialysis to peritoneal dialysis, the diarrhea persisted. A colostomy was subsequently performed, which, although it did not completely resolve the diarrhea, allowed for better control, improving the patient's self-care and independence. Notably, the catheter exit site was maintained on the opposite side of the abdomen. Despite initial concerns about the feasibility of peritoneal dialysis (PD) in patients with stomas, including the challenges of creating a stoma in patients with an existing PD catheter, this case demonstrates the successful continuation of PD following a colostomy. Traditionally, intestinal stomas have been viewed as a relative contraindication to PD due to risks such as leakage and infection. However, current guidelines recommend using extended catheters with a presternal exit site to minimize these risks. The patient's quality of life improved significantly after the colostomy, with no major complications observed during follow-up. This report underscores the importance of tailoring treatment to individual patient needs, balancing risks with potential well-being benefits, and highlights the necessity of interdisciplinary collaboration and adherence to best practices. Given the limited literature on PD in patients with intestinal stomas, this case contributes valuable clinical insights for future management.

BackgroundAlthough the impact of aerobic exercise (AE) and resistance training (RT) on peritoneal dialysis (PD) patients is well established, the impact of exercise programs on residual kidney function (RKF) has not been elucidated.MethodsPatients were randomly assigned to either the exercise (n = 25) or control groups (n = 30). Patients in the exercise group performed AE three times a week and RT twice a week at home for 24 weeks. The control group did not receive any specific intervention. The primary outcome was RKF, assessed by residual glomerular filtration rate (rGFR). Secondary outcomes included urinary protein levels, distance covered in the incremental shuttle walking test (ISWT), and glycated hemoglobin (HbA1c) percentages.ResultsLinear mixed-effects models showed no significant changes in mean rGFR between the exercise and control groups at 12 weeks (-0.40; 95% confidence interval (CI): -2.17, 1.36; p = 0.65) and at 24 weeks (0.65; 95% CI: -1.15, 2.45; p = 0.48). There was a trend toward improvement in mean urinary protein level and ISWT results, and a significant decrease in mean HbA1c percentage at 24 weeks in the exercise group (-1.07, 95% CI: -2.29, 0.15, p = 0.09; 37.7, 95% CI: -10.1, 85.5, p = 0.12; -0.57, 95% CI: -0.97, -0.18, p = 0.005, respectively) compared to the control group.ConclusionThe 24-week home-based exercise program did not demonstrate beneficial effects on RKF in incident PD patients. Nonetheless, it may have an impact on reducing urinary protein levels and HbA1c percentages.

Exercise and physical activity have been shown to improve health outcomes among people receiving peritoneal dialysis (PD), however, little is known about PD clinicians' perceptions and practices regarding exercise counselling. To inform exercise program design and implementation, we distributed a cross-sectional online questionnaire to PD clinicians between July and December 2021 through professional nephrology societies and networks. As part of this survey, participants were asked, "What are the most important aspects you would like to see incorporated in an exercise program for PD patients?" Six hundred and nine respondents provided 1249 unique perspectives. Responses were coded using summative content analysis and grouped into themes. The overarching theme identified was the need for individualized and accessible programming. Under this umbrella, the four main sub-themes identified were: promotion of specific exercises, overcoming common barriers to exercise, perceived cornerstones of exercise prescriptions, and program design to address patient-relevant outcomes. Overall, PD clinicians believed that PD does not preclude exercise participation and recognized the potential for exercise to improve physical, mental, and social well-being. The involvement of exercise professionals was valued in PD clinical programs. However, additional education for practitioners and patients regarding safety and the benefits of exercise is required to assist in widespread implementation and acceptance of exercise programming in the PD population.

Background: Clinical data supporting the target haemoglobin range in patients undergoing peritoneal dialysis (PD) are scarce. This study investigated the association between haemoglobin levels and all-cause mortality in Japanese patients undergoing PD using data from a nationwide dialysis registry.

Methods: A total of 4875 patients aged ≥18 years who were undergoing PD at the end of 2012 were analysed. Patients receiving combination therapy with haemodialysis or missing haemoglobin data were excluded. Haemoglobin values were categorised into six groups (<9.0, 9.0-9.9, 10.0-10.9, 11.0-11.9, 12.0-12.9 and ≥13.0 g/dL) and their association with mortality evaluated.

Results: Patients' mean age was 63 years, and 62% were men. The mean haemoglobin level was 10.7 g/dL, and 14% were anuric. Erythropoiesis-stimulating agents were used in 89%. During a median follow-up of 3.5 years, 1586 patients died. Haemoglobin levels <9.0 and ≥13.0 g/dL were significantly associated with mortality, as compared with levels of 10.0-10.9 g/dL (adjusted hazard ratios [95% confidence intervals]: 1.25 [1.06-1.48] and 1.45 [1.13-1.88], respectively). Restricted cubic spline analysis revealed a U-shaped association between haemoglobin levels and mortality. A haemoglobin level ≥12 g/dL was associated with mortality in patients with a history of cardiovascular disease (p interaction = 0.023).

Conclusion: We provide important insights into the target haemoglobin in patients undergoing PD. Our findings suggest that setting a lower upper limit for haemoglobin levels may be beneficial for patients with a history of cardiovascular disease.

Peritoneal dialysis (PD) is a well-established modality for kidney replacement therapy (KRT) globally, offering benefits such as better preservation of residual kidney function, improved quality of life, and reduced resource requirements. Despite these advantages, the global utilization of PD remains suboptimal, particularly in South Asia (SA), where a significant gap in PD delivery exists. This study aims to uncover the perceived barriers hindering PD utilization among nephrologists in SA. This is a cross-sectional survey involving 732 nephrologists from SA region. . The majority of respondents (44.7%) reported initiating less than six PD cases annually, reflecting low PD utilization. Cost and financial reimbursement policies emerged as major barriers, with 44.3% considering PD more expensive than haemodialysis (HD). Accessibility, negative attitudes toward PD, and fear of complications were identified as critical factors influencing PD adoption. The study also highlighted variations in PD costs among SA countries, emphasizing the need for tailored health economic strategies. This analysis provides insights into the multifaceted challenges faced by SA nephrologists in promoting PD and underscores the importance of targeted interventions.

BackgroundPeritonitis is a serious complication associated with risks of death and transfer to haemodialysis for patients receiving peritoneal dialysis (PD). To mitigate such risks, it is important to identify potentially reversible risk factors, such as hypokalaemia.MethodPatients who started PD at the Princess Alexandra Hospital, Australia from 1^st January 2013 to 31^st December 2022 were included. Hypokalaemia, defined as serum potassium <3.5 mmol/L, was assessed at the time of PD initiation and evaluated as categories (<3.5 mmol/L, 3.5-4.5 mmol/L and >4.5 mmol/L) based on 6-month average after PD commencement. Time to first peritonitis was examined using multi-variable Cox survival analyses censored for transplantation, recovery of kidney function or loss to follow up. Competing risk regression was conducted as sensitivity analysis. Peritonitis rates were compared using Poisson regression analysis.ResultsIn total, 486 patients were included. 6-Month average serum potassium level was <3.5 mmol/L in 30 patients (6.2%), 3.5-4.5 mmol/L in 301 patients (62%) and >4.5 mmol/L in 155 patients (32%). During the study period, 192 patients experienced peritonitis with comparable proportions across all three groups (35%, 40% and 40%, respectively). Using multi-variable regression modelling, we found that time to first peritonitis was not significantly associated with hypokalaemia based on 6-month average (hazard ratio 1.14, 95% confidence interval [CI] 0.67-1.95) or baseline hypokalaemia (hazard ratio 0.73, 95% CI 0.34-1.54). Using the categories based on 6-month average serum potassium level, mean peritonitis rate was higher among patients in the <3.5 mmol/L group (0.79 episodes/patient-year) compared to those in the 3.5-4.5 mmol/L (0.61 episodes/patient-year) and >4.5 mmol/L (0.47 episodes/patient-year), whilst the difference was not significant (p = 0.14).ConclusionIn this study, no significant association was identified between hypokalaemia and risk of peritonitis, although estimates were imprecise.