1
|
Driehuis E, Eshuis M, Abrahams A, François K, Vernooij RW. Automated peritoneal dialysis versus continuous ambulatory peritoneal dialysis for people with kidney failure. Cochrane Database Syst Rev 2024; 9:CD006515. [PMID: 39258519 PMCID: PMC11388675 DOI: 10.1002/14651858.cd006515.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
BACKGROUND Peritoneal dialysis (PD) is a home-based kidney replacement therapy (KRT) performed in people with kidney failure. PD can be performed by manual filling and draining of the abdominal cavity, i.e. continuous ambulatory PD (CAPD), or using a device connected to the PD catheter that is programmed to perform PD exchanges, i.e. automated PD (APD). APD is considered to have several advantages over CAPD, such as a lower incidence of peritonitis, fewer mechanical complications, and greater psychosocial acceptability. Acknowledging the increasing uptake of APD in incident and prevalent patients undergoing PD, it is important to re-evaluate the evidence on the comparative clinical and patient-reported outcomes of APD compared to CAPD. This is an update of a Cochrane review published in 2007. OBJECTIVES To compare clinical and patient-reported outcomes of APD to CAPD in people with kidney failure. SEARCH METHODS In this update, we searched the Cochrane Kidney and Transplant Register of Studies until 29 August 2024. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing APD with CAPD in adults (≥ 18 years) with kidney failure. DATA COLLECTION AND ANALYSIS Two authors independently screened the search results and extracted data. Data synthesis was performed using random-effects meta-analyses, expressing effect estimates as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data and mean differences (MD) with 95% CIs for continuous data. Certainty in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS Two RCTs (131 randomised people) comparing APD with CAPD were included in this update. One RCT had a follow-up of six months, and one RCT had a follow-up of 24 months. The risk of bias in the included studies was mostly low, except for the high risk of performance bias for subjective outcomes. The evidence is very uncertain about the effect of APD compared to CAPD on death, hospitalisations, PD-related peritonitis, change of dialysis modality, residual kidney function, health-related quality of life (HRQoL), overhydration, blood pressure, exit-site infections, tunnel infections, mechanical complications, PD catheter removal, or dialysis adequacy measures. These results were largely based on low to very low certainty evidence; hence, caution is warranted when drawing conclusions. AUTHORS' CONCLUSIONS Insufficient evidence exists to decide between APD and CAPD in kidney failure patients with regard to clinical and patient-reported outcomes. Therefore, current evidence is insufficient as a guide for clinical practice. Given that the sample sizes of existing studies are generally small with insufficient follow-up, there is a need for large-scale, multicentre studies. Future research should focus on possible differences between APD and CAPD in residual kidney function, euvolaemia, and patient-reported outcomes such as HRQoL, symptoms, patient satisfaction and life participation.
Collapse
Affiliation(s)
- Esmee Driehuis
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Nephrology, Amsterdam UMC, location VUmc, Amsterdam, Netherlands
| | - Marga Eshuis
- Department of Nephrology, Bravis ziekenhuis, Roosendaal, Netherlands
| | - Alferso Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| | - Karlien François
- Division of Nephrology and Hypertension, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Robin Wm Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
2
|
Ito Y, Tu C, Yamaguchi M, Koide S, Ryuzaki M, Bieber B, Pisoni RL, Perl J, Minakuchi J, Kawanishi H. Risk factors of peritoneal dialysis-related peritonitis in the Japan Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Clin Kidney J 2024; 17:sfae202. [PMID: 39050865 PMCID: PMC11267232 DOI: 10.1093/ckj/sfae202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Indexed: 07/27/2024] Open
Abstract
Background Peritoneal dialysis (PD)-related peritonitis is a major complication of PD. Wide variations in peritonitis prevention, treatment strategies and consequences are seen between countries. These between-country differences may result from modifiable risk factors and clinical practices. Methods A total of 1225 Japanese PD patients were included and prospectively followed in the Peritoneal Dialysis Outcomes and Practice Patterns Study phase 1 (2014-2018) and phase 2 (2018-2022). Associations between PD-related peritonitis and various risk factors were assessed by Cox proportional hazards survival models. Results During follow-up (median 1.52 years), 539 peritonitis episodes were experienced by 364 patients. The country crude peritonitis rate was 0.27 episodes/patient-year. In the fully adjusted model, noticeable patient-level factors associated with experiencing any peritonitis included age {hazard ratio [HR] 1.07 per 5-year increase [95% confidence interval (CI) 1.01-1.14]}, serum albumin level [HR 0.63 per 1 g/dl higher (95% CI 0.48-0.82)] and continuous ambulatory peritoneal dialysis (PD) [HR 1.31 versus automated PD (95% CI 1.05-1.63)]. The adoption of antibiotic prophylaxis practice at the time of PD catheter insertion [HR 0.63 (95% CI 0.51-0.78)] or when having complicated dental procedures [HR 0.74 (95% CI 0.57-0.95)] or lower endoscopy [HR 0.69 (95% CI 0.54-0.89)] were associated with lower hazards of any peritonitis, while a routine facility practice of having more frequent regular medical visits was associated with a higher hazard. Conclusion Identification of risk factors in Japan may be useful for developing future versions of guidelines and improving clinical practices in Japan. Investigation of country-level risk factors for PD-related peritonitis is useful for developing and implementing local peritonitis prevention and treatment strategies.
Collapse
Affiliation(s)
- Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Charlotte Tu
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Makoto Yamaguchi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | | | | | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | | | | | - Hideki Kawanishi
- Tsuchiya General Hospital, Hiroshima, Japan
- PDOPPS steering committee member
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Zhou Q, Zhao R, Shen X, Zhang H, Zhai Y, Gu Y, Shen Q, Xu H. Experience of the homecare of children on automatic peritoneal dialysis during the COVID-19 outbreak: A qualitative descriptive study. Nurs Open 2023; 10:2203-2212. [PMID: 36397267 PMCID: PMC10006596 DOI: 10.1002/nop2.1469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/24/2022] [Accepted: 10/22/2022] [Indexed: 11/19/2022] Open
Abstract
AIMS To describe the home care experience, challenges and coping strategies of caregivers with children on automatic peritoneal dialysis (PD) in mainland China during the early stage of the COVID-19 outbreak. DESIGN A qualitative descriptive approach was adopted. Semi-structured telephone interviews were conducted among 14 families with children on automatic peritoneal dialysis from February 2nd to 10th, 2020. The care routine, stress and coping strategies of caregivers of children on peritoneal dialysis were collected. The data were analysed using thematic analysis. METHODS Four key themes were defined: (1) concerns about PD treatment intertwined with worries about COVID-19; (2) retaining a sense of normality in the middle of the challenges; (3) staying safe; and (4) staying positive and carrying on. RESULTS Families with children on automatic PD addressed the stress from COVID-19 and its containment measures by closely adhering to COVID-19 preventative measures, actively adjusting mentality and maintaining a sense of normality during the outbreak. This implies that healthcare staff need to be more aware of the complex medical needs of families with children on automatic PD, advocate for them and facilitate their navigation through the repurposed healthcare system.
Collapse
Affiliation(s)
- Qing Zhou
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| | - Rui Zhao
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| | - Xia Shen
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| | - Hui Zhang
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| | - Yihui Zhai
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| | - Ying Gu
- Department of Nursing, Children's Hospital, Fudan University, Shanghai, China
| | - Qian Shen
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital, Fudan University, Shanghai, China
| |
Collapse
|
5
|
Kanjanabuch T, Pongpirul K. Peritoneal dialysis care during the COVID-19 pandemic, Thailand. Bull World Health Organ 2022; 100:155-160. [PMID: 35125540 PMCID: PMC8795847 DOI: 10.2471/blt.21.286792] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022] Open
Abstract
PROBLEM The coronavirus disease 2019 (COVID-19) pandemic could affect health service provision of less urgent interventions, such as peritoneal dialysis for chronic kidney disease patients. APPROACH To assess how peritoneal dialysis centres in Thailand adapted their provision of care, we invited medical directors and peritoneal dialysis managers to respond to an online survey on 1 July 2021. We asked whether they had modified or deferred their training, catheter insertion or removal, intravenous supplements, follow-up and home visits, and workload. LOCAL SETTING Patients needing dialysis receive peritoneal dialysis free of charge in Thailand. As of 31 December 2020, 240 peritoneal dialysis centres in Thailand have provided care to 32 284 patients. RELEVANT CHANGES At 24.6% (29/118) of centres, educational sessions for patients were modified. Catheter insertion continued at 71.9% (82/114) of centres. Few facilities (19.7%; 23/117) continued to perform peritoneal equilibration tests as usual. On-site intravenous injections were mostly transferred to health centres close to the patients' homes. Most centres reduced their outpatient follow-up visits (51.7%; 61/118) and stopped visiting patients at home (66.9%; 79/118). Peritoneal dialysis nurses reported an increased workload at 62.7% (74/118) of centres, and in many instances (66.1%; 78/118) were providing nursing care to COVID-19 patients and administering COVID-19 vaccines. LESSONS LEARNT Health-care providers altered clinical care activities to protect their patients from COVID-19. However, further evidence is needed on the consequences of such alteration in care. To prepare for future pandemics, actors need to explore nonconventional peritoneal dialysis care as well as financial and nonfinancial incentive mechanisms for such care.
Collapse
Affiliation(s)
- Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- School of Global Health, Faculty of Medicine, Chulalongkorn University,1873 Rama IV Rd, Patumwan, Bangkok 10330, Thailand
| |
Collapse
|
6
|
Gardezi AI, Muth B, Ghaffar A, Aziz F, Garg N, Mohamed M, Foley D, Kaufman D, Djamali A, Mandelbrot D, Parajuli S. Continuation of Peritoneal Dialysis in Adult Kidney Transplant Recipients With Delayed Graft Function. Kidney Int Rep 2021; 6:1634-1641. [PMID: 34169204 PMCID: PMC8207463 DOI: 10.1016/j.ekir.2021.03.899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Peritoneal dialysis (PD) has been used increasingly in past decade. Many of these patients undergo transplantation and may require dialysis for delayed graft function (DGF). The outcomes of DGF based on the post-transplantation dialysis modality are not well known. METHODS We retrospectively reviewed all adult kidney transplant recipients (KTRs) from the University of Wisconsin School of Medicine and Public Health who developed DGF between November 2015 and April 2019. Patients were divided into those who received hemodialysis (HD) or PD during the DGF period. Immediate graft explant, DGF among living donor KTRs, or those requiring just a single dialysis treatment were excluded. RESULTS Of 224 KTRs with DGF during the study period, 167 fulfilled our selection criteria. There were 16 patients in the PD and 151 in the HD group. Baseline characteristics were similar between the two groups, except diabetes was more prevalent in the HD group. Five of 16 PD patients had to be transitioned to HD. There was no difference in DGF duration, hospital length of stay, infectious or surgical complications, rejection at various time periods, graft function at last follow-up, or graft failure. In multivariate analysis, only rejection within the first year of transplantation (hazard ratio [HR]: 4.26; 95% confidence interval [CI]: 1.20-15.08; P = 0.02) and post-surgical complications (HR: 3.79; 95% CI: 1.03- 13.91; P = 0.04) were associated with death-censored graft failure (DCGF). The use of PD for treatment of DGF was not associated with DCGF. CONCLUSIONS In carefully selected patients, PD can be continued safely for DGF without any effect on short-term or long-term transplant outcomes.
Collapse
Affiliation(s)
- Ali I. Gardezi
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Brenda Muth
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Adil Ghaffar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fahad Aziz
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Neetika Garg
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Maha Mohamed
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David Foley
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Dixon Kaufman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Arjang Djamali
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Didier Mandelbrot
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sandesh Parajuli
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
7
|
Frehat MQF, Al-Salaita GM, Al-Bderat JT, Alhadidi AM, Mohammad SA, Shaaban AM, Al Mardini R. Chronic peritoneal dialysis in children: a single-centre experience in Jordan. Sudan J Paediatr 2020; 20:34-41. [PMID: 32528199 DOI: 10.24911/sjp.106-1578945921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of the present study is to share the experience of chronic peritoneal dialysis (PD) at King Hussein Medical Center, Amman, Jordan, and to highlight the complications of this procedure. This is a retrospective chart review study for all the children from day 1 of life to 14 years, who underwent chronic PD for end-stage renal disease (ESRD) during the period of 10 years extending from 2009 to 2019. The following data were collected: mode of dialysis, type of peritoneal dialysis, age of starting peritoneal dialysis, gender, aetiology of ESRD, duration on PD, complications and outcome. A total number of 269 children were included: 229 patients received haemodialysis and 40 children (22 boys and 18 girls) received PD. Of those, two children were on automated PD and 38 children were on continuous ambulatory peritoneal dialysis. The mean age at the start of PD was 62 ± 38 months. The mean duration of PD was 43 months. The mean catheter duration was 34 months. Six patients were shifted to haemodialysis permanently and four patients received a kidney transplant. Eleven patients died. The most common complications were peritonitis (52.5%), exit-site infection (30%) and malfunctioning catheter (12.5%). The rate of peritonitis was one episode per 22 patient-months. Peritoneal dialysis is a promising mode of dialysis for children in Jordan. Peritonitis is the most common complication associated with PD. Kidney transplantation is the best modality of renal replacement therapy in terms of long-term survival and quality of life and should be encouraged on national level.
Collapse
Affiliation(s)
- Mahdi Qasem Farah Frehat
- Pediatric Nephrology Department, Queen Rania Al Abdallah Hospital for Children, King Hussein Medical Center, Amman, Jordan
| | - Ghazi Mohammad Al-Salaita
- Pediatric Nephrology Department, Queen Rania Al Abdallah Hospital for Children, King Hussein Medical Center, Amman, Jordan
| | - Jwaher Thiab Al-Bderat
- Pediatric Nephrology Department, Queen Rania Al Abdallah Hospital for Children, King Hussein Medical Center, Amman, Jordan
| | - Aghadir Mohammad Alhadidi
- Pediatric Department, Queen Rania Al Abdallah Hospital for Children, King Hussein Medical Center, Amman, Jordan
| | - Samera Adnan Mohammad
- Dialysis Unit, Queen Rania Al Abdallah Hospital for Children, King Hussein Medical Center, Amman, Jordan
| | - Ahmad Mohammad Shaaban
- Pediatric Department, Queen Rania Al Abdallah Hospital for Children, King Hussein Medical Center, Amman, Jordan
| | - Reham Al Mardini
- Pediatrics and Pediatric nephrology, Private Practice, Amman, Jordan
| |
Collapse
|
8
|
Long B, Koyfman A, Lee CM. Emergency medicine evaluation and management of the end stage renal disease patient. Am J Emerg Med 2017; 35:1946-1955. [PMID: 28893450 DOI: 10.1016/j.ajem.2017.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/02/2017] [Accepted: 09/03/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. OBJECTIVE This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population. DISCUSSION ESRD incidence is rapidly increasing, and patients commonly require renal replacement therapy including hemodialysis (HDS) or peritoneal dialysis (PD), each type with specific features. These patients possess greater risk of neurologic complications, cardiopulmonary pathology, infection, and access site complications. Focused history and physical examination are essential. Neurologic issues include uremic encephalopathy, cerebrovascular pathology, and several others. Cardiopulmonary complications include pericarditis, pericardial effusion/tamponade, acute coronary syndrome, sudden cardiac death, electrolyte abnormalities, pulmonary edema, and air embolism. Infections are common, with patients more commonly presenting in atypical fashion. Access site infections and metastatic infections must be treated aggressively. Access site complications include bleeding, aneurysm/pseudoaneurysm, thrombosis/stenosis, and arterial steal syndrome. Specific medication considerations are required for analgesics, sedatives, neuromuscular blocking agents, antimicrobials, and anticoagulants. CONCLUSIONS Consideration of renal physiology with complications in ESRD can assist emergency providers in the evaluation and management of these patients. ESRD affects many organ systems, and specific pharmacologic considerations are required.
Collapse
Affiliation(s)
- Brit Long
- San Antonio Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Courtney M Lee
- Joint Base Elmendorf Richardson Medical Center, Department of Emergency Medicine, 5955 Zeamer Ave, JBER, AK, 99506, United States
| |
Collapse
|
9
|
Li PKT, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, Fish DN, Goffin E, Kim YL, Salzer W, Struijk DG, Teitelbaum I, Johnson DW. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int 2016; 36:481-508. [PMID: 27282851 PMCID: PMC5033625 DOI: 10.3747/pdi.2016.00078] [Citation(s) in RCA: 619] [Impact Index Per Article: 77.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Beth Piraino
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Javier de Arteaga
- Department of Nephrology, Hospital Privado and Catholic University, Cordoba, Argentina
| | - Stanley Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | - Ana E Figueiredo
- Nursing School-FAENFI, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas N Fish
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Eric Goffin
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Belgium
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - William Salzer
- University of Missouri-Columbia School of Medicine, Department of Internal Medicine, Section of Infectious Disease, MI, USA
| | - Dirk G Struijk
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
10
|
Nadeau-Fredette AC, Hawley CM, Pascoe EM, Chan CT, Clayton PA, Polkinghorne KR, Boudville N, Leblanc M, Johnson DW. An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry). Clin J Am Soc Nephrol 2015; 10:1397-407. [PMID: 26068181 PMCID: PMC4527016 DOI: 10.2215/cjn.00840115] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/20/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Home dialysis is often recognized as a first-choice therapy for patients initiating dialysis. However, studies comparing clinical outcomes between peritoneal dialysis and home hemodialysis have been very limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This Australia and New Zealand Dialysis and Transplantation Registry study assessed all Australian and New Zealand adult patients receiving home dialysis on day 90 after initiation of RRT between 2000 and 2012. The primary outcome was overall survival. The secondary outcomes were on-treatment survival, patient and technique survival, and death-censored technique survival. All results were adjusted with three prespecified models: multivariable Cox proportional hazards model (main model), propensity score quintile-stratified model, and propensity score-matched model. RESULTS The study included 10,710 patients on incident peritoneal dialysis and 706 patients on incident home hemodialysis. Treatment with home hemodialysis was associated with better patient survival than treatment with peritoneal dialysis (5-year survival: 85% versus 44%, respectively; log-rank P<0.001). Using multivariable Cox proportional hazards analysis, home hemodialysis was associated with superior patient survival (hazard ratio for overall death, 0.47; 95% confidence interval, 0.38 to 0.59) as well as better on-treatment survival (hazard ratio for on-treatment death, 0.34; 95% confidence interval, 0.26 to 0.45), composite patient and technique survival (hazard ratio for death or technique failure, 0.34; 95% confidence interval, 0.29 to 0.40), and death-censored technique survival (hazard ratio for technique failure, 0.34; 95% confidence interval, 0.28 to 0.41). Similar results were obtained with the propensity score models as well as sensitivity analyses using competing risks models and different definitions for technique failure and lag period after modality switch, during which events were attributed to the initial modality. CONCLUSIONS Home hemodialysis was associated with superior patient and technique survival compared with peritoneal dialysis.
Collapse
Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Medicine, Université de Montreal, Montreal, Canada
| | - Carmel M Hawley
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kevan R Polkinghorne
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Department of Nephrology, Monash Medical Centre, Monash Health, Clayton, Australia; Departments of Medicine, Epidemiology, and Preventative Medicine, Monash University, Melbourne, Australia; and
| | - Neil Boudville
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Martine Leblanc
- Department of Medicine, Université de Montreal, Montreal, Canada
| | - David W Johnson
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia;
| |
Collapse
|
11
|
Mallipattu S, Duffoo M, Fallahi A, Uribarri J. Manifold exchange: a delivery option in managing patients on peritoneal dialysis. Perit Dial Int 2015; 34:657-63. [PMID: 25228216 DOI: 10.3747/pdi.2013.00205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sandeep Mallipattu
- Division of Nephrology Department of Medicine Stony Brook University Stony Brook, NY Dialysis Department The Mount Sinai Hospital New York, NY Department of Medicine Beth Israel Medical Center New York, NY Division of Nephrology Department of Medicine Icahn School of Medicine at Mount Sinai New York, NY
| | - Marcia Duffoo
- Division of Nephrology Department of Medicine Stony Brook University Stony Brook, NY Dialysis Department The Mount Sinai Hospital New York, NY Department of Medicine Beth Israel Medical Center New York, NY Division of Nephrology Department of Medicine Icahn School of Medicine at Mount Sinai New York, NY
| | - Arzhang Fallahi
- Division of Nephrology Department of Medicine Stony Brook University Stony Brook, NY Dialysis Department The Mount Sinai Hospital New York, NY Department of Medicine Beth Israel Medical Center New York, NY Division of Nephrology Department of Medicine Icahn School of Medicine at Mount Sinai New York, NY
| | - Jaime Uribarri
- Division of Nephrology Department of Medicine Stony Brook University Stony Brook, NY Dialysis Department The Mount Sinai Hospital New York, NY Department of Medicine Beth Israel Medical Center New York, NY Division of Nephrology Department of Medicine Icahn School of Medicine at Mount Sinai New York, NY
| |
Collapse
|
12
|
Tong A, Lesmana B, Johnson DW, Wong G, Campbell D, Craig JC. The perspectives of adults living with peritoneal dialysis: thematic synthesis of qualitative studies. Am J Kidney Dis 2012. [PMID: 23177729 DOI: 10.1053/j.ajkd.2012.08.045] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Most patients with end-stage renal disease require dialysis to survive because they are unable to access kidney transplantation. Peritoneal dialysis (PD) is recommended by some clinical practice guidelines as the dialysis treatment of choice for adults without significant comorbid conditions or those with residual kidney function. This study aims to synthesize published qualitative studies of patients' experiences, beliefs, and attitudes about PD. METHODS We conducted a systematic review and thematic synthesis of qualitative studies of adult perspectives of living with PD. Databases (MEDLINE, Embase, PsycINFO, and CINAHL), theses, and reference lists were searched to November 2011. RESULTS 39 studies involving 387 participants were included. We identified 7 themes: resilience and confidence (determination and overcoming vicissitudes), support structures (strong family relationship, peer support, professional dedication, social abandonment, and desire for holistic care), overwhelming responsibility (disruptive intrusion, family burden, and onerous treatment regimen), control (gaining bodily awareness, achieving independence and self-efficacy, and information seeking), freedom (flexibility and autonomy, retaining social functioning, and ability to travel), sick identity (damage to self-esteem and invisible suffering), and disablement (physical incapacitation and social loss and devaluation). CONCLUSIONS PD can offer patients a sense of control, independence, self-efficacy, and freedom. However, holistic and multidisciplinary care is needed to mitigate the risks of impaired self-esteem, physical incapacitation, reduced social functioning, and poor sense of self-worth. Strategies that aim to strengthen social support and promote resilience and confidence in patients are integral to achieving positive adjustment, improved psychosocial outcomes, and treatment satisfaction.
Collapse
Affiliation(s)
- Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
| | | | | | | | | | | |
Collapse
|
13
|
Villa G, Fernández-Ortiz L, Cuervo J, Rebollo P, Selgas R, González T, Arrieta J. Cost-effectiveness analysis of the Spanish renal replacement therapy program. Perit Dial Int 2011; 32:192-9. [PMID: 21965620 DOI: 10.3747/pdi.2011.00037] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We undertook a cost-effectiveness analysis of the Spanish Renal Replacement Therapy (RRT) program for end-stage renal disease patients from a societal perspective. The current Spanish situation was compared with several hypothetical scenarios. METHODS A Markov chain model was used as a foundation for simulations of the Spanish RRT program in three temporal horizons (5, 10, and 15 years). The current situation (scenario 1) was compared with three different scenarios: increased proportion of overall scheduled (planned) incident patients (scenario 2); constant proportion of overall scheduled incident patients, but increased proportion of scheduled incident patients on peritoneal dialysis (PD), resulting in a lower proportion of scheduled incident patients on hemodialysis (HD) (scenario 3); and increased overall proportion of scheduled incident patients together with increased scheduled incidence of patients on PD (scenario 4). RESULTS The incremental cost-effectiveness ratios (ICERs) of scenarios 2, 3, and 4, when compared with scenario 1, were estimated to be, respectively, -€83 150, -€354 977, and -€235 886 per incremental quality-adjusted life year (ΔQALY), evidencing both moderate cost savings and slight effectiveness gains. The net health benefits that would accrue to society were estimated to be, respectively, 0.0045, 0.0211, and 0.0219 ΔQALYs considering a willingness-to-pay threshold of €35 000/ΔQALY. CONCLUSIONS Scenario 1, the current Spanish situation, was dominated by all the proposed scenarios. Interestingly, scenarios 3 and 4 showed the best results in terms of cost-effectiveness. From a cost-effectiveness perspective, an increase in the overall scheduled incidence of RRT, and particularly that of PD, should be promoted.
Collapse
Affiliation(s)
- Guillermo Villa
- BAP Health Outcomes Research1 and Department of Medicine, Universidad de Oviedo, Oviedo, Spain.
| | | | | | | | | | | | | |
Collapse
|
14
|
Matthaiou DK, Peppas G, Falagas ME. Meta-analysis on Surgical Infections. Infect Dis Clin North Am 2009; 23:405-30. [DOI: 10.1016/j.idc.2009.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
15
|
Davison SN, Jhangri GS, Jindal K, Pannu N. Comparison of volume overload with cycler-assisted versus continuous ambulatory peritoneal dialysis. Clin J Am Soc Nephrol 2009; 4:1044-50. [PMID: 19406971 DOI: 10.2215/cjn.00020109] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Cycler-assisted peritoneal dialysis (CCPD) has been associated with decreased sodium removal compared with continuous ambulatory peritoneal dialysis (CAPD) as a result of peritoneal sodium sieving during the short dwells that are associated with CCPD. This may have adverse consequences for management of extracellular fluid volume (ECFV). This study compared ECFV in patients who received CAPD or CCPD; CCPD dwell times were maximized by limiting the number of exchanges, and the use of icodextrin for the long daytime dwells was widespread. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was an observational, cross-sectional study of 158 prevalent patients (90 CAPD, 68 CCPD). Demographic data, blood work, and 24-h dialysate and urine samples were collected from all participants between January 2004 and July 2006. They subsequently underwent assessment of ECFV by multifrequency bioimpedance spectroscopy analysis. Multivariate analysis was used to determine the relationship between peritoneal dialysis modality and ECFV. Potential cofounders including age, comorbidity, time on dialysis, residual renal function, and icodextrin use were identified a priori. RESULTS There were no differences in BP, use of antihypertensive medications, or the presence of peripheral edema between CAPD and CCPD patients. Similarly, there was no difference in the ratio of ECFV to total body water between CAPD (51.8%) and CCPD (51.9%) patients (P = 0.929). CONCLUSIONS There is no difference in BP, sodium removal, or volume control in patients who use a contemporary approach to CCPD that uses fewer night cycles and liberalizes the use of icodextrin when compared with CAPD.
Collapse
Affiliation(s)
- Sara N Davison
- Division of Nephrology, University of Alberta, Alberta, Canada.
| | | | | | | |
Collapse
|
16
|
Michels WM, Verduijn M, Boeschoten EW, Dekker FW, Krediet RT. Similar survival on automated peritoneal dialysis and continuous ambulatory peritoneal dialysis in a large prospective cohort. Clin J Am Soc Nephrol 2009; 4:943-9. [PMID: 19357244 DOI: 10.2215/cjn.04440908] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Automated peritoneal dialysis (APD) is increasingly used in comparison with continuous ambulatory peritoneal dialysis (CAPD). Although APD is expected to improve survival, convincing evidence of major advantages is lacking. The objective was to investigate whether overall mortality and technique failure of incident dialysis patients treated with APD are different from those treated with CAPD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients on APD or CAPD at 3 mo after start of dialysis were selected from a prospective multicenter cohort study in incident dialysis patients (NECOSAD). Overall mortality was studied with an intention-to-treat design; the event was death. Technique failure was studied with an as-treated design; the event was a switch of dialysis modality. Hazard ratios (HRs) were calculated with a follow-up of 5 yr. The HRs were adjusted for gender, age, primary kidney disease, comorbidity, residual GFR, urine production and plasma albumin at 3 mo after inclusion. RESULTS Eighty-seven APD and 562 CAPD patients were included. In the intention-to-treat analysis 154 CAPD and 21 APD patients died. The crude HR for overall mortality was 0.98 (95% CI: 0.62-1.54), the adjusted HR was 1.09. In the as-treated analysis 238 CAPD and 34 APD patients switched therapy, whereas 91 CAPD and 7 APD patients died. The crude HR for technique failure was 0.92 (95% CI: 0.64-1.31) and did not change after adjustment. CONCLUSIONS No difference was found in overall mortality and technique failure for APD compared with CAPD in incident dialysis patients.
Collapse
Affiliation(s)
- Wieneke Marleen Michels
- Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | | | | | | | | | | |
Collapse
|