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Lumlertgul D, Tinroongroj N, Lumlertgul S, Siwapitak P, Tungkanakorn R, Kaewpanya S. Rescue plan for CAPD peritonitis: Using ultrasonography as a guide on when to remove the catheter. Ther Apher Dial 2023; 27:1113-1124. [PMID: 37632328 DOI: 10.1111/1744-9987.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 07/05/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Ultrasound has been found to facilitate early identification of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS A retrospective analysis was carried out to evaluate the effectiveness of ultrasonography-guided removal of the Tenckhoff catheter in reducing complications like a shift to hemodialysis or death in CAPD patients. RESULTS The "peritonitis rescue plan" supported timely decision-making for the removal of the infected catheter and resulted in a lower peritonitis episode per patient per month ratio (from 1:36 to 1:122) in 2021, a lower death rate (from 19% to 6.6%) and lower incidences of shifts to hemodialysis (from 2%-9% to 0%) as compared to that before the implementation of the plan in 2019. CONCLUSION The implementation of the "peritonitis rescue plan" and the removal of the infected catheter within 3 days of peritonitis being detected was successful in improving the standard of care for patients undergoing CAPD.
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Affiliation(s)
- Dusit Lumlertgul
- CAPD Institute, Chiangmai Kidney Clinic, Chiangmai, Thailand
- Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
- Renal Disease Unit, Pan Hospital, Chiang Rai, Thailand
- Renal Disease Unit, Fang Hospital, Chiangmai, Thailand
| | - Nantawan Tinroongroj
- CAPD Institute, Chiangmai Kidney Clinic, Chiangmai, Thailand
- Bangkok Hospital, Chiangmai, Thailand
| | - Suthaporn Lumlertgul
- CAPD Institute, Chiangmai Kidney Clinic, Chiangmai, Thailand
- Department of Emergency Medicine, Chulalongkorn Hospital, Bangkok, Thailand
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Gardezi AI, Aziz F, Parajuli S. The Role of Peritoneal Dialysis in Different Phases of Kidney Transplantation. KIDNEY360 2022; 3:779-787. [PMID: 35721606 PMCID: PMC9136899 DOI: 10.34067/kid.0000482022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/23/2022] [Indexed: 04/28/2023]
Abstract
The utilization of peritoneal dialysis (PD) has been increasing in the past decade owing to various government initiatives and recognition of benefits such as better preservation of residual renal function, quality of life, and lower cost. The Advancing American Kidney Health initiative aims to increase the utilization of home therapies such as PD and kidney transplantation to treat end stage kidney disease (ESKD). A natural consequence of this development is that more patients will receive PD, and many will eventually undergo kidney transplantation. Therefore, it is important to understand the effect of pretransplant PD on posttransplant outcomes such as delayed graft function (DGF), rejection, thrombosis, graft, and patient survival. Furthermore, some of these patients may develop DGF, which raises the question of the utility of PD during DGF and its risks. Although transplant is the best renal replacement therapy option, it is not everlasting, and many transplant recipients must go on dialysis after allograft failure. Can PD be a good option for these patients? This is another critical question. Furthermore, a significant proportion of nonrenal solid organ transplant recipients develop ESKD. Is PD feasible in this group? In this review, we try to address all of these questions in the light of available evidence.
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Affiliation(s)
- Ali I. Gardezi
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Said N, Lau WJ, Ho YC, Lim SK, Zainol Abidin MN, Ismail AF. A Review of Commercial Developments and Recent Laboratory Research of Dialyzers and Membranes for Hemodialysis Application. MEMBRANES 2021; 11:767. [PMID: 34677533 PMCID: PMC8540739 DOI: 10.3390/membranes11100767] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022]
Abstract
Dialyzers have been commercially used for hemodialysis application since the 1950s, but progress in improving their efficiencies has never stopped over the decades. This article aims to provide an up-to-date review on the commercial developments and recent laboratory research of dialyzers for hemodialysis application and to discuss the technical aspects of dialyzer development, including hollow fiber membrane materials, dialyzer design, sterilization processes and flow simulation. The technical challenges of dialyzers are also highlighted in this review, which discusses the research areas that need to be prioritized to further improve the properties of dialyzers, such as flux, biocompatibility, flow distribution and urea clearance rate. We hope this review article can provide insights to researchers in developing/designing an ideal dialyzer that can bring the best hemodialysis treatment outcomes to kidney disease patients.
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Affiliation(s)
- Noresah Said
- Advanced Membrane Technology Research Centre (AMTEC), School of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Skudai 81310, Malaysia; (N.S.); (M.N.Z.A.); (A.F.I.)
| | - Woei Jye Lau
- Advanced Membrane Technology Research Centre (AMTEC), School of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Skudai 81310, Malaysia; (N.S.); (M.N.Z.A.); (A.F.I.)
| | - Yeek-Chia Ho
- Centre of Urban Resource Sustainability, Department of Civil and Environmental Engineering, Institute of Self-Sustainable Building, Universiti Teknologi PETRONAS, Seri Iskandar 32610, Malaysia;
| | - Soo Kun Lim
- University Malaya Primary Care Research Group (UMPCRG), Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Muhammad Nidzhom Zainol Abidin
- Advanced Membrane Technology Research Centre (AMTEC), School of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Skudai 81310, Malaysia; (N.S.); (M.N.Z.A.); (A.F.I.)
| | - Ahmad Fauzi Ismail
- Advanced Membrane Technology Research Centre (AMTEC), School of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Skudai 81310, Malaysia; (N.S.); (M.N.Z.A.); (A.F.I.)
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Issa N, Lakhani L. Peritoneal Dialysis for Delayed Graft Function After Kidney Transplantation: To Do or Not to Do? Kidney Int Rep 2021; 6:1494-1496. [PMID: 34169188 PMCID: PMC8207459 DOI: 10.1016/j.ekir.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Naim Issa
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | - Laila Lakhani
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Gardezi AI, Muth B, Ghaffar A, Aziz F, Garg N, Mohamed M, Foley D, Kaufman D, Djamali A, Mandelbrot D, Parajuli S. Continuation of Peritoneal Dialysis in Adult Kidney Transplant Recipients With Delayed Graft Function. Kidney Int Rep 2021; 6:1634-1641. [PMID: 34169204 PMCID: PMC8207463 DOI: 10.1016/j.ekir.2021.03.899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Peritoneal dialysis (PD) has been used increasingly in past decade. Many of these patients undergo transplantation and may require dialysis for delayed graft function (DGF). The outcomes of DGF based on the post-transplantation dialysis modality are not well known. METHODS We retrospectively reviewed all adult kidney transplant recipients (KTRs) from the University of Wisconsin School of Medicine and Public Health who developed DGF between November 2015 and April 2019. Patients were divided into those who received hemodialysis (HD) or PD during the DGF period. Immediate graft explant, DGF among living donor KTRs, or those requiring just a single dialysis treatment were excluded. RESULTS Of 224 KTRs with DGF during the study period, 167 fulfilled our selection criteria. There were 16 patients in the PD and 151 in the HD group. Baseline characteristics were similar between the two groups, except diabetes was more prevalent in the HD group. Five of 16 PD patients had to be transitioned to HD. There was no difference in DGF duration, hospital length of stay, infectious or surgical complications, rejection at various time periods, graft function at last follow-up, or graft failure. In multivariate analysis, only rejection within the first year of transplantation (hazard ratio [HR]: 4.26; 95% confidence interval [CI]: 1.20-15.08; P = 0.02) and post-surgical complications (HR: 3.79; 95% CI: 1.03- 13.91; P = 0.04) were associated with death-censored graft failure (DCGF). The use of PD for treatment of DGF was not associated with DCGF. CONCLUSIONS In carefully selected patients, PD can be continued safely for DGF without any effect on short-term or long-term transplant outcomes.
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Affiliation(s)
- Ali I. Gardezi
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Brenda Muth
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Adil Ghaffar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fahad Aziz
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Neetika Garg
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Maha Mohamed
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David Foley
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Dixon Kaufman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Arjang Djamali
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Didier Mandelbrot
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sandesh Parajuli
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Helanterä I, Ibrahim HN, Lempinen M, Finne P. Donor Age, Cold Ischemia Time, and Delayed Graft Function. Clin J Am Soc Nephrol 2020; 15:813-821. [PMID: 32404337 PMCID: PMC7274280 DOI: 10.2215/cjn.13711119] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/05/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Increased donor age is one of the most important risk factors for delayed graft function (DGF), and previous studies suggest that the harmful effect of cold ischemia time is increased in kidneys from older donors. Our aim was to study the association of increased donor age and cold ischemia time with the risk of delayed graft function in a large cohort kidney transplants from the current era. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Scientific Registry of Transplant Recipients was used for this observational, retrospective registry analysis to identify all deceased donor kidney transplantations in the United States between 2010 and September 2018, who were on dialysis pretransplantation (n=90,810). The association of donor age and cold ischemia time with the risk of DGF was analyzed in multivariable models adjusted for recipient characteristics (age, race, sex, diabetes, calculated panel-reactive antibodies, pretransplant dialysis duration) and donor characteristics (cause of death, sex, race, body mass index, creatinine, donation after circulatory death status, history of hypertension, and HLA mismatch). RESULTS Cold ischemia time and donor age were independently associated with the risk of DGF, but the risk of DGF was not statistically significantly lower in donor age categories between 50 and 64 years, compared with donors ≥65 years. The harmful association of cold ischemia time was not higher in kidneys from older donors in any age category, not even among donation after circulatory death donors. When donor risk was assessed with kidney donor profile index, although a statistically significant interaction with cold ischemia time was found, no practically meaningful increase in cold-ischemia susceptibility of kidneys with a high kidney donor profile index was found. CONCLUSIONS We were unable to demonstrate an association between donor age and DGF. The association of longer cold ischemia time with the risk of DGF was not magnified in older or more marginal donors.
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Affiliation(s)
- Ilkka Helanterä
- Abdominal Center, Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hassan N Ibrahim
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Marko Lempinen
- Abdominal Center, Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Patrik Finne
- Abdominal Center, Department of Nephrology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Etta P. Automated peritoneal dialysis is a superior option for the management of postrenal transplant delayed graft function. INDIAN JOURNAL OF TRANSPLANTATION 2020. [DOI: 10.4103/ijot.ijot_43_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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