Low-Volume Tidal Peritoneal Dialysis Is a Preferable Mode in Patients Initiating Urgent-Start Automated Peritoneal Dialysis: A Randomized, Open-Label, Prospective Control Study

Tidal Versus Intermittent Peritoneal Dialysis in Chronic Peritoneal Dialysis Patients: Randomized, Open-Label, Prospective Control Study

BACKGROUND

Tidal peritoneal dialysis (TPD) provides better fluid flow mechanics and is more comfortable for the patient, owing to fewer alarms and less pain during inflow and outflow. The long-term characteristics of patients with TPD were not evident. In this randomized controlled follow-up study, we aimed to explore the characteristics of patients with TPD, compared to IPD.

METHODS

A total of 85 patients were randomized to either IPD or 70% TPD between January 2019 and December 2020, and all patients were followed up on December 2021. The characteristics of patients between the two groups were analyzed using a t-test or chi-square as appropriate. The overall survival and technical survival were analyzed using Kaplan-Meier analysis.

RESULTS

Forty-two patients were assigned to IPD, and 43 patients were assigned to TPD. The basal characteristics of patients were not different between the two groups. In an average of 16 months of follow-up, 19 patients died, and 25 patients dropped out of peritoneal dialysis. The two groups had no difference in overall survival and technical survival. TPD was associated with high urine volume (p = 0.001), lower blood urea nitrogen (p = 0.002), lower phosphorus (p = 0.004), and fewer cycler alarms (p < 0.001). The chance of patients reporting abdominal fullness was higher in patients with TPD (p = 0.001).

CONCLUSION

In the randomized, controlled, follow-up study, TPD may preserve residual renal function and is associated with lower urea nitrogen and phosphorus in chronic peritoneal dialysis patients. TPD is associated with fewer cycler alarms but may increase the chance of patients reporting abdominal distension.

Research hotspots and development trends in volume management of peritoneal dialysis patients: a bibliometrics and visual analysis up to 2022

OBJECTIVES

Among different renal replacement therapies (RRTs), peritoneal dialysis (PD) is a family based treatment method with multiple advantages, which allowing patients to maintain autonomy, avoiding frequent hospital visits, and preventing the spread of the disease virus. To visually analyze the literatures related to volume management of PD patients through bibliometric methods, to explore research hotspots and development trends in this field.

METHODS

The relevant literatures of PD patient volume management in the Web of Science core collection database were retrieved with the terms of peritoneal dialysis, volume management, capacity management, fluid status, and volume overload. The retrieval time was from the establishment of the database to October 2022. CiteSpace 6.1.R3 software was used to visually analyze Country, Institution, Author, Keyword, and draw keyword clusters and keyword emergence maps.

RESULTS

A total of 788 articles were included in the analysis, and the annual number of papers was on the rise, with the American, China, and Brirain in the top three, and Peking University and University College London in the top. Keywords cluster analysis showed 11 clusters. In the keyword emergence analysis, the keywords with higher emergence intensity rank are continuous cyclic peritoneal dialysis, ambulatory peritoneal dialysis, and icodextrin. The current research hotspots and trends are in the evaluation of peritoneal dialysis patients' volume status, the selection and adjustment of dialysis prescriptions, and adverse health outcomes.

CONCLUSION

The research on peritoneal dialysis volume management in China started late, but it has developed rapidly, and has a firm grasp of current research hotspots. However, there is less cooperation with other countries, so international exchanges and cooperation should be strengthened. At present, the volume assessment methods and dialysis modes are still the research hotspots, paying more attention to the adverse health outcomes of patients.

Urgent Implantation of Peritoneal Dialysis Catheter in Chronic Kidney Disease and Acute Kidney Injury-A Review

Acute kidney injury (AKI) and sudden exacerbation of chronic kidney disease (CKD) frequently necessitate urgent kidney replacement therapy (UKRT). Peritoneal dialysis (PD) is recognized as a viable modality for managing such patients. Urgent-start peritoneal dialysis (USPD) may be associated with an increased number of complications and is rarely utilized. This review examines recent literature investigating the clinical outcomes of USPD in CKD and AKI. Relevant research was identified through searches of the MEDLINE (PubMed), Scopus, Web of Science, and Google Scholar databases using MeSH terms and relevant keywords. Included studies focused on the emergency use of peritoneal dialysis in CKD or AKI and reported treatment outcomes. While no official recommendations exist for catheter implantation in USPD, the impact of the technique itself on outcomes was found to be less significant compared with the post-implantation factors. USPD represents a safe and effective treatment modality for AKI, although complications such as catheter malfunctions, leakage, and peritonitis were observed. Furthermore, USPD demonstrated efficacy in managing CKD, although it was associated with a higher incidence of complications compared to conventional-start peritoneal dialysis. Despite its cost-effectiveness, PD requires greater technical expertise from medical professionals. Close supervision and pre-planning for catheter insertion are essential for CKD patients. Whenever feasible, an urgent start should be avoided. Nevertheless, in emergency scenarios, USPD does remain a safe and efficient approach.

Peritoneal dialysis access outcomes reported in randomized controlled trials: A systematic review

BACKGROUND

Functional peritoneal dialysis (PD) access is critical to the success of PD therapy. The aim of this review is to describe the spectrum of definitions and methods employed in the measurement of unique outcomes across PD access trials particularly focusing on the outcomes of PD access flow restriction and operative-related outcomes.

METHODS

Using Cochrane CENTRAL registry, MEDLINE, and EMBASE, we searched for studies restricted to randomized controlled trials (RCTs) involving interventions related to PD access without restrictions on age, language, or publication year. Studies were screened and data abstracted by two independent reviewers. Definitions, outcome measures, and time points of measurements were captured and documented separately. Unique combinations of these variables resulted in reporting the different ways of measurements.

RESULTS

Of the 1768 screened studies, 47 RCTs were included among which 817 PD access outcomes were grouped into 7 broad categories. Interventions evaluated in the RCTs were catheter type/configuration (n = 17), insertion technique (n = 15), multiple interventions (n = 3), and other (6 interventions, n = 12). PD access flow restriction (a subcategory of mechanical outcomes) and operative-related outcomes were reported in 91% and 58% of the included trials, respectively. Tip migration was the most frequently reported flow restriction outcome (59% of RCTs) followed by catheter dysfunction (23% of RCTs). Of the components utilized in definition of flow restriction, description of the impaired flow was reported in 37% of RCTs, need for intervention in 42% of RCTs, and presumed etiology of flow restriction in 60% of RCTs.

CONCLUSION

Variability exists in the definitions, reporting methods, choice of outcomes, and analysis of the PD access outcomes across RCTs. Operative-related outcomes remain underreported across RCTs. Outcomes relating to PD access flow restriction were the most common complications reported in the included RCTs but were reported heterogeneously with variability in reporting of the three key components of its definition including description and severity of the flow restriction, the need for intervention and etiology of flow restriction. In the future, defining PD access flow restriction should include all of these components to better evaluate the comparative effect of various PD access interventions.