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Iyengar A, Kalyesubula R, Darwish R, Luyckx VA. International equity in access to home dialysis. Curr Opin Nephrol Hypertens 2024:00041552-990000000-00187. [PMID: 39282856 DOI: 10.1097/mnh.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
PURPOSE OF REVIEW Discussion of inequalities and inequities in global distribution of and access to home dialysis. RECENT FINDINGS The majority of patients receiving home dialysis receive peritoneal dialysis, but these are concentrated in few countries across the globe. Peritoneal dialysis as the most common form of home dialysis has many advantages in terms of individual freedoms, similar outcomes to haemodialysis, being less costly in some countries, and more scalable than in-centre haemodialysis. Despite this there are many inequities in access at the patient, clinician, health system and geopolitical levels. Poverty, discrimination and lack of support at home are important drivers of inequities at the patient level. At the clinician and health systems level lack of experience in home dialysis, lack of resources and lack of time drive patients towards in-centre dialysis. At the geopolitical level, high costs associated with procurement and distribution of peritoneal dialysis solutions exacerbate inequities in access. SUMMARY The challenge of reducing global inequities in access to home dialysis in low- and middle-income countries are vast and would require training of the doctors, nurses, families, patients, leaders and community partners. Once this is achieved, dealing with costs and logistics of supplies is crucial to improve and sustain equitable access.
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Affiliation(s)
- Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
| | - Robert Kalyesubula
- Department of Physiology and Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Section of Nephrology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Valerie A Luyckx
- University Children's Hospital
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzlerland
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
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Aujo JC, Coetzee A, Masu A, Enimil A, Luyckx VA, Nourse PJ, McCulloch MI. Discontinuation of maintenance peritoneal dialysis in children-A 10-year review from a single center in a low resource setting. Perit Dial Int 2024; 44:380-389. [PMID: 38863313 DOI: 10.1177/08968608241259608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION In South Africa, only children considered eligible for transplantation are offered dialysis as bridge to kidney transplantation. Maintenance peritoneal dialysis (PD) is preferred and has several advantages over hemodialysis (HD). While awaiting transplantation, PD may be discontinued due to permanent transfer to HD or death while on PD, of which the occurrence and burden is not known in our setting. We investigated the rate of discontinuation of maintenance PD, and associated factors among children awaiting a kidney transplant under challenging socio-economic circumstances in a low resource setting. METHODS Single center retrospective analysis of children receiving maintenance PD. Outcomes included the proportion of children who discontinued PD before transplantation, associated factors and timing of discontinuation, and the proportion transplanted. Time to discontinuation or transplantation was displayed using a Kaplan-Meier curve. RESULTS Sixty-seven children who received maintenance automated PD as initial dialysis modality were identified from the kidney transplant waiting list between January 2009 and December 2018. Complete data was available for 52 of the 67 children. Four children had prior failed kidney transplants. The median age was 11 years (interquartile range 6.0, 13.1). Overall, 17/52 (32.7%) children discontinued PD, with 13 (25%) transfers to HD and 4 deaths (7.7%), whereas 29/52 (55.8%) received a kidney transplant. Three of the deaths were PD related. Six children remained on maintenance PD at the end of the study period. Over a half of our patients discontinued PD by 12 months, and 80% by 30 months. Most PD discontinuations were associated with peritonitis. CONCLUSIONS The proportion discontinuing PD was high, highlighting the need to optimize measures to improve retention rates, especially through prevention of peritonitis.
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Affiliation(s)
- Judith Caroline Aujo
- Department of Pediatrics and Child Health, Mulago National Referral Hospital, Kampala, Uganda
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Ashton Coetzee
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Adelaide Masu
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Anthony Enimil
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Valerie A Luyckx
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Peter J Nourse
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Mignon I McCulloch
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
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Zhou S, Wang X, Han Q, He L, Tang W, Zhang A. Elevated serum fatty acid-binding protein 4 level predicts all-cause and cardiovascular mortality in peritoneal dialysis patients: a five-year study. Ren Fail 2023; 45:2262624. [PMID: 37782286 PMCID: PMC10547445 DOI: 10.1080/0886022x.2023.2262624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND To explore the prospective role of serum fatty acid-binding protein 4 (FABP4) in the outcomes of peritoneal dialysis (PD) patients. METHODS A prospective observational study was conducted with 159 patients on PD. Demographic and clinical data at baseline were collected from medical records. Biochemical data were recorded based on blood samples measured in a central laboratory. Serum FABP4 concentrations were determined using enzyme-linked immunosorbent assay. Body composition was measured using a Body Composition Monitor. Abdominal lateral plain radiography was used to evaluate vascular calcification. The primary endpoints were all-cause and cardiovascular death. RESULTS The median of serum FABP4 concentration was 154.6 ng/mL (interquartile range, 132.8-269.7 ng/mL). Increased serum FABP4 was associated with increased vascular calcification proportion, time on dialysis, body mass index, high-sensitivity C-reactive protein (hs-CRP), intact parathyroid hormone (iPTH), triglycerides, body fat mass, and body fat percentage (p < 0.05). Increased serum FABP4 was associated with decreased residual kidney Kt/V urea (p < 0.05). Patients with hs-CRP≥ 3 mg/L had significantly higher serum FABP4 than those with hs-CRP< 3 mg/L (p < 0.05). Patients with vascular calcification had significantly higher serum FABP4 than those without vascular calcification (p < 0.05). During a median follow-up of 58.0 months, 58 all-cause deaths and 26 cardiovascular deaths occurred. High serum FABP4 levels were independently predictive for all-cause [hazard ratio (HR), 1.003; 95% confidence interval (CI), 1.001-1.005; p = 0.016] and cardiovascular death (HR, 1.005; 95% CI, 1.001-1.008; p = 0.006) in PD patients. CONCLUSIONS Increased serum FABP4 levels can independently predict all-cause and cardiovascular death in patients on PD.
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Affiliation(s)
- Sijia Zhou
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Xiaoxiao Wang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Qingfeng Han
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Lian He
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Wen Tang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Aihua Zhang
- Department of Nephrology, Xuanwu Hospital Capital Medical University, Beijing, China
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Sethi S, Sethi N, Makkar V, Kaur S, Sohal PM. Malnutrition-Inflammation Score: A Valid Tool to Assess Nutritional Status in Patient with End-stage Renal Disease. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:559-565. [PMID: 37929549 DOI: 10.4103/1319-2442.388197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Nutritional assessment is a basic and necessary process in the nutritional management of dialysis patients. Malnutrition is a prevalent complication in patients on maintenance hemodialysis (HD). The study aimed to evaluate its relationship with the duration of dialysis, demographic and socioeconomic profile of HD patients, and to assess malnutrition inflammation score (MIS) in HD patients. In this descriptive-analytical study, 153 HD patients were selected with random sampling. All the patients were interviewed and the MIS of the patients was recorded. Evaluate the relationship of malnutrition with the duration of dialysis, demographic and socioeconomic profile of HD patients, and to assess MIS in HD patients. Patients were followed up for 3 months. Data were analyzed with Chi-square and t-tests and Pearson correlation coefficient. A total of 153 patients were studied, 53 (34.64%) patients had good nutritional status and 100 (65.35%) patients had malnutrition. The mean of patients MIS score was 10.71 ± 5.14. Malnutrition rates in males and females were not significantly different. There was a positive and significant relationship between age and MIS score (P = 0.035). There was also a significant correlation between the level of education and MIS score (P = 0.042). The mean dialysis duration was 25.52 ± 2 6.27 months. There was a significant difference in the duration of dialysis in mild to severely malnourished patients (P = 0.002). A significant correlation between MIS score and the serum calcium and serum iron results (r = 0.402). The rise in serum prealbumin level was significantly greater at 3 months. MIS score is the best tool to assess nutritional status in patients with ESRD undergoing HD, because it can recognize various degrees of malnutrition that may remain undetected by a single laboratory assessment. The correlation between MIS score and age and dialysis period was significant.
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Affiliation(s)
- Suman Sethi
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Nitin Sethi
- Department of Plastic and Cosmetic Surgery, Fortis Hospital, Ludhiana, Punjab, India
| | - Vikas Makkar
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Simran Kaur
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Preet M Sohal
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Bhargava V, Jasuja S, Wai TSC, Bhalla AK, Sagar G, Jha V, Ramachandran R, Sahay M, Alexander S, Vachharajani T, Lydia A, Mostafi M, Pisharam JK, Jacob C, Gunawan A, Leong GB, Thwin KT, Agrawal RK, Vareesangthip K, Tanchanco R, Choong L, Herath C, Lin CC, Akhtar SF, Alsahow A, Rana DS, Rajapurkar MM, Kher V, Verma S, Krishnaswamy S, Gupta A, Bahl A, Gupta A, Khanna UB, Varughese S, Gallieni M. Peritoneal dialysis: Status report in South and South East Asia. Nephrology (Carlton) 2021; 26:898-906. [PMID: 34313370 PMCID: PMC7615904 DOI: 10.1111/nep.13949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/05/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) is largely underutilized globally. We analyzed PD utilization, impact of economic status, projected growth and impact of state policy(s) on PD growth in South Asia and Southeast Asia (SA&SEA) region. METHODS The National Nephrology Societies of the region responded to a questionnaire on KRT practices. The responses were based on the latest registry data, acceptable community-based studies and societal perceptions. The representative countries were divided into high income and higher-middle income (HI & HMI) and low income and lower-middle income (LI & LMI) groups. RESULTS Data provided by 15 countries showed almost similar percentage of GDP as health expenditure (4%-7%). But there was a significant difference in per capita income (HI & HMI -US$ 28 129 vs. LI & LMI - US$ 1710.2) between the groups. Even after having no significant difference in monthly cost of haemodialysis (HD) and PD in LI & LMI countries, they have poorer PD utilization as compared to HI & HMI countries (3.4% vs. 10.1%); the reason being lack of formal training/incentives and time constraints for the nephrologist while lack of reimbursement and poor general awareness of modalities has been a snag for the patients. The region expects ≥10% PD growth in the near future. Hong Kong and Thailand with 'PD first' policy have the highest PD utilization. CONCLUSION Important deterrents to PD underutilization were lack of PD centric policies, lackadaisical patient/physician's attitude, lack of structured patient awareness programs, formal training programs and affordability.
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Affiliation(s)
- Vinant Bhargava
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Sanjiv Jasuja
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Tang Sydeny Chi Wai
- Department of Nephrology, Hong Kong Society of Nephrology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Anil K. Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Gaurav Sagar
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Vivekanand Jha
- Chair of global Kidney Health, George Institute of Global Health, New Delhi, India
| | | | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Hyderabad, India
| | | | | | - Aida Lydia
- Department of Nephrology&Hypertension, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mamun Mostafi
- Department of Nephrology, Armed Forces Medical College, Dhaka, Bangladesh
| | | | - Chakko Jacob
- Department of Nephrology, Bangalore Baptist Hospital, Bangalore, India
| | - Atma Gunawan
- Department of Nephrology, Brawijaya University, Malang city, Indonesia
| | - Goh Bak Leong
- Department of Nephrology, Serdang Hospital, Kajang, Malaysia
| | - Khin Thida Thwin
- Department of Nephrology, University Of Medicine, Yangon, Myanmar
| | | | | | | | - Lina Choong
- Department of Nephrology, Singapore General Hospital, Singapore, Singapore
| | - Chula Herath
- Department of Nephrology, Sri Jayewardenepura General Hospital, Kotte, Sri Lanka
| | - Chih-Ching Lin
- Department of Nephrology, Taipei Veterans General Hospital, Teipei city, Taiwan
| | - Syed Fazal Akhtar
- Department of Nephrology, Sindh Institute of Urology and Transplantation, karachi, Pakistan
| | - Ali Alsahow
- Department of Nephrology, Jahra Hospital, Al-Jahra, Kuwait
| | | | - Mohan M. Rajapurkar
- Department of Nephrology, Muljibhai Patel Urological Hospital, Gujrat, India
| | - Vijay Kher
- Department of Nephrology, Medanta Hospital, Gurugram, Haryana, India
| | - Shalini Verma
- Clinical Research, AVATAR foundation, New Delhi, India
| | | | - Amit Gupta
- Department of Nephrology, Apollo Medics Hospital, Kanpur–Lucknow, Uttar Pradesh, India
| | - Anupam Bahl
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Ashwani Gupta
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Umesh B. Khanna
- Department of Nephrology, Lancelot Kidney and GI Centre, Mumbai, India
| | | | - Maurizio Gallieni
- ’L. Sacco’ Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
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Kamath N, Reddy HV, Iyengar A. Clinical and dialysis outcomes of manual chronic peritoneal dialysis in low-body-weight children from a low-to-middle-income country. Perit Dial Int 2021; 40:6-11. [PMID: 32063141 DOI: 10.1177/0896860819873541] [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] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is the preferred modality of renal replacement therapy in children with end-stage renal disease (ESRD). In developing countries, the challenges of initiating and sustaining chronic peritoneal dialysis (CPD) are many and are not well-described in the literature. METHODS This was a retrospective study of children aged 0-18 years on manual PD. The objective was to compare the clinical (growth) and dialysis outcomes (dialysis adequacy and peritonitis rates) in young children with low body weight (LBW; ≤15 kg) on CPD with children weighing >15 kg. RESULTS We found that at baseline, the dialysis prescription, sociodemographic parameters, and the prevalence of complications of ESRD were similar in both groups. On follow-up, however, growth was significantly more affected in LBW children than the rest of the cohort. The adequacy of dialysis and peritonitis rates were comparable between groups. CONCLUSIONS Despite all the challenges, manual CPD is a feasible modality of dialysis in young children with LBW, and their outcomes are comparable to older children even in low-to-middle-income countries. Appropriate early management of associated complications and improving dialysis adequacy are necessary to improve the outcomes in these children.
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Affiliation(s)
- Nivedita Kamath
- Department of Pediatric Nephrology, St John's Medical College, India
| | | | - Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College, India
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Alao MA, Ibrahim OR, Asinobi AO, Akinsola A. Long-term survival of children following acute peritoneal dialysis in a resource-limited setting. Kidney Res Clin Pract 2020; 39:469-478. [PMID: 33024063 PMCID: PMC7770994 DOI: 10.23876/j.krcp.20.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/07/2020] [Accepted: 07/02/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a paucity of data on long term-outcomes of children who undergo acute peritoneal dialysis (PD) in resource-limited settings. We reviewed the outcomes of children who underwent PD after 18 months of follow-up. METHODS We conducted a prospective cohort study in children with acute kidney injury (AKI) who underwent PD. Diagnosis of AKI was based on the 2012 Kidney Disease: Improving Global Outcomes definition. We assessed outcomes of in-hospital mortality, 18-month post-dialysis survival, factors associated with survival, and progression to chronic kidney disease (CKD). RESULTS Twenty-nine children with a median age of 6 (3 to 11) years underwent acute PD. In-hospital mortality was 3/29 (10.3%) and rose to 27.6% during follow-up. Seven (24.1%) children were lost to follow-up. Of the 14 remaining children, six (42.9%) experienced full recovery of renal function, while eight (57.1%) progressed to CKD. Among those who experienced full recovery, median (interquartile range) estimated glomerular filtration rate (eGFR) rose from 12.67 (7.05, 22.85) mL/min/1.73 m2 to 95.56 (64.50, 198.00) mL/min/1.73 m2, P = 0.031. No significant changes in median eGFR from baseline were observed among those who progressed to CKD (P = 0.383) or in non-survivors (P = 0.838). According to Kaplan-Meier curve analyses, 18-month survival during follow-up was 66.0% (95% CI, 45.0% to 86.5%). Age < 5 was associated with greater likelihood of survival (OR, 3.217; 95% CI, 1.240 to 8.342). CONCLUSION Progression of post-PD AKI to CKD occurred in more than half of survivors. Age < 5 was associated with greater likelihood of survival.
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Affiliation(s)
- Michael Abel Alao
- Department of Paediatrics, Bowen University Teaching Hospital, Nigeria & Bowen University College of Medicine, Ogbomosho, Nigeria
| | | | - Adanze Onyenonachi Asinobi
- Department of Paediatrics, University College Hospital & University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Akinwale Akinsola
- Department of Internal Medicine, Bowen University Teaching Hospital, Nigeria & Bowen University College of Medicine, Ogbomosho, Nigeria
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Varughese S, Agarwal SK, Raju TR, Khanna T. Options of Renal Replacement Therapy in CKDu. Indian J Nephrol 2020; 30:261-263. [PMID: 33273791 PMCID: PMC7699668 DOI: 10.4103/ijn.ijn_396_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/08/2020] [Accepted: 07/03/2020] [Indexed: 11/17/2022] Open
Abstract
Patients with advanced Chronic Kidney Disease of Unknown origin (CKDu) need to plan for renal replacement therapy. The patients usually affected are probably best served with living-related renal transplantation. Potential donors from the same area are possibly at risk for developing CKDu and need close monitoring post kidney donation. Peritoneal dialysis (PD) is probably a better option as hemodialysis (HD) centers are located in urban areas only and patients have the convenience of receiving therapy at home. The “PD first” pilot project of Sri Lanka is a unique initiative that trains community physicians to offer PD to patients with advanced CKDu. In Telengana and Andhra Pradesh, the Aarogyasri insurance scheme provides for poor patients to avail of free HD and transplantation in government and private hospitals. Much more needs to be done to care for all those who are affected. A public–private partnership model for providing comprehensive care to patients with advanced CKDu can be undertaken in all areas affected by CKDu that makes renal replacement therapy (RRT) available and accessible, irrespective of financial and social limitations.
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Affiliation(s)
- Santosh Varughese
- Professor and Head of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sanjay K Agarwal
- Professor and Head of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - T Ravi Raju
- Dr. N.T.R. University of Health Sciences, Vijayawada, Andhra Pradesh, India
| | - Tripti Khanna
- Division of NCD, Indian Council of Medical Research (ICMR), New Delhi, India
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Murthy VS, Shukla VS. A Study of Executive Function in Patients with Chronic Kidney Disease before and after a Single Session of Hemodialysis. J Neurosci Rural Pract 2020; 11:250-255. [PMID: 32367979 PMCID: PMC7195962 DOI: 10.1055/s-0040-1703961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Executive functions (EFs) are critical to daily life and sensitive to our physiological functioning and emotional states. The number of people living with chronic kidney disease (CKD) on hemodialysis (HD) globally is increasing steadily. We aimed to determine the impact of a single session of HD on EFs in patients with CKD receiving maintenance HD (MHD). Methods This was a quasi-experimental study conducted at the department of psychiatry and dialysis unit of a tertiary hospital. Patients undergoing MHD underwent screening to rule out delirium, using the Confusion Assessment Method prior to EF testing. The tests of EF used were the Trail-Making Test-Part B (TMT-B) and Frontal Assessment Battery (FAB), both of which were administered before and after a session of HD. Statistical tests used were Wilcoxon matched pairs signed ranks test, paired t -test, single sample t -test, and correlation analyses. Results The mean time taken on TMT-B before HD was 195.36 seconds and after HD, 171.1 seconds; difference is significant ( p = 0.0001). The mean FAB score was 13.19 before HD and 14.83 after HD; the difference is significant ( p < 0.0001). Significant differences were observed on similarities (p = 0.003), lexical fluency (p = 0.02), and go-no go ( p = 0.003) subtests of FAB. Mean TMT-B scores before and after HD differed significantly from that of a reference study (reference TMT-B 150.69 seconds), p = 0.0002 and 0.04, respectively. Conclusion We conclude that patients with CKD on MHD, in general, have worse executive cognitive functioning compared with healthy populations. A session of HD results in significant improvement in these functions.
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Affiliation(s)
- Vasantmeghna S. Murthy
- Department of Psychiatry, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Vedant S. Shukla
- Department of Psychiatry, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
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Abstract
PURPOSE OF REVIEW To assess the use, access to and outcomes of hemodialysis and peritoneal dialysis in low-resource settings. RECENT FINDINGS Hemodialysis tends to predominate because of costs and logistics, however services tend to be located in larger cities, often paid for out of pocket. Outcomes of dialysis-requiring acute kidney injury and end-stage kidney disease may be similar with hemodialysis and peritoneal dialysis, and therefore choice of therapy is dominated by availability, accessibility and patient or physician choice. Some countries have implemented peritoneal dialysis-first policies to reduce costs and improve access, because peritoneal dialysis requires less infrastructure, can be scaled up more easily and can be cheaper when fluids are manufactured locally. SUMMARY Access to both hemodialysis and peritoneal dialysis remains highly inequitable in lower-resource settings. Although challenges associated with dialysis in low-resource settings are similar, and there are more adults who require dialysis in low-resource settings, addressing hemodialysis and peritoneal dialysis needs of children in low-resource settings requires attention as the global inequities are greatest in this area. Lower-income countries are increasingly seeking to improve access to dialysis through various strategies, but meeting the costs of the entire dialysis population continues to be a major challenge.
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AQP1-Containing Exosomes in Peritoneal Dialysis Effluent As Biomarker of Dialysis Efficiency. Cells 2019; 8:cells8040330. [PMID: 30970608 PMCID: PMC6523141 DOI: 10.3390/cells8040330] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/29/2019] [Accepted: 04/06/2019] [Indexed: 11/24/2022] Open
Abstract
The water channel Aquaporin 1 (AQP1) plays a fundamental role in water ultrafiltration during peritoneal dialysis (PD) and its reduced expression or function may be responsible for ultrafiltration failure (UFF). In humans, AQP1 is expressed in the endothelium of the peritoneal capillaries but its expression in mesothelial cells (MC) and its functional role in PD is still being debated. Here, we studied a cohort of 30 patients using PD in order to determine the presence of AQP1 in peritoneal biopsies, AQP1 release in the PD effluent through exosomes and the correlation of AQP1 abundance with the efficiency of peritoneal ultrafiltration. The experiments using immunofluorescence showed a strong expression of AQP1 in MCs. Immunoblotting analysis on vesicles isolated from PD effluents showed a consistent presence of AQP1, mesothelin and Alix and the absence of the CD31. Thus, this suggests that they have an exclusive mesothelial origin. The immunoTEM analysis showed a homogeneous population of nanovesicles and confirmed the immunoblotting results. Interestingly, the quantitative analysis by ELISA showed a positive correlation between AQP1 in the PD effluent and ultrafiltration (UF), free water transport (FWT) and Na-sieving. This evidence opens the discussion on the functional role of mesothelial AQP1 during PD and suggests that it may represent a potential non-invasive biomarker of peritoneal barrier integrity, with predictive potential of UFF in PD patients.
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Abstract
The series of papers that are included in this China Supplement to Peritoneal Dialysis International chart peritoneal dialysis (PD) research over the last several years in that country, provide detailed analysis of a large de-identified dataset from the Baxter Patient Support Program, and include 2 papers that describe clinical experiences relevant to the local context. These studies present a fascinating insight into the practice of PD in China, adding considerably to the sum of worldwide PD experience. China presents important opportunities for clinical research to answer key questions relevant to our therapy.
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Briggs V, Davies S, Wilkie M. International Variations in Peritoneal Dialysis Utilization and Implications for Practice. Am J Kidney Dis 2019; 74:101-110. [PMID: 30799030 DOI: 10.1053/j.ajkd.2018.12.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/11/2018] [Indexed: 12/21/2022]
Abstract
In many countries, the use of peritoneal dialysis (PD) remains low despite arguments that support its greater use, including dialysis treatment away from hospital settings, avoidance of central venous catheters, and potential health economic advantages. Training patients to manage aspects of their own care has the potential to enhance health literacy and increase patient involvement, independence, quality of life, and cost-effectiveness of care. Complex reasons underlie the variable use of PD across the world, acting at the level of the patient, the health care team that is responsible for them, and the health care system that they find themselves in. Important among these is the availability of competitively priced dialysis fluid. A number of key interventions can affect the uptake of PD. These include high-quality patient education around dialysis modality choice, timely and successful catheter placement, satisfactory patient training, and continued support that is tailored for specific needs, for example, when people present late requiring dialysis. Several health system changes have been shown to increase PD use, such as targeted funding, PD First initiatives, or physician-inserted PD catheters. This review explores the factors that explain the considerable international variation in the use of PD and presents interventions that can potentially affect them.
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Affiliation(s)
| | | | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, United Kingdom.
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Abraham G, Gupta A, Prasad KN, Rohit A, Bhalla AK, Billa V, Chakravati R, Das T, Dhinakaran T, Dutta AR, Giri P, Jeloka T, Kumar S, Marwaha A, Raghavan RV, Ravichandran R, Rohit R, Sarkar CN, Singh NSK. Microbiology, clinical spectrum and outcome of peritonitis in patients undergoing peritoneal dialysis in India: Results from a multicentric, observational study. Indian J Med Microbiol 2018; 35:491-498. [PMID: 29405139 DOI: 10.4103/ijmm.ijmm_17_392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD)-related peritonitis is a major risk factor for drop out of patients on continuous ambulatory PD (CAPD) and automated PD (APD). Factors affecting PD-related peritonitis and centre-specific microbiological data are lacking in India. A multicentric prospective observational study was designed to overcome the gaps in the existing data regarding causative organism and outcome. METHODOLOGY The present study was a prospective, uncontrolled, open-label; observational study conducted in 21 centres representing all the four geographical regions (North, South, East and West) of India between April 2010 and December 2011. RESULTS A total of 244 patients on chronic PD with peritonitis were enrolled in the study (CAPD and APD), who met the inclusion criteria, from 21 centres covering the different geographical areas of India. Amongst the 85 samples that were culture positive, 38 (44.7%) were in the monsoon season followed by 23 (27.1%) in the post-monsoon, 18 (21.2%) during winter and 11 (12.9%) during summer. Maximum culture positivity (72.7%) was observed with automated culture technique. Microorganisms could be isolated in only 85 cases (35.3%) while the remaining samples were culture negative (156/241, 64.7% of samples). Organisms isolated were Gram-negative in 47.8%, Gram-positive in 36.7%, fungal in 13.3% and Mycobacterium tuberculosis in 2.2%. CONCLUSION This large multicentre study of peritonitis offers insights into the aetiology and outcomes of infectious complications of chronic PD in India that are germane to clinical decision-making.
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Affiliation(s)
- Georgi Abraham
- Department of Nephrology, Madras Medical Mission, Chennai, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kashi Nath Prasad
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anusha Rohit
- Department of Microbiology, Madras Medical Mission, Chennai, India
| | | | | | | | - Tonmoy Das
- Department of Nephrology, International Hospital, Guwahati, Assam, India
| | - Thadakanathan Dhinakaran
- Department of Nephrology, Madurai Kidney Center and Transplantation Research Center, Madurai, India
| | - Arup Ratan Dutta
- Department of Nephrology, Fortis Hospital and Kidney Institute, Kolkata, West Bengal, India
| | - Padmanabhan Giri
- Department of Nephrology, Renal Care Hospital, Trichy, Tamil Nadu, India
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- Department of Nephrology, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Tarun Jeloka
- Department of Nephrology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Sampath Kumar
- Department of Nephrology, Meenakshi Mission Hospital and Research Center, Madurai, India
| | - Ajay Marwaha
- Department of Nephrology, Kidney Hospital, Jalandhar, Punjab, India
| | | | | | - Roshan Rohit
- Department of Medical Research and Medical Affairs-Industry, Baxter Pvt. Ltd, India
| | - Chandra Nath Sarkar
- Department of Nephrology, Fortis Hospital and Kidney Institute, Kolkata, West Bengal, India
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Affiliation(s)
| | - Georgi Abraham
- Nephrology, Madras Medical Mission, Chennai, Tamil Nadu, India; and
- Nephrology, Pondicherry Institute of Medical Sciences, Pondicherry, Puducherry, India
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Gorbatkin C, Bass J, Finkelstein FO, Gorbatkin SM. Peritoneal Dialysis in Austere Environments: An Emergent Approach to Renal Failure Management. West J Emerg Med 2018; 19:548-556. [PMID: 29760854 PMCID: PMC5942023 DOI: 10.5811/westjem.2018.3.36762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/16/2018] [Accepted: 03/09/2018] [Indexed: 12/26/2022] Open
Abstract
Peritoneal dialysis (PD) is a means of renal replacement therapy (RRT) that can be performed in remote settings with limited resources, including regions that lack electrical power. PD is a mainstay of end-stage renal disease (ESRD) therapy worldwide, and the ease of initiation and maintenance has enabled it to flourish in both resource-limited and resource-abundant settings. In natural disaster scenarios, military conflicts, and other austere areas, PD may be the only available life-saving measure for acute kidney injury (AKI) or ESRD. PD in austere environments is not without challenges, including catheter placement, availability of dialysate, and medical complications related to the procedure itself. However, when hemodialysis is unavailable, PD can be performed using generally available medical supplies including sterile tubing and intravenous fluids. Amidst the ever-increasing global burden of ESRD and AKI, the ability to perform PD is essential for many medical facilities.
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Affiliation(s)
- Chad Gorbatkin
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - John Bass
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | | | - Steven M. Gorbatkin
- Atlanta VA Medical Center, Emory University, Department of Nephrology, Atlanta, Georgia
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Moore J, Garcia P, Rohloff P, Flood D. Treatment of end-stage renal disease with continuous ambulatory peritoneal dialysis in rural Guatemala. BMJ Case Rep 2018; 2018:bcr-2017-223641. [PMID: 29705734 PMCID: PMC5931272 DOI: 10.1136/bcr-2017-223641] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A 42-year-old indigenous Maya man presented to a non-profit clinic in rural Guatemala with signs, symptoms and laboratory values consistent with uncontrolled diabetes. Despite appropriate treatment, approximately 18 months after presentation, he was found to have irreversible end-stage renal disease (ESRD) of uncertain aetiology. He was referred to the national public nephrology clinic and subsequently initiated home-based continuous ambulatory peritoneal dialysis. With primary care provided by the non-profit clinic, his clinical status improved on dialysis, but socioeconomic and psychological challenges persisted for the patient and his family. This case shows how care for people with ESRD in low- and middle-income countries requires scaling up renal replacement therapy and ensuring access to primary care, mental healthcare and social work services.
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Affiliation(s)
- Jillian Moore
- Harvard Medical School, Boston, Massachusetts, USA.,Wuqu' Kawoq, Santiago Sacatepéquez, Guatemala
| | - Pablo Garcia
- Wuqu' Kawoq, Santiago Sacatepéquez, Guatemala.,Department of Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, USA
| | - Peter Rohloff
- Wuqu' Kawoq, Santiago Sacatepéquez, Guatemala.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David Flood
- Wuqu' Kawoq, Santiago Sacatepéquez, Guatemala.,Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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Mcgee J, Pandey B, Maskey A, Frazer T, Mackinney T. Free dialysis in Nepal: Logistical challenges explored. Hemodial Int 2018; 22:283-289. [PMID: 29446212 DOI: 10.1111/hdi.12629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Indexed: 11/30/2022]
Abstract
Nepal's Ministry of Health began offering free lifetime hemodialysis (HD) in 2016. There has been a large growth in renal replacement therapy (RRT) services offered in Nepal since 2010, when the last known data on the subject was published. In 2016, 42 HD centers existed (223% increase since 2010) serving 1975 end stage renal disease patients (303% increase since 2010); 36 nephrologists were registered (200% increase since 2010), 12 were trained in transplantation, and 790 transplants had been performed to date. We estimate the incidence of end stage renal disease to be 2900 patients (100 per million population). With an annual cost of approximately US$2300 per dialysis patient, offering free dialysis could potentially cost the government US$6.7 million per year, suggesting that 2.1% of the annual health budget would be allocated to 0.01% of the population. The geographic zone surrounding the capital city, Kathmandu, contains 50% of HD centers, but only 14.5% of Nepal's population. Forty-eight percent of the population lives within zones without HD service, therefore infrastructure challenges exist in providing equitable access to RRT. The aim of this article is to summarize the current statistics of RRT in Nepal.
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Affiliation(s)
- John Mcgee
- The Medical College of Wisconsin is a private, accredited medical school and graduate school of sciences located in Milwaukee, Wisconsin, United States
| | - Bimal Pandey
- Patan Academy of Health Sciences is an autonomous, not-for-profit, public institution of higher education located in Patan, Lalitpur, Nepal
| | - Abhishek Maskey
- Manipal College of Medical Sciences is a private medical college associated with Manipal Teaching Hospital, located in Pokhara, Nepal
| | - Tifany Frazer
- The Medical College of Wisconsin is a private, accredited medical school and graduate school of sciences located in Milwaukee, Wisconsin, United States
| | - Theodore Mackinney
- The Medical College of Wisconsin is a private, accredited medical school and graduate school of sciences located in Milwaukee, Wisconsin, United States.,Patan Academy of Health Sciences is an autonomous, not-for-profit, public institution of higher education located in Patan, Lalitpur, Nepal
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Abraham G, Gupta A. Safe and Cost-Effective Peritoneal Dialysis Access by Skilled Nephrologists in Developing Countries. Perit Dial Int 2017; 36:587-588. [PMID: 27903849 DOI: 10.3747/pdi.2016.00088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Georgi Abraham
- Nephrology, Madras Medical Mission, 4-A, Dr. J. Jayalalitha Nagar, Mogappair, Chennai, Tamil Nadu, India
| | - Amit Gupta
- Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow, Uttar Pradesh, India
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Neoh KG, Li M, Kang ET, Chiong E, Tambyah PA. Surface modification strategies for combating catheter-related complications: recent advances and challenges. J Mater Chem B 2017; 5:2045-2067. [DOI: 10.1039/c6tb03280j] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This review summarizes the progress made in addressing bacterial colonization and other surface-related complications arising from catheter use.
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Affiliation(s)
- Koon Gee Neoh
- Department of Chemical and Biomolecular Engineering
- National University of Singapore
- Singapore 119077
| | - Min Li
- Department of Chemical and Biomolecular Engineering
- National University of Singapore
- Singapore 119077
| | - En-Tang Kang
- Department of Chemical and Biomolecular Engineering
- National University of Singapore
- Singapore 119077
| | - Edmund Chiong
- Department of Surgery
- National University of Singapore
- Singapore 119077
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Appalsawmy UD, Akbani H. Acute peritoneal dialysis in a Jehovah's Witness post laparotomy. BMJ Case Rep 2016; 2016:bcr2016214353. [PMID: 27581233 PMCID: PMC5015135 DOI: 10.1136/bcr-2016-214353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 11/03/2022] Open
Abstract
A 56-year-old man who was a Jehovah's Witness with an advanced directive against autologous procedures developed acute kidney injury needing renal replacement therapy while he was intubated and ventilated on the intensive care unit. He was being treated for hyperosmolar hyperglycaemic state. He also had a healing laparotomy wound, having undergone a splenectomy less than a month ago following a road traffic accident. His hyperkalaemia and metabolic acidosis were refractory to medical treatment. As he became oligoanuric, decision was taken to carry out acute peritoneal dialysis (PD) by inserting a Tenckhoff catheter in his abdomen using peritoneoscopic technique. The patient was started on automated PD without any complications. His urine output gradually improved, and his renal function eventually recovered. On discharge from hospital, his renal function was within normal range, and he had no abdominal complications from the acute PD.
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Affiliation(s)
| | - Habib Akbani
- Renal Department, Bradford Royal Infirmary, Bradford, Bradford, UK
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Addressing Peritoneal Dialysis: In Vitro PD Models, In Vivo Rodent PD Model, Clinical Biobanks, and Underutilization of PD. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4964316. [PMID: 26881221 PMCID: PMC4735936 DOI: 10.1155/2016/4964316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 11/26/2015] [Indexed: 11/17/2022]
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