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Wu HH, Poulikakos D, Hurst H, Lewis D, Chinnadurai R. Delivering Personalized, Goal-Directed Care to Older Patients Receiving Peritoneal Dialysis. KIDNEY DISEASES (BASEL, SWITZERLAND) 2023; 9:358-370. [PMID: 37901709 PMCID: PMC10601915 DOI: 10.1159/000531367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/26/2023] [Indexed: 10/31/2023]
Abstract
Background An aging population living with chronic kidney disease and progressing to kidney failure, subsequently receiving peritoneal dialysis (PD) is growing. A significant proportion of these patients are also living with multi-morbidities and some degree of frailty. Recent practice recommendations from the International Society of Peritoneal Dialysis advocate for high-quality, goal-directed PD prescription, and the Standardized Outcomes of Nephrology-PD initiative emphasized the need for an individualized, goal-based care approach in all patients receiving PD treatment. In older patients, this approach to PD care is even more important. A frailty screening assessment, followed by a comprehensive geriatric assessment (CGA) prior to PD initiation and when dictated by change in relevant circumstances is paramount in tailoring PD care and prescription according to the needs, life goals, as well as clinical status of older patients with kidney failure. Summary Our review aimed to summarize the different dimensions to be taken into account when delivering PD care to the older patient - from frailty screening and CGA in older patients receiving PD to employing a personalized, goal-directed PD prescription strategy, to preserving residual kidney function, optimizing blood pressure (BP) control, and managing anemia, to addressing symptom burden, to managing nutritional intake and promoting physical exercise, and to explore telehealth opportunities for the older PD population. Key Messages What matters most to older PD patients may not be simply extending survival, but more importantly, to be living comfortably on PD treatment with minimal symptom burden in a home environment and to minimize treatment complications.
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Affiliation(s)
- Henry H.L. Wu
- Department of Renal Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
- Renal Research, Kolling Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Dimitrios Poulikakos
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Helen Hurst
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Paula Ormandy School of Health and Society, University of Salford, Salford, UK
| | - David Lewis
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Rajkumar Chinnadurai
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
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Salazar-Félix NA, Martin-Del-Campo F, Cueto-Manzano AM, Romo-Flores ML, Velázquez-Vidaurri AL, Sánchez-Soriano A, Ruvalcaba-Contreras N, Calderón-Fabian A, Rojas-Campos E, Cortés-Sanabria L. Prevalence of mild cognitive impairment in automated peritoneal dialysis patients. Nephrol Dial Transplant 2021; 36:2106-2111. [PMID: 34375410 DOI: 10.1093/ndt/gfab238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cognitive deterioration decreases quality of life, self-care and adherence to treatment, increasing mortality risk. There is scarce information of cognitive impairment in peritoneal dialysis, and data are controversial. OBJECTIVE To determine the frequency and associated factors of cognitive impairment in patients on automated peritoneal dialysis (APD). METHODS Cross-sectional study; 71 patients on APD underwent clinical, biochemical and cognitive function evaluation by means of the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Cognitive function was also evaluated in healthy controls. RESULTS Mean age was 42 ± 16 years, 79% were men and dialysis vintage was 17 (7-32) months. In APD patients, cognitive impairment was present in 7% (mild deterioration) and 68% according to the MMSE and MoCA, respectively, and in 4% and 37% in the healthy controls. Patients with cognitive impairment (according to MoCA) were older, with lower educational degree, had more frequently diabetes, and higher serum glucose, as well as lower serum creatinine, phosphorus and sodium concentrations than patients with normal cognitive function. In multiple linear regression analysis, predictors for the MoCA score (R2 0.63, p = 0.002) were schooling [B = 0.54 (0.20 to 0.89), p = 0.003], age [B=-0.11 (-0.21 to -0.01), p = 0.04], serum sodium [B = 0.58 (0.05 to 1.11), p = 0.03] and creatinine concentrations [B = 3.9 (0.03 to 0.83), p = 0.03]. CONCLUSION In this sample of APD patients with mean age in the early 40 s, the prevalence of cognitive impairment by MoCA test was 65%, and it was associated to older age, lower educational level and lower serum concentrations of sodium and creatinine.
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Affiliation(s)
- Noé A Salazar-Félix
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Fabiola Martin-Del-Campo
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alfonso M Cueto-Manzano
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - María L Romo-Flores
- Unidad de Diálisis Peritoneal, Hospital General Regional No. 46, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alma L Velázquez-Vidaurri
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Artemio Sánchez-Soriano
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Neri Ruvalcaba-Contreras
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alejandro Calderón-Fabian
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Enrique Rojas-Campos
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Laura Cortés-Sanabria
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
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Impact of kidney size on mortality in diabetic patients receiving peritoneal dialysis. Sci Rep 2021; 11:8203. [PMID: 33859292 PMCID: PMC8050039 DOI: 10.1038/s41598-021-87684-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 03/23/2021] [Indexed: 11/21/2022] Open
Abstract
Although patients with diabetes mellitus mostly present with enlarged or normal-sized kidneys throughout their life, a small proportion of patients have small kidneys. This longitudinal study enrolled 83 diabetic patients treated with peritoneal dialysis (PD) between 2015 and 2019. Patients were stratified into two groups, those with enlarged or normal (n = 67) or small (n = 16) kidneys, based on their kidney sizes before dialysis. Patients with small kidney size were not only older (76.63 ± 10.63 vs. 68.03 ± 11.26 years, P = 0.007), suffered longer duration of diabetes mellitus (272.09 ± 305.09 vs. 151.44 ± 85.31 month, P = 0.006) and predominantly female (75.0 vs. 41.8%, P = 0.017), but also had lower serum levels of creatinine (9.63 ± 2.82 vs. 11.74 ± 3.32 mg/dL, P = 0.022) and albumin (3.23 ± 0.67 vs. 3.60 ± 0.47 g/dL, P = 0.010) than patients with enlarged or normal kidney size. At the end of analysis, 14 (16.9%) patients died. Patients with small kidney size demonstrated higher all-cause (50.0 vs. 9.0%, P < 0.001) and infection-related (43.8 vs. 7.5%, P < 0.001) mortality than patients with enlarged or normal kidney size. In a multivariate-logistic-regression model, small kidney size was a powerful predictor of mortality (odds ratio 6.452, 95% confidence interval 1.220–34.482, P = 0.028). Diabetic patients with small kidney size at the beginning of PD carry a substantial risk for mortality.
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Eroglu E, Heimbürger O, Lindholm B. Peritoneal dialysis patient selection from a comorbidity perspective. Semin Dial 2020; 35:25-39. [PMID: 33094512 DOI: 10.1111/sdi.12927] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 12/17/2022]
Abstract
Despite many medical and socioeconomic advantages, peritoneal dialysis (PD) is an underutilized dialysis modality that in most countries is used by only 5%-20% of dialysis patients, while the vast majority are treated with in-center hemodialysis. Several factors may explain this paradox, such as lack of experience and infrastructure for training and monitoring of PD patients, organizational issues, overcapacity of hemodialysis facilities, and lack of economic incentives for dialysis centers to use PD instead of HD. In addition, medical conditions that are perceived (rightly or wrongly) as contraindications to PD represent barriers for the use of PD because of their purported potential negative impact on clinical outcomes in patients starting PD. While there are few absolute contraindications to PD, high age, comorbidities such as diabetes mellitus, obesity, polycystic kidney disease, heart failure, and previous history of abdominal surgery and renal allograft failure, may be seen (rightly or wrongly) as relative contraindications and thus barriers to initiation of PD. In this brief review, we discuss how the presence of these conditions may influence the strategy of selecting patients for PD, focusing on measures that can be taken to overcome potential problems.
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Affiliation(s)
- Eray Eroglu
- Division of Nephrology, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey.,Division of Renal Medicine and Baxter Novum, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Olof Heimbürger
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Sumi Y, Sakai Y, Mugishima K, Suzuki A, Otsuka Y, Otsuka T, Tsuruoka S. Current Practice and Outcomes of Peritoneal Dialysis in the Nippon Medical School Musashi Kosugi Hospital. J NIPPON MED SCH 2018; 85:102-109. [PMID: 29731493 DOI: 10.1272/jnms.2018_85-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Various innovations for preventing complications and improving a patient's quality of life have been implemented for peritoneal dialysis (PD), which was established in Japan approximately 35 years ago and introduced at our hospital in 1999. Herein, we investigate the outcomes of patients undergoing PD to identify approaches for improving their long-term prognosis. METHODS This retrospective study included 114 patients who underwent PD between September 1999 and August 2017 and included various parameters such as patient survival rate, technical survival rate, cause (s) of PD withdrawal, incidence of peritonitis, dialysis duration, and change in residual renal function (RRF). Furthermore, factors associated with PD withdrawal and duration, as well as risk factors for peritonitis, were examined. RESULTS Mean (± standard deviation) PD duration was 35.62 (±29.88) months in all patients and 37.16 (±34.09) months in 58 patients who withdrew from treatment. Five-year continuance and survival rates were 40.41% and 55.74%, respectively (p=0.0061). However, in patients aged ≥65 years, the continuance and survival rates were not significantly different (p=0.1250). Furthermore, the continuance and survival rates in diabetic patients were not significantly different from those of non-diabetic patients (p=0.1334 and 0.7140, respectively). Comparison of changes in RRF in young and elderly patients revealed that it was not significantly sustained in elderly patients (p=0.0259). The Cox proportional hazards model revealed that age (p=0.0455) and total cholesterol levels (p=0.0494) were independent risk factors for PD withdrawal, and multiple regression analysis showed that the presence of peritonitis (p=0.0063) and low-density lipoprotein cholesterol (LDL-C) levels (p=0.0087) were significant factors for PD duration. Peritonitis incidence was 0.077 times per patient per year, and multivariate analysis identified PD duration (p=0.0009) and LDL-C levels (p=0.0054) as independent risk factors for peritonitis. CONCLUSION The findings of this study revealed that assessment of the nutritional status of the patient and prevention of peritonitis are important for continuation of PD. PD is a safe treatment option that can maintain the quality of life in elderly patients. In a rapidly aging society, the need for PD-based medical care is expected to increase.
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Affiliation(s)
- Yuichiro Sumi
- Department of Nephrology, Nippon Medical School Musashi Kosugi Hospital.,Department of Nephrology, Graduate School of Medicine, Nippon Medical School
| | - Yukinao Sakai
- Department of Nephrology, Nippon Medical School Musashi Kosugi Hospital.,Department of Nephrology, Graduate School of Medicine, Nippon Medical School
| | - Koji Mugishima
- Department of Nephrology, Nippon Medical School Musashi Kosugi Hospital
| | - Anna Suzuki
- Department of Nephrology, Nippon Medical School Musashi Kosugi Hospital
| | - Yusuke Otsuka
- Department of Nephrology, Nippon Medical School Musashi Kosugi Hospital.,Department of Nephrology, Graduate School of Medicine, Nippon Medical School
| | - Tomoyuki Otsuka
- Department of Nephrology, Nippon Medical School Musashi Kosugi Hospital
| | - Shuichi Tsuruoka
- Department of Nephrology, Graduate School of Medicine, Nippon Medical School
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Guillouët S, Lobbedez T, Lanot A, Verger C, Ficheux M, Béchade C. Factors associated with nurse assistance among peritoneal dialysis patients: a cohort study from the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant 2018; 33:1446-1452. [PMID: 29294042 DOI: 10.1093/ndt/gfx338] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/09/2017] [Indexed: 11/13/2022] Open
Abstract
Background No information is available regarding nurse-assisted peritoneal dialysis (PD) in non-elderly subjects. This study was carried out to estimate the rate of nurse-assisted PD among non-elderly patients and to assess which individual and centre factors were associated with nurse-assisted PD. The other objective was to estimate the magnitude of the centre effect on the utilization of nurse-assisted PD using hierarchical modelling. Methods This was a retrospective study based on data from the French Language Peritoneal Dialysis Registry. Patients incident on PD > 18 and < 65 years of age were included. Results There were 2269 incidents of PD initiation between January 2008 and December 2012 in 127 PD centres with 114 (5%) on family-assisted PD and 272 (12%) on nurse-assisted PD. At the individual level, compared with autonomous patients, nurse assistance was associated with age {odds ratio [OR] 1.79 [95% confidence interval (CI) 1.51-2.13]}, gender [OR 0.47 (95% CI 0.35-0.64)], comorbidities and underlying nephropathy. There was significant heterogeneity between centres in the nurse assistance utilization (variance of random effect 0.12). At the centre level, the type of centre, centre experience, centre organization and private nurse density were not associated with nurse-assisted PD. Conclusions The rate of nurse-assisted PD among non-elderly patients was 12%. There was a significant centre effect in the utilization of nurse assistance that was not explained by the centres' characteristics. Nurse-assisted PD utilization in non-elderly patients is associated with patient characteristics and also with centre practices.
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Affiliation(s)
- Sonia Guillouët
- Service de Néphrologie, CHU de Caen, Caen Cedex 9, France.,Registre de Dialyse Péritonéale de Langue Française, Pontoise, France
| | - Thierry Lobbedez
- Service de Néphrologie, CHU de Caen, Caen Cedex 9, France.,Registre de Dialyse Péritonéale de Langue Française, Pontoise, France.,Université Caen Normandie-UFR de Médecine (Medical School), Caen Cedex 5, France
| | - Antoine Lanot
- Service de Néphrologie, CHU de Caen, Caen Cedex 9, France.,Université Caen Normandie-UFR de Médecine (Medical School), Caen Cedex 5, France
| | - Christian Verger
- Registre de Dialyse Péritonéale de Langue Française, Pontoise, France
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Pommer W, Wagner S, Müller D, Thumfart J. Attitudes of nephrologists towards assisted home dialysis in Germany. Clin Kidney J 2018; 11:400-405. [PMID: 29942506 PMCID: PMC6007628 DOI: 10.1093/ckj/sfx108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/28/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Assisted home dialysis (AHD) is an option to combine the benefits of home dialysis therapy with the needs of dialysis patients who are unable to perform self-treatment at home. While this method is growing in many countries worldwide, no data so far are reported for Germany. METHODS A survey was designed to identify the barriers to the implementation of AHD with the focus on attitudes and beliefs concerning AHD. The survey was sent to all 2060 members of the Germany Society of Nephrology. RESULTS The response rate was 14% of nephrologists (n = 286), representing 24% of all German centres. AHD was regarded as a highly meaningful option (>90% of all responding nephrologists). Fifty-five percent of the centres practice AHD (preferred peritoneal dialysis). The number of treated patients on AHD was small (77% of the centres treat no more than 10 patients). The nephrologists in centres that performed AHD were of older age and the number of dialysis patients treated in these centres was greater. AHD was offered in 57% of centres at chronic kidney disease Stage 4. Inadequate conventional dialysis and patient's request were reasons for choosing AHD. Barriers for offering AHD were lack of reimbursement, shortage of staff, lack of expertise and lack of team motivation. CONCLUSIONS In the view of German nephrologists, AHD is a meaningful method to provide home dialysis care. Inadequate funding and a lack of qualified staff were identified as severe barriers to implementation of AHD. To overcome these barriers and to achieve a higher penetration of AHD, dedicated actions have to be considered. Further studies are needed to prove the AHD concept with regard to outcome effects and cost efficacy.
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Affiliation(s)
- Wolfgang Pommer
- Kuratorium für Dialyse und Nierentransplantation (KfH), Neu-Isenburg, Germany
| | | | - Dominik Müller
- Department of Pediatric Nephrology, Charité, Berlin, Germany
| | - Julia Thumfart
- Department of Pediatric Nephrology, Charité, Berlin, Germany
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Bevilacqua MU, Turnbull L, Saunders S, Er L, Chiu H, Hill P, Singh RS, Levin A, Copland MA, Jamal A, Brumby C, Dunne O, Taylor PA. Evaluation of A 12-Month Pilot of Long-Term and Temporary Assisted Peritoneal Dialysis. Perit Dial Int 2017; 37:307-313. [DOI: 10.3747/pdi.2016.00201] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/20/2016] [Indexed: 11/15/2022] Open
Abstract
Background Peritoneal dialysis (PD) is challenging for patients with functional limitations, and assisted PD can support these patients, but previous reports of assisted PD have not examined the role of temporary assisted PD and had difficulty identifying adequate comparator cohorts. Methods Peritoneal Dialysis Assist (PDA), a 12-month pilot of long-term and temporary assisted PD was completed in multiple PD centers in British Columbia, Canada. Continuous cycler PD (CCPD) patients were identified for PDA by standardized criteria, and service could be long-term or temporary/respite. The PDA program provided daily assistance with cycler dismantle and setup, but patients remained responsible for cycler connections and treatment decisions. Outcomes were compared against both the general CCPD population and patients who met PDA criteria but were not enrolled (PDA-eligible). Results Fifty-three PDA patients had an 88% 1-year death- and transplant-censored technique survival that was similar to the general CCPD cohort (84%) and PDA-eligible cohort (86%). The PDA cohort had lower peritonitis rates (0.18 episodes/patient-year vs 0.22 and 0.36, respectively), but higher hospitalization (55% vs 34% and 35%, respectively). Long-term PDA cost approximately CDN$15,000/year in addition to existing dialysis costs. A total of 8/11 respite PDA patients (73%) returned to self-care PD after a median PDA use of 29 days, which costs $1,250/patient. Conclusions Peritoneal Dialysis Assist provides effective support to functionally-limited CCPD patients and yields acceptable clinical outcomes. The program costs less than transfer to HD or long-term care, which represents cost minimization for failing self-care PD patients. Respite PDA provides effective temporary support; most patients returned to self-care PD and service was cost-effective compared with alternatives of hospitalization or transfer to HD.
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Affiliation(s)
- Micheli U. Bevilacqua
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Linda Turnbull
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Sushila Saunders
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Lee Er
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Helen Chiu
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Penny Hill
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Rajinder S. Singh
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver, BC, Canada; and British Columbia Provincial Renal Agency, Vancouver, BC, Canada
| | - Michael A. Copland
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Abeed Jamal
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Brumby
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Orla Dunne
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paul A. Taylor
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Habib A, Durand AC, Brunet P, Duval-Sabatier A, Moranne O, Bataille S, Benhaim L, Bargas É, Gentile S. Facteurs influençant le choix de la dialyse péritonéale : le point de vue des patients et des néphrologues. Nephrol Ther 2017; 13:93-102. [DOI: 10.1016/j.nephro.2016.07.451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/21/2016] [Accepted: 07/08/2016] [Indexed: 11/25/2022]
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10
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Effectiveness of a day care program in supporting patients on peritoneal dialysis and their caregivers. Int Urol Nephrol 2016; 48:799-805. [DOI: 10.1007/s11255-016-1241-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
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11
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Lim HA, Yu Z, Kang AWC, Foo MWY, Griva K. The Course of Quality of Life in Patients on Peritoneal Dialysis: A 12-month Prospective Observational Cohort Study. Int J Behav Med 2015; 23:507-14. [DOI: 10.1007/s12529-015-9521-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Quality of life and emotional distress in patients and burden in caregivers: a comparison between assisted peritoneal dialysis and self-care peritoneal dialysis. Qual Life Res 2015. [PMID: 26195319 DOI: 10.1007/s11136-015-1074-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Assisted peritoneal dialysis (PD) involving caregivers allows more patients to get started on home-based dialysis with good clinical outcomes, but evidence on patient-reported and caregiver-reported outcomes is lacking. This study aimed to compare assisted PD versus self-care PD on quality of life (QoL) and psychosocial outcomes for patients and caregivers. The effect of PD modality [automated PD (APD); continuous ambulatory PD (CAPD)] in relation to self-care or assisted care was also examined. METHODS A cross-sectional sample of 231 PD patients [142 self-care (57 APD/85 CAPD) and 89 assisted care PD (45 APD/44 CAPD)], 72 caregivers of assisted PD patients and 39 family members of self-care PD patients completed the Kidney Disease Quality of Life Short Form (KDQOL-SF), World Health Organisation Quality of Life Instrument-brief and the Hospital Anxiety and Depression Scale. Caregivers and family members completed the Lay Care-Giving for Adults Receiving Dialysis questionnaire and Zarit Burden Interview. RESULTS Case-mix-adjusted comparisons indicated comparable QoL in all dimensions with the exception of physical SF-12 (p = .001) and the KDQOL effects of kidney disease in favour of self-care PD. Levels of anxiety (9.72 ± 4.90; 8.25 ± 5.22) and depression (8.63 ± 3.80; 6.35 ± 4.76) were equivalent in assisted PD and self-care PD, respectively. Assisted PD caregivers reported more task-orientated duties (p = .007), yet levels of perceived burden were equal to those reported by family members of self-care PD. CONCLUSION Our findings of mostly comparable patient and caregiver outcomes in assisted PD and self-care PD suggest that caregiver burden and QoL should not be a barrier to using assisted PD.
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Zhang L, Hawley CM, Johnson DW. Focus on peritoneal dialysis training: working to decrease peritonitis rates. Nephrol Dial Transplant 2015; 31:214-22. [PMID: 26908816 DOI: 10.1093/ndt/gfu403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/02/2014] [Indexed: 11/12/2022] Open
Abstract
Patient training has widely been considered to be one of the most critical factors for achieving optimal peritoneal dialysis clinical outcomes, including avoidance of peritonitis. However, research in this important area has been remarkably scant to date. This article will critically review the clinical evidence underpinning PD patient training and will specifically focus on four key areas: who should provide training and how, when and where should it be performed to obtain the best results. Evidence gaps and future research directions will also be discussed.
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Affiliation(s)
- Lei Zhang
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
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Lan L, Jiang J, Wang P, Ren W, Hu Z. Peritoneal dialysis catheter placement in the right lower quadrant is associated with a lower risk of catheter tip migration: a retrospective single-center study. Int Urol Nephrol 2014; 47:557-62. [PMID: 25547920 DOI: 10.1007/s11255-014-0899-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 12/06/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to investigate the effect of a modified technique for peritoneal dialysis catheter placement in the right lower quadrant with respect to catheter tip migration. METHODS This retrospective study included 237 patients with end-stage renal disease who underwent implantation of a two-cuff straight-end swan-neck catheter for peritoneal dialysis. Ninety-eight patients received conventional catheter placement in the left quadrant (beside the umbilicus 12-13 cm above the pubic symphysis) with catheter exit site on the left, and 139 patients received modified catheter placement in the right lower quadrant (beside the umbilicus 6-7 cm above the pubic symphysis) with catheter exit site on the right. Dialysate inflow time, dialysate outflow time, ultrafiltration volume, infection, hemorrhage, intestinal obstruction, and catheter tip migration were recorded. RESULTS There were no significant differences in dialysate inflow time, dialysate outflow time, ultrafiltration volume, infection, hemorrhage, or intestinal obstruction between the conventional and modified groups. Catheter tip migration occurred in 19 (19.3%) of the 98 patients in the conventional group, and in 5 (3.6%) of the 139 patients in the modified group. The frequency of occurrence of catheter tip migration was significantly less in the modified group compared with the conventional group (p < 0.01). In addition, repositioning of the catheter occurred in all five patients with catheter tip migration in the modified group after conservative treatment, whereas 12 patients required surgical repositioning of the catheter in the conventional group. CONCLUSIONS The modified technique is superior to the conventional technique in reducing catheter tip migration. This technique can be widely performed in the clinic.
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Affiliation(s)
- Lei Lan
- Department of Nephrology, Affiliated Anhui Provincial Hospital, Anhui Medical University, Hefei, 230001, China
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15
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Griva K, Yu Z, Chan S, Krisnasamy T, Yamin RBA, Zakaria FB, Wu SY, Oei E, Foo M. Age is not a contraindication to home-based dialysis - Quality-of-Life outcomes favour older patients on peritoneal dialysis regimes relative to younger patients. J Adv Nurs 2014; 70:1902-14. [PMID: 24495288 DOI: 10.1111/jan.12355] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
Abstract
AIM To compare Quality of Life, anxiety and depression between older (≥65 years) and younger (<65 years) patients across automated peritoneal dialysis and continuous ambulatory peritoneal dialysis. BACKGROUND There is a lack of studies as to whether the different peritoneal dialysis modalities confer similar outcomes in older and younger patients. DESIGN Cross-sectional. METHODS A total of 201 patients completed the Kidney Disease Quality of Life Short-Form, World Health Organization Quality of Life Instrument, Short Form and Hospital Anxiety and Depression Scale. Comorbidity and biochemical values were abstracted from medical records. RESULTS Older patients reported significantly better quality of life than younger patients in the Kidney Disease Quality of Life Short-Form effects of kidney disease and patient satisfaction and the World Health Organization Quality of Life Instrument overall Quality-of-Life/health despite worse clinical profile. Quality of life outcomes were comparable between automated peritoneal dialysis and continuous ambulatory peritoneal dialysis with the exception of the Kidney Disease Quality of Life Short-Form symptoms in favour of automated peritoneal dialysis. Levels of anxiety and depression were equivalent for older and younger patients across peritoneal dialysis modalities. The observed quality-of-life advantages for older patients persisted after case-mix adjustments and extended to more quality-of-life domains and depression and anxiety. CONCLUSION Our findings of superior quality of life in patients aged ≥ 65 support the expansion of peritoneal dialysis use in older patients. Patients across different age groups should be given non-biased information about both peritoneal dialysis modalities and individual preferences should be elicited and carefully considered by healthcare providers.
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Affiliation(s)
- Konstadina Griva
- Department of Psychology, National University of Singapore, Singapore
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16
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Puttinger H. [Peritoneal dialysis--an ideal initial dialysis mode]. Wien Med Wochenschr 2013; 163:271-9. [PMID: 23817731 DOI: 10.1007/s10354-013-0200-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 03/26/2013] [Indexed: 11/25/2022]
Abstract
Peritoneal dialysis (PD) has become an established dialysis modality besides hemodialysis (HD). Although PD is an equal form of dialysis compared to HD, patients numbers on PD remain low worldwide. There are several reasons for this fact. The medical staff in some centers is not used to PD, so there is not enough information about the different dialysis methods available for the patients and the staff doesn't get the training that would be necessary to get familiar with PD. There are some concerns about offering PD to certain groups of patients despite excellent results as to quality of dialysis, good preservation of residual renal function, low costs compared to HD and better quality of life than on HD. However, PD should be offered to all patients requiring dialysis with very few exeptions as an ideal initial dialysis method. This includes patients with diabetes, patients with kidney transplant failure, patients with congestive heart failure and older patients.
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Affiliation(s)
- Heidi Puttinger
- Klinische Abteilung für Nephrologie und Dialyse, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Franco MRG, Fernandes N, Ribeiro CA, Qureshi AR, Divino-Filho JC, da Glória Lima M. A Brazilian experience in assisted automated peritoneal dialysis: a reliable and effective home care approach. Perit Dial Int 2013; 33:252-8. [PMID: 23660606 PMCID: PMC3649893 DOI: 10.3747/pdi.2012.00031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 08/15/2012] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Automated assisted peritoneal dialysis (AAPD) has been shown to be successful as renal replacement therapy for elderly and physically incapable end-stage renal disease (ESRD) patients. In early 2003, a pioneer AAPD program was initiated at GAMEN Renal Clinic in Rio de Janeiro, Brazil. ♢ OBJECTIVE We evaluated the results of an AAPD program offered as an option to elderly ESRD patients with physical or cognitive debilities or as last resort to patients with vascular access failure or hemodynamic instability during hemodialysis. ♢ METHODS A cohort of 30 consecutive patients started AAPD from January 2003 to March 2008 and was followed to July 2009. Demographics, clinical and laboratory parameters, causes of death, and patient and technique survival were analyzed. ♢ RESULTS Median age of the patients was 72 years (range: 47 - 93 years), with 60% being older than 65. The Davies score was greater than 2 in 73% of patients, and the Karnofsky index was less than 70 in 40%. The overall peritonitis rate was 1 episode in 37 patient-months. The total duration of AAPD ranged from 3 to 72 months. Patient survival was 80% at 12 months, 60% at 24 months, and 23.3% at 48 months. The most common cause of death was cardiovascular problems (70%). ♢ CONCLUSIONS In this clinical observational study, AAPD fulfilled its expected role, offering an opportune, reliable, and effective homecare alternative for ESRD patients with no other renal replacement therapy options.
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Tennankore KK, Chan CT, Curran SP. Intensive home haemodialysis: benefits and barriers. Nat Rev Nephrol 2012; 8:515-22. [DOI: 10.1038/nrneph.2012.145] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Berger JR, Hedayati SS. Renal replacement therapy in the elderly population. Clin J Am Soc Nephrol 2012; 7:1039-46. [PMID: 22516288 DOI: 10.2215/cjn.10411011] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
ESRD has become an important problem for elderly patients. The segment of the ESRD population age 65 years or older has grown considerably, and this growth is expected to accelerate in coming years. Nephrologists caring for the elderly with advanced kidney disease will encounter patients with comorbid conditions common in younger patients, as well as physical, psychological, and social challenges that occur with increased frequency in the aging population. These challenging factors must be addressed to help inform decisions regarding the option to initiate dialysis, the choice of dialysis modality, whether to pursue kidney transplantation, and end-of-life care. This article will highlight some common problems encountered by elderly patients with ESRD and review data on the clinical outcomes of elderly patients treated with different modalities of dialysis, outcomes of kidney transplantation in the elderly, and nondialytic management of CKD stage 5.
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Affiliation(s)
- Joseph R Berger
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Smyth A. End-Stage Renal Disease and Renal Replacement Therapy in older Patients. Nephrourol Mon 2012; 4:425-30. [PMID: 23573460 PMCID: PMC3614263 DOI: 10.5812/numonthly.1825] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 07/15/2011] [Accepted: 07/20/2011] [Indexed: 11/16/2022] Open
Abstract
As the world’s population continues to age, practitioners encounter increasing numbers of older patients with end-stage renal disease (ESRD) who require renal replacement therapy (RRT). Conservative management may be considered in older patients and has been shown to offer comparable survival rates and hospital-free days to RRT patients. At present, for those who choose RRT, hemodialysis is the most commonly used modality. Many practitioners believe that peritoneal dialysis (PD), including assisted peritoneal dialysis, can be used safely in this population. Age is not a contra-indication to peritoneal dialysis, and a choice of modality should be offered to older patients. Assisted peritoneal dialysis has been used successfully in multiple regions without an increase in complication rates. Quality of life is an important issue for older patients with ESRD, and studies such as Broadening options for long-term Dialysis in the Elderly support the use of PD in older patients as it is associated with fewer fluctuations in symptoms of ESRD and less intrusion into people’s lives. This review discusses the appropriateness of initiating RRT in older patients, choices of modality, underutilization of PD in older patients, use of assisted PD, complication rates, and quality of life in these patients. overall, PD seems to be a safe and effective modality of RRT in older patients, and assisted PD can be used in patients with limited functional impairment.
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Affiliation(s)
- Andrew Smyth
- Department of Nephrology, Galway University hospitals, Galway, Ireland
- Department of Medicine, National University of Ireland Galway, Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
- Corresponding author: Andrew Smyth, Department of Nephrology, Galway University hospitals, c/o University hospital Galway, Newcastle Road, Galway, Ireland. Tel.: +353-91495964, Fax: +353-91585852, E-mail:
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Chanouzas D, Ng KP, Fallouh B, Baharani J. What influences patient choice of treatment modality at the pre-dialysis stage? Nephrol Dial Transplant 2011; 27:1542-7. [PMID: 21865216 DOI: 10.1093/ndt/gfr452] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is little information on factors influencing patient choice of renal replacement modality (RRM) in the UK. Pre-dialysis education programmes have been associated with increased uptake of peritoneal dialysis (PD) in other countries but their relevance in informing patient choice within UK centres has not been extensively studied. In this study, we examined how patient choice of different treatment modalities [haemodialysis (HD), PD and conservative management (CM)] is influenced by personal and demographic parameters. METHODS Questionnaires were sent to 242 pre-dialysis patients from a single centre. Patients were asked to rate factors affecting their treatment choice. Demographics, functional status, educational day attendance and Charlson index (CI) scores were also collected. RESULTS One hundred and eighteen replies were received. Seventy per cent of patients had chosen HD, 20% PD and 10% had opted for CM. There was a clear association between age and modality choice. Mean age of patients choosing PD was 55 years compared to 68 years for HD and 84 years for CM (P<0.001). Similarly, the degree of co-morbidity was linked with treatment choice, with patients choosing PD having a mean CI score of 4.1 compared to 5.8 among HD patients and 7.7 for CM (P<0.001). Factors rated as important by all three groups were: the ability to cope, fitting modality with lifestyle, distance to centre and verbal and written information about modality. Conversely, factors rated as not important by all groups were: use of internet, religious beliefs and friends' views. Using analysis of variance, there was a statistically significant variance between the HD and the PD group responses in the following factors: provision of written information (P=0.048), fitting modality with lifestyle (P=0.025), family/home/work circumstances (P=0.003) and past medical history (P=0.018). Fifty per cent of patients who chose PD attended a formal education day compared to 32.9% that chose HD and 0% that chose CM (P=0.011). The following demographic factors were crucial in predicting RRM choice: being married (PD 95.7%, HD 53.8%, CM 41.7%; P<0.001), being employed (PD 33.3%, HD 11.5%, CM 0%; P=0.015) and having another person living at home (PD 100%, HD 69.5%, CM 50%; P=0.003). Patients who have had a social services assessment in the last 12 months or received private care services or disability allowance were more likely to choose CM. CONCLUSIONS This study highlights important factors influencing patient choice of end-stage renal disease treatment modality including CM. While some of these are non-modifiable, such as age and degree of co-morbidity, others draw attention to the importance of good information provision and pre-dialysis education in empowering socially able patients to choose self-care therapies. Furthermore, the overwhelming association of having a strong social support network and being functionally able with choosing PD emphasizes the need for assisted PD.
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Affiliation(s)
- Dimitrios Chanouzas
- Renal Department, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
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Lim WH, Dogra GK, McDonald SP, Brown FG, Johnson DW. Compared with younger peritoneal dialysis patients, elderly patients have similar peritonitis-free survival and lower risk of technique failure, but higher risk of peritonitis-related mortality. Perit Dial Int 2011; 31:663-71. [PMID: 21632440 DOI: 10.3747/pdi.2010.00209] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The number of elderly patients with end-stage kidney disease (ESKD) is increasing worldwide, but the proportion of elderly patients commencing peritoneal dialysis (PD) is falling. The reluctance of elderly ESKD patients to consider PD may be related to a perception that PD is associated with greater rates of complications. In the present study, we compared outcomes between younger and older PD patients. METHODS Using Australia and New Zealand Dialysis Registry data, all adult ESKD patients commencing PD between 1991 and 2007 were categorized into under 50, 50 - 64.9, and 65 years of age or older groups. Time to first peritonitis, death-censored technique failure, and peritonitis-associated and all-cause mortality were evaluated by multivariate Cox proportional hazards model analysis. RESULTS Of the 12 932 PD patients included in the study, 3370 (26%) were under 50 years of age, 4386 (34%) were 50 - 64.9 years of age, and 5176 (40%) were 65 years of age or older. Compared with younger patients (<50 years), elderly patients (≥ 65 years) had a similar peritonitis-free survival and a lower risk of death-censored technique failure [hazard ratio (HR): 0.85; 95% confidence interval (CI): 0.79 to 0.93], but they had higher peritonitis-related (HR: 2.31; 95% CI: 1.68 to 3.18) and all-cause mortality (HR: 2.90; 95% CI: 2.60 to 3.23). CONCLUSIONS Not unexpectedly, elderly patients have higher peritonitis-related and all-cause mortality, which is likely a consequence of a greater prevalence of comorbid disease. However, compared with younger patients, elderly patients have superior technique survival and similar peritonitis-free survival, suggesting that PD is a viable renal replacement therapy in this group of patients.
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Affiliation(s)
- Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, SA, Australia.
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It is not polite to ask a dialysis patient his age! Int Urol Nephrol 2011; 43:1101-5. [PMID: 21547468 DOI: 10.1007/s11255-011-9968-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
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Peritoneal dialysis in an ageing population: a 10-year experience. Int Urol Nephrol 2011; 44:283-93. [PMID: 21537856 DOI: 10.1007/s11255-011-9973-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is becoming increasingly prevalent and there are increasing numbers of older patients with advanced CKD. Peritoneal dialysis (PD) is a potential treatment. This study aims to compare PD outcomes in age-defined populations in the largest PD centre in the Republic of Ireland over 10 years. METHODS We retrospectively identified all adult patients, over the age of 50 years, who commenced PD as their first modality of renal replacement therapy (RRT) between 1 January 1998 and 31 December 2008 at our institution. Primary outcome was patient survival; secondary outcomes were technique failure, peritonitis-free survival, transplantation and hospitalisations. RESULTS One hundred and forty-eight patients with a mean age of 63 years were included. Twenty-two patients were on assisted PD, the majority of whom were aged 70 years or over (P = 0.001). There were no differences in patient survival or technique failure by age group, Charlson Co-Morbidity Index (CCI), modified-CCI or adjusted CCI. Renal transplantation occurred predominantly in younger patients (P = 0.001) with lower m-CCI (P = 0.001) and a-CCI (P = 0.002) who performed PD independently (P = 0.004). Older patients required longer hospital stays to initiate PD (P = 0.004). Assisted PD was not associated with an increase in early complications or technique failure but death rates were higher (P = 0.002). CONCLUSION This study shows PD to be an acceptable modality of renal replacement therapy in elderly patients, with no observed differences in survival, technique survival or complication rates. Co-morbidities appear to play a stronger role in predicting survival than age alone. Assisted PD is a viable option in those unable to undergo PD independently.
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Griva K, Davenport A, Harrison M, Newman S. An evaluation of illness, treatment perceptions, and depression in hospital- vs. home-based dialysis modalities. J Psychosom Res 2010; 69:363-70. [PMID: 20846537 DOI: 10.1016/j.jpsychores.2010.04.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 03/30/2010] [Accepted: 04/20/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Depressive symptoms are common among patients with end-stage renal disease (ESRD). In order to better understand what factors influence these symptoms, we examined the impact of illness and treatment cognitions on emotional adjustment and the influence of dialysis modality (hospital- vs. home-based dialysis) on this relationship. METHODS A cross-sectional sample of 145 ESRD patients on four different dialysis modalities [hospital hemodialysis (HD), n=52; home HD, n=25; continuous ambulatory peritoneal dialysis (CAPD), n=45; automated PD (APD), n=23] completed the Illness Perceptions Questionnaire, the Illness Effects Questionnaire, the Treatment Effects Questionnaire, and the Beck Depression Inventory. Measures of ESRD severity/comorbidity and biochemistry were also collected. RESULTS Perceptions of treatment disruptiveness and attributions to poor medical care were significantly greater in CAPD. Home-based treatments were not found to confer an emotional adjustment advantage compared to hospital HD. There were marked differences across home-based modalities, with n=22 (44.4%) CAPD meeting the clinical cutoff of depression (≧16) vs. n=6 (26.1%) in APD and n=2 (8%) in home HD. After adjusting for case-mix differences, the mean levels of depressed mood remained significantly higher in CAPD patients compared to APD and home HD (P<.01). On multiple regression analysis, 42.5% of the variance in depression was explained by the End-Stage Renal Severity Index, dialysis modality, perceived treatment disruptiveness, and beliefs about illness consequences and the extent to which the illness could be controlled. CONCLUSION The findings suggest that the benefits of self-care are not uniformly manifested across dialysis modalities and that patients' cognitions are important determinants of depressed mood with implications for future research and clinical practice.
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Affiliation(s)
- Konstadina Griva
- Department of Psychology, National University of Singapore, Singapore; Unit of Behavioural Medicine, University College London, UK
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Paraskevas KI, Kotsikoris I, Koupidis SA, Tzovaras AA, Mikhailidis DP. Cardiovascular events in chronic dialysis patients: emphasizing the importance of vascular disease prevention. Int Urol Nephrol 2010; 42:999-1006. [DOI: 10.1007/s11255-010-9795-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Accepted: 06/11/2010] [Indexed: 12/14/2022]
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Covic A, Bammens B, Lobbedez T, Segall L, Heimbürger O, van Biesen W, Fouque D, Vanholder R. Educating end-stage renal disease patients on dialysis modality selection. NDT Plus 2010; 3:225-233. [PMID: 28657058 PMCID: PMC5477971 DOI: 10.1093/ndtplus/sfq059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 03/24/2010] [Indexed: 01/20/2023] Open
Affiliation(s)
- Adrian Covic
- Nephrology Clinic, 'Dr. C. I. Parhon' University Hospital, Iasi, Romania
| | - Bert Bammens
- Department of Nephrology and Renal Transplantation, University Hospitals, Leuven, Belgium
| | | | - Liviu Segall
- Nephrology Clinic, 'Dr. C. I. Parhon' University Hospital, Iasi, Romania
| | - Olof Heimbürger
- Department of Clinical Science, Karolinska Institute, Stockholm, Sweden
| | | | - Denis Fouque
- Department of Nephrology, 'E. Herriot' Hospital, Lyon, France
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Current world literature. Curr Opin Pediatr 2010; 22:246-55. [PMID: 20299870 DOI: 10.1097/mop.0b013e32833846de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Taskapan H, Tam P, LeBlanc D, Ting RH, Nagai GR, Chow SS, Fung J, Ng PS, Sikaneta T, Roscoe J, Oreopoulos DG. Peritoneal dialysis in the nursing home. Int Urol Nephrol 2010; 42:545-51. [PMID: 20174996 DOI: 10.1007/s11255-010-9714-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
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Incidence of end-stage renal disease in the elderly: a steadily rising global socioeconomic epidemic. Int Urol Nephrol 2009; 42:523-5. [DOI: 10.1007/s11255-009-9691-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 11/30/2009] [Indexed: 11/25/2022]
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Abstract
A number of attempts to create a commonly accepted terminology regarding definitions and terms used for clinical entities, methods, problems, and materials encountered by health professionals involved in peritoneal dialysis (PD) were undertaken in the past, the last one in 1990. Later on, some relevant sporadic attempts in a number of textbooks have been made, but they did not include the whole spectrum of PD. This glossary is an attempt to address the need for a universally accepted PD terminology including the latest advances in PD connection systems and fluids.
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“Pedogeriatrics”: a pediatric nephrologist’s outlook on common challenges facing pediatric and geriatric nephrologists. Int Urol Nephrol 2009; 42:253-7. [DOI: 10.1007/s11255-009-9593-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 05/14/2009] [Indexed: 10/20/2022]
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