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Slon-Roblero MF, Sanchez-Alvarez JE, Bajo-Rubio MA. Personalized peritoneal dialysis prescription-beyond clinical or analytical values. Clin Kidney J 2024; 17:i44-i52. [PMID: 38846417 PMCID: PMC11151113 DOI: 10.1093/ckj/sfae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Indexed: 06/09/2024] Open
Abstract
Traditionally, dialysis adequacy has been assessed primarily by determining the clearance of a single small solute, urea. Nevertheless, it has become increasingly evident that numerous other factors play a crucial role in the overall well-being, outcomes and quality of life of dialysis patients. Consequently, in recent years, there has been a notable paradigm shift in guidelines and recommendations regarding dialysis adequacy. This shift represents a departure from a narrow focus only on the removal of specific toxins, embracing a more holistic, person-centered approach. This new perspective underscores the critical importance of improving the well-being of individuals undergoing dialysis while simultaneously minimizing the overall treatment burden. It is based on a double focus on both clinical outcomes and a comprehensive patient experience. To achieve this, a person-centered approach must be embraced when devising care strategies for each individual. This requires a close collaboration between the healthcare team and the patient, facilitating an in-depth understanding of the patient's unique goals, priorities and preferences while striving for the highest quality of care during treatment. The aim of this publication is to address the existing evidence on this all-encompassing approach to treatment care for patients undergoing peritoneal dialysis and provide a concise overview to promote a deeper understanding of this person-centered approach.
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Affiliation(s)
- María Fernanda Slon-Roblero
- Department of Nephrology, Hospital Universitario de Navarra, IdiSNA (Instituto de Investigación Sanitaria de Navarra), Navarra, Spain
| | - J Emilio Sanchez-Alvarez
- Department of Nephrology, Hospital Universitario de Cabueñes, RICORS (Redes de Investigación Cooperativa Orientadas a Resultados en Salud), Gijón, Spain
| | - Maria Auxiliadora Bajo-Rubio
- Department of Nephrology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Hospital de la Princesa, RICORS (Redes de Investigación Cooperativa Orientadas a Resultados en Salud), Madrid, Spain
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2
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Zheng S, Auguste BL. Five Things to Know About Volume Overload in Peritoneal Dialysis. Can J Kidney Health Dis 2023; 10:20543581221150590. [PMID: 36704235 PMCID: PMC9871973 DOI: 10.1177/20543581221150590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/01/2022] [Indexed: 01/22/2023] Open
Abstract
Volume overload in peritoneal dialysis (PD) is common and associated with significant morbidity and mortality. If left untreated, it can result in premature technique failure in patients receiving PD. Practitioners should be aware of common causes and formulate a stepwise approach in the management of volume overload.
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Affiliation(s)
- Sijia Zheng
- Department of Medicine, University of
Toronto, ON, Canada
| | - Bourne L. Auguste
- Department of Medicine, University of
Toronto, ON, Canada,Division of Nephrology, Sunnybrook
Health Sciences Centre, Toronto, ON, Canada,Bourne L. Auguste, CNIB Kidney Centre,
Division of Nephrology, Sunnybrook Health Sciences Centre, 1929 Bayview Avenue,
3rd Floor, Toronto, ON M4G 3E8, Canada.
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3
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Dong X, Wu H, Ye H, Yi C, Diao X, Liu R, Mao H, Huang F, Yu X, Yang X. Incidence and Risk Factors Associated with Technique Failure in the First Year of Peritoneal Dialysis: A Single Center Retrospective Cohort Study in Southern China. BMC Nephrol 2022; 23:207. [PMID: 35690721 PMCID: PMC9188716 DOI: 10.1186/s12882-022-02833-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background Technique failure is more likely to occur during the first 12 months after peritoneal dialysis (PD) initiation, which is a great challenge encountered in PD patients. The aim of this study was to investigate the incidence and risk factors associated with technique failure within the first year of PD patients in Southern China. Methods Incident PD patients who were followed up for at least one year at The First Affiliated Hospital of Sun Yat-sen University from January 1, 2006 to December 31, 2015 were included. Technique failure was defined as transferring to hemodialysis (HD) for more than 30 days or death within the first year after start of PD. A competitive risk regression analysis was used to explore the incidence and risk factors of the technique failure. Results Overall, 2,290 incident PD patients were included in this study, with a mean age of 48.2 ± 15.7 years, 40.9% female and 25.2% with diabetes. A total of 173 patients (7.5%) had technique failure during the first year of PD. Among them, the patient death account for 62.4% (n = 108) and transferring to HD account for 37.6% (n = 65). The main reasons for death were cardiovascular diseases (n = 32, 29.6%), infection (n = 15, 13.8%) and for conversion to HD were mechanical cause (n = 28, 43.1%), infection cause (n = 22, 33.8%). The risk factors for the technique failure included advanced age (HR 2.78, 95%CI 1.82–4.30), low body mass index (BMI < 18.5 kg/m2: HR 1.77, 95%CI 1.17–2.67), history of congestive heart failure (HR 2.81, 95%CI 1.58–4.98), or time on HD before PD ≤ 3 months (HR 1.49, 95%CI 1.05–2.10), peritonitis (HR 2.02, 95%CI 1.36–3.01);while higher serum albumin (HR 0.93, 95%CI 0.89–0.96) and using employee medical insurance to pay expenses (HR 0.47, 95%CI 0.32–0.69) were associated with reduced risk. Conclusions Advanced age, poor nutritional status, history of HD or congestive heart failure, and peritonitis are related factors that increase the risk of technique failure in the first year of PD, while patients' type of medical insurance may also have an influence on early technique failure. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02833-4.
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Affiliation(s)
- Xiao Dong
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Haishan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Xiangwen Diao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Ruihua Liu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. .,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China. .,GuangdongProvincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. .,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, People's Republic of China.
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4
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Vera M, Cheak BB, Chmelíčková H, Bavanandan S, Goh BL, Abdul Halim AG, Garcia I, Gajdoš M, Alonso Valente R, De los Ríos T, Atiye S, Stauss-Grabo M, Galli E. Current clinical practice in adapted automated peritoneal dialysis (aAPD)-A prospective, non-interventional study. PLoS One 2021; 16:e0258440. [PMID: 34882678 PMCID: PMC8659299 DOI: 10.1371/journal.pone.0258440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022] Open
Abstract
Adapted automated peritoneal dialysis (aAPD), comprising a sequence of dwells with different durations and fill volumes, has been shown to enhance both ultrafiltration and solute clearance compared to standard peritoneal dialysis with constant time and volume dwells. The aim of this non-interventional study was to describe the different prescription patterns used in aAPD in clinical practice and to observe outcomes characterizing volume status, dialysis efficiency, and residual renal function over 1 year. Prevalent and incident, adult aAPD patients were recruited during routine clinic visits, and aAPD prescription, volume status, residual renal function and laboratory data were documented at baseline and every quarter thereafter for 1 year. Treatments were prescribed according to the nephrologist's medical judgement in accordance with each center's clinical routine. Of 180 recruited patients, 160 were analyzed. 27 different aAPD prescription patterns were identified. 79 patients (49.4%) received 2 small, short dwells followed by 3 long, large dwells. During follow-up, volume status changed only marginally, with visit mean values ranging between 1.59 (95% confidence interval: 1.19; 1.99) and 1.97 (1.33; 2.61) L. Urine output and creatinine clearance decreased significantly, accompanied by reductions in ultrafiltration and Kt/V. 25 patients (15.6%) received a renal transplant and 15 (9.4%) were changed to hemodialysis. Options for individualization offered by aAPD are actually used in practice for optimized treatment. Changes observed in renal function and dialysis efficiency measures reflect the natural course of chronic kidney disease. No safety events were observed during the study period.
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Affiliation(s)
- Manel Vera
- Nephrology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Bee Boon Cheak
- Department of Nephrology, Hospital Selayang, Selangor, Malaysia
| | | | | | - Bak Leong Goh
- Department of Nephrology & Clinical Research Centre, Hospital Serdang, Selangor, Malaysia
| | | | - Isabel Garcia
- Nephrology, Hospital Universitario di Girona Josep Trueta, Girona, Spain
| | - Martin Gajdoš
- Nephrology, NC Centre Sokolov, Sokolov, Czech Republic
| | - Rafael Alonso Valente
- Nephrology, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Saynab Atiye
- Fresenius Medical Care, Global Medical Office, Bad Homburg, Germany
| | | | - Emilio Galli
- Nefrologia e dialisi, ASST Bergamo Ovest, Treviglio, Italy
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5
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Öberg CM. Optimization of bimodal automated peritoneal dialysis prescription using the three-pore model. Perit Dial Int 2021; 41:381-393. [PMID: 33910417 DOI: 10.1177/08968608211010055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Previous studies suggested that automated peritoneal dialysis (APD) could be improved in terms of shorter treatment times and lower glucose absorption using bimodal treatment regimens, having 'ultrafiltration (UF) cycles' using a high glucose concentration and 'clearance cycles' using low or no glucose. The purpose of this study is to explore such regimes further using mathematical optimization techniques based on the three-pore model. METHODS A linear model with constraints is applied to find the shortest possible treatment time given a set of clinical treatment goals. For bimodal regimes, an exact analytical solution often exists which is herein used to construct optimal regimes giving the same Kt/V urea and/or weekly creatinine clearance and UF as a 6 × 2 L 1.36% glucose regime and an 'adapted' (2 × 1.5 L 1.36% + 3 × 3 L 1.36%) regime. RESULTS Compared to the non-optimized (standard and adapted regimes), the optimized regimens demonstrated marked reductions (>40%) in glucose absorption while having an identical weekly creatinine clearance (35 L) and UF (0.5 L). Larger fill volumes of 1200 mL/m2 (UF cycles) and 1400 mL/m2 (clearance cycles) can be used to shorten the total treatment time. CONCLUSION These theoretical results imply substantial improvements in glucose absorption using optimized APD regimens while achieving similar water and solute removal as non-optimized APD regimens. While the current results are based on a well-established theoretical model for peritoneal dialysis, experimental and clinical studies need to be performed to validate the current findings.
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Affiliation(s)
- Carl M Öberg
- Department of Nephrology, 5193Lund University, Skåne University Hospital, Clinical Sciences Lund, Sweden
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6
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Flythe JE, Chang TI, Gallagher MP, Lindley E, Madero M, Sarafidis PA, Unruh ML, Wang AYM, Weiner DE, Cheung M, Jadoul M, Winkelmayer WC, Polkinghorne KR. Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2020; 97:861-876. [PMID: 32278617 PMCID: PMC7215236 DOI: 10.1016/j.kint.2020.01.046] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/05/2019] [Accepted: 01/08/2020] [Indexed: 02/07/2023]
Abstract
Blood pressure (BP) and volume control are critical components of dialysis care and have substantial impacts on patient symptoms, quality of life, and cardiovascular complications. Yet, developing consensus best practices for BP and volume control have been challenging, given the absence of objective measures of extracellular volume status and the lack of high-quality evidence for many therapeutic interventions. In February of 2019, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference titled Blood Pressure and Volume Management in Dialysis to assess the current state of knowledge related to BP and volume management and identify opportunities to improve clinical and patient-reported outcomes among individuals receiving maintenance dialysis. Four major topics were addressed: BP measurement, BP targets, and pharmacologic management of suboptimal BP; dialysis prescriptions as they relate to BP and volume; extracellular volume assessment and management with a focus on technology-based solutions; and volume-related patient symptoms and experiences. The overarching theme resulting from presentations and discussions was that managing BP and volume in dialysis involves weighing multiple clinical factors and risk considerations as well as patient lifestyle and preferences, all within a narrow therapeutic window for avoiding acute or chronic volume-related complications. Striking this challenging balance requires individualizing the dialysis prescription by incorporating comorbid health conditions, treatment hemodynamic patterns, clinical judgment, and patient preferences into decision-making, all within local resource constraints.
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Affiliation(s)
- Jennifer E Flythe
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA.
| | - Tara I Chang
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Martin P Gallagher
- George Institute for Global Health, Renal and Metabolic Division, Camperdown, Australia; Concord Repatriation General Hospital, Department of Renal Medicine, Sydney, Australia
| | - Elizabeth Lindley
- Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Magdalena Madero
- Department of Medicine, Division of Nephrology, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | - Pantelis A Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mark L Unruh
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Daniel E Weiner
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Michel Jadoul
- Department of Nephrology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Health, Clayton, Melbourne, Australia; Department of Medicine, Monash University, Clayton, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahan, Melbourne, Australia.
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7
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Vrtovsnik F, Verger C, Van Biesen W, Fan S, Shin SK, Rodríguez C, Garcia Méndez I, van der Sande FM, De Los Ríos T, Ihle K, Gauly A, Ronco C, Heaf J. The impact of volume overload on technique failure in incident peritoneal dialysis patients. Clin Kidney J 2019; 14:570-577. [PMID: 33623681 PMCID: PMC7886558 DOI: 10.1093/ckj/sfz175] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background Technique failure in peritoneal dialysis (PD) can be due to patient- and procedure-related factors. With this analysis, we investigated the association of volume overload at the start and during the early phase of PD and technique failure. Methods In this observational, international cohort study with longitudinal follow-up of incident PD patients, technique failure was defined as either transfer to haemodialysis or death, and transplantation was considered as a competing risk. We explored parameters at baseline or within the first 6 months and the association with technique failure between 6 and 18 months, using a competing risk model. Results Out of 1092 patients of the complete cohort, 719 met specific inclusion and exclusion criteria for this analysis. Being volume overloaded, either at baseline or Month 6, or at both time points, was associated with an increased risk of technique failure compared with the patient group that was euvolaemic at both time points. Undergoing treatment at a centre with a high proportion of PD patients was associated with a lower risk of technique failure. Conclusions Volume overload at start of PD and/or at 6 months was associated with a higher risk of technique failure in the subsequent year. The risk was modified by centre characteristics, which varied among regions.
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Affiliation(s)
| | - Christian Verger
- Registre de Dialyse Péritonéale de Langue Française, Pontoise, France
| | - Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Stanley Fan
- Department of Renal Medicine and Transplantation, The Royal London Hospital, London, UK
| | - Sug-Kyun Shin
- Department of Internal Medicine, NHIC ILsan Hospital, Koyang, Korea
| | - Carmen Rodríguez
- Nephrology Service, Hospital Universitario Central de Asturia, Oviedo, Spain
| | | | - Frank M van der Sande
- Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Tatiana De Los Ríos
- Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Katharina Ihle
- Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Adelheid Gauly
- Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Claudio Ronco
- Department of Nephrology Dialysis and Transplantation International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - James Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
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