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Mobley D, Kalloo SD, Baskin KM, Koh E, McLennan G, Narayan R, Towbin R, White S, Weintraub JL. Research Priorities for Percutaneous Arteriovenous Fistula Creation in Patients with End-Stage Renal Disease: Proceedings and Recommendations from a Multidisciplinary Research Consensus Panel. J Vasc Interv Radiol 2021; 32:1240.e1-1240.e8. [PMID: 34332723 DOI: 10.1016/j.jvir.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/29/2021] [Indexed: 11/19/2022] Open
Abstract
Recently developed endovascular techniques to create percutaneous arteriovenous fistulas are an alternative to surgical arteriovenous fistula creation, although there is currently a lack of high-level evidence regarding their creation, maturation, utilization, and long-term function. Recognizing this, the Society of Interventional Radiology Foundation sponsored a Research Consensus Panel and Summit for the prioritization of a research agenda to identify and address the gaps in current knowledge.
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Affiliation(s)
- David Mobley
- Division of Vascular and Interventional Radiology, Department of Radiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY.
| | - Sean D Kalloo
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Kevin M Baskin
- Interventional Radiology, Sharon Regional Medical Center, Sharon, PA
| | - Elsie Koh
- American Endovascular Care, New York, NY
| | - Gordon McLennan
- Interventional Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rajeev Narayan
- Interventional Nephrology, San Antonio Kidney Disease Center, San Antonio, TX
| | - Richard Towbin
- Department of Interventional and Pediatric Radiology, Phoenix Children's Hospital, Phoenix, AZ
| | - Sarah White
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Joshua L Weintraub
- Department of Radiology (in Surgery), Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY
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Rajora N, Shastri S, Pirwani G, Saxena R. How To Build a Successful Urgent-Start Peritoneal Dialysis Program. KIDNEY360 2020; 1:1165-1177. [PMID: 35368794 PMCID: PMC8815497 DOI: 10.34067/kid.0002392020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022]
Abstract
In-center hemodialysis (HD) remains the predominant dialysis therapy in patients with ESKD. Many patients with ESKD present in late stage, requiring urgent dialysis initiation, and the majority start HD with central venous catheters (CVCs), which are associated with poor outcomes and high cost of care. Peritoneal dialysis (PD) catheters can be safely placed in such patients with late-presenting ESKD, obviating the need for CVCs. PD can begin almost immediately in the recumbent position, using low fill volumes. Such PD initiations, commencing within 2 weeks of the catheter placement, are termed urgent-start PD (USPD). Most patients with an intact peritoneal cavity and stable home situation are eligible for USPD. Although there is a small risk of PD catheter-related mechanical complications, most can be managed conservatively. Moreover, overall outcomes of USPD are comparable to those with planned PD initiations, in contrast to the high rate of catheter-related infections and bacteremia associated with urgent-start HD. The ongoing coronavirus disease 2019 pandemic has further exposed the vulnerability of patients with ESKD getting in-center HD. PD can mitigate the risk of infection by reducing environmental exposure to the virus. Thus, USPD is a safe and cost-effective option for unplanned dialysis initiation in patients with late-presenting ESKD. To develop a successful USPD program, a strong infrastructure with clear pathways is essential. Coordination of care between nephrologists, surgeons or interventionalists, and hospital and PD center staff is imperative so that patient education, home visits, PD catheter placements, and urgent PD initiations are accomplished expeditiously. Implementation of urgent-start PD will help to increase PD use, reduce cost, and improve patient outcomes, and will be a step forward in fostering the goal set by the Advancing American Kidney Health initiative.
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Affiliation(s)
- Nilum Rajora
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shani Shastri
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gulzar Pirwani
- University of Texas Southwestern/DaVita Peritoneal Dialysis Center, Irving, Texas
| | - Ramesh Saxena
- Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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Hiramatsu T, Okumura S, Asano Y, Mabuchi M, Iguchi D, Furuta S. Quality of Life and Emotional Distress in Peritoneal Dialysis and Hemodialysis Patients. Ther Apher Dial 2019; 24:366-372. [DOI: 10.1111/1744-9987.13450] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/03/2019] [Accepted: 10/28/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Takeyuki Hiramatsu
- Department of NephrologyAichi Welfare Cooperative Agricultural Federation Konan‐Kosei Hospital Konan City Japan
| | - Shota Okumura
- Department of NephrologyAichi Welfare Cooperative Agricultural Federation Konan‐Kosei Hospital Konan City Japan
| | - Yuko Asano
- Department of NephrologyAichi Welfare Cooperative Agricultural Federation Konan‐Kosei Hospital Konan City Japan
| | - Masatsuna Mabuchi
- Department of NephrologyAichi Welfare Cooperative Agricultural Federation Konan‐Kosei Hospital Konan City Japan
| | - Daiki Iguchi
- Department of NephrologyAichi Welfare Cooperative Agricultural Federation Konan‐Kosei Hospital Konan City Japan
| | - Shinji Furuta
- Department of NephrologyAichi Welfare Cooperative Agricultural Federation Konan‐Kosei Hospital Konan City Japan
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Davidson I, Gallieni M, Saxena R. Peritoneal Dialysis and Av Fistulae: Our Algorithm for Determining the “Best” Dialysis Access. J Vasc Access 2018. [DOI: 10.1177/112972980600700401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- I.J.A. Davidson
- The University of Texas Southwestern Medical Center, Dallas, TX - USA
| | - M. Gallieni
- Renal Unit, San Paolo Hospital, University of Milano - Italy
| | - R. Saxena
- The University of Texas Southwestern Medical Center, Dallas, TX - USA
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Al Azzi Y, Zeldis E, Nadkarni GN, Schanzer H, Uribarri J. Outcomes of dialysis catheters placed by the Y-TEC peritoneoscopic technique: a single-center surgical experience. Clin Kidney J 2016; 9:158-61. [PMID: 26798478 PMCID: PMC4720193 DOI: 10.1093/ckj/sfv113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/12/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the last few years, peritoneal dialysis (PD) catheter placement techniques and outcomes have become important because of the growing population of PD patients. Although there are a growing number of catheters placed by the minimally invasive Y-TEC peritoneoscopic technique, there are still limited data on outcomes for these catheters, especially those placed by a surgeon. We aimed to conduct a retrospective study of our experience with PD catheters placed by the Y-TEC peritoneoscopic technique in our institution. METHODS We reviewed patients with peritoneoscopic PD catheter insertion over the last decade and described their complications and outcomes. In a secondary analysis, we compared the outcomes and complications of these catheters with those with open placement placed by the same surgeon. RESULTS We had complete data on 62 patients with peritoneoscopic catheter placement during the study period. The mean age was 55 years, 48.4% were females and the most common cause of end-stage renal disease was diabetes mellitus (33%). Surgical complications were seen in only 6/62 (9.6%) and peritonitis in 16/62 (26%) of peritoneoscopic catheters. Most catheters were used after 2 months of placement, while 12.3% were used within 2 months. When compared with 93 patients with open placement of catheters as a secondary analysis, peritoneoscopic catheters were found to have a higher 2-year survival. CONCLUSION Our large series of peritoneoscopically placed catheters by a surgeon demonstrate low surgical complications and peritonitis rates as well as superior 2-year survival compared with open placement of catheters.
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Affiliation(s)
- Yorg Al Azzi
- Division of Nephrology, Department of Medicine , Mount Sinai Hospital, Icahn School of Medicine , New York, NY , USA
| | - Etti Zeldis
- Division of Nephrology, Department of Medicine , Mount Sinai Hospital, Icahn School of Medicine , New York, NY , USA
| | - Girish N Nadkarni
- Division of Nephrology, Department of Medicine , Mount Sinai Hospital, Icahn School of Medicine , New York, NY , USA
| | - Harry Schanzer
- Division of Vascular Surgery, Department of Surgery , Mount Sinai Hospital, Icahn School of Medicine , New York, NY , USA
| | - Jaime Uribarri
- Division of Nephrology, Department of Medicine , Mount Sinai Hospital, Icahn School of Medicine , New York, NY , USA
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Lee CJ, Subeq YM, Lee RP, Liou HH, Hsu BG. Calcitriol decreases TGF-β1 and angiotensin II production and protects against chlorhexide digluconate-induced liver peritoneal fibrosis in rats. Cytokine 2013; 65:105-18. [PMID: 24210651 DOI: 10.1016/j.cyto.2013.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 08/20/2013] [Accepted: 10/04/2013] [Indexed: 11/30/2022]
Abstract
Peritoneal fibrosis is a major complication of peritoneal dialysis that can lead to ultrafiltration failure. This study investigates the protective effects of calcitriol on chlorhexidine digluconate-induced peritoneal fibrosis in rats. Peritoneal fibrosis was induced in Sprague-Dawley rats by daily administration of 0.5mL 0.1% chlorhexidine digluconate in normal saline via peritoneal dialysis for 1week. Rats received daily intravenous injections of calcitriol (low-dose, 10ng/kg; or high-dose, 100ng/kg) for 1week. After 7days, conventional 4.25% Dianeal (30mL) was administered via peritoneal dialysis over 4h. Peritoneal solute transport was calculated from the dialysate concentration relative to its concentration in the initial infused dialysis solution (D4/D0 glucose) for glucose, and the dialysate-to-plasma concentration ratio (D4/P4 urea) at 4h for urea. Rats were then sacrificed and the liver peritoneum was harvested for immunohistochemical analysis via microscopy. After dialysis, the D4/P4 Urea level was reduced; increases were observed in the D4/D0 glucose level and the levels of active transforming growth factor-β1 and angiotensin II in serum and dialysate; the liver peritoneum and muscle peritoneum was markedly thickened, and the expression of α-SMA, fibronectin, collagen, vascular endothelial growth factor, angiotensin II, transforming growth factor-β1, and phosphorylated Smad2/3 (P-Smad2/3)-positive cells in the liver peritoneum was elevated in the peritoneal fibrosis group compared with the vehicle group. Calcitriol decreased the serum and dialysate active transforming growth factor-β1 and angiotensin II level, decreased the thickness of the liver peritoneum and muscle peritoneum, and decreased the expression of α-SMA, fibronectin, collagen, vascular endothelial growth factor, angiotensin II, transforming growth factor-β1, and P-Smad2/3-positive cells in liver peritoneum cells. High-dose calcitriol exhibited better protective effects against peritoneal fibrosis than did the lower dose. Calcitriol protected against chlorhexidine digluconate-induced peritoneal fibrosis in rats by decreasing transforming growth factor-β1 and angiotensin II production.
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Affiliation(s)
- Chung-Jen Lee
- Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan
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Peritoneal Dialysis Access: Open versus Laparoscopic Surgical Techniques. J Vasc Access 2013; 14:307-17. [DOI: 10.5301/jva.5000174] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2013] [Indexed: 11/20/2022] Open
Abstract
Aim To outline pros and cons with the open and laparoscopic techniques when placing peritoneal dialysis (PD) catheters. Background Controversy exists regarding which technique, the open and laparoscopic, if any, is superior to the other. In addition, there is the question of which approach is best in rescuing malfunctioning PD catheters. Results Rather than promoting one doctrine fits all, philosophically, doing the right thing for the patient by specific criteria is ethically the better model. These specific selection criteria include patient characteristics, the team's skills and knowledge and institutional resources and commitment. Also, the sophistication of a PD unit for training and monitoring of patients is crucial for successful outcomes. Open paramedian and two laparoscopic approaches are described in detail, outlining advantages and disadvantages of each, with suggestions when one method is preferred. Conclusions In general, the laparoscopic technique is associated with longer operative times, higher costs and the need to utilize general anesthesia. It is, however, the preferred method when rescuing malfunctioning catheters and may increase the PD patient population in patients with previous abdominal surgeries. The dialysis access surgeon should be familiar with both open and laparoscopic techniques and appropriately choose the ideal method based upon the individual patient and institutional resources.
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Risk factors associated with peritoneal dialysis catheter survival: a 9-year single-center study in 315 patients. J Vasc Access 2011; 11:316-22. [PMID: 20890875 DOI: 10.5301/jva.2010.5774] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To review the peritoneal dialysis (PD) catheter outcomes at our center and assess factors affecting catheter survival. METHODS We carried out a retrospective study on 315 patients who had their first PD catheter placed between January 2001 and September 2009 at the UT Southwestern/DaVita Peritoneal Dialysis Clinic at Dallas, Texas. Medical records were reviewed for demographic and clinical information of the patients. The primary end point of the study was PD catheter failure, defined as removal of a dysfunctional PD catheter due to catheter-related complications. Catheter survival was estimated using the Kaplan-Meier method. Cox proportional hazard regression model was used to identify factors that are independently associated with catheter survival. RESULTS The mean age of the patients was 49.7 ± 29 yrs. The study population included 54.6% females, 42.5% African American, 27.9% Caucasian and 22.9% Hispanic patients. Diabetes was the primary etiology of end-stage renal disease in 43.2% of patients. More than 90% of patients had one or more co-morbidities, and 57.5% had previous abdominal surgery. The mean BMI for the group was 28.6 ± 13.8 kg/m2. Less than a quarter of the patients (24.1%) had non-infectious/mechanical catheter problems. Overall PD catheter survival rates over 12, 24 and 36 months were 92.9%, 91.9% and 91.1%, respectively. PD catheter-related non-infectious problem was the only independent variable that was significantly associated with catheter survival (hazard ratio 22.467; 95% CI 6.665-75.732). No significant association was observed between the PD catheter survival and other risk factors including age, body mass index (BMI), diabetic status, co-morbidities, previous abdominal surgeries or infections. CONCLUSIONS Our study shows an excellent 3-yr PD catheter survival (91.1%). Only PD catheter-related non-infectious problems are significantly associated with catheter failure. Other factors such as age, gender, race, BMI, diabetic status, co-morbidities, previous abdominal surgeries, peritoneal infections or exit site/tunnel infections were not found to affect the PD catheter survival and should not be considered barriers to PD initiation.
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Tanizawa K, Fukunaga K, Okumura N, Sugimura M, Tanaka E, Hajiro T, Sakuramoto M, Minakuchi M, Hashimoto S, Yasuda T, Kaji Y, Ikezoe K, Sato E, Nakajima T, Taguchi Y. Successful chemotherapy for small-cell lung cancer in an elderly patient undergoing continuous ambulatory peritoneal dialysis. Intern Med 2010; 49:1179-83. [PMID: 20558939 DOI: 10.2169/internalmedicine.49.3497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A standard treatment has not yet been established for elderly small-cell lung cancer patients, especially when they have end-stage renal disease. We report the first case of successful chemoradiotherapy in an elderly small-cell lung cancer patient undergoing continuous ambulatory peritoneal dialysis. A 77-year-old Japanese man on continuous ambulatory peritoneal dialysis was diagnosed as having limited disease small-cell lung cancer. He received four monthly cycles of chemotherapy consisting of carboplatin at 240 mg/m(2) on day 1 and etoposide at 40 mg/m(2) on days 1 and 3. He underwent additional hemodialysis on days 1 and 3, while continuous ambulatory peritoneal dialysis continued as usual on the other days. Following chemotherapy, he underwent hyperfractionated radiotherapy to a total dose of 45 Grey, resulting in complete remission of the disease. A pharmacokinetic study showed an area under the concentration-time curve of carboplatin of 3.41 to 4.88 mg.min/mL, increasing gradually over the first three cycles, while etoposide did not show this gradual increase. The increased area under the concentration-time curve of carboplatin may have reflected a worsened renal function during chemotherapy. Despite dose reductions and favorable areas under the concentration-ime curve of carboplatin, the patient suffered grade 3-4 hematological toxicities, necessitating transfusions and a further dose reduction. The patient died of recurrent small-cell lung cancer 19 months after diagnosis.
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Vazquez MA. Patients Could Consider PD More Often. J Vasc Access 2009. [DOI: 10.1177/112972980901000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Neil N, Guest S, Wong L, Inglese G, Bhattacharyya SK, Gehr T, Walker DR, Golper T. The financial implications for medicare of greater use of peritoneal dialysis. Clin Ther 2009; 31:880-8. [DOI: 10.1016/j.clinthera.2009.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2009] [Indexed: 11/28/2022]
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Neil N, Walker DR, Sesso R, Blackburn JC, Tschosik EA, Sciaraffia V, García-Contreras F, Capsa D, Bhattacharyya SK. Gaining efficiencies: resources and demand for dialysis around the globe. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:73-9. [PMID: 18680485 DOI: 10.1111/j.1524-4733.2008.00414.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES End-stage renal disease (ESRD) is a debilitating condition resulting in death unless treated. Treatment options are transplantation and dialysis. Alternative dialysis modalities are peritoneal dialysis (PD) and hemodialysis (HD), each of which has been shown to produce similar outcomes and survival. Nevertheless, the financial implications of each modality are different and these differences vary by country, especially in the developing world. Changes in clinically appropriate dialysis delivery leading to more efficient use of resources would increase the resources available to treat ESRD or other disabling conditions. This article outlines the relative advantages of HD and PD and uses budget impact analysis to estimate the country-specific, 5-year financial implications on total dialysis costs assuming utilization shifts from HD to PD in two high-income (UK, Singapore), three upper-middle-income (Mexico, Chile, Romania), and three lower-middle-income (Thailand, China, Colombia) countries. RESULTS Peritoneal dialysis is a clinically effective dialysis option that can be significantly cost-saving compared to HD, even in developing countries. CONCLUSIONS The magnitude of costs associated with treating ESRD patients globally is large and growing. PD is a clinically effective dialysis option that can be used by a majority of ESRD patients and can also be significantly cost-saving compared to HD therapy. Increasing clinically appropriate PD use would substantially reduce health-care costs and help health-care systems meet ever-tightening budget constraints.
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Affiliation(s)
- Nancy Neil
- Lifecycle Sciences Group, ICON Clinical Research, San Francisco, CA 94105, USA.
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Squamous Metaplasia of the Ovarian Surface Epithelium and Subsurface Fibrosis: Distinctive Pathologic Findings in the Ovaries and Fallopian Tubes of Patients on Peritoneal Dialysis. Int J Gynecol Pathol 2008; 27:465-74. [DOI: 10.1097/pgp.0b013e3181671aad] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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