Peritoneal Dialysis International最新文献

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.

In acute kidney injury, no dialytic method has been shown to be superior in terms of mortality or recovery of kidney function. Peritoneal dialysis is an excellent treatment option, since it is continuous and can be adapted to clinical needs, it offers hemodynamic stability, adequate solute clearance, correction of electrolyte and acidosis disorders, appropriate ultrafiltration in volume overload, it is cheaper, does not require anticoagulation, provides calories, can be performed at the patient's bedside, its prescription is simple and does not require such sophisticated machinery. And when compared with other modalities, it has been shown to be equally efficient and safe, although its use is limited, partly due to the lack of knowledge and experience with this modality. Existing clinical evidence has consistently shown that this modality has very similar results in terms of the most relevant objectives evaluated in AKI. This modality offers certain advantages in specific contexts of acute kidney injury, such as cardiorenal syndrome, hepatorenal syndrome, in unstable patients on vasopressors, and in neurocritical patients. For all these reasons, we believe that peritoneal dialysis in acute kidney injury has sufficient arguments to be implemented more frequently and receive the value it deserves.

Icodextrin (ICO) is widely used in peritoneal dialysis (PD). Hyperosmolar hyponatremia (hypoNa) has been reported as an adverse event of ICO, but it is unknown whether there is a dose effect relationship between the two. We present a case demonstrating this relationship. A 61-year-old woman with end-stage kidney disease (ESKD) and no history of diabetes, began PD with a single daily dwell of 1L of ICO. Her serum Na during the previous 6 months (n = 16) was 138.9 (mmol/L) ± 2.2 (SD). Within days of starting PD, the Na fell to 132 and over the ensuing 9 months (n = 27) it averaged 133.6 ± 2.1. As her PD prescription (Rx) was changed throughout two hospital admissions and subsequent outpatient management, she maintained normonatremia when using dextrose exchanges and became hyponatremic with ICO exchanges. With increasing daily doses of ICO, her hyponatremia became more severe (nadir of Na 121 with 3L of daily ICO use). She ultimately returned to exclusively dextrose cycles for two years and remained normonatremic. Years later a single 2L ICO dwell was started, and she developed hypoNa again (Na 131). ICO was stopped and Na normalized. We plotted serum Na vs total daily ICO dose and showed a strong correlation (R² = 0.737). HypoNa is a risk factor for ESKD patients that lead to increased morbidity and mortality. This report demonstrates that the severity of ICO-induced hyponatremia is directly proportional to the amount of ICO used. For patients developing hyponatremia, instead of discontinuing ICO, practitioners might consider reducing the dose.

BackgroundSex-based differences may influence the clinical management, complication risks, and healthcare resource utilization of hospitalized end-stage kidney disease (ESKD) patients undergoing peritoneal dialysis (PD). Understanding these disparities is essential for optimizing patient care and informing healthcare policy.MethodsThis study was conducted using the National Inpatient Sample to identify hospitalized adult ESKD patients receiving PD from the year 2003 to 2018. The outcomes included 1) PD-related outcomes, defined as a composite of peritonitis, mechanical complications, catheter removal or revision, and adequacy issues, 2) non-PD-related outcomes, defined as a composite of sepsis, cardiac arrest, and need for mechanical ventilation 3) transfer to hemodialysis, and 4) in-hospital mortality. The associations between sex and in-hospital outcomes were analyzed using multivariable logistic regression and were adjusted for demographic factors, comorbidities, primary diagnoses, admission types, and hospital characteristics. Discharge weights were applied to generate nationally representative estimates.ResultsOf 97,036 hospitalized ESKD patients receiving PD analyzed, 48,906 (50.4%) were females. In adjusted analyses, there were no overall sex differences in PD-related outcomes, non-PD-related outcomes, or in-hospital mortality. However, age- and comorbidity-based variations were observed in PD-related outcomes. Female sex was associated with lower odds of transfer to hemodialysis, particularly among younger patients and those without heart failure or peripheral vascular disease. Notably, sex differences in in-hospital mortality were observed only among patients with elective admissions.ConclusionThere were sex-based disparities in the outcomes and healthcare utilization of hospitalized ESKD patients receiving PD. These findings underscore the need for sex-specific, individualized strategies to improve PD care and inform clinical and policy decisions.