1
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Li J, Zhang W, Wang X, Sun N, Li L, Chang W. Peritoneal Phosphate Clearance: Determinants and Association With Mortality. Semin Dial 2024; 37:259-268. [PMID: 38506151 DOI: 10.1111/sdi.13205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 01/14/2024] [Accepted: 02/18/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Dialytic phosphate removal is a cornerstone of the management of hyperphosphatemia in peritoneal dialysis (PD) patients, but the influencing factors on peritoneal phosphate clearance (PPC) are incompletely understood. Our objective was to explore clinically relevant factors associated with PPC in patients with different PD modality and peritoneal transport status and the association of PPC with mortality. METHODS This is a cross-sectional and prospective observational study. Four hundred eighty-five PD patients were enrolled and divided into 2 groups according to PPC. All-cause mortality was evaluated after followed-up for at least 3 months. RESULTS High PPC group showed lower mortality compared with Low PPC group by Kaplan-Meier analysis and log-rank test. Both multivariate linear regression and multivariate logistic regression revealed that high transport status, total effluent dialysate volume per day, continuous ambulatory PD (CAPD), and protein in total effluent dialysate volume appeared to be positively correlated with PPC; body mass index (BMI) and the normalized protein equivalent of total nitrogen appearance (nPNA) were negatively correlated with PPC. Besides PD modality and membrane transport status, total effluent dialysate volume showed a strong relationship with PPC, but the correlation differed among PD modalities. CONCLUSIONS Higher PPC was associated with lower all-cause mortality risk in PD patients. Higher PPC correlated with CAPD modality, fast transport status, higher effluent dialysate volume and protein content, and with lower BMI and nPNA.
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Affiliation(s)
- Jinping Li
- Department of Nephrology, Tianjin First Central Hospital, Tianjin, China
| | - Wenyu Zhang
- Department of Nephrology, Tianjin First Central Hospital, Tianjin, China
| | - Xichao Wang
- Department of Nephrology, Tianjin First Central Hospital, Tianjin, China
| | - Na Sun
- Department of Nephrology, Tianjin First Central Hospital, Tianjin, China
| | - Lei Li
- Department of Nephrology, Tianjin First Central Hospital, Tianjin, China
| | - Wenxiu Chang
- Department of Nephrology, Tianjin First Central Hospital, Tianjin, China
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2
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Augustyńska J, Lichodziejewska-Niemierko M, Naumnik B, Seweryn M, Leszczyńska A, Gellert R, Lindholm B, Lange J, Kopel J. Automated Peritoneal Dialysis With Remote Patient Monitoring: Clinical Effects and Economic Consequences for Poland. Value Health Reg Issues 2024; 40:53-62. [PMID: 37976660 DOI: 10.1016/j.vhri.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Remote patient monitoring (RPM) of patients treated with automated peritoneal dialysis (APD) at home allows clinicians to supervise and adjust the dialysis process remotely. This study aimed to review recent scientific studies on the use of RPM in patients treated with APD and based on extracted relevant data assess possible clinical implications and potential economic value of introducing such a system into practice in Poland. METHODS A systematic literature review was performed in the MEDLINE, EMBASE, and Cochrane databases. The model of clinical effects and costs associated with APD was built as a cost-effectiveness analysis with a 10-year time horizon from the Polish National Health Fund perspective. Cost-effectiveness analysis compared 2 strategies: APD with RPM versus APD without RPM. RESULTS Thirteen publications assessing the clinical value of RPM among patients with APD were found. The statistical significance of APD with RPM compared with APD without RPM was identified for the main clinical outcomes: frequency and length of hospitalizations, APD technique failure, and death. An incremental cost-effectiveness ratio was equal to €27 387 per quality-adjusted life-year. The obtained incremental cost-effectiveness ratio is below the willingness-to-pay threshold for the use of medical technologies in Poland (€36 510 per quality-adjusted life-year), which means that APD with RPM was a cost-effective technology. CONCLUSIONS RPM in patients starting APD is a clinical option that is worth considering in Polish practice because it has the potential to decrease the frequency of APD technique failure and shorten the length of hospitalization.
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Affiliation(s)
| | | | - Beata Naumnik
- The First Department of Nephrology and Transplantation with Dialysis Unit, Medical University of Białystok, Białystok, Poland
| | | | | | - Ryszard Gellert
- Department of Nephrology and Internal Medicine, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Bengt Lindholm
- Division of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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3
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Lambie M, Davies S. An update on absolute and relative indications for dialysis treatment modalities. Clin Kidney J 2023; 16:i39-i47. [PMID: 37711635 PMCID: PMC10497377 DOI: 10.1093/ckj/sfad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Indexed: 09/16/2023] Open
Abstract
Background Choosing a dialysis modality is an important decision for people to make as their kidney failure progresses. In doing so, their options should be informed by any absolute or relative indications that may favour one modality over another. Methods In creating this update, we reviewed literature using a framework that considered first, high-level outcomes (survival and modality transition) from large registry data and cohort studies when considering optimal patient pathways; second, factors at a dialysis provider level that might affect relative indications; and third, specific patient-level factors. Both main types of dialysis modality, peritoneal (PD) and haemodialysis (HD), and their subtypes were considered. Results For most people starting dialysis, survival is independent of modality, including those with diabetes. Better survival is seen in those with less comorbidity starting with PD or home HD, reflecting continued improvements over recent decades that have been greater than improvements seen for centre HD. There are provider-level differences in the perceived relative indications for home dialysis that appear to reflect variability in experience, prejudice, enthusiasm, and support for patients and carers. Absolute contraindications are uncommon and, in most cases, where modality prejudice exists, e.g. obesity, Adult Polycystic Kidney Disease, and social factors, this is not supported by reported outcomes. Conclusion Absolute contraindications to a particular dialysis modality are rare. Relative indications for or against particular modalities should be considered but are rarely more important than patient preferences.
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Affiliation(s)
- Mark Lambie
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, UK
| | - Simon Davies
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, UK
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4
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Girimaji N, Sunnesh A, Nagalakshmi T, Bethasaida Manuel M, Reddy Vutukuru V, Rapur R, Vishnubhotla S. Prevalence and outcome of abdominal wall hernia in patients with end-stage renal disease on peritoneal dialysis. Ther Apher Dial 2023; 27:320-327. [PMID: 36858048 DOI: 10.1111/1744-9987.13917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We aimed to study the prevalence, risk factors, management, and outcome of hernias in end-stage renal disease (ESRD) patients on peritoneal dialysis (PD) from India. METHODS This was a retrospective study of ESRD-PD patients who developed hernias over 11 years. RESULTS Of 470 PD patients, 21 developed hernias (4.2%). Mean age of patients was 49.9 ± 15.36 years; 15 (66.66%) were males; 18 (85.71%) patients had umbilical hernia, 3 (14.28%) had inguinal hernia. Continuous ambulatory PD (CAPD) versus automated PD (APD) (OR: 11.623, 95% CI: 2.060-65.581, p = 0.005) was the independent risk factor identified. Incarcerated umbilical/inguinal hernia was managed surgically (6 [28.57%]); uncomplicated umbilical hernia (15 [71.42%]) managed conservatively (shift to (APD) [33.33%]; switch to low-volume APD [20%], switch to low-volume CAPD [46.66%]). None had postoperative hernia recurrences; 4 (19%) had PD technique failure; median PD survival was 36 (IQR 17-55) months. CONCLUSION Although complicated hernias in PD require surgical repair, uncomplicated umbilical hernias can be managed conservatively by switching to APD/low-volume CAPD, with good long-term PD technique survival.
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Affiliation(s)
- Niveditha Girimaji
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupathi, Andhra Pradesh, India
| | - Anapalli Sunnesh
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupathi, Andhra Pradesh, India
| | - Tandalam Nagalakshmi
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupathi, Andhra Pradesh, India
| | - Maria Bethasaida Manuel
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupathi, Andhra Pradesh, India
| | - Venkatarami Reddy Vutukuru
- Department of Gastroenterology, Sri Venkateswara Institute of Medical Sciences, Tirupathi, Andhra Pradesh, India
| | - Ram Rapur
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupathi, Andhra Pradesh, India
| | - Sivakumar Vishnubhotla
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupathi, Andhra Pradesh, India
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5
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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6
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Jin H, Lv S, Wang L, Zhang M, Wang Q, Fang W, Lin X, Che X, Yan H, Yu Z, Jiang N, Li Z, Che M, Ding L, Huang J, Zhou Y, Ni Z. Automated Peritoneal Dialysis in Urgent-Start Dialysis ESRD Patients:Safety and Dialysis Adequacy. Ther Apher Dial 2022; 27:464-470. [PMID: 36263921 DOI: 10.1111/1744-9987.13943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent evidence suggests that automated peritoneal dialysis (APD) might be a feasible alternative to hemodialysis (HD) in urgent-start peritoneal dialysis. METHODS This prospective study enrolled ESRD patients who had started APD as an urgent-start dialysis modality at a single center. Dialysis-related complications were recorded. Dialysis adequacy and electrolytes imbalance were compared between baseline, 14 days and 42 days after catheter insertion. Technique survival and patient survival were also recorded. RESULTS A total of 36 patients were included in the study. Mean follow-up duration was 22 months. During the follow-up, 11 PD patients(30.6%) developed dialysis-related complications. Only two patients(5.6%) required re-insertion and one patients(2.8%) transfer to HD. The 2-year technique survival rate and patient survival rate were 94.4% and 97.2% , respectively. CONCLUSION In considering safety and dialysis adequacy, APD could be a feasible dialysis modality for urgent-start dialysis in ESRD patients, using a standard procedure.
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Affiliation(s)
- Haijiao Jin
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Shifan Lv
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Ling Wang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Minfang Zhang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Qin Wang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Wei Fang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Xinghui Lin
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Xiajing Che
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Hao Yan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Zanzhe Yu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Na Jiang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Zhenyuan Li
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Miaoling Che
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Li Ding
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Jiaying Huang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Yin Zhou
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine
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7
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Ling CW, Sud K, Van C, Peterson GM, Patel RP, Zaidi STR, Castelino RL. Practice variations in antibiotic administration for the management of peritonitis in patients on automated peritoneal dialysis in Australia and New Zealand. ARCH ESP UROL 2022; 42:647-651. [PMID: 35016558 DOI: 10.1177/08968608211069231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the absence of guidelines on the management of peritoneal dialysis (PD)-associated peritonitis in patients on automated peritoneal dialysis (APD), variations in clinical practice potentially exist between PD units that could affect clinical outcomes. This study aimed to document the current practices of treating PD-associated peritonitis in patients on APD across Australia and New Zealand and the reasons for practice variations using a cross-sectional online survey. Of the 62 PD units, 34 medical leads (55%) responded to the survey. When treating APD-associated peritonitis, 21 units (62%) continued patients on APD and administered intraperitoneal (IP) antibiotics in manual daytime exchanges; of these, 17 (81%) considered allowing at least 6 h dwell time for adequate absorption of the IP antibiotics as an important reason for adding manual daytime exchange. Nine units (26%) temporarily switched patients from APD to continuous ambulatory peritoneal dialysis (CAPD); of these, five (55%) reported a lack of pharmacokinetic (PK) data for IP antibiotics in APD, four (44%) reported a shortage of APD-trained nursing staff to perform APD exchanges during hospitalisation and three (33%) reported inadequate time for absorption of IP antibiotics on APD as important reasons for their practice. Four units (12%) continued patients on APD and administered IP antibiotics during APD exchanges; of these, three (75%) believed that PK data available in CAPD could be extrapolated to APD. This study demonstrates wide variations in the management of APD-associated peritonitis in Australia and New Zealand; it points towards the lack of PK on antibiotics used to treat peritonitis as an important reason underpinning practice variations.
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Affiliation(s)
- Chau Wei Ling
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Kamal Sud
- Department of Renal Medicine, Nepean, Blacktown and Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Nepean Clinical School, Sydney, New South Wales, Australia.,Peritoneal Dialysis Unit, Regional Dialysis Centre, Blacktown Hospital, New South Wales, Australia.,Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) Peritoneal Dialysis Working Group, Adelaide, South Australia, Australia
| | - Connie Van
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia.,Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Rahul P Patel
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Syed Tabish Razi Zaidi
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia.,Professional Services Unit, HPS Pharmacies, EBOS Group, Docklands, Victoria, Australia.,School of Healthcare, University of Leeds, West Yorkshire, UK
| | - Ronald L Castelino
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia.,Department of Pharmacy, Blacktown Hospital, New South Wales, Australia
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8
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Salazar-Félix NA, Martin-Del-Campo F, Cueto-Manzano AM, Romo-Flores ML, Velázquez-Vidaurri AL, Sánchez-Soriano A, Ruvalcaba-Contreras N, Calderón-Fabian A, Rojas-Campos E, Cortés-Sanabria L. Prevalence of mild cognitive impairment in automated peritoneal dialysis patients. Nephrol Dial Transplant 2021; 36:2106-2111. [PMID: 34375410 DOI: 10.1093/ndt/gfab238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cognitive deterioration decreases quality of life, self-care and adherence to treatment, increasing mortality risk. There is scarce information of cognitive impairment in peritoneal dialysis, and data are controversial. OBJECTIVE To determine the frequency and associated factors of cognitive impairment in patients on automated peritoneal dialysis (APD). METHODS Cross-sectional study; 71 patients on APD underwent clinical, biochemical and cognitive function evaluation by means of the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Cognitive function was also evaluated in healthy controls. RESULTS Mean age was 42 ± 16 years, 79% were men and dialysis vintage was 17 (7-32) months. In APD patients, cognitive impairment was present in 7% (mild deterioration) and 68% according to the MMSE and MoCA, respectively, and in 4% and 37% in the healthy controls. Patients with cognitive impairment (according to MoCA) were older, with lower educational degree, had more frequently diabetes, and higher serum glucose, as well as lower serum creatinine, phosphorus and sodium concentrations than patients with normal cognitive function. In multiple linear regression analysis, predictors for the MoCA score (R2 0.63, p = 0.002) were schooling [B = 0.54 (0.20 to 0.89), p = 0.003], age [B=-0.11 (-0.21 to -0.01), p = 0.04], serum sodium [B = 0.58 (0.05 to 1.11), p = 0.03] and creatinine concentrations [B = 3.9 (0.03 to 0.83), p = 0.03]. CONCLUSION In this sample of APD patients with mean age in the early 40 s, the prevalence of cognitive impairment by MoCA test was 65%, and it was associated to older age, lower educational level and lower serum concentrations of sodium and creatinine.
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Affiliation(s)
- Noé A Salazar-Félix
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Fabiola Martin-Del-Campo
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alfonso M Cueto-Manzano
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - María L Romo-Flores
- Unidad de Diálisis Peritoneal, Hospital General Regional No. 46, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alma L Velázquez-Vidaurri
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Artemio Sánchez-Soriano
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Neri Ruvalcaba-Contreras
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alejandro Calderón-Fabian
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Enrique Rojas-Campos
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Laura Cortés-Sanabria
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
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9
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Albaker W. Successful Treatment of Bacillus licheniformis Peritonitis in Peritoneal Dialysis Patient with Intraperitoneal Vancomycin: A Case Report. Int Med Case Rep J 2021; 14:215-218. [PMID: 33854382 PMCID: PMC8039197 DOI: 10.2147/imcrj.s305902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
Bacillus licheniformis is a rare pathogen causing peritonitis in peritoneal dialysis (PD) patients, and it is usually recognized among immunosuppressed or traumatized patients. A 24-year-old lady was treated for peritonitis as an outpatient with empirical therapy. PD culture grew Bacillus licheniformis after 48 hours, and she continued receiving intraperitoneal (IP) vancomycin for a total of three weeks. The patient was clinically stable throughout the course of therapy and showed complete resolution of her symptoms. This was the first case of reported Bacillus peritonitis in an automated peritoneal dialysis (APD) patient with rapid clinical and biochemical improvement without evidence of relapse or recurrence.
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Affiliation(s)
- Waleed Albaker
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
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10
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Tangwonglert T, Davenport A. Peritoneal sodium removal compared to glucose absorption in peritoneal dialysis patients treated by continuous ambulatory peritoneal dialysis and automated peritoneal dialysis with and without a daytime exchange. Ther Apher Dial 2021; 25:654-662. [PMID: 33403730 DOI: 10.1111/1744-9987.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/18/2020] [Accepted: 01/02/2021] [Indexed: 11/28/2022]
Abstract
Sodium removal in peritoneal dialysis (PD) depends on convective clearance, typically generated by a glucose gradient, but this can result in glucose absorption. We wished to determine which factors determine peritoneal sodium losses to glucose absorption (PD Na/Gluc). Peritoneal sodium losses and glucose absorption were calculated from measured 24-h collections of PD effluent, in patients attending for assessment of peritoneal membrane function. Five hundred and fifty eight patients; 317 (56.8%) males, mean age 56.1 ± 16.0 years, were studied, 281 treated by automated peritoneal dialysis (APD) with a daytime exchange (50.4%); 179 (32.1%) by APD and 98 (17.6%) by continuous ambulatory peritoneal dialysis (CAPD). All patients used glucose containing dialysates, with 352 (63.1%) using icodextrin and 210 (37.6%) hypertonic (22.7 g/L glucose) dialysates. The ratio of PD Na/Gluc was 0.14 (0.02-0.29). Patients using icodextrin had a higher ratio (0.16 (0.03-0.32) versus 0.11 (-0.02-0.26), P < .001), as did those using 22.7 g/L glucose versus 13.6 g/L (0.16 (0.06-0.32) versus 0.13 (-0.01-0.19), P < .01), and CAPD versus APD (0.18 (0.05-0.36) versus 0.11 (0.0-0.27), P < .05), respectively. A multivariable model showed that 24-h ultrafiltration (odds ratio [OR] 7.6 (95% confidence interval [3.9-14.8]), P < .001 was associated with increased PD Na/Gluc, whereas APD (OR 0.19 (0.06-0.62), P < .01 and increased extracellular water to total body water (OR 0.001 [0-0.08], P = .03) were associated with lower ratios. Twenty four-hour peritoneal ultrafiltration was strongly associated with PD Na/Gluc, whereas patients treated with APD cyclers without a daytime icodextrin exchange and those with an increased extracellular water to total body water had lower peritoneal sodium losses but with greater peritoneal glucose absorption.
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Affiliation(s)
- Theerasak Tangwonglert
- Nephrology Division, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free Hospital, University College London Medical School, London, UK
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11
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Al-Hwiesh AK, Mohammed AM, Elnokeety M, Al-Hwiesh A, Al-Audah N, Esam S, Abdul-Rahman IS. Successfully treating three patients with acute kidney injury secondary to COVID-19 by peritoneal dialysis: Case report and literature review. Perit Dial Int 2020; 40:496-498. [PMID: 32998645 DOI: 10.1177/0896860820953050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19) is a pandemic disease that increased the burden on health-care system. In the Kingdom of Saudi Arabia, 74,795 cases have been reported until 26 May 2020 and the number of cases is rapidly increasing. The mortality rate of COVID-19 worldwide is 6.37%. Here we report three cases of acute kidney injury (AKI) secondary to pneumonia of severe COVID-19; they were treated with automated peritoneal dialysis (PD) with full recovery. To the best of our knowledge, few reports in the literature have discussed the use of PD in AKI secondary to COVID-19.
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Affiliation(s)
- Abdullah K Al-Hwiesh
- Department of Internal Medicine, Nephrology Division, King Fahd Hospital of the University, 48023Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Abdelgalil Moaz Mohammed
- Department of Internal Medicine, Nephrology Division, King Fahd Hospital of the University, 48023Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Mahmoud Elnokeety
- Department of Internal Medicine, Nephrology Division, King Fahd Hospital of the University, 48023Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Amani Al-Hwiesh
- College of Medicine, 48023Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nadia Al-Audah
- Department of Pathology, Dammam Central Hospital, Saudi Arabia
| | - Syed Esam
- Department of Internal Medicine, Nephrology Division, King Fahd Hospital of the University, 48023Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Ibrahiem Saeed Abdul-Rahman
- Department of Internal Medicine, Nephrology Division, King Fahd Hospital of the University, 48023Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
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12
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Lam E, Lien YTK, Kraft WK, Piraino B, Vozmediano V, Schmidt S, Zhang J. Vancomycin in peritoneal dialysis: Clinical pharmacology considerations in therapy. Perit Dial Int 2020; 40:384-393. [PMID: 32065053 PMCID: PMC9847573 DOI: 10.1177/0896860819889774] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Intraperitoneal vancomycin is the first-line therapy in the management of peritoneal dialysis (PD)-related peritonitis. However, due to the paucity of data, vancomycin dosing for peritonitis in patients on automated peritoneal dialysis (APD) is empiric and based on clinical experience rather than evidence. Studies in continuous ambulatory peritoneal dialysis (CAPD) patients have been used to provide guidelines for dosing and are often extrapolated for APD use, but it is unclear whether this is appropriate. This review summarizes the available pharmacokinetic data used to inform optimal dosing in patients on CAPD or APD. The determinants of vancomycin disposition and pharmacodynamic effects are critically summarized, knowledge gaps explored, and a vancomycin dosing algorithm in PD patients is proposed.
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Affiliation(s)
- Edwin Lam
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yi Ting Kayla Lien
- Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, FL, USA
| | - Water K Kraft
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Beth Piraino
- Renal Electrolyte Division, School of Medicine, University of Pittsburgh, PA, USA
| | - Valvanera Vozmediano
- Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, FL, USA
| | - Stephan Schmidt
- Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, FL, USA
| | - Jingjing Zhang
- Division of Nephrology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Amici G, Lo Cicero A, Presello F, Zuccolo M, Romanini D, Bellina B, Janczar M, Castenetto E, Chiodarelli C, Martino FK. [The advantages of remote patient monitoring in automated peritoneal dialysis]. G Ital Nefrol 2020; 37:37-03-2020-9. [PMID: 32530154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The follow-up automated peritoneal dialysis (APD) patients has been recently improved as data can be transmitted remotely to an internet cloud. The introduction of remote patient monitoring (RPM) technologies also allows a better clinical control and tailoring of dialysis treatment through a web-based software (Claria-Sharesource Baxter). The aim of the present study is to determine the impact of RPM in a single center, both in clinical and organizational terms, compared to traditional technologies. We studied 26 prevalent APD patients aged 69±13 years, observing them for a period of six months while using the traditional technology and then further six months using the new technology. The patients had been on dialysis for 9 months before the start of the study and a relevant portion of them lived in mountainous or hilly areas. Our study shows an increase in the number of proactive calls from the center to the patients, a reduction of anxiety in patients and caregivers, an earlier detection of clinical problems, a reduction of unscheduled (urgent) visits and finally a reduction of hospitalizations after the adoption of RPM software. In our experience, the RPM system showed a good performance and a simple interface, allowing for the precise assessment of daily APD. Furthermore, RPM system improved the interaction between patients and healthcare providers, with a significant benefit in terms of safety and of care quality.
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Affiliation(s)
- Gianpaolo Amici
- Struttura Complessa di Nefrologia e Dialisi, AAS 3 "Alto Friuli-Collinare-Medio Friuli", Ospedali di San Daniele del Friuli e Tolmezzo (UD), Italy
| | - Antonina Lo Cicero
- Struttura Complessa di Nefrologia e Dialisi, AAS 3 "Alto Friuli-Collinare-Medio Friuli", Ospedali di San Daniele del Friuli e Tolmezzo (UD), Italy
| | - Fabiana Presello
- Struttura Complessa di Nefrologia e Dialisi, AAS 3 "Alto Friuli-Collinare-Medio Friuli", Ospedali di San Daniele del Friuli e Tolmezzo (UD), Italy
| | - Mery Zuccolo
- Struttura Complessa di Nefrologia e Dialisi, AAS 3 "Alto Friuli-Collinare-Medio Friuli", Ospedali di San Daniele del Friuli e Tolmezzo (UD), Italy
| | - Dino Romanini
- Struttura Complessa di Nefrologia e Dialisi, AAS 3 "Alto Friuli-Collinare-Medio Friuli", Ospedali di San Daniele del Friuli e Tolmezzo (UD), Italy
| | - Barbara Bellina
- Struttura Complessa di Nefrologia e Dialisi, AAS 3 "Alto Friuli-Collinare-Medio Friuli", Ospedali di San Daniele del Friuli e Tolmezzo (UD), Italy
| | - Mariusz Janczar
- Struttura Complessa di Nefrologia e Dialisi, AAS 3 "Alto Friuli-Collinare-Medio Friuli", Ospedali di San Daniele del Friuli e Tolmezzo (UD), Italy
| | - Enza Castenetto
- Struttura Complessa di Nefrologia e Dialisi, AAS 3 "Alto Friuli-Collinare-Medio Friuli", Ospedali di San Daniele del Friuli e Tolmezzo (UD), Italy
| | - Consuelo Chiodarelli
- Struttura Complessa di Nefrologia e Dialisi, AAS 3 "Alto Friuli-Collinare-Medio Friuli", Ospedali di San Daniele del Friuli e Tolmezzo (UD), Italy
| | - Francesca Katiana Martino
- UO Nefrologia, Dialisi e Trapianto di rene. Ospedale San Bortolo, Vicenza e International Renal Research Institute, Vicenza, Italy
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Jaques DA, Davenport A. Characterization of sodium removal to ultrafiltration volume in a peritoneal dialysis outpatient cohort. Clin Kidney J 2020; 14:917-924. [PMID: 33777375 PMCID: PMC7986363 DOI: 10.1093/ckj/sfaa035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background Failure to control volume is the second most common cause of peritoneal dialysis (PD) technique failure. Sodium is primarily removed by convection, but according to the three-pore model, water and sodium movements are not necessarily concordant. We wished to determine factors increasing sodium to water clearance in clinical practice. Methods We reviewed 24-h peritoneal dialytic sodium removal (DSR) and ultrafiltration (UF) volume in consecutive PD patients attending for routine assessment of peritoneal membrane function and adequacy testing. We used a regression model with the DSR/UF ratio as the dependent variable. A second model with DSR as the dependent variable and interaction testing for UF was used as sensitivity analysis. Results We included 718 adult PD patients. Mean values were 51.8 ± 64.6 mmol/day and 512 ± 517 mL/day for DSR and UF, respectively. In multivariable analysis, DSR/UF ratio was positively associated with transport type (fast versus slow, P < 0.001), serum sodium (P < 0.001) and diabetes (P = 0.026), and negatively associated with PD mode [automated PD versus continuous ambulatory PD (CAPD), P < 0.001] and the use of 2.27% glucose dialysate (P < 0.001). Sensitivity analysis showed positive interaction with UF for transport type (P < 0.001) and serum sodium (P = 0.032) and negative interaction for PD mode (P < 0.001) and cycles number (P < 0.001). Conclusions CAPD, fast transport and high serum sodium allow relatively more sodium to be removed compared with water. Icodextrin has no effect on sodium removal once confounders have been accounted for. Although widely used in the assessment of PD patients, UF should not be considered as a surrogate for DSR in clinical practice.
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Affiliation(s)
- David A Jaques
- Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland.,UCL Department of Nephrology, Royal Free Hospital, University College London, London, UK
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free Hospital, University College London, London, UK
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Thaweethamcharoen T, Sritippayawan S, Noparatayaporn P, Aiyasanon N. Cost-Utility Analysis of Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis for Thai Patients With End-Stage Renal Disease. Value Health Reg Issues 2020; 21:181-187. [PMID: 32044691 DOI: 10.1016/j.vhri.2019.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 08/18/2019] [Accepted: 10/18/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Continuous ambulatory peritoneal dialysis (CAPD) is the first option for patients with end-stage renal disease under the benefit package of Thailand. Nevertheless, automated peritoneal dialysis (APD) may benefit these patients in terms of both medical and quality-of-life aspects, but it is more expensive. The economic evidence for the comparison between CAPD and APD is not inconclusive. Thus, this study aims to evaluate the cost-effectiveness of CAPD compared with APD in PD patients. OBJECTIVES To assess the health-related quality of life and costs between patients treated with CAPD and APD. METHODS A Markov model was developed to evaluate the cost-effectiveness of CAPD and APD from the societal perspective. Costs and outcomes were calculated over a lifetime horizon and discounted at an annual rate of 3%. The outcomes were presented as quality-adjusted life-years (QALYs) of CAPD and APD. Utility scores were calculated from the utility values of the 5-level EuroQol questionnaire. A probabilistic sensitivity analysis using 5000 Monte Carlo simulations was performed to evaluate the stability of the results. RESULTS The costs of APD and CAPD were 12 868 080 and 11 144 786 Thai baht, respectively, whereas the QALYs were 24.28 and 24.72 QALYs, respectively. APD was more costly but less effective than CAPD. The most sensitive parameter was direct medical cost of outpatient visits. When the willingness-to-pay threshold was 160 000 Thai baht per QALY, the probability of APD providing a cost-effective alternative to CAPD was 19%. CONCLUSION APD was not a cost-effective strategy as compared with CAPD at the current Thai threshold. These findings should encourage clinicians and policy makers to encompass the use of CAPD as a good value for money for PD treatment.
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Affiliation(s)
- Tanita Thaweethamcharoen
- Siriraj Health Technology Assessment Unit, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Pharmacy Department, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suchai Sritippayawan
- Renal Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prapaporn Noparatayaporn
- Siriraj Health Technology Assessment Unit, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Pharmacy Department, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Nipa Aiyasanon
- Renal Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Fujioka H, Koike T, Shimizu A, Kakeshita K, Kobayashi S, Kiyosawa T, Arisawa Y, Murai S, Yamazaki H, Kinugawa K. [A case of oldest-old patient with chronic renal failure successfully treated with peritoneal dialysis]. Nihon Ronen Igakkai Zasshi 2020; 57:316-320. [PMID: 32893214 DOI: 10.3143/geriatrics.57.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
He was a 92-year-old male patient with mild cognitive impairment while preserved activity of daily life. His renal dysfunction gradually increased due to the nephrosclerosis accompanied by systemic edema and water retention. We eventually decided to initiate peritoneal dialysis instead of standard hemodialysis for his end-stage renal dysfunction refractory to optimal medical therapy, given his preserved cognitive function and family support. He underwent an established therapeutic program for the peritoneal dialysis at home with an Information and Communication Technology (ICT).Given the increase in age of the patients with renal dysfunction, peritoneal dialysis has been receiving great attention as a home care strategy. The recent improvement in the device technology and ICT that enables us remote monitoring would reduce patients' effort in the management of peritoneal dialysis. Collaboration with home nursing and care workers would also be warranted for successful home care.
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Affiliation(s)
- Hayato Fujioka
- The Second Department of Internal Medicine, University of Toyama
| | - Tsutomu Koike
- The Second Department of Internal Medicine, University of Toyama
| | - Ayako Shimizu
- The Second Department of Internal Medicine, University of Toyama
| | - Kota Kakeshita
- The Second Department of Internal Medicine, University of Toyama
| | - Shiori Kobayashi
- The Second Department of Internal Medicine, University of Toyama
| | - Taigo Kiyosawa
- The Second Department of Internal Medicine, University of Toyama
| | - Yu Arisawa
- The Second Department of Internal Medicine, University of Toyama
| | - Sayaka Murai
- The Second Department of Internal Medicine, University of Toyama
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Takura T, Hiramatsu M, Nakamoto H, Kuragano T, Minakuchi J, Ishida H, Nakayama M, Takahashi S, Kawanishi H. Health economic evaluation of peritoneal dialysis based on cost-effectiveness in Japan: a preliminary study. Clinicoecon Outcomes Res 2019; 11:579-590. [PMID: 31576157 PMCID: PMC6768123 DOI: 10.2147/ceor.s212911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 08/20/2019] [Indexed: 11/23/2022] Open
Abstract
Background In Japan, the medical expenditures associated with dialysis have garnered considerable interest; however, a cost-effectiveness evaluation of peritoneal dialysis (PD) is yet to be evaluated. In particular, the health economics of the “PD first” concept, which can be advantageous for clinical practice and healthcare systems, must be evaluated. Methods This multicenter study investigated the cost-effectiveness of PD. The major effectiveness indicator was quality-adjusted life year (QALY), with a preference-based utility value based on renal function, and the cost indicator was the amount billed for a medical service at each medical institution for qualifying illnesses. In comparison with hemodialysis (HD), a baseline analysis of PD therapy was conducted using a cost-utility analysis (CUA). Continuous ambulatory PD (CAPD) and automated PD (APD) were compared based on the incremental cost-utility ratio (ICUR) and propensity score (PS) with a limited number of cases. Results The mean duration since the start of PD was 35.0±14.4 months. The overall CUA for PD (179 patients) was USD 55,019/QALY, which was more cost effective (USD/monthly utility) compared with that for HD for 12–24 months (4,367 vs. 4,852; p<0.05). The CUA reported significantly better results in the glomerulonephritis group than in the other diseases, and the baseline CUA was significantly age sensitive. The utility score was higher in the APD group (mean age, 70.1±3.5 years) than in the CAPD group (mean age, 70.6±4.2 years; 0.987 vs. 0.860; p<0.05, 9 patients). Compared with CAPD, APD had an overall ICUR of USD 126,034/QALY. Conclusion The cost-effectiveness of PD was potentially good in the elderly and in patients on dialysis for <24 months. Therefore, the prevalence of PD may influence the public health insurance system, particularly when applying the “PD first” concept.
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Affiliation(s)
- Tomoyuki Takura
- Department of Health Economy and Society Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Hiramatsu
- Outpatient Center Hospital, Okayama Saiseikai General Hospital, Okayama City, Okayama, Japan
| | - Hidetomo Nakamoto
- General Intrarenal Medicine, Saitama Medical University, Saitama, Japan
| | - Takahiro Kuragano
- Internal Medicine (Nephrology and Dialysis), Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Jun Minakuchi
- Nephrology (Endocrinology), Kawashima Hospital, Tokushima City, Tokushima, Japan
| | | | | | - Susumu Takahashi
- Head Office, International Kidney Evaluation Association Japan, Tokyo, Japan
| | - Hideki Kawanishi
- Artificial Organs and Surgery, Tsuchiya General Hospital, Hiroshima City, Hiroshima, Japan
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18
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Zhang Y, Feng S, Lu Y, Zhan Z, Shen H. Efficacy of APD in perioperative period of non-abdominal operation for peritoneal dialysis patients. Int J Gen Med 2019; 12:207-212. [PMID: 31213879 PMCID: PMC6538830 DOI: 10.2147/ijgm.s203158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/11/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives: Whether automated peritoneal dialysis (APD) is a feasible strategy in perioperative period of uremic patients undergoing nonabdominal surgery remains unclear. This study was conducted to research the perioperative management and the best choice of dialysis modalities for peritoneal dialysis patients. Materials and methods: A retrospective analysis was made on the clinical data of 58 ESRD patients who had received peritoneal dialysis for more than three months were treated with APD during perioperative period from July 2015 to March 2018 in the Second Affiliated Hospital of Soochow University. The differences of clinical parameters, such as urine volume, ultrafiltration volume, hemoglobin, renal function and electrolytes were collected and analyzed before and after APD. Results: The vital signs of 58 patients were stable after APD treatment, and there were no significant differences in 24-hour urine volume, hemoglobin and electrolytes (calcium, phosphorus, potassium, sodium) before and after surgery (P>0.05). Compared with those before treatment, the amount of ultrafiltration increased significantly (P<0.05), creatinine, urea nitrogen and parathyroid hormone decreased significantly (P<0.05), while albumin decreased (P<0.05). Conclusion: Application of APD for peritoneal dialysis patients undergoing nonabdominal surgery during the perioperative period is safe and effective.
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Affiliation(s)
- Yi Zhang
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Sheng Feng
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Ying Lu
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Zhoubing Zhan
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Huaying Shen
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
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Abstract
Over the last decade, urgent start peritoneal dialysis (USPD), defined as initiation of peritoneal dialysis (PD) before the traditionally recommended break-in period of 2-4 weeks, has increasingly been seen as a viable option for late-presenting end-stage renal disease patients, obviating the need for haemodialysis via central venous catheter. Different prescriptions and protocols involving both manual and automated exchanges have been published, but there is no head-to-head comparison of the two modalities and no consensus on the most suitable modality exists. Evaluation of the available evidence suggests that PD can be initiated urgently using either or both options without much difference in the outcome. The two most critical aspects dictating the success of a USPD programme are using low dwell volumes and keeping patients in a strict supine position during the dialysis exchanges in the first couple of weeks of the therapy. These measures are crucial in keeping the intraperitoneal pressure to a minimum and reduce the risk of mechanical complications, including catheter leaks and malpositioning.
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Affiliation(s)
- Muhammad M Javaid
- School of Rural Health Mildura, Monash University, Mildura, VC, Australia.,Department of Medicine, Mildura Base Hospital, Mildura, VC, Australia
| | - Behram A Khan
- Division of Nephrology, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Srinivas Subramanian
- Division of Nephrology, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Öberg CM, Martuseviciene G. Computer Simulations of Continuous Flow Peritoneal Dialysis Using the 3-Pore Model-A First Experience. Perit Dial Int 2019; 39:236-242. [PMID: 30846606 DOI: 10.3747/pdi.2018.00225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/28/2018] [Indexed: 11/15/2022] Open
Abstract
Background:Continuous flow peritoneal dialysis (CFPD) is performed using a continuous flux of dialysis fluid via double or dual-lumen PD catheters, allowing a higher dialysate flow rate (DFR) than conventional treatments. While small clinical studies have revealed greatly improved clearances using CFPD, the inability to predict ultrafiltration (UF) may confer a risk of potentially harmful overfill. Here we performed physiological studies of CFPD in silico using the extended 3-pore model.Method:A 9-h CFPD session was simulated for: slow (dialysate to plasma creatinine [D/P crea] < 0.6), fast (D/P crea > 0.8) and average (0.6 ≤ D/P crea ≤ 0.8) transporters using 1.36%, 2.27%, or 3.86% glucose solutions. To avoid overfill, we applied a practical equation, based on the principle of mass-balance, to predict the UF rate during CFPD treatment.Results:Increasing DFR > 100 mL/min evoked substantial increments in small- and middle-molecule clearances, being 2 - 5 times higher compared with a 4-h continuous ambulatory PD (CAPD) exchange, with improvements typically being smaller for average and slow transporters. Improved UF rates, exceeding 10 mL/min, were achieved for all transport types. The β2-microglobulin clearance was strongly dependent on the UF rate and increased between 60% and 130% as a function of DFR. Lastly, we tested novel intermittent-continuous regimes as an alternative strategy to prevent overfill, being effective for 1.36% and 2.27%, but not for 3.86% glucose.Conclusion:While we find substantial increments in solute and water clearance with CFPD, previous studies have shown similar improvements using high-volume tidal automated PD (APD). Lastly, the current in silico results need confirmation by studies in vivo.
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Affiliation(s)
- Carl M Öberg
- Renal Physiology and Peritoneal Dialysis Group, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Giedre Martuseviciene
- Renal Physiology and Peritoneal Dialysis Group, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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21
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Öberg CM, Rippe B. Optimizing Automated Peritoneal Dialysis Using an Extended 3-Pore Model. Kidney Int Rep 2017; 2:943-951. [PMID: 29270500 PMCID: PMC5733752 DOI: 10.1016/j.ekir.2017.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 03/04/2017] [Accepted: 04/21/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction In the current study, an extended 3-pore model (TPM) is presented and applied to the problem of optimizing automated peritoneal dialysis (APD) with regard to osmotic water transport (UF), small/middle-molecule clearance, and glucose absorption. Methods Simulations were performed for either intermittent APD (IPD) or tidal APD (TPD). IPD was simulated for fill and drain volumes of 2 L, whereas TPD was simulated using a tidal volume of 0.5 L, 1 L, or 1.5 L with full drains and subsequent fills (2 L) occurring after every fifth dwell. A total of 25 cycles for a large number of different dialysate flow rates (DFR) were simulated using 3 different glucose concentrations (1.36%, 2.27%, and 3.86%) and 3 different peritoneal transport types: slow (peritoneal equilibrium test D/Pcrea < 0.6), fast (peritoneal equilibrium test D/Pcrea > 0.8), and average. Solute clearance and UF were simulated to occur during the entire dwell, including both fill and drain periods. Results It is demonstrated that DFRs exceeding ∼ 3 L/h are of little benefit both for UF and small-solute transport, whereas middle-molecule clearance is enhanced at higher DFRs. The simulations predict that large reductions (> 20%) in glucose absorption are possible by using moderately higher DFRs than a standard 6 × 2 L prescription and by using shorter optimized “bi-modal” APD regimens that alternate between a glucose-free solution and a glucose-containing solution. Discussion Reductions in glucose absorption appear to be significant with the proposed regimens for APD; however, further research is needed to assess the feasibility and safety of these regimens.
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Affiliation(s)
- Carl M. Öberg
- Lund University, Skåne University Hospital, Clinical Sciences Lund, Department of Nephrology, Lund, Sweden
- Correspondence: Carl M. Öberg, Department of Nephrology, Skåne University Hospital, S-211 85 Lund, Sweden.Department of Nephrology, Skåne University HospitalS-211 85 LundSweden
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Ankawi GA, Woodcock NI, Jain AK, Garg AX, Blake PG. The Use of Incremental Peritoneal Dialysis in a Large Contemporary Peritoneal Dialysis Program. Can J Kidney Health Dis 2016; 3:2054358116679131. [PMID: 28781885 PMCID: PMC5518964 DOI: 10.1177/2054358116679131] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/23/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The use of an incremental peritoneal dialysis (PD) strategy in a large contemporary patient population has not been described. OBJECTIVE We report the use of this strategy in clinical practice, the prescriptions required, and the clearances achieved in a large center which has routinely used this approach for more than 10 years. DESIGN This is a cross-sectional observational study. SETTING A single large Canadian academic center. PATIENTS This study collected data on 124 prevalent PD patients at a single Canadian academic center. METHODS AND MEASUREMENTS The proportion of patients who achieve the clearance target on a low clearance or incremental PD prescription; the actual PD prescriptions and consequent total, peritoneal, and renal urea clearances [Kt/V] achieved; and patient and technique survival and peritonitis rate in comparison with national and international reports. RESULTS Of the 124 prevalent PD patients in this PD unit, 106 (86%) were achieving the Kt/V target, and of these, 54 (44% of all patients) were doing so using incremental PD prescriptions. Fifty of these incremental PD patients were using automated PD (APD) with either no day dwell (68%) or less than 7 days a week treatment (12%) or both (20%). Patient survival in our PD unit was not different from that reported in Canada as a whole. Peritonitis rates were better than internationally recommended standards. LIMITATIONS This is an observational study with no randomized control group. CONCLUSIONS Incremental PD is feasible in a contemporary PD population treated mainly with APD. Almost half of the patients were able to achieve clearance targets while receiving less onerous and less costly low clearance prescriptions. We suggest that incremental PD should be widely used as a cost-effective strategy in PD.
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Abstract
Peritoneal dialysis (PD) is a widely accepted and increasingly popular form of dialysis. The invention and technological advancement of the PD cycler further makes PD a convenient option. Prescription-specific parameters are entered into the cycler, which then automatically carries out the steps involved in continuous cycling PD. We review the basics, technical aspects, challenges, and advancements of the cycler.
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Affiliation(s)
- Rafia I Chaudhry
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas A Golper
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA
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24
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Batarse RR, Steiger RM, Guest S. Peritoneal dialysis prescription during the third trimester of pregnancy. Perit Dial Int 2014; 35:128-34. [PMID: 24711639 DOI: 10.3747/pdi.2013.00229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 01/04/2014] [Indexed: 11/15/2022] Open
Abstract
Management of the pregnant patient on peritoneal dialysis (PD) is potentially challenging because uterine enlargement may negatively affect catheter function and prescribed dwell volumes. Additional reports of the management of these patients are needed. Here, we describe a near-full-term delivery in a 27-year-old woman who had been on dialysis for 7 years. Peritoneal dialysis was continued during the entire pregnancy. In the third trimester, a higher delivered automated PD volume allowed for adequate clearance and control of volume status. A decision to hospitalize the patient to limit activity and facilitate the delivery of increased dialysate is believed to have contributed to the successful outcome for mother and infant. Our report discusses the management of this patient and reviews published dialysis prescriptions used during the third trimester of pregnancy in patients treated with PD.
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Affiliation(s)
- Rodolfo R Batarse
- Nephrology, Hypertension, Transplant Medicine, Rancho Mirage, and University of California San Diego Medical Center, San Diego, California, USA
| | - Ralph M Steiger
- Desert Regional Medical Center, Palm Springs, California, USA
| | - Steven Guest
- Baxter Healthcare Corporation, Deerfield, Illinois, USA
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Katavetin P, Theerasin Y, Treamtrakanpon W, Saiprasertkit N, Kanjanabuch T. Treatment failure in automated peritoneal dialysis and double-bag continuous ambulatory peritoneal dialysis. Nephrology (Carlton) 2014; 18:545-8. [PMID: 23730742 DOI: 10.1111/nep.12107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2013] [Indexed: 11/29/2022]
Abstract
AIM Automated peritoneal dialysis (APD) and double-bag continuous ambulatory peritoneal dialysis (CAPD) are the two current standard modalities of peritoneal dialysis (PD). Outcomes of these two modalities have not been well described. METHODS A single-centre, retrospective review was carried out to compare the treatment failure rate of APD and double-bag CAPD. Treatment failure was a combined endpoint including death and technique failure. Cox regression was used to compare risk (hazard ratio, HR) of treatment failure in APD and CAPD. RESULTS There were 121 patients included in this study, 55 with APD and 66 with CAPD. APD patients had significantly lower risk of treatment failure (death and technique failure) than CAPD patients (HR 0.58, 95% confidence interval [CI]: 0.37-0.91, P=0.02). The lower risk of treatment failure in APD compared to CAPD was mainly caused by the significantly lower risk of technique failure (HR 0.30, 95%CI: 0.10-0.93, P=0.04). The mortality rates of the two modalities were not significantly different (HR 0.69, 95%CI: 0.42-1.12, P=0.13). CONCLUSION Our data suggest that APD may have lower risk of treatment failure compared with double-bag CAPD. These potential benefits of APD might justify the use of this modality despite its higher cost.
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Affiliation(s)
- Pisut Katavetin
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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26
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Griva K, Yu Z, Chan S, Krisnasamy T, Yamin RBA, Zakaria FB, Wu SY, Oei E, Foo M. Age is not a contraindication to home-based dialysis - Quality-of-Life outcomes favour older patients on peritoneal dialysis regimes relative to younger patients. J Adv Nurs 2014; 70:1902-14. [PMID: 24495288 DOI: 10.1111/jan.12355] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
Abstract
AIM To compare Quality of Life, anxiety and depression between older (≥65 years) and younger (<65 years) patients across automated peritoneal dialysis and continuous ambulatory peritoneal dialysis. BACKGROUND There is a lack of studies as to whether the different peritoneal dialysis modalities confer similar outcomes in older and younger patients. DESIGN Cross-sectional. METHODS A total of 201 patients completed the Kidney Disease Quality of Life Short-Form, World Health Organization Quality of Life Instrument, Short Form and Hospital Anxiety and Depression Scale. Comorbidity and biochemical values were abstracted from medical records. RESULTS Older patients reported significantly better quality of life than younger patients in the Kidney Disease Quality of Life Short-Form effects of kidney disease and patient satisfaction and the World Health Organization Quality of Life Instrument overall Quality-of-Life/health despite worse clinical profile. Quality of life outcomes were comparable between automated peritoneal dialysis and continuous ambulatory peritoneal dialysis with the exception of the Kidney Disease Quality of Life Short-Form symptoms in favour of automated peritoneal dialysis. Levels of anxiety and depression were equivalent for older and younger patients across peritoneal dialysis modalities. The observed quality-of-life advantages for older patients persisted after case-mix adjustments and extended to more quality-of-life domains and depression and anxiety. CONCLUSION Our findings of superior quality of life in patients aged ≥ 65 support the expansion of peritoneal dialysis use in older patients. Patients across different age groups should be given non-biased information about both peritoneal dialysis modalities and individual preferences should be elicited and carefully considered by healthcare providers.
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Affiliation(s)
- Konstadina Griva
- Department of Psychology, National University of Singapore, Singapore
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Lee KO, Park SJ, Kim JH, Lee JS, Kim PK, Shin JI. Outcomes of peritonitis in children on peritoneal dialysis: a 25-year experience at Severance Hospital. Yonsei Med J 2013; 54:983-9. [PMID: 23709435 PMCID: PMC3663235 DOI: 10.3349/ymj.2013.54.4.983] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/04/2012] [Accepted: 09/14/2012] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Relatively little is known on the microbiology, risk factors and outcomes of peritoneal dialysis (PD)-associated peritonitis in Korean children. We performed this study in order to evaluate the incidence, treatment and clinical outcomes of peritonitis in pediatric PD patients at Severance Hospital. MATERIALS AND METHODS We analyzed data from 57 PD patients younger than 18 years during the period between June 1, 1986 and December 31, 2011. The collected data included gender, age at commencement of PD, age at peritonitis, incidence of peritonitis, underlying causes of end stage renal disease, microbiology of peritonitis episodes, antibiotics sensitivity, modality and outcomes of PD. RESULTS We found 56 episodes of peritonitis in 23 of the 57 PD patients (0.43 episodes/patient-year). Gram-positive bacteria were the most commonly isolated organisms (40 episodes, 71.4%). Peritonitis developed in 17 patients during the first 6 months following initiation of PD (73.9%). Peritonitis episodes rarely resulted in relapse or the need for permanent hemodialysis and no patient deaths were directly attributable to peritonitis. Antibiotic regimens included cefazolin+tobramycin from the years of 1986 to 2000 and cefazolin+ ceftazidime from the years of 2001 to 2011. While antibiotic therapy was successful in 48 episodes (85.7%), the treatment was ineffective in 8 episodes (14.3%). The rate of continuous ambulatory PD (CAPD) peritonitis was statistically higher than that of automated PD (APD) (p=0.025). CONCLUSION Peritonitis was an important complication of PD therapy and we observed a higher incidence of PD peritonitis in patients with CAPD when compared to APD.
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Affiliation(s)
- Kyong Ok Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Jin Park
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Ji Hong Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Seung Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pyung Kil Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Il Shin
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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28
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Cortés-Sanabria L, Rodríguez-Arreola BE, Ortiz-Juárez VR, Soto-Molina H, Pazarín-Villaseñor L, Martínez-Ramírez HR, Cueto-Manzano AM. Comparison of direct medical costs between automated and continuous ambulatory peritoneal dialysis. Perit Dial Int 2013; 33:679-86. [PMID: 23547280 DOI: 10.3747/pdi.2011.00274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We set out to estimate the direct medical costs (DMCs) of peritoneal dialysis (PD) and to compare the DMCs for continuous ambulatory PD (CAPD) and automated PD (APD). In addition, DMCs according to age, sex, and the presence of peritonitis were evaluated. METHODS Our retrospective cohort analysis considered patients initiating PD, calculating 2008 costs and, for comparison, updating the results for 2010. The analysis took the perspective of the Mexican Institute of Social Security, including outpatient clinic and emergency room visits, dialysis procedures, medications, laboratory tests, hospitalizations, and surgeries. RESULTS No baseline differences were observed for the 41 patients evaluated (22 on CAPD, 19 on APD). Median annual DMCs per patient on PD were US$15 072 in 2008 and US$16 452 in 2010. When analyzing percentage distribution, no differences were found in the DMCs for the modality groups. In both APD and CAPD, the main costs pertained to the dialysis procedure (CAPD 41%, APD 47%) and hospitalizations (CAPD 37%, APD 32%). Dialysis procedures cost significantly more (p = 0.001) in APD (US$7 084) than in CAPD (US$6 071), but total costs (APD US$15 389 vs CAPD US$14 798) and other resources were not different. The presence of peritonitis increased the total costs (US$16 075 vs US$14 705 for patients without peritonitis, p = 0.05), but in the generalized linear model analysis, DMCs were not predicted by age, sex, dialysis modality, or peritonitis. A similar picture was observed for costs extrapolated to 2010, with a 10% - 20% increase for each component--except for laboratory tests, which increased 52%, and dialysis procedures, which decreased 3%, from 2008. CONCLUSIONS The annual DMCs per patient on PD in this study were US$15 072 in 2008 and US$16 452 in 2010. Total DMCs for dialysis procedures were higher in APD than in CAPD, but the difference was not statistically significant. In both APD and CAPD, 90% of costs were attributable to the dialysis procedure, hospitalizations, and medications. In a multivariate analysis, no independent variable significantly predicted a higher DMC.
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Affiliation(s)
- Laura Cortés-Sanabria
- Unidad de Investigación Médica en Enfermedades Renales,1 Hospital de Especialidades, CMNO, and Coordinación de Salud Pública,2 Delegación Jalisco, IMSS, Guadalajara
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29
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Verrina E, Cappelli V, Perfumo F. Selection of modalities, prescription, and technical issues in children on peritoneal dialysis. Pediatr Nephrol 2009; 24:1453-64. [PMID: 18521632 PMCID: PMC2697927 DOI: 10.1007/s00467-008-0848-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 03/31/2008] [Accepted: 03/31/2008] [Indexed: 11/08/2022]
Abstract
Peritoneal dialysis (PD) is widely employed as a dialytic therapy for uraemic children, especially in its automated form (APD), that is associated with less burden of care on patient and family than continuous ambulatory PD. Since APD offers a wide range of treatment options, based on intermittent and continuous regimens, prescription can be individualized according to patient's age, body size, residual renal function, nutritional intake, and growth-related metabolic needs. Transport capacity of the peritoneal membrane of each individual patient should be assessed, and regularly monitored, by means of standardized peritoneal function tests validated in pediatric patients. To ensure maximum recruitment of peritoneal exchange area, fill volume should be scaled to body surface area and adapted to each patient, according to clinical tolerance and intraperitoneal pressure. PD solutions should be employed according to their biocompatibility and potential ultrafiltration capacity; new pH-neutral, glucose-free solutions can be used in an integrated way in separate dwells, or by appropriately mixing during the same dialytic session. Kinetic modelling software programs may help in the tailoring of PD prescription to individual patients' characteristics and needs. Owing to advances in the technology of new APD machines, greater programming flexibility, memorized delivery control, and tele-dialysis are currently possible.
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Affiliation(s)
- Enrico Verrina
- Dialysis Unit, Nephrology and Dialysis Division, Giannina Gaslini Institute, Largo G. Gaslini, 5, 16148, Genoa, Italy.
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