Peritoneal Dialysis International最新文献

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.

BackgroundThe stability of antimicrobials in peritonitis during peritoneal dialysis (PD) solutions is a critical factor influencing treatment success. This study investigated the stability of daptomycin (DAP) when combined with icodextrin-based PD solution, by measuring DAP concentrations and observing any structural changes.MethodsA dose of DAP (350 mg) was dissolved in 7 mL of saline in a clean bench. The solution was then injected into the large compartment (1,260 mL) of NICOPELIQ^® Peritoneal Dialysis Solution and thoroughly mixed. Samples were collected at intervals ranging from 0 to 336 h (7 points in total). The concentration of DAP was quantified using high-performance liquid chromatography (HPLC). The structure of any unidentified peaks was determined using HPLC coupled with electrospray ionization tandem mass spectrometry.ResultsDAP maintained 90% of the initial concentration in NICOPELIC^® for 72 h at room temperature and 12 h at 37 °C. Unidentified peaks, distinct from DAP, were detected during analysis. Further investigation indicated that these peaks corresponded to anhydrated DAP.ConclusionsThe findings from this stability study are expected to enhance the effectiveness of outpatient management and preparation for treating peritonitis using DAP.

Scrotal and penile edema is a noninfectious complication of peritoneal dialysis (PD). A tear in the Spigelian fascia is occasionally recognized as a Spigelian hernia. However, there is no documented evidence that this is a contributing factor for scrotal edema in individuals undergoing PD. We encountered a case of scrotal edema in a patient undergoing PD due to bilateral metachronous tears in the Spigelian fascia, which was successfully treated through surgical repair. A 20-year-old man with end-stage kidney disease due to Alport syndrome underwent PD. Eight months after induction of PD, he heard a rupture sound in the left inguinal region after coughing and developed genital edema. A computed tomography scan showed a tear in the left Spigelian fascia. Surgical repair was successful and there was no recurrence after PD was resumed. Seven months after surgery, he heard a rupture sound in the right inguinal region after coughing and developed genital edema. A computed tomography scan showed a tear in the right Spigelian fascia. Surgical repair was successful and there has been no recurrence since. It is important to recognize that the development of scrotal edema in a patient undergoing PD may be indicative of a tear in the Spigelian fascia.

BackgroundStaff-assisted peritoneal dialysis (PD) can help overcome barriers to self-care but is not yet available in the United States (US). We developed and implemented a staff-assisted PD program that fits within current regulatory and cost restraints in the US healthcare environment.MethodsPatient care technicians (PCTs) were trained on PD procedures and troubleshooting common problems. The program expanded from two centers in August 2020 to sixteen by October 2022. We described the logistic elements of program delivery, and patient and treatment outcomes for patients discharged by end of April 2023, with a cohort follow up until October 2023.ResultsA total of 121 patients were referred to the program. The most common indications for referral were physical function limitations, cognitive impairment, and psychosocial challenges. Staff assistance was provided for 73 patients. Mean age was 72 (standard deviation 14) years. A total of 604 visits were delivered, with a median 5 (interquartile range [IQR] 3-10, range: 1-49) visits per patient. Median duration of assistance was 8 (IQR: 2-21, range: 1-84) days. Assistance was most frequently needed for PD treatment setup and for observing and directing the technique. No peritonitis events or exit-site infections were reported. Sixty-eight patients (93%) were discharged on PD without staff assistance. The 6- and 12-month survival of PD without assistance was 71% and 57%, respectively.ConclusionsStaff-assisted PD for limited time periods is operationally feasible with PCTs in the US and can support transitioning and maintaining patients on PD.ClinicalTrials.gov Identifier: NCT04319185.