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Baillie J, Gill P, Courtenay M. Perceptions of peritonitis risk, prevention, diagnosis and stigma: Findings from a mixed methods study with patients and relatives using peritoneal dialysis. J Ren Care 2024; 50:138-150. [PMID: 36946307 DOI: 10.1111/jorc.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/27/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Peritonitis is the main treatment-related complication of peritoneal dialysis and a primary concern for patients and their relatives. Therefore, understanding their perceptions of peritonitis is important. OBJECTIVES To explore patients' and relatives' perceptions of peritoneal dialysis-associated peritonitis risk, prevention measures and experiences of diagnosis, and experience of perceived stigma. DESIGN A sequential mixed methods study design was used, including a questionnaire and semi-structured interviews. PARTICIPANTS Patients using peritoneal dialysis and relatives (n = 75) from six National Health Service organisations from the United Kingdom. MEASUREMENTS A structured questionnaire was administered with patients and relatives (n = 75) using peritoneal dialysis; data were analysed using descriptive statistics. Thirty questionnaire respondents were then purposively sampled and interviewed in-depth; data were analysed thematically. Data were collected 2017-2018. Ethical and governance approvals were gained. RESULTS Qualitative and quantitative analyses were integrated and three themes presented: • Perceptions of risk: participants assessed their risk of developing peritonitis and possible implications on their health and relatives. Participants felt greatly responsible for preventing infection. • Preventing peritonitis: participants reported similar and some differing measures to minimise their risk of developing peritonitis. Participants wanted to be seen as "clean". • Diagnosis of peritonitis: peritonitis diagnosis was embarrassing and stigmatising for many individuals. This was influenced by the response of healthcare professionals and the cause of peritonitis. CONCLUSIONS It is important that healthcare professionals are aware of how responsible patients and relatives feel about preventing peritonitis, the emotional effect of this responsibility and crucially the impact this may have on seeking help.
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Affiliation(s)
- Jessica Baillie
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Paul Gill
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Hayat A, Cho Y, Pascoe E, Krishnasamy R, Borlace M, Chen J, Boudville N, Sud K, Varnfield M, Francis R, Pitt R, Hughes JT, Johnson DW. Uptake and Outcomes of Peritoneal Dialysis among Aboriginal and Torres Strait Islander People: Analysis of Registry Data. Kidney Int Rep 2024; 9:1484-1495. [PMID: 38707791 PMCID: PMC11068974 DOI: 10.1016/j.ekir.2024.01.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Peritoneal dialysis (PD) enables people to use kidney replacement therapy (KRT) outside of healthcare-dependent settings, a strong priority of Aboriginal and Torres Strait Islander people. Methods We undertook an observational study analyzing registry data to describe access to PD and its outcome as the first KRT among Aboriginal and Torres Strait Islander people between January 1, 2004 and December 31 2020. Results Out of 4604 Aboriginal and Torres Strait Islander people, reflecting 10.4% of all Australians commencing KRT, PD was the first KRT modality among 665 (14.4%). PD utilization was 17.2% in 2004 to 2009 and 12.7% in 2016 to 2020 (P = 0.002); 1105 episodes of peritonitis were observed in 413 individuals, median of 3 (interquartile range [IQR], 2-5) episodes/patient. The crude peritonitis rate was 0.53 (95% confidence interval [CI], 0.50-0.56) episodes/patient-years without any significant changes over time. The median time to first peritonitis was 1.1 years. A decrease in the peritonitis incidence rate ratio (IRR) was observed in 2016 to 2020 (IRR, 0.63 [95% CI, 0.52-0.77], P < 0.001) compared to earlier eras (2010-2015: IRR, 0.90 [95% CI, 0.76-1.07], P = 0.23; Ref: 2004-2009). The cure rates decreased from 80.0% (n = 435) in 2004 to 2009, to 70.8% (n = 131) in 2016 to 2020 (P < 0.001). Conclusion Aboriginal and Torres Strait Islander people who utilized PD as their first KRT during 2004 to 2020 recorded a higher peritonitis rate than the current benchmark of 0.4 episodes/patient-years. The cure rates have worsened recently, which should be a big concern. There is an exigent need to address these gaps in kidney care for Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Ashik Hayat
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Yeoungjee Cho
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - E.M. Pascoe
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Rathika Krishnasamy
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Sunshine Coast University Hospital, Queensland, Australia
| | - Monique Borlace
- Department of Nephrology, Royal Adelaide Hospital, Adelaide, Australia
| | - Jenny Chen
- Department of Renal Medicine, Wollongong Hospital, Wollongong, Australia
- School of Medicine, University of Wollongong, Wollongong, Australia
| | - Neil Boudville
- Medical School, University of Western Australia, Perth, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kamal Sud
- Nepean KIdney Research Centre, Department of Renal Medicine, Nepean Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - M. Varnfield
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Australian e-Health Research Centre; CSIRO, Brisbane, Australia
| | - Ross Francis
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Rochelle Pitt
- Inala Indigenous Health Services, Queensland, Australia
| | - Jaquelyne T. Hughes
- Royal Darwin Hospital, Northern Territory, Darwin, Australia
- Rural and Remote Health, College of Medicine and Public Health, Flinders University Northern Territory, Nhulunbuy, Australia
- Wagadagam tribe of near west Torres Strait
| | - David Wayne Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
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Tobada SB, Chatelet V, Bechade C, Lanot A, Boyer A, Couchoud C, Toure F, Boime S, Lobbedez T, Beaumier M. Is social deprivation associated with the peritoneal dialysis outcomes? A cohort study with REIN registry data. Perit Dial Int 2024:8968608241237685. [PMID: 38632672 DOI: 10.1177/08968608241237685] [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: 04/19/2024] Open
Abstract
BACKGROUND Social deprivation is associated with lower peritoneal dialysis (PD) uptake. This study was carried out to evaluate the role of social deprivation on the outcome of PD. METHODS This was a retrospective study of data extracted from the Renal Epidemiology and Information Network registry for patients older than 18 years who started PD in metropolitan France between 1 January 2017 and 30 June 2018. The end of the observation period was 31 December 2020. The exposure was the European Deprivation Index calculated using the patient's address. The events of interest were death, transfer to haemodialysis (HD), transplantation and the composite event of death or transfer to HD. A Cox model and Fine and Gray model were used for the analysis. RESULTS A total of 1581 patients were included, of whom 418 (26.5%) belonged to Quintile 5 of the European Deprivation Index (the most deprived patients). In the Cox model, the most deprived subjects did not have a greater risk of death (cause-specific hazard ratio (cs-HR): 0.76 [95% confidence interval (CI): 0.53-1.10], transfer to HD (cs-HR 1.37 [95% CI: 0.95-1.98]) or the composite event of death or transfer to HD (cs-HR: 1.08 [95% CI: 0.84-1.38]) or a lower risk of kidney transplantation (cs-HR: 0.73 [95% CI: 0.48-1.10]). In the competing risk analysis, the most deprived subjects had a higher risk of transfer to HD (subdistribution hazard ratio (sd-HR): 1.54 [95% CI: 1.08-2.19]) and lower access to kidney transplantation (sd-HR: 0.68 [0.46-0.99]). CONCLUSION In PD patients, social deprivation was not associated with death or the composite event of death or transfer to HD. Socially deprived individuals had a greater risk of transfer to HD and lower access to kidney transplantation in the competing risk analysis.
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Affiliation(s)
- Steve Biko Tobada
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
| | - Valérie Chatelet
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Clemence Bechade
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Antoine Lanot
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Annabel Boyer
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Cécile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France
| | - Fatouma Toure
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France
- Service de Néphrologie, Dialyse et Transplantation, CHU de Limoges, Limousin, France
| | - Sabrina Boime
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France
- Grand Est, Observatoire Régional de Santé (ORS), Alsace, France
| | - Thierry Lobbedez
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen Cedex, France
- INSERM U1086 - ANTICIPE - Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen Cedex, France
| | - Mathilde Beaumier
- Néphrologie, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, Basse-Normandie, France
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Maisons V, Lanot A, Luque Y, Sautenet B, Esteve E, Guillouet E, François H, Bobot M. Simulation-based learning in nephrology. Clin Kidney J 2024; 17:sfae059. [PMID: 38680455 PMCID: PMC11053359 DOI: 10.1093/ckj/sfae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Indexed: 05/01/2024] Open
Abstract
Simulation is a technique to replace and amplify real experiences with guided ones that evoke or replicate substantial aspects of the real world in a fully interactive fashion. In nephrology (a particularly complex specialty), simulation can be used by patients, nurses, residents, and attending physicians alike. It allows one to learn techniques outside the stressful environment of care such as central venous catheter placement, arteriovenous fistula management, learning about peritoneal dialysis, or performing a kidney biopsy. Serious games and virtual reality are emerging methods that show promise. Simulation could also be important in relational aspects of working in a team or with the patient. The development of simulation as a teaching tool in nephrology allows for maintaining high-quality training for residents, tailored to their future practice, and minimizing risks for patients. Additionally, this education helps nephrologists maintain mastery of technical procedures, making the specialty attractive to younger generations. Unfortunately, the inclusion of simulation training programmes faces occasional logistical or funding limitations that universities must overcome with the assistance and innovation of teaching nephrologists. The impact of simulation-based teaching on clinical outcomes needs to be investigated in clinical studies.
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Affiliation(s)
- Valentin Maisons
- Service de Néphrologie, CHU de Tours, Tours, France
- U1246, INSERM, SPHERE, Université de Tours, Université de Nantes, Tours, Nantes, France, INI-CRCT, France
| | - Antoine Lanot
- Normandie University, Unicaen, CHU de Caen Normandie, Nephrology, Côte de Nacre Caen, France
- “ANTICIPE” U1086 INSERM-UCN, Centre Francois Baclesse, 3 Av. du General Harris, Caen, France
| | - Yosu Luque
- Soins Intensifs Néphrologiques Rein Aigu, Hôpital Tenon, APHP, Paris, France
- Sorbonne Université, INSERM UMR_S1155, CORAKID, Hôpital Tenon, Paris, France
| | - Benedicte Sautenet
- Service de Néphrologie, CHU de Tours, Tours, France
- U1246, INSERM, SPHERE, Université de Tours, Université de Nantes, Tours, Nantes, France, INI-CRCT, France
| | - Emmanuel Esteve
- Sorbonne Université, INSERM UMR_S1155, CORAKID, Hôpital Tenon, Paris, France
- Service Néphrologie et Dialyses, Département de Néphrologie, Hôpital Tenon, APHP, Paris, France
| | - Erwan Guillouet
- Normandie University, Unicaen, CHU de Caen Normandie, Nephrology, Côte de Nacre Caen, France
- NorSimS Simulation Center, Caen University Hospital, Caen, France
| | - Hélène François
- Sorbonne Université, INSERM UMR_S1155, CORAKID, Hôpital Tenon, Paris, France
- Service de Transplantation rénale-Néphrologie, Département de néphrologie, Hôpital Pitié Salpétrière, APHP, Paris, France
| | - Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France
- Aix Marseille Univ, INSERM 1263, INRAE 1260, C2VN, Marseille, France
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Shinzawa M, Matsumoto A, Kitamura H, Sakaguchi Y, Takahashi A, Matsui I, Mizui M, Yamamoto R, Isaka Y. The association between embedded catheter implantation and hospitalization costs for peritoneal dialysis initiation: a retrospective cohort study. Clin Exp Nephrol 2024; 28:245-253. [PMID: 37962745 PMCID: PMC10881681 DOI: 10.1007/s10157-023-02416-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/25/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Compared with the conventional peritoneal dialysis (PD) catheter insertion, embedding PD catheter implantation is one of the procedures for planned PD initiation. However, facilities where embedded PD catheter implantation is available are limited, and the impact of embedded PD catheter implantation on hospitalization cost and length of hospitalization is unknown. METHODS This retrospective single-center cohort study included 132 patients with PD initiation between 2005 and 2020. The patients were divided into two groups: 64 patients in the embedding group and 68 patients in the conventional insertion group. We created a multivariable generalized linear model (GLM) with the gamma family and log-link function to evaluate the association among catheter embedding, the duration and medical costs of hospitalization for PD initiation. We also evaluated the effect modification between age and catheter embedding. RESULTS Catheter embedding (β coefficient - 0.13 [95% confidence interval - 0.21, - 0.05]) and age (per 10 years 0.08 [0.03, 0.14]) were significantly associated with hospitalization costs. Catheter embedding (- 0.21 [- 0.32, - 0.10]) and age (0.11 [0.03, 0.19]) were also identified as factors significantly associated with length of hospitalization. The difference between the embedding group and the conventional insertion group in hospitalization costs for PD initiation (P for interaction = 0.060) and the length of hospitalization (P for interaction = 0.027) was larger in young-to-middle-aged patients than in elderly patients. CONCLUSIONS Catheter embedding was associated with lower hospitalization cost and shorter length of hospitalization for PD initiation than conventional PD catheter insertion, especially in young-to-middle-aged patients.
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Affiliation(s)
- Maki Shinzawa
- Department of Nephrology, Osaka University Graduate School of Medicine, D-11 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Health and Counseling Center, Osaka University, Toyonaka, Japan.
| | - Ayumi Matsumoto
- Department of Nephrology, Osaka University Graduate School of Medicine, D-11 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Harumi Kitamura
- Department of Nephrology, Osaka University Graduate School of Medicine, D-11 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yusuke Sakaguchi
- Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, Suita, Japan
| | - Atsushi Takahashi
- Department of Nephrology, Osaka University Graduate School of Medicine, D-11 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Isao Matsui
- Department of Nephrology, Osaka University Graduate School of Medicine, D-11 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masayuki Mizui
- Department of Nephrology, Osaka University Graduate School of Medicine, D-11 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ryohei Yamamoto
- Health and Counseling Center, Osaka University, Toyonaka, Japan
- Laboratory of Behavioral Health Promotion, Department of Health Promotion Medicine , Osaka University Graduate School of Medicine, Toyonaka, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, D-11 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Albert A, Richter S, Kalk P, Stieger P, Woitas RP, Braun-Dullaeus RC, Albert C. Analysis of a nurse-provided on-call peritoneal dialysis support in an outpatient reference care centre. BMC Nurs 2024; 23:144. [PMID: 38429782 PMCID: PMC10905825 DOI: 10.1186/s12912-024-01812-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/20/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND To analyse the nature of medical or technical emergency issues of ambulatory peritoneal dialysis (PD) patients calling a nurse-provided emergency PD support service of a reference centre that is provided all year in the after-hours. METHODS We retrospectively analysed patients' chief complaint, urgency, resolution of and association to current PD treatment and modality directed to an on-call nurse-provided PD support service from 2015-2021 based on routinely collected health data. Calls were systematically categorized being technical/procedural-, medical-, material-related or type of correspondence. Call urgency was categorized to have "immediate consequence", inquiry was eligible for "processing next working day" or whether there was "no need for further action". Call outcomes were classified according to whether patients were able to initiate, resume or finalize their treatments or whether additional interventions were required. Unexpected adverse events such as patients' acute hospitalization or need for nurses' home visits were evaluated and quantified. RESULTS In total 753 calls were documented. Most calls were made around 7:30 a.m. (5:00-9:00; median, 25-75th CI) and 6:30 p.m. (5:00-8:15). 645 calls were assigned to continuous ambulatory- (CAPD) or automated PD (APD). Of those, 430 calls (66.7%) had an "immediate consequence". Of those 77% (N = 331) were technical/procedural-, 12.8% (N = 55) medical- and 6.3% (N = 27) material related issues. 4% (N = 17) were categorized as other correspondence. Issues disrupting the course of PD were identified in 413 cases. In 77.5% (N = 320) patients were able to initiate, resume or finalize their treatment after phone consultation. Last-bag exchange was used in 6.1% enabling continued therapy in 83.6%. In 35 cases a nurse visit at patients' home or patients' visit to the practice at the earliest possible date were required, while hospitalization was required in seven medical category cases (5.4% and 1.09% of total assessed calls, respectively). CONCLUSION The on-call PD-nurse provides patient support for acute and imminent issues enabling them to successfully initiate, resume or finalize their prescribed treatment. Nurses triage of acute conditions facilitated rapid diagnostics and therapy. Maintaining quality PD homecare, the provision of trained personnel is indispensable. The information gathered in this study may therefore be used as a foundation to tailor educational programs for nephrology nurses and doctors to further develop their competencies in PD.
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Affiliation(s)
- Annemarie Albert
- Diaverum Renal Services, Am Neuen Garten 11, Potsdam, 14469, Germany
- Department of Nephrology and Endocrinology, Ernst von Bergmann Hospital, Charlottenstraße 72, Potsdam, 14467, Germany
| | - Stefan Richter
- Diaverum Renal Services, Am Neuen Garten 11, Potsdam, 14469, Germany
| | - Philipp Kalk
- Diaverum Renal Services, Am Neuen Garten 11, Potsdam, 14469, Germany
| | - Philipp Stieger
- University Clinic for Cardiology and Angiology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany
| | | | - Rüdiger C Braun-Dullaeus
- University Clinic for Cardiology and Angiology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany
| | - Christian Albert
- Diaverum Renal Services, Am Neuen Garten 11, Potsdam, 14469, Germany.
- University Clinic for Cardiology and Angiology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany.
- Department of Nephrology, Central Clinic Bad Berka, Robert-Koch-Allee 9, Bad Berka, 99438, Germany.
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Kamath N, Borzych-Dużałka D, Kaur A, Neto G, Arbeiter K, Yap YC, Lahoche A, Eid L, Hooman N, Richardson T, Schaefer F, Warady BA. Pediatric peritoneal dialysis training program and its relationship to peritonitis: a study of the International Pediatric Peritoneal Dialysis Network. Pediatr Nephrol 2023; 38:4111-4118. [PMID: 37405492 DOI: 10.1007/s00467-023-05995-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND The guidelines for training of patients and caregivers to perform home peritoneal dialysis (PD) uniformly include recommendations pertaining to the prevention of peritonitis. The objective of this study conducted by the International Pediatric Peritoneal Dialysis Network (IPPN) was to investigate the training practices for pediatric PD and to evaluate the impact of these practices on the peritonitis and exit-site infection (ESI) rate. METHODS A questionnaire regarding details of the PD program and training practices was distributed to IPPN member centers, while peritonitis and ESI rates were either derived from the IPPN registry or obtained directly from the centers. Poisson univariate and multivariate regression was used to determine the training-related peritonitis and ESI risk factors. RESULTS Sixty-two of 137 centers responded. Information on peritonitis and ESI rates were available from fifty centers. Training was conducted by a PD nurse in 93.5% of centers, most commonly (50%) as an in-hospital program. The median total training time was 24 hours, with a formal assessment conducted in 88.7% and skills demonstration in 71% of centers. Home visits were performed by 58% of centers. Shorter (< 20 hours) training duration and lower number of training tools (both p < 0.02) were associated with higher peritonitis rate, after adjustment for proportion of treated infants and income of country of residence. CONCLUSIONS An association between training duration and the number of training tools represent potentially modifiable risk factors to reduce peritonitis rates within the pediatric PD population. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
| | - Dagmara Borzych-Dużałka
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Amrit Kaur
- Royal Manchester Children's Hospital, Manchester, UK
| | - Gisela Neto
- Pediatric Nephrology Unit, Dona Estefania Hospital, Lisbon, Portugal
| | | | - Yok Chin Yap
- Women and Children Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Loai Eid
- Dubai Hospital, Dubai, United Arab Emirates
| | - Nakysa Hooman
- Ali Asghar Clinical Research Development Center, Department of Pediatrics, Iran University of Medical Science, Tehran, Iran
| | | | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, USA
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8
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Yang W, Zeng L, Yang H, Guo F, Zhou D, Cui W, Wu S, Chen C, Zhao J, Wang W, Yang N, Lin H, Li L. Effect of national holidays on health outcomes of patients receiving peritoneal dialysis in a single center over a ten-year period. Ren Fail 2023; 45:2153697. [PMID: 36645059 PMCID: PMC9848312 DOI: 10.1080/0886022x.2022.2153697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND National holidays are associated with high mortality in some diseases, but little is known about patients undergoing peritoneal dialysis (PD). The research aimed to investigate the impact of national holidays on the health outcomes of PD patients. METHODS Over ten years, all episodes of unplanned hospitalization, death, and peritonitis in PD patients were collected in our center. Seven national holidays in China were chosen, and non-holiday days were selected as the control period. The effect of national holidays was observed by comparing the hospitalization, death, and peritonitis rates between holiday and non-holiday groups. RESULTS There were 297 events in all holiday periods and 1247 in non-holiday periods. There is no significant difference in hospitalization rate between holiday and non-holiday groups (32.4% ± 6.4% vs. 29.2% ± 3.4%, p = 0.175). So is the death rate [6.3% (4.8-12.3%) vs.5.0% (4.2-8.9%), p = 0.324] and peritonitis rate [0.19 (0.13-0.53) vs. 0.22 (0.18-0.27), p = 0.445] between the two groups. Significant differences were observed in the distribution of peritonitis causes between the two groups (p = 0.017). The rate of secondary to other infections in the holiday group was significantly higher than in the non-holiday group (25.0 vs. 10.3%, p = 0.015). CONCLUSION Our study suggested no national holiday effect on health outcomes of PD patients based on ten-year data in our center.
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Affiliation(s)
- Wei Yang
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Li Zeng
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Huibin Yang
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Fujia Guo
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Dan Zhou
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China,College of Integrative Medicine, Dalian Medical University, Dalian, China
| | - Wenting Cui
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuran Wu
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Cong Chen
- Graduate School, Dalian Medical University, Dalian, China
| | - Jiayao Zhao
- Graduate School, Dalian Medical University, Dalian, China
| | - Weidong Wang
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ning Yang
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongli Lin
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China,Hongli Lin Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, 116011, Liaoning Province, China
| | - Longkai Li
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China,CONTACT Longkai Li
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9
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Chow JSF, Boudville N, Cho Y, Palmer S, Pascoe EM, Hawley CM, Reidlinger DM, Hickey LE, Stastny R, Valks A, Vergara L, Movva R, Kiriwandeniya C, Candler H, Mihala G, Buisman B, Equinox KL, Figueiredo AE, Fuge T, Howard K, Howell M, Jaure A, Jose MD, Lee A, Miguel SS, Moodie JA, Nguyen TT, Pinlac G, Reynolds A, Saweirs WWM, Steiner-Lim GZ, TeWhare B, Tomlins M, Upjohn M, Voss D, Walker RC, Wilson J, Johnson DW. Multi-center, pragmatic, cluster-randomized, controlled trial of standardized peritoneal dialysis (PD) training versus usual care on PD-related infections (the TEACH-PD trial): trial protocol. Trials 2023; 24:730. [PMID: 37964367 PMCID: PMC10647147 DOI: 10.1186/s13063-023-07715-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/07/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD)-related infections, such as peritonitis, exit site, and tunnel infections, substantially impair the sustainability of PD. Accordingly, PD-related infection is the top-priority research outcome for patients and caregivers. While PD nurse trainers teach patients to perform their own PD, PD training curricula are not standardized or informed by an evidentiary base and may offer a potential approach to prevent PD infections. The Targeted Education ApproaCH to improve Peritoneal Dialysis outcomes (TEACH-PD) trial evaluates whether a standardized training curriculum for PD nurse trainers and incident PD patients based on the International Society for Peritoneal Dialysis (ISPD) guidelines reduces PD-related infections compared to usual training practices. METHODS The TEACH-PD trial is a registry-based, pragmatic, open-label, multi-center, binational, cluster-randomized controlled trial. TEACH-PD will recruit adults aged 18 years or older who have not previously undergone PD training at 42 PD treatment units (clusters) in Australia and New Zealand (ANZ) between July 2019 and June 2023. Clusters will be randomized 1:1 to standardized TEACH-PD training curriculum or usual training practice. The primary trial outcome is the time to the first occurrence of any PD-related infection (exit site infection, tunnel infection, or peritonitis). The secondary trial outcomes are the individual components of the primary outcome, infection-associated catheter removal, transfer to hemodialysis (greater than 30 days and 180 days), quality of life, hospitalization, all-cause death, a composite of transfer to hemodialysis or all-cause death, and cost-effectiveness. Participants are followed for a minimum of 12 months with a targeted average follow-up period of 2 years. Participant and outcome data are collected from the ANZ Dialysis and Transplant Registry (ANZDATA) and the New Zealand Peritoneal Dialysis (NZPD) Registry. This protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. DISCUSSION TEACH-PD is a registry-based, cluster-randomized pragmatic trial that aims to provide high-certainty evidence about whether an ISPD guideline-informed standardized PD training curriculum for PD nurse trainers and adult patients prevents PD-related infections. TRIAL REGISTRATION ClinicalTrials.gov NCT03816111. Registered on 24 January 2019.
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Affiliation(s)
- Josephine S F Chow
- South Western Sydney Local Health District, Liverpool, NSW, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
- University of New South Wales, Kennington, NSW, Australia.
- Western Sydney University, Sydney, NSW, Australia.
- University of Tasmania, Hobart, TAS, Australia.
| | - Neil Boudville
- Medical School, University of Western Australia, Crawley, WA, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Yeoungjee Cho
- Department of Kidney and Transplant Service, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Suetonia Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Te Whatu Ora Health New Zealand, Hamilton, New Zealand
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
- Metro South Kidney and Transplant Service, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Donna M Reidlinger
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Laura E Hickey
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Ruth Stastny
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Andrea Valks
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Liza Vergara
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Ramya Movva
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Charani Kiriwandeniya
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Hayley Candler
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Gabor Mihala
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Bernadette Buisman
- Health New Zealand, Te Whatu Ora Te Tai Tokerau, Hamilton, New Zealand
- University of Auckland, Te Tai Tokerau Northtec, Auckland, New Zealand
| | | | - Ana E Figueiredo
- School of Nursing, Escola de Ciências da Saúde E da Vida, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Martin Howell
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Matthew D Jose
- University of Tasmania, Hobart, TAS, Australia
- Renal Unit, Royal Hobart Hospital, Hobart, TAS, Australia
| | | | - Susana S Miguel
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | | | - Thu T Nguyen
- Health New Zealand, Te Whatu Ora Te Toka Tumai, Hamilton, New Zealand
| | - Geraldine Pinlac
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Annie Reynolds
- Health New Zealand, Te Whatu Ora Te Matua a Māui Hawkes Bay, Hamilton, New Zealand
| | - Walaa W M Saweirs
- Health New Zealand, Te Whatu Ora Te Tai Tokerau, Hamilton, New Zealand
| | - Genevieve Z Steiner-Lim
- NICM Health Research Institute, Western Sydney University Sydney, Campbelltown, NSW, Australia
| | - Bronwen TeWhare
- Health New Zealand, Te Whatu Ora Taranaki, Hamilton, New Zealand
| | - Melinda Tomlins
- Department of Nephrology, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Megan Upjohn
- Health New Zealand, Te Whatu Ora Te Toka Tumai, Hamilton, New Zealand
| | - David Voss
- Health New Zealand, Te Whatu Ora Counties Manukau, Hamilton, New Zealand
| | - Rachael C Walker
- Te Pukenga Eastern Institute of Technology, Christchurch, New Zealand
| | - Joanne Wilson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - David W Johnson
- Department of Kidney and Transplant Service, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
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10
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Begin B, Richardson T, Ehrlich J, Warady BA, Neu AM. Training practices and peritonitis rates in children on maintenance peritoneal dialysis: results from the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) collaborative. Pediatr Nephrol 2023; 38:3401-3406. [PMID: 37097515 DOI: 10.1007/s00467-023-05975-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Comprehensive training of children on peritoneal dialysis (PD) and their caregivers is crucial to minimize peritonitis risk. Few studies have evaluated the impact of training on infection, so many published recommendations rely on expert opinion. This study uses data from the SCOPE collaborative to examine the impact of compliance with 4 components of PD training on the risk for peritonitis. METHODS A retrospective cohort study of children enrolled in the SCOPE collaborative between 2011 and 2021 who received training prior to initiating PD. Compliance with 4 training components were assessed: performance of a home visit, 1:1 training, delaying training ≥ 10 days after PD catheter insertion and average individual training session length ≤ 3 h. Univariate and multivariable generalized linear mixed modeling were used to assess relationships between peritonitis ≤ 90 days after PD training and median days to peritonitis and compliance with each component as well as all-or-none compliance. RESULTS Among 1450 trainings, 51.7% had median session length ≤ 3 h, 67.1% delayed training ≥ 10 days after catheter insertion, 74.3% had a home visit and 94.6% had 1:1 training. Only 333 trainings (23%) were compliant with all 4 training components. There was no statistically significant association between compliance with individual components, or all-or-none compliance and either the percentage of catheters with peritonitis ≤ 90 days after training end or median days to peritonitis. CONCLUSION No associations between 4 PD training components and risk for peritonitis were found. SCOPE requires monthly review of PD catheter practices which may have decreased the impact of training non-compliance. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Brandy Begin
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, USA
| | | | | | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Alicia M Neu
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, 200 N Wolfe Street, Room 3055, Baltimore, MD, 21287, USA.
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11
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Jaelani TR, Ibrahim K, Jonny J, Pratiwi SH, Haroen H, Nursiswati N, Ramadhani BP. Peritoneal Dialysis Patient Training Program to Enhance independence and Prevent Complications: A Scoping Review. Int J Nephrol Renovasc Dis 2023; 16:207-222. [PMID: 37720493 PMCID: PMC10505035 DOI: 10.2147/ijnrd.s414447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/04/2023] [Indexed: 09/19/2023] Open
Abstract
Background Peritoneal dialysis (PD) training is essential to ensure patient independence and prevent life-threatening complications, such as peritonitis. The International Society for Peritoneal Dialysis (ISPD) recommends that every PD unit worldwide implement local PD training programs with the goal of improving self-care capabilities. This scoping review aims to give an overview of recent literature and recommendations on PD training programs aiming to improve the quality of care and outcomes for PD patients. Methods The literature search was conducted using the PC (Population, Concept) approach. The population of interest in this study is PD patients, and the study concept is the PD training program. Several databases were used to conduct the literature search, including PubMed, Science Direct, and CINAHL. The search process began from July 2022 until January 2023. The inclusion criteria for the search included research articles and recommendations. Results The search yielded 22 articles recommending training programs lasting from 5-8 days, with 1-3-hour sessions and a nurse-to-patient ratio of 1:1. A cumulative training time of 15 hours or more is recommended to enhance patient independence and reduce peritonitis rates. Home-based or in-unit PD training, conducted by experienced nurses using adult learning strategies, has shown significant value in improving self-care and preventing peritonitis. Evaluating training outcomes should encompass knowledge, skills, and attitudes, and the impact on peritonitis rates. Training programs should be flexible and consider physiological and psychosocial barriers to achieving the best results. Conclusion There are a variety of strategies for dialysis training concerning duration, session length, patient-to-trainer ratio, timing, methods, location, compliance, and the need for retraining. More evidence is needed to assess the impact of PD patient training programs on self-care capabilities and peritonitis incidence. Future studies should investigate the effects of training programs on compliance, self-efficacy, and patient and nurse perspectives.
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Affiliation(s)
| | - Kusman Ibrahim
- Faculty of Nursing, Padjadjaran University, Bandung, West Java, Indonesia
| | - Jonny Jonny
- Nephrology Division, Department of Internal Medicine, Gatot Soebroto Indonesia Army Central Hospital, Jakarta, Indonesia
| | | | - Hartiah Haroen
- Faculty of Nursing, Padjadjaran University, Bandung, West Java, Indonesia
| | | | - Bunga Pinandhita Ramadhani
- Nephrology Division, Department of Internal Medicine, Gatot Soebroto Indonesia Army Central Hospital, Jakarta, Indonesia
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12
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Nardelli L, Scalamogna A, Castellano G. Utility of ultrasonographic examination in catheter-related infections in peritoneal dialysis: a clinical approach. J Nephrol 2023; 36:1751-1761. [PMID: 36939999 PMCID: PMC10543158 DOI: 10.1007/s40620-023-01589-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/17/2023] [Indexed: 03/21/2023]
Abstract
Peritoneal dialysis- (PD) related infections continue to be a major cause of morbidity and mortality in patients on renal replacement therapy via PD. However, despite the great efforts in the prevention of PD-related infectious episodes, approximately one third of technical failures are still caused by peritonitis. Recent studies support the theory that ascribes to exit-site and tunnel infections a direct role in causing peritonitis. Hence, prompt exit site infection/tunnel infection diagnosis would allow the timely start of the most appropriate treatment, thereby decreasing the potential complications and enhancing technique survival. Ultrasound examination is a simple, rapid, non-invasive and widely available procedure for tunnel evaluation in PD catheter-related infections. In case of an exit site infection, ultrasound examination has greater sensitivity in diagnosing simultaneous tunnel infection compared to the physical exam alone. This allows distinguishing the exit site infection, which will likely respond to antibiotic therapy, from infections that are likely to be refractory to medical therapy. In case of a tunnel infection, the ultrasound allows localizing the catheter portion involved in the infectious process, thus providing significant prognostic information. In addition, ultrasound performed after two weeks of antibiotic administration allows monitoring patient response to therapy. However, there is no evidence of the usefulness of ultrasound examination as a screening tool for the early diagnosis of tunnel infections in asymptomatic PD patients.
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Affiliation(s)
- Luca Nardelli
- Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Della Commenda 15, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy.
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Antonio Scalamogna
- Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Della Commenda 15, 20122, Milan, Italy
| | - Giuseppe Castellano
- Division of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Della Commenda 15, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
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13
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Bestin M, Chanteloup C, Grégoire C, Lebastard S. [The benefits of home visits for peritoneal dialysis patients]. REVUE DE L'INFIRMIERE 2023; 72:38-39. [PMID: 37633692 DOI: 10.1016/j.revinf.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Peritoneal dialysis is exclusively an extrarenal purification technique performed in the patient's own home. The patient is either autonomous, or assisted by a private nurse or a member of his or her family. The nursing team at the center where the patient is being cared for organizes home visits to meet the patient and his or her family in their living environment. These visits provide an opportunity to review compliance with protocols and maintain the partnership with the patient. The team at the Caen Normandy university center for kidney disease shares its experience in this area of care.
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Affiliation(s)
- Magali Bestin
- Consultations/hôpital de jour, Centre universitaire des maladies rénales, CHU de Caen Normandie, Avenue de la Côte-de-Nacre, 14033 Caen, cedex 9, France.
| | - Céline Chanteloup
- Consultations/hôpital de jour, Centre universitaire des maladies rénales, CHU de Caen Normandie, Avenue de la Côte-de-Nacre, 14033 Caen, cedex 9, France
| | - Christophe Grégoire
- Consultations/hôpital de jour, Centre universitaire des maladies rénales, CHU de Caen Normandie, Avenue de la Côte-de-Nacre, 14033 Caen, cedex 9, France
| | - Sarah Lebastard
- Consultations/hôpital de jour, Centre universitaire des maladies rénales, CHU de Caen Normandie, Avenue de la Côte-de-Nacre, 14033 Caen, cedex 9, France
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14
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Reimann F, Tomlins M. Prescribing and peritoneal dialysis. Aust Prescr 2023; 46:5-8. [PMID: 38053668 PMCID: PMC10664089 DOI: 10.18773/austprescr.2023.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Peritoneal dialysis is a home-based therapy for patients with end-stage kidney disease. It is less efficient in removing solutes and fluid than haemodialysis but offers more flexibility and independence. Peritoneal transport characteristics affect the dialysis prescription. The timing of drug administration is independent of the dialysis process except for the administration of intraperitoneal antibiotics. Dose reductions should follow current recommendations for patients with kidney disease. Fluid overload is common in patients undergoing peritoneal dialysis. Residual kidney function can ameliorate this problem and needs to be preserved. Dialysis solutions with high glucose concentrations contribute to adverse metabolic effects. Peritoneal dialysis-related catheter complications and infections may require patients to transition to haemodialysis. Antifungal prophylaxis needs to be co-administered for the duration of antibiotic courses for any indication to reduce the risk of fungal peritonitis. Close communication with the patient's supervising dialysis unit is required.
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Affiliation(s)
| | - Melinda Tomlins
- Department of Nephrology, John Hunter Hospital, Newcastle, NSW
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15
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Kim JE, Park WY, Kim H. Renal Replacement Therapy For Elderly Patients with ESKD Through Shared Decision-Making. Electrolyte Blood Press 2023; 21:1-7. [PMID: 37434803 PMCID: PMC10329902 DOI: 10.5049/ebp.2023.21.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/02/2022] [Accepted: 04/02/2023] [Indexed: 07/13/2023] Open
Abstract
The incidence and prevalence of end-stage kidney disease (ESKD) in Korea are increasing, and ESKD constitutes a very important medical and social issue. Elderly dialysis patients have the highest risk of early mortality within 3 months after initiating dialysis, and geriatric syndromes such as aging, frailty, functional impairment, and cognitive impairment are crucial for the prognosis of elderly patients. Shared decision-making (SDM) is an approach through which clinicians and patients can achieve informed preferences, thereby yielding better clinical outcomes and quality of life. Through SDM-based, close consultation among patients, families, and healthcare providers, an ESKD Life-Plan for elderly patients should be established. A multidisciplinary approach led by nephrologists can help them to provide proper vascular access for dialysis at the right time, with the right evidence, and to the right patient. Strategies that can improve peritoneal dialysis in elderly patients include assisted peritoneal dialysis, homecare support programs, and automated peritoneal dialysis. In order to enhance the role of kidney transplantation in elderly patients with ESKD, it is necessary to accurately identify patients' clinical conditions before transplantation and to perform active rehabilitation activities and postoperative management to promote recovery after transplantation. With the aging population and the increase in ESKD in the elderly, clinicians must identify factors affecting the mortality and quality of life of elderly dialysis patients.
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Affiliation(s)
- Jin Eop Kim
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Gangwond-do, Republic of Korea
| | - Woo Yeong Park
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Hyunsuk Kim
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Gangwond-do, Republic of Korea
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16
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Perl J, Brown EA, Chan CT, Couchoud C, Davies SJ, Kazancioğlu R, Klarenbach S, Liew A, Weiner DE, Cheung M, Jadoul M, Winkelmayer WC, Wilkie ME. Home dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2023; 103:842-858. [PMID: 36731611 DOI: 10.1016/j.kint.2023.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/09/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023]
Abstract
Home dialysis modalities (home hemodialysis [HD] and peritoneal dialysis [PD]) are associated with greater patient autonomy and treatment satisfaction compared with in-center modalities, yet the level of home-dialysis use worldwide is low. Reasons for limited utilization are context-dependent, informed by local resources, dialysis costs, access to healthcare, health system policies, provider bias or preferences, cultural beliefs, individual lifestyle concerns, potential care-partner time, and financial burdens. In May 2021, KDIGO (Kidney Disease: Improving Global Outcomes) convened a controversies conference on home dialysis, focusing on how modality choice and distribution are determined and strategies to expand home-dialysis use. Participants recognized that expanding use of home dialysis within a given health system requires alignment of policy, fiscal resources, organizational structure, provider incentives, and accountability. Clinical outcomes across all dialysis modalities are largely similar, but for specific clinical measures, one modality may have advantages over another. Therefore, choice among available modalities is preference-sensitive, with consideration of quality of life, life goals, clinical characteristics, family or care-partner support, and living environment. Ideally, individuals, their care-partners, and their healthcare teams will employ shared decision-making in assessing initial and subsequent kidney failure treatment options. To meet this goal, iterative, high-quality education and support for healthcare professionals, patients, and care-partners are priorities. Everyone who faces dialysis should have access to home therapy. Facilitating universal access to home dialysis and expanding utilization requires alignment of policy considerations and resources at the dialysis-center level, with clear leadership from informed and motivated clinical teams.
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Affiliation(s)
- Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Christopher T Chan
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Simon J Davies
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Rümeyza Kazancioğlu
- Department of Nephrology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | - Scott Klarenbach
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Daniel E Weiner
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Martin E Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
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17
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Gursu M, Shehaj L, Elcioglu OC, Kazancioglu R. The optimization of peritoneal dialysis training in long-term. FRONTIERS IN NEPHROLOGY 2023; 3:1108030. [PMID: 37675347 PMCID: PMC10479566 DOI: 10.3389/fneph.2023.1108030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/20/2023] [Indexed: 09/08/2023]
Abstract
Peritoneal dialysis is a home based therapy for patients with advanced chronic kidney disease. This method provides adequate clearance of uremic toxins and removal of excess fluid when a proper dialysis prescription is combined with patient adherence. Peritonitis is the most frequent infectious complication among these patients and may render the continuity of the treatment. Training patients and their caregivers have prime importance to provide proper treatment and prevent complications including infectious ones. The training methods before the onset of treatment are relatively well established. However, patients may break the rules in the long term and tend to take shortcuts. So, retraining may be necessary during follow-up. There are no established guidelines to guide the retraining of PD patients yet. This review tends to summarize data in the literature about retraining programs and also proposes a structured program for this purpose.
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Affiliation(s)
- Meltem Gursu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Larisa Shehaj
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
- Department of Internal Medicine, Salus Hospital, Tirana, Albania
- ISN fellow in Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Omer Celal Elcioglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Rumeyza Kazancioglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
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18
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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.
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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
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Fujii Y, Matsumura H, Shirasu A, Nakakura H, Yamazaki S, Kanazawa T, Saito N, Hirano H, Azuma H, Nozu K, Ashida A. Unexpected cause of repeated peritoneal dialysis-related complications: a case study of autism spectrum disorder with normal intelligence quotient in an adolescent. RENAL REPLACEMENT THERAPY 2023. [DOI: 10.1186/s41100-023-00470-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Autism spectrum disorder (ASD) is a common communication disorder, with an incidence rate of 3%. In most cases, clinicians can diagnose ASD in a single outpatient visit. However, in the case of ASD patients without intellectual disability, clinicians are sometimes unaware for a prolonged period that a patient has ASD. In such cases, delayed diagnosis can lead to serious complications.
Case presentation
An 18-year-old boy had repeated severe complications of peritoneal dialysis. At the age of 9, the patient presented with proteinuria, and 5 years later, he developed end-stage kidney disease. Percutaneous renal biopsy and the clinical symptoms revealed focal segmental glomerulosclerosis with Charcot-Marie-Tooth disease due to a gene mutation in INF2. Peritoneal dialysis was initiated at the age of 14, but led to many related complications, including peritonitis, hypertensive retinopathy and encephalopathy, and acute heart failure. Initially, we were unaware of his developmental characteristics and autism spectrum disorder without intellectual disability, but through lengthy observations by various healthcare professionals, his unique characteristics were noticed. Because the patient often displayed a discrepancy between behavior and speech, we cautiously studied his thoughts and behaviors, and developed a special approach to ensure safe peritoneal dialysis.
Conclusions
When many peritoneal dialysis-related complications occur in a patient with normal intelligence quotient, autism spectrum disorder should be considered as a possible cause.
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Perez-Moran D, García-Cortés LR, Doubova SV. Patients and nursing-related factors associated with switching from peritoneal dialysis to hemodialysis: A cross-sectional survey. Nurs Health Sci 2023. [PMID: 36790129 DOI: 10.1111/nhs.13014] [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: 11/02/2022] [Revised: 01/30/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023]
Abstract
The study aimed at analyzing patients and nursing-related factors associated with switching from peritoneal dialysis to hemodialysis. A telephone survey with 574 patients receiving care at six peritoneal dialysis centers of the Mexican Institute of Social Security was conducted: 64.3% were on peritoneal dialysis, and 35.7% had transitioned from peritoneal dialysis to hemodialysis. Data were collected on participants' sociodemographic and clinical characteristics, peritoneal dialysis center size, and nursing workload. Descriptive, bivariate, and multiple Poisson regression analyses were performed. Factors associated with an increased probability of switching from peritoneal dialysis to hemodialysis were a history of catheter dysfunction, peritonitis, and being treated in a large peritoneal dialysis center with a low (<50 patients per nurse per month) or high nursing workload (>70 patients per nurse per month) located in the State of Mexico, compared to a medium-size peritoneal dialysis center with a moderate workload (50-70 patients per nurse per month). To decrease the odds of switching from peritoneal dialysis to hemodialysis, improvement programs should aim to limit nurses' workload to 50-70 patients per nurse per month and implement evidence-based nursing interventions to prevent, detect, and manage peritonitis and peritoneal catheter dysfunction.
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Affiliation(s)
- Diana Perez-Moran
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Luis R García-Cortés
- Regional Decentralized Operational Administration body, East State of Mexico, Mexican Institute of Social Security, Mexico City, Mexico
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
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21
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Peritoneal dialysis training performed remotely: results and comparison with Home Training. Clin Exp Nephrol 2023; 27:72-78. [PMID: 36129554 PMCID: PMC9490724 DOI: 10.1007/s10157-022-02276-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/04/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Traditional training (Home Training) in peritoneal dialysis (PD) is based on the physical presence of nurse and patient/caregiver. These "space-time" constraints can influence the training's duration, methodology and results. A remote caregiving system (Videodialysis) in our Center has proved to be effective and safe in remotely guiding patients/caregivers with cognitive/psychological barriers to self-care-PD. Since 08/01/2016, to overcome the limitations of Home Training, Videodialysis has also been used to carry out remote patients/caregivers training (Video Training). Retrospective comparison between Video Training (08/01/2016-05/31/2020) and Home Training (01/01/2014-07/31/2016). METHODS Following initial home-visit Video Training is performed via telemedicine from the Center, whereas Home Training is carried out at the patient's home. Only first trainings for all incident PD patients/caregivers were considered. The following patients were excluded: 9 in nursing homes, 13 kept on Videodialysis due to barriers to self-care, 6 uncompleted procedures, 4 other. Total duration, home visits, exchanges/procedures, peritonitis, technique survival were compared between Home Training and Video Training. RESULTS 46 trainings were considered (median; IQR): 21 Home Training (CAPD/APD: 11/10) in 17 patients (74.3 years (58.8-78.0; assisted PD: 64.7%) and 25 Video Training (CAPD/APD: 8/17) in 21 patients (65.9 years (56.9-76.4) N.S.; assisted PD: 52.4%). Duration (days): Home Training: CAPD 4.0 (4.0-5.5); APD 8.0 (5.3-10.5); Video Training: CAPD 4.5 (3.8-5.0) (N.S.); APD 8.0 (6.0-13.0) (N.S.). Home-visit (number): Home Training: CAPD 9.0 (7.0-10.0); APD 11.0 (7.8-15.5); Video Training: CAPD 2.0 (2.0-3.5) (p < 0.001); APD 5.0 (4.0-6.0) (p < 0.001). Peritonitis (episodes): Home Training: 5 (Follow-up: 471 pts/months); Video Training: 0 (Follow-up 280 pts/months). 2-Year technique survival. Home Training: 56.3%; Video Training: 76.9% (N.S.). CONCLUSIONS Video Training is as effective as Home Training, while significantly reducing the number of home visits.
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22
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Chua AN, Kumar R, Warady BA. Care of the pediatric patient on chronic peritoneal dialysis. Pediatr Nephrol 2022; 37:3043-3055. [PMID: 35589990 DOI: 10.1007/s00467-022-05605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 01/10/2023]
Abstract
Peritoneal dialysis is the most commonly prescribed dialysis modality for infants and young children with kidney failure worldwide. Provision of high-quality care for the pediatric patient on chronic peritoneal dialysis requires a multidisciplinary approach and a strong collaboration with the patient and their caregiver. This article not only reviews current recommendations and advances in the care of pediatric patients on peritoneal dialysis with a focus on the provision of high-quality care and improvement in outcomes, but it also draws attention to health care disparities that exist locally and globally.
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Affiliation(s)
- Annabelle N Chua
- Division of Pediatric Nephrology, Department of Pediatrics, Duke Children's Hospital, Duke University School of Medicine, Box 3959, Durham, NC, 27710, USA.
| | - Reeti Kumar
- Division of Pediatric Nephrology, Department of Pediatrics, Duke Children's Hospital, Duke University School of Medicine, Box 3959, Durham, NC, 27710, USA
| | - Bradley A Warady
- Division of Nephrology, University of Missouri-Kansas City School of Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
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23
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Lopes MB, Karaboyas A, Zhao J, Johnson DW, Kanjanabuch T, Wilkie M, Nitta K, Kawanishi H, Perl J, Pisoni RL. Association of single and serial measures of serum phosphorus with adverse outcomes in patients on peritoneal dialysis: results from the international PDOPPS. Nephrol Dial Transplant 2022; 38:193-202. [PMID: 36029279 PMCID: PMC9869855 DOI: 10.1093/ndt/gfac249] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND While high serum phosphorus levels have been related to adverse outcomes in hemodialysis patients, further investigation is warranted in persons receiving peritoneal dialysis (PD). METHODS Longitudinal data (2014-17) from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), a prospective cohort study, were used to examine associations of serum phosphorus with all-cause mortality and major adverse cardiovascular events via Cox regression adjusted for confounders. Serum phosphorus levels were parameterized by four methods: (i) baseline serum phosphorus; (ii) mean 6-month serum phosphorus; (iii) number of months with serum phosphorus >4.5 mg/dL; and (iv) mean area-under-the-curve of 6-month serum phosphorus control. RESULTS The study included 5847 PD patients from seven countries; 9% of patients had baseline serum phosphorus <3.5 mg/dL, 24% had serum phosphorus ≥3.5 to ≤4.5 mg/dL, 30% had serum phosphorus >4.5 to <5.5 mg/dL, 20% had serum phosphorus ≥5.5 to <6.5 mg/dL, and 17% had serum phosphorus ≥6.5 mg/dL. Compared with patients with baseline serum phosphorus ≥3.5 to ≤4.5 mg/dL, the adjusted all-cause mortality hazard ratio (HR) was 1.19 (0.92,1.53) for patients with baseline serum phosphorus ≥5.5 to <6.5 mg/dL and HR was 1.53 (1.14,2.05) for serum phosphorus ≥6.5 mg/dL. Associations between serum phosphorus measurements over 6 months and clinical outcomes were even stronger than for a single measurement. CONCLUSIONS Serum phosphorus >5.5 mg/dL was highly prevalent (37%) in PD patients, and higher serum phosphorus levels were a strong predictor of morbidity and death, particularly when considering serial phosphorus measurements. This highlights the need for improved treatment strategies in this population. Serial serum phosphorus measurements should be considered when assessing patients' risks of adverse outcomes.
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Affiliation(s)
| | | | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia,Translational Research Institute, Brisbane, Australia
| | - Talerngsak Kanjanabuch
- Center of Excellence in Kidney Metabolic Disorders and Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Jeffrey Perl
- St Michael's Hospital, University of Toronto, Toronto, ON, Canada
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24
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Abstract
The practice and clinical outcomes of peritoneal dialysis (PD) have demonstrated significant improvement over the past 20 years. The aim of this review is to increase awareness and update healthcare professionals on current PD practice, especially with respect to patient and technique survival, patient modality selection, pathways onto PD, understanding patient experience of care and use prior to kidney transplantation. These improvements have been impacted, at least in part, by greater emphasis on shared decision-making in dialysis modality selection, the use of advanced laparoscopic techniques for PD catheter implantation, developments in PD connecting systems, glucose-sparing strategies, and modernising technology in managing automated PD patients remotely. Evidence-based clinical guidelines such as those prepared by national and international societies such as the International Society of PD have contributed to improved PD practice underpinned by a recognition of the place of continuous quality improvement processes.
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Affiliation(s)
- Ayman Karkar
- Medical Affairs - Renal Care, Scientific Office, Baxter A.G., Dubai, United Arab Emirates
| | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, UK
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25
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García-Meza WJM, Carrillo-Cervantes AL, Villarreal-Reyna MDLÁ, Delabra-Salinas MM, Lobo-Ventura BA. Adherence to the ambulatory peritoneal dialysis procedure and limitations of care of older adults or their caregivers. ENFERMERIA CLINICA (ENGLISH EDITION) 2022; 32:239-248. [PMID: 35568354 DOI: 10.1016/j.enfcle.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 11/16/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Continuous Ambulatory Peritoneal Dialysis is an appropriate technique for older adults and its success is mainly based on the correct exchange technique. However, individuals may present barriers to compliance, due to deterioration of physical and cognitive function, depression, and prevalence of visual impairments. OBJECTIVE AND METHODOLOGY A descriptive correlational study was conducted to determine the relationship between adherence to the continuous ambulatory peritoneal dialysis procedure and the limitations of care for older adults with chronic renal failure or their caregivers. For convenience, 54 participants from two institutions were selected. A home visit was made at exchange times and a certificate of sociodemographic variables was applied, data such as training days, time of performing the procedure and number of home visits they received were included. Adherence to the procedure was evaluated with a checklist of correctly performed steps in the dialysis technique with Ultra Bag® twin bag equipment (from Baxter). To measure care limitations, we evaluated near visual acuity with Jaeger's equivalent primer, visual fields with the confrontational visual field test, manual sensory dexterity and acuity with Moberg's Pick-Up test, cognitive function using Folstein's MMSE, and depressive symptoms using the CES-D20 instrument. RESULTS AND CONCLUSIONS In adherence to the procedure, participants correctly performed an average of 23.42 (SD ± 5.54) steps, which corresponds to 71.72% of the technique. Regarding care limitations, 55.6% presented impaired near visual acuity, 29.6% visual field deficit, 33.3% impaired manual dexterity, 14.8% alteration in manual sensory acuity, 46.3% possible impairment of cognitive function, and 18.5% depressive symptomatology. Participants with greater adherence to the CAPD procedure had better dexterity in the dominant (p = 0.010) and non-dominant (p = 0.010) hand, better sensory acuity of the non-dominant hand (p = 0.023), and greater cognitive function (p = 0.044). It is concluded that the care limitations (manual dexterity, manual sensory acuity, and cognitive function) are related to adherence to the dialytic procedure.
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Affiliation(s)
| | | | | | | | - Blanca Aidé Lobo-Ventura
- Servicio de diálisis, Instituto Mexicano del Seguro Social, Hospital General de Zona #2, Saltillo, Coahuila, Mexico
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26
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Perez-Moran D, Perez-Cuevas R, Doubova SV. Challenges for Peritoneal Dialysis Centers Before and During the COVID-19 Pandemic in Mexico. Arch Med Res 2022; 53:431-440. [PMID: 35527074 PMCID: PMC9050655 DOI: 10.1016/j.arcmed.2022.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/31/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Diana Perez-Moran
- Unidad de Investigación en Epidemiología y Servicios de Salud Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Ricardo Perez-Cuevas
- Division of Social Protection and Health, Interamerican Development Bank, Jamaica Country Office, Jamaica
| | - Svetlana V Doubova
- Unidad de Investigación en Epidemiología y Servicios de Salud Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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27
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Guía clínica de la Sociedad Española de Nefrología para la prevención y tratamiento de la infección peritoneal en diálisis peritoneal. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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28
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Yekinni IO, Viker T, Hunter R, Tucker A, Elfering S, Rheault MN, Erdman A. Design and proof-of-concept evaluation of a touchless connector system for preventing peritoneal dialysis-associated peritonitis. BMJ INNOVATIONS 2022; 8:98-104. [PMID: 35677314 PMCID: PMC9173658 DOI: 10.1136/bmjinnov-2021-000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION In this paper, we describe the design of a touchless peritoneal dialysis connector system and how we evaluated its potential for preventing peritoneal dialysis-associated peritonitis, in comparison to the standard of care. The unique feature of this system is an enclosure within which patients can connect and disconnect for therapy, protecting their peritoneal catheters from touch or aerosols. METHODS We simulated a worst-case contamination scenario by spraying 40mL of a standardized inoculum [ 1×107 colony-forming units (CFU) per milliliter] of test organisms, Staphylococcus epidermidis ATCC1228 and Pseudomonas aeruginosa ATCC39327, while test participants made mock connections for therapy. We then compared the incidence of fluid path contamination by test organisms in the touchless connector system and the standard of care. 4 participants were recruited to perform a total of 56 tests, divided in a 1:1 ratio between both systems. Peritoneal dialysis fluid sample from each test was collected and maintained at body temperature (37° C) for 16 hours before being plated on Luria Bertani agar, Mannitol Salts Agar and Pseudomonas isolation agar for enumeration. RESULTS No contamination was observed in test samples from the touchless connector system, compared to 65%, 75% and 70% incidence contamination for the standard of care on Luria Bertani agar, Mannitol Salts Agar and Pseudomonas isolation agar respectively. CONCLUSION Results show that the touchless connector system can prevent fluid path contamination even in heavy bacterial exposures and may help reduce peritoneal dialysis-associated peritonitis risks from inadvertent contamination with further development.
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Affiliation(s)
| | | | - Ryan Hunter
- Department of Microbiology and Immunology, University of Minnesota Medical School, Minnesota, USA
| | - Aaron Tucker
- Bakken Medical Devices Center, University of Minnesota, Minnesota, USA
| | - Sarah Elfering
- Department of Medicine, University of Minnesota Medical School, Minnesota, USA
| | - Michelle N. Rheault
- Department of Pediatrics, University of Minnesota Medical School, Minnesota, USA
| | - Arthur Erdman
- Bakken Medical Devices Center, University of Minnesota, Minnesota, USA
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Rodríguez-Zamora MC, Moreno-Serrano AP, Cabrera-Delgado AM, Regalado-Ruiz LA, Amato-Martínez JD. Vivencias del paciente ante el diagnóstico de enfermedad renal crónica y su ingreso a diálisis peritoneal. ENFERMERÍA NEFROLÓGICA 2022. [DOI: 10.37551/s2254-28842022007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: Un número importante de pacientes que ingresan al programa de diálisis peritoneal reciben simultaneamente la noticia de que tienen enfermedad renal crónica en etapa terminal y requieren diálisis peritoneal. Para muchos de ellos la noticia es inesperada y desconsoladora, ya que tienen que acceder a la diálisis para poder seguir viviendo. Material y Método: Estudio cualitativo, descriptivo con enfoque fenomenológico. De 106 pacientes incidentes del programa de diálisis peritoneal ambulatoria a quienes se les solicitó consentimiento informado para contestar el instrumento (Coping Inventory Strategies), se seleccionaron 14 pacientes que relataron sus vivencias respecto a su diagnóstico de enfermedad renal crónica y la necesidad urgente de diálisis peritoneal. Se les pidió que escribieran en una cuartilla cómo enfrentaron la noticia de insuficiencia renal crónica y requerir diálisis peritoneal. Resultados: Se incluyeron en el estudio a 14 pacientes, con edad comprendida entre 41 y 61 años, y el 66% fueron mujeres. Se identificaron tres categorías y siete subcategorías: sociolaboral (estigma social e incertidumbre por el trabajo); actitud ante la muerte (resignación y sentimiento de culpa) y acompañamiento familiar (toma de decisiones, motivación y apoyo). El mayor número de pacientes se ubicó en la categoría de actitud ante la muerte y en la subcategoría de resignación como estrategia de afrontamiento. Conclusiones: Los pacientes describieron la fase en la que se enteraron de su diagnóstico y el ingreso a diálisis peritoneal como el momento más difícil y traumático, manifestaron sentimientos de angustia, limitaciones personales o sociales y reconocieron la dependencia del apoyo familiar.
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30
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McIsaac M, Chan CT, Auguste BL. The need for individualizing teaching and assurance of knowledge transmission to patients training for home dialysis. Nephrology (Carlton) 2022; 27:733-738. [PMID: 35315965 DOI: 10.1111/nep.14040] [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: 12/19/2021] [Revised: 02/07/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022]
Abstract
Patients have varied learning styles and this has implications for home haemodialysis (HHD). Assessment tools directed toward understanding these styles remains understudied. As a consequence, this may lead to substandard retention rates or adverse events in HHD programs. As part of a continuous quality improvement initiative we have aimed to improve our understanding of patient learning styles and consequently tailor home dialysis training to individuals. To objectively determine knowledge translation and comprehension, irrespective of learning styles, we have introduced an objective structured clinical examination (OSCE). This assessment tool allows for further refinement of educational priorities by highlighting both deficiencies and strengths. Thereafter, an exit OSCE ensures patients attain an acceptable standard to complete home haemodialysis independently. We hope this tool will help shape future training criteria for HHD programs and consequently reduce adverse event rates.
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Affiliation(s)
- Mark McIsaac
- University Health Network, University of Toronto, Toronto, Canada
| | | | - Bourne L Auguste
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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31
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Chen J, Zheng B, Yin L, Zhou Q, Liu W, Li P, Zhao X, Chen X, Li Y, Ding H, Li G. Exploring agreement and feasibility between virtual home visits and in-person home visits for peritoneal dialysis patients-a paired study. Ren Fail 2022; 44:490-502. [PMID: 35285398 PMCID: PMC8928823 DOI: 10.1080/0886022x.2022.2049305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Virtual home visits may improve chronic disease management. However, whether they are suitable for peritoneal dialysis (PD) patients has not yet been fully investigated. This study aimed to compare the agreement and acceptance of virtual home visits and in-person home visits in PD patients. METHODS This was a paired, single center, noninferiority trial. Participants received a virtual home visit and an in-person home visit simultaneously. A home visit checklist was built for standardization visits. The content was divided into three parts: domestic habits (57 items), bag exchange procedures (56 items), and exit site care (53 items). Satisfaction questionnaires for both patients and nurses were designed to assess attitudes toward home visits and socioeconomic effects. RESULTS A total of 30 PD patients were enrolled in a single center. The information collected from virtual home visits and in-person home visits was found to be highly consistent. The perfect agreement was found in 52/57, 49/56, and 44/53 items (Cohen's kappa 0.81-1.00), substantial agreement in 4/57, 7/56, and 8/53 items (Cohen's kappa 0.61-0.80). Patients reported almost identical satisfaction for virtual home visits and in-person home visits (Z = 0.39, p = 0.70). PD nurses reported similar feasibility and patient cooperation for the two visit types (Z = 0.99, p = 0.33; Z = 1.65, p = 0.10, respectively). In addition, virtual home visits were found to be more cost-effective than in-person home visits. CONCLUSIONS Virtual home visits information collection was similar to in-person home visits in PD. There were no differences in participant satisfaction and feasibility between the two visit types.
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Affiliation(s)
- Jin Chen
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Zheng
- Department of Sanitary Technology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Lijuan Yin
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qin Zhou
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wenshu Liu
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Pengli Li
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiuxiu Zhao
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiuling Chen
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Li
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hanlu Ding
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guisen Li
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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32
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Li PKT, Chow KM, Cho Y, Fan S, Figueiredo AE, Harris T, Kanjanabuch T, Kim YL, Madero M, Malyszko J, Mehrotra R, Okpechi IG, Perl J, Piraino B, Runnegar N, Teitelbaum I, Wong JKW, Yu X, Johnson DW. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int 2022; 42:110-153. [PMID: 35264029 DOI: 10.1177/08968608221080586] [Citation(s) in RCA: 168] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.
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Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Stanley Fan
- Translational Medicine and Therapeutic, William Harvey Research Institute, Queen Mary University, London, UK
| | - Ana E Figueiredo
- Nursing School Escola de Ciências da Saúde e da Vida Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tess Harris
- Polycystic Kidney Disease Charity, London, UK
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Magdalena Madero
- Division of Nephrology, Department of Medicine, National Heart Institute, Mexico City, Mexico
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Diseases, The Medical University of Warsaw, Poland
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, DC, USA
| | - Ikechi G Okpechi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, South Africa
| | - Jeff Perl
- St Michael's Hospital, University of Toronto, ON, Canada
| | - Beth Piraino
- Department of Medicine, Renal Electrolyte Division, University of Pittsburgh, PA, USA
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Isaac Teitelbaum
- Division of Nephrology, Department of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Xueqing Yu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangzhou, China
- Guangdong Academy of Medical Sciences, Guangzhou, China
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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33
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Kusahana E, Uchiyama K, Yamaguchi N, Hirashima M, Togashi T, Yamamoto Y, Imai M, Ashida M, Yamamura K, Nakayama T, Yasuda I, Morimoto K, Washida N, Itoh H. Self-assessment sheet submission rate predicts technique survival in patients initiating peritoneal dialysis. Nephrology (Carlton) 2022; 27:501-509. [PMID: 35166424 DOI: 10.1111/nep.14029] [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: 11/25/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/27/2022]
Abstract
AIM Patients play a crucial role in preventing peritoneal dialysis (PD)-related events, including peritonitis and fluid overload, as PD procedures are mainly carried out at home. We asked patients to submit a PD self-assessment sheet at each outpatient visit in our daily clinical practice and evaluated its usefulness for outcomes in patients initiating PD. METHODS This retrospective cohort study included patients who underwent PD catheter insertion between January 2008 and October 2018. The submission rate of a PD self-assessment sheet was calculated from medical records until PD cessation or study completion (October 2020). The association between the submission rate and technique survival was analysed. RESULTS Among the 105 recruited patients (78 men, 60.4 ± 12.2 years), 44 discontinued PD and transferred to haemodialysis during the study period. The follow-up was 52.3 (28.7-79.3) months, and the median submission rate was 78%. The log-rank test showed that technique survival was significantly better in patients with a submission rate ≥ 78% than those with a submission rate < 78% (P = 0.006). The submission rate remained significantly associated with less technique failure (hazard ratio 0.88 per 10%, P = 0.002) by the Cox regression analysis adjusted for age, sex, Charlson comorbidity index, estimated glomerular filtration rate and geriatric nutritional risk index. CONCLUSION The submission rate of a PD self-assessment sheet is useful as a predictor of technique survival in patients initiating PD. Instruction that increases submission may improve technique survival in PD patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ei Kusahana
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kiyotaka Uchiyama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Nobuko Yamaguchi
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Apheresis and Dialysis Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Maiko Hirashima
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Apheresis and Dialysis Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Tomoko Togashi
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yuriko Yamamoto
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Michiyo Imai
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Mayumi Ashida
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Keiko Yamamura
- Department of Nursing, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takashin Nakayama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Itaru Yasuda
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kohkichi Morimoto
- Apheresis and Dialysis Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Naoki Washida
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Department of Nephrology, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, Chiba, Japan
| | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
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34
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García-Meza WJM, Carrillo-Cervantes AL, Villarreal-Reyna MDLÁ, Delabra-Salinas MM, Lobo-Ventura BA. Adherencia al procedimiento de diálisis peritoneal ambulatoria y limitaciones de cuidado de adultos mayores o sus cuidadores. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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35
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Okpechi IG, Jha V, Cho Y, Ye F, Ijezie CI, Jindal K, Klarenbach S, Makusidi MA, Okpechi-Samuel US, Okwuonu C, Shah N, Thompson S, Tonelli M, Johnson DW, Bello AK. The case for Increased Peritoneal Dialysis Utilization in Low- and Lower-Middle-Income Countries. Nephrology (Carlton) 2022; 27:391-403. [PMID: 35060223 DOI: 10.1111/nep.14024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/03/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Abstract
Peritoneal dialysis (PD) has several advantages compared to hemodialysis (HD), but there is evidence showing underutilization globally, especially in low-income and lower-middle-income countries (LLMICs) where kidney replacement therapies (KRT) are often unavailable, inaccessible, and unaffordable. Only 11% of all dialysis patients worldwide use PD, more than 50% of whom live in China, the United States of America, Mexico, or Thailand. Various barriers to increased PD utilization have been reported worldwide including patient preference, low levels of education, and lower provider reimbursement. However, unique but surmountable barriers are applicable to LLMICs including the excessively high cost of providing PD (related to PD fluids in particular), excessive cost of treatment borne by patients (relative to HD), lack of adequate PD training opportunities for doctors and nurses, low workforce availability for kidney care, and challenges related to some PD outcomes (catheter-related infections, hospitalizations, mortality, etc.). This review discusses some known barriers to PD use in LLMICs and leverages data that show a global trend in reducing rates of PD-related infections, reducing rates of modality switches from HD, and improving patient survival in PD to discuss how PD use can be increased in LLMICs. We therefore, challenge the idea that low PD use in LLMICs is unavoidable due to these barriers and instead present opportunities to improve PD utilization in LLMICs.
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Affiliation(s)
- Ikechi G Okpechi
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada.,Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India.,School of Public Health, Imperial College, London, United Kingdom.,Manipal Academy of Higher Education, Manipal, India
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Feng Ye
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Chukwuonye I Ijezie
- Division of Renal Medicine, Department of Internal Medicine, Umuahia, Nigeria
| | - Kailash Jindal
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Scott Klarenbach
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Muhammad A Makusidi
- Department of Medicine, College of Health Sciences, Usmanu Danfodiyo University, Renal Centre, Sokoto State, Nigeria
| | | | - Chimezie Okwuonu
- Division of Renal Medicine, Department of Internal Medicine, Umuahia, Nigeria
| | - Nikhil Shah
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Stephanie Thompson
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - David W Johnson
- Translational Research Institute, Brisbane, QLD, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Aminu K Bello
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
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Jeloka TK, Abraham G, Bhalla AK, Balasubramaniam J, Dutta A, Gokulnath, Gupta A, Jha V, Khanna U, Mahajan S, Nayak KS, Prasad KN, Prasad N, Rathi M, Raju S, Rohit A, Sahay M, Sampathkumar K, Sivakumar V, Varughese S. Continuous Ambulatory Peritoneal Dialysis Peritonitis Guidelines - Consensus Statement of Peritoneal Dialysis Society of India - 2020. Indian J Nephrol 2021; 31:425-434. [PMID: 34880551 PMCID: PMC8597799 DOI: 10.4103/ijn.ijn_73_19] [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: 04/07/2019] [Revised: 05/08/2019] [Accepted: 06/30/2019] [Indexed: 11/25/2022] Open
Abstract
Continuous ambulatory peritoneal dialysis (CAPD) related peritonitis is a major cause of technique failure, morbidity, and mortality in patients on CAPD. Its prevention and management is key to success of CAPD program. Due to variability in practice, microbiological trends and sensitivity towards antibiotics, there is a need for customized guidelines for management of CAPD related peritonitis (CAPDRP) in India. With this need, Peritoneal Dialysis Society of India (PDSI) organized a structured meeting to discuss various aspects of management of CAPDRP and formulated a consensus agreement which will help in management of patients with CAPDRP.
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Affiliation(s)
- Tarun K Jeloka
- Department of Nephrology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Georgi Abraham
- Department of Nephrology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - A K Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - J Balasubramaniam
- Department of Nephrology, Kidney Care Centre, Tirunelveli, Tamil Nadu, India
| | - A Dutta
- Department of Nephrology, Fortis Hospital and Kidney Institute, Kolkata, West Bengal, India
| | - Gokulnath
- Department of Nephrology, Apollo Hospital, Bengaluru, Karnataka, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
| | - V Jha
- The George Institute for Global Health, New Delhi, India
| | - Umesh Khanna
- Department of Nephrology, Lancelot Kidney and GI Centre, Mumbai, Maharashtra, India
| | - Sandeep Mahajan
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - K S Nayak
- Department of Nephrology, Virinchi Hospitals, Hyderabad, Telangana, India
| | - K N Prasad
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
| | - Manish Rathi
- Department of Nephrology, Post Graduate Institute, Chandigarh, India
| | - Sreebhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Anusha Rohit
- Department of Microbiology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Hospital, Hyderabad, Telangana, India
| | - K Sampathkumar
- Department of Nephrology, Meenakshi Mission Hopsital and Research Centre, Madurai, Tamil Nadu, India
| | - V Sivakumar
- Department of Nephrology, SriVenkateshwara Institute of Medical sciences, Tirupati, Andhra Pradesh, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
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Devia M, Vesga J, Sanchez R, Sanabria RM, Figueiredo AE. Development of an instrument to assess self-management capacity of patients receiving peritoneal dialysis: CAPABLE. Perit Dial Int 2021; 42:370-376. [PMID: 34886728 DOI: 10.1177/08968608211059897] [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: 11/15/2022] Open
Abstract
BACKGROUND Treatment of kidney failure with peritoneal dialysis (PD) at home implies that the patient and/or their caregiver develop a series of skills and basic knowledge about this therapy. There is not a specific inventory of the patient's abilities to safely perform the PD procedure at home. The objective of this study was to describe the development of an instrument that allows measuring the self-management capacity of patients receiving PD, locating the performance areas that justify the need for intervention by a caregiver. METHODS This is a qualitative study developed in three phases: The first phase was the identification of performance areas through bibliographic search and validation of the results with focus groups of experts in PD. The second phase was the design of a system to measure self-management capacities. The third phase was a pilot test of the preliminary version of the instrument applied in 20 incident PD patients. RESULTS Three domains were identified to evaluate the fundamental components of self-management capacity: cognitive and sensory, each one evaluated with four items and motor domain evaluated with eight items. After applying the instrument, we found that 15 patients (75%) did not require support from the caregiver in any of the items. PD patients and nurses found the tool valuable, easy to understand and applicable in the early evaluation of a PD patient. CONCLUSIONS We developed an easy-to-administer instrument to measure the self-management capacity of patients receiving PD. This inventory could locate areas that require specific support from a caregiver. Planning an individualised and focused education and training process could result in better health outcomes.
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Affiliation(s)
| | - Jasmin Vesga
- Baxter Renal Care Services, Bucaramanga, Colombia
| | - Ricardo Sanchez
- Department of Clinical Epidemiology, School of Medicine, National University of Colombia, Bogota, DC, Colombia
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38
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Yip JYC. Peritoneal Dialysis Failure and its Impact on Holistic Kidney Care: A Case Report. SAGE Open Nurs 2021; 7:23779608211037496. [PMID: 34869856 PMCID: PMC8642045 DOI: 10.1177/23779608211037496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 06/03/2021] [Accepted: 07/18/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Peritonitis remains the primary cause of treatment failure among patients with
end-stage kidney disease on continuous ambulatory peritoneal dialysis. However, detailed
case analyses illustrating the application of current research in clinical practice
remain scant. This case report aimed to elucidate the roles of dialysis nurses in a
hospital setting in the management of a 62-year-old male patient with a history of
kidney failure secondary to amyloidosis. Case Presentation The patient was diagnosed with continuous ambulatory peritoneal dialysis-associated
peritonitis. Management and Outcomes Dialysis nurses applied evidence-based practices in the management of the patient’s
exit-site infection, imbalanced nutrition, and psychosocial concerns. The patient was
discharged after 7 days, with a comprehensive treatment regimen, including an
individualized peritoneal dialysis protocol adjusted to his daily schedules, education
on self-care techniques, and continual nutritional management to prevent recurrence and
improve his overall health. This case report shows that admissions for continuous
ambulatory peritoneal dialysis-associated peritonitis require evidence-based nursing
interventions specific to, and geared toward, each patient’s prioritized health
problems. Discussion Peritonitis cases are preventable with appropriate nursing interventions that can lower
the chance of treatment failure and long-term impact caused by an abrupt switch to
hemodialysis. To successfully manage patients with continuous ambulatory peritoneal
dialysis-associated peritonitis, dialysis nurses should appreciate the intricacies of
the analyses underpinning their professional practices in promoting the patient’s
self-care techniques.
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Affiliation(s)
- Jeffrey Yuk Chiu Yip
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China
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39
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Hasegawa T, Noma H, Hamano T, Abe M, Wada A, Honda H, Ito Y, Masakane I, Nitta K. Association between the use of exchange devices for peritoneal dialysis fluids and peritonitis incidence: A nationwide cohort study. Perit Dial Int 2021; 42:177-184. [PMID: 34663130 DOI: 10.1177/08968608211051591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The use of exchange devices for peritoneal dialysis (PD) fluids is a common practice in Japan. Evidence on the effectiveness of exchange devices in preventing PD-related peritonitis is scarce. We evaluated the association between the use of exchange devices for PD fluids and peritonitis incidence. METHODS We retrospectively enrolled 3845 patients, aged ≥20 years, receiving PD for ≥3 months, with available data on the exchange procedure for PD fluids and peritonitis incidence that was obtained from the Japan Renal Data Registry, a nationwide annual survey. The patients were grouped according to whether the manual or device PD fluid exchange method was used. The onset of peritonitis was defined as a leukocyte count of >100/µL (neutrophils ≥50%) in PD effluents. We applied quasi-Poisson regression analyses to estimate the incidence rate ratio (IRR). Age, sex, PD vintage, body mass index, automated PD use, residual kidney function, comorbidities, haemoglobin and serum albumin were adjusted as potential confounders. RESULTS Older age, automated PD use, diabetes as comorbidity and lower haemoglobin levels were associated with the use of exchange devices for PD fluids. Patients using devices for PD fluid exchange (69.2%) had an increased risk of peritonitis of 37% (IRR: 1.37, 95% confidence interval (CI): 1.07-1.75) and 28% (IRR: 1.28, 95% CI: 1.00-1.63) in the crude and multivariate adjustment models, respectively. CONCLUSIONS The use of exchange devices for PD fluids and peritonitis incidence showed no favourable association. There may remain possible residual confounding by indication.
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Affiliation(s)
- Takeshi Hasegawa
- Showa University Research Administration Center (SURAC), Showa University, Tokyo, Japan
- Division of Nephrology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
- Department of Hygiene, Public Health and Preventive Medicine, Graduate School of Medicine, Showa University, Tokyo, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Japan
| | - Hisashi Noma
- Department of Statistical Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Takayuki Hamano
- Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | | | - Hirokazu Honda
- Division of Nephrology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Yasuhiko Ito
- Division of Nephrology and Rheumatology, Aichi Medical University, Japan
| | - Ikuto Masakane
- Division of Nephrology, Motomachi Yabuki Clinic, Yamagata, Japan
| | - Kosaku Nitta
- Kidney Center, Department of Medicine, Tokyo Women's Medical University, Japan
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40
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Nataatmadja M, Zhao J, McCullough K, Fuller DS, Cho Y, Krishnasamy R, Boudville N, Figueiredo AE, Ito Y, Kanjanabuch T, Perl J, Piraino BM, Pisoni RL, Szeto CC, Teitelbaum I, Woodrow G, Johnson DW. International peritoneal dialysis training practices and the risk of peritonitis. Nephrol Dial Transplant 2021; 37:937-949. [PMID: 34634100 DOI: 10.1093/ndt/gfab298] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The effects of training practices on outcomes of patients receiving peritoneal dialysis (PD) are poorly understood and there is a lack of evidence informing best training practices. This prospective cohort study aims to describe and compare international PD training practices and their association with peritonitis. METHODS Adult patients on PD < 3 months participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) were included. Training characteristics (including duration, location, nurse affiliation, modality, training of family members, use of individual/group training, and use of written/oral competency assessments) were reported at patient and facility levels. Hazard ratio for time to first peritonitis was estimated using Cox models, adjusted for selected patient and facility case-mix variables. RESULTS 1376 PD patients from 120 facilities across 7 countries were included. Training was most commonly performed at the facility (81%), by facility-affiliated nurses (87%) in a 1:1 setting (79%). In the UK, being trained by both facility and third-party nurses was associated with reduced peritonitis risk (aHR 0.31, 95% CI 0.15-0.62, vs facility nurses only). However, this training practice was utilized in only 5 of 14 UK facilities. No other training characteristics were convincingly associated with peritonitis risk. CONCLUSIONS There was no evidence to support that peritonitis risk was associated with when, where, how, or how long PD patients are trained.
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Affiliation(s)
- Melissa Nataatmadja
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia.,Sunshine Coast Health Institute, Birtinya, Australia
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, USA
| | | | | | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Neil Boudville
- Department of Nephrology, Sir Charles Gairdner Hospital, Perth, Australia.,Medical School, University of Western Australia, Perth, Australia
| | - Ana E Figueiredo
- School of Health Sciences and Life, Nursing School, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jeffrey Perl
- Arbor Research Collaborative for Health, Ann Arbor, USA.,St Michael's Hospital, Toronto, Canada
| | | | | | - Cheuk C Szeto
- The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | | | - Graham Woodrow
- Renal Unit, St James's University Hospital, Leeds, United Kingdom
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
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Teo S, Yuen TW, Cheong CWS, Rahman MA, Bhandari N, Hussain NH, Mistam H, Geng J, Goh CYP, Than M, Chan YH, Yap HK, Ng KH. Structured re-training to reduce peritonitis in a pediatric peritoneal dialysis program: a quality improvement intervention. Pediatr Nephrol 2021; 36:3191-3200. [PMID: 33797581 DOI: 10.1007/s00467-021-05039-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Decline in skills and knowledge among patients and/or caregivers contributes to peritoneal-dialysis (PD)-related peritonitis. Re-training is important, but no guidelines exist. We describe the implementation of a structured re-training program to decrease peritonitis rates. METHODS This is a prospective quality improvement study involving pediatric patients on long-term home automated PD at National University Hospital, Singapore, between 2012 and 2018. With increasing peritonitis rates, systematic root cause analysis was performed, and based on the contributory factors identified, a structured re-training program was implemented from 2015. This was conducted in 5 cycles, each consisting of 4 modules (hand hygiene, exit site care, peritonitis, and PD troubleshooting). RESULTS Peritonitis rates were analyzed in 2 phases: Phase 1 (2012-2014) when no re-training was performed and Phase 2 (2016-2018) after re-training was instituted. Fifty-nine patients were included. Of these, 45 patients were in Phase 1, 32 in Phase 2, and 18 in both phases. Peritonitis rates decreased from 0.37 ± 0.67 episodes per patient-year in Phase 1 to 0.13 ± 0.32 episodes per patient-year in Phase 2. After adjusting for age at kidney failure onset, PD vintage, years of nursing experience, and the average patient-to-nurse ratio over the study period for each patient, the adjusted peritonitis rates decreased by 0.38 episodes per patient-year (95% CI, 0.09 to 0.67, p = 0.011) from Phase 1 to Phase 2. CONCLUSION Despite an improvement in staffing ratio, peritonitis rates only improved significantly after intensive structured re-training was instituted.
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Affiliation(s)
- Sharon Teo
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Tin Wei Yuen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Md Azizur Rahman
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Neha Bhandari
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Noor-Haziah Hussain
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Hamidah Mistam
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Jing Geng
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Charmaine Yan-Pin Goh
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Mya Than
- Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong-Huak Chan
- Biostatistics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui-Kim Yap
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kar-Hui Ng
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Béchade C, Lanot A, Guillouët S, Ficheux M, Boyer A, Lobbedez T. Impact of assistance on peritonitis due to breach in aseptic procedure in diabetic patients: A cohort study with the RDPLF data. Perit Dial Int 2021; 42:185-193. [PMID: 34514906 DOI: 10.1177/08968608211039669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Diabetic patients often have physical impairment that could lead to manipulation errors in peritoneal dialysis (PD) and touch contamination. Nurse assistance in diabetic PD patients is known to help prevent peritonitis. We made the hypothesis that this lower risk of peritonitis was observed thanks to prevention of breach in aseptic procedure. We evaluated the impact of nurse-assisted PD on specific causes of peritonitis, especially on peritonitis due to a breach in aseptic procedure. METHODS This was a retrospective observational study of the data from the French Language Peritoneal Dialysis Registry. All diabetic patients older than age 18 years starting PD in France between 1 January 2012 and 31 December 2015 were included in the study. The event of interest was the first peritonitis event due to a breach in aseptic procedure. Death, kidney transplantation and peritonitis due to another mechanism were considered as competing events. We examined the association of the covariates with all the possible outcomes using a subdistribution hazard model developed for survival analysis in the presence of competing risks. RESULTS Four thousand one hundred one diabetic patients incident in PD were included in the study. At least one peritonitis event occurred in 1611 patients over the study period. A breach in aseptic procedure was reported in 441/1611 cases (27.3%): 209/575 (36.3%) in the self-care PD group, 56/217 (25.8%) in the family-assisted PD group and 176/819 (21.5%) in the nurse-assisted PD group. Both nurse and family assistance were associated with a lower risk of peritonitis due to breach in aseptic procedure in bivariate analysis. After adjustment on age, modified Charlson index, sex and diabetic nephropathy, patients treated by nurse-assisted PD (subdistribution hazard ratio (sd-HR) 0.52, 95% confidence interval (CI) 0.40-0.67) and those treated by family-assisted PD (sd-HR 0.70, 95% CI 0.51-0.95) had a lower likelihood of peritonitis due to a connection error compared to self-care PD in multivariate analysis. The modality of assistance was not associated with other causes of peritonitis in the multivariate analysis. CONCLUSION While both nurse-assisted PD and family-assisted PD were associated with lower risk of peritonitis due to a breach in aseptic procedure compared to self-care PD in our study, the protective effect was greater with nurse assistance.
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Affiliation(s)
- Clémence Béchade
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France.,"ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Antoine Lanot
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France.,"ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Sonia Guillouët
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France
| | - Maxence Ficheux
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France
| | - Annabel Boyer
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France
| | - Thierry Lobbedez
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France.,"ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France
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van Eck van der Sluijs A, Vonk S, van Jaarsveld BC, Bonenkamp AA, Abrahams AC. Good practices for dialysis education, treatment, and eHealth: A scoping review. PLoS One 2021; 16:e0255734. [PMID: 34379654 PMCID: PMC8357118 DOI: 10.1371/journal.pone.0255734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 07/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recommendations regarding dialysis education and treatment are provided in various (inter)national guidelines, which should ensure that these are applied uniformly in nephrology and dialysis centers. However, there is much practice variation which could be explained by good practices: practices developed by local health care professionals, which are not evidence-based. Because an overview of good practices is lacking, we performed a scoping review to identify and summarize the available good practices for dialysis education, treatment, and eHealth. METHODS Embase, Pubmed, the Cochrane Library, CINAHL databases and Web of Science were searched for relevant articles using all synonyms for the words 'kidney failure', 'dialysis', and 'good practice'. Relevant articles were structured according to the categories dialysis education, dialysis treatment or eHealth, and assessed for content and results. RESULTS Nineteen articles (12 for dialysis education, 3 for dialysis treatment, 4 for eHealth) are identified. The good practices for education endorse the importance of providing complete and objective predialysis education, assisting peritoneal dialysis (PD) patients in adequately performing PD, educating hemodialysis (HD) patients on self-management, and talking with dialysis patients about their prognosis. The good practices for dialysis treatment focus mainly on dialysis access devices and general quality improvement of dialysis care. Finally, eHealth is useful for HD and PD and affects both quality of care and health-related quality of life. CONCLUSION Our scoping review identifies 19 articles describing good practices and their results for dialysis education, dialysis treatment, and eHealth. These good practices could be valuable in addition to guidelines for increasing shared-decision making in predialysis education, using patients' contribution in the implementation of their dialysis treatment, and advanced care planning.
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Affiliation(s)
| | - Sanne Vonk
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brigit C. van Jaarsveld
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Diapriva Dialysis Center, Amsterdam, The Netherlands
| | - Anna A. Bonenkamp
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Alferso C. Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
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Komatsu S, Hara T, Hiratsuka M, Yamada Y. Association between conscientiousness and peritoneal dialysis-related peritonitis. Nephrology (Carlton) 2021; 26:999-1006. [PMID: 34288286 DOI: 10.1111/nep.13952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/26/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Abstract
AIM Peritonitis is a critical complication in patients undergoing peritoneal dialysis. Patient characteristics, especially conscientiousness, potentially influence self-care activity. This study aimed to examine the relationship between the peritonitis risk and the patient conscientiousness. METHODS This retrospective observational study was conducted at three Japanese medical centres in 2018. Adult patients undergoing peritoneal dialysis were evaluated for conscientiousness with the Japanese version of the Ten-Item Personality Inventory. We followed the patients from peritoneal dialysis induction retrospectively on chart review. The primary outcome was time to first episode of peritonitis after initiation of peritoneal dialysis in the entire observation period. Hazard ratios were estimated using a Cox model adjusted for potential confounders. RESULTS Among 111 patients enrolled, 32 experienced peritonitis. The patients were divided into the more conscientious group (n = 64) and less conscientious group (n = 47) based on a mean conscientiousness score of 3.991. Additionally, less conscientious patients tended to be at higher risk for peritonitis during the entire study period (hazard ratio adjusted for age and sex, 1.99; 95% confidence interval, 0.98-4.03; p = .057). The increased risk in the less conscientious group was statistically significant in the first year (adjusted hazard ratio, 6.98; 95% confidence interval, 1.42-34.40; p = .017). CONCLUSION Less conscientious patients significantly have shorter peritonitis-free survival in the early phase after peritoneal dialysis induction although not significantly during the entire study period. Personality trait assessment using the Ten-Item Personality Inventory could be helpful in educating and following up patients undergoing peritoneal dialysis.
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Affiliation(s)
- Shintaro Komatsu
- Department of Nephrology, Nagoya University School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Hara
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Maki Hiratsuka
- Department of Nephrology, Kariya Toyota General Hospital, Kariya, Japan
| | - Yosuke Yamada
- Department of Nephrology, Shinshu University School of Medicine, Nagano, Japan
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Ito Y, Ryuzaki M, Sugiyama H, Tomo T, Yamashita AC, Ishikawa Y, Ueda A, Kanazawa Y, Kanno Y, Itami N, Ito M, Kawanishi H, Nakayama M, Tsuruya K, Yokoi H, Fukasawa M, Terawaki H, Nishiyama K, Hataya H, Miura K, Hamada R, Nakakura H, Hattori M, Yuasa H, Nakamoto H. Peritoneal Dialysis Guidelines 2019 Part 1 (Position paper of the Japanese Society for Dialysis Therapy). RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00348-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AbstractApproximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.
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Changes before and after COVID-19 pandemic on the personal hygiene behaviors and incidence of peritonitis in peritoneal-dialysis patients: a multi-center retrospective study. Int Urol Nephrol 2021; 54:411-419. [PMID: 34146219 PMCID: PMC8214068 DOI: 10.1007/s11255-021-02924-5] [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: 01/04/2021] [Accepted: 06/06/2021] [Indexed: 01/24/2023]
Abstract
Background The impact of Coronavirus disease (COVID-19) pandemic and its influence on personal hygiene behaviors and peritonitis rate in peritoneal-dialysis patients is unknown. Methods A multi-center retrospective study was conducted. We reviewed all the cases of peritoneal-dialysis (PD) patients from four major PD centers in Wuhan before and after COVID-19. There were 567 patients enrolled in total. Information was collected on personal hygiene behaviors, basic clinical characteristics, lab results, peritonitis details. We used Chi-square analysis to compare the personal hygiene behaviors, and used Chi-square goodness-of-fit analysis to compare the peritonitis rates before and after COVID-19. Multivariate logistic regression analysis was used to analyze the risk factors for peritonitis rate. Results There were no significant differences on peritonitis rates in six-month period before and after COVID-19 (p = 0.0756, Fig. 2 and Table 3). But Gram-positive infections decreased dramatically (p = 0.0041, Table 4). Personal hygiene behaviors such as length of time for washing hands when performing PD treatment, the frequency of washing hands before PD treatment and six general behaviors had significant differences (P < 0.05 Table 2). The multivariate logistic regression analysis showed never washing hands before PD treatment and serum albumin level were the risk factors of peritonitis during COVID-19 (OR 14.408, 95%CI 3.930 –52.821, P = 0.0002; OR 4.681, 95% CI 1.755 –12.485, P = 0.002, Table 5). Conclusions The COVID-19 pandemic had a significant positive influence on personal hygiene behaviors. Peritonitis rate did not significantly decrease but Gram-positive infections dramatically decreased. Never hand washing before PD treatment and serum albumin were the risk factors for peritonitis. We should emphasize hand washing before PD treatment in training and re-training program.
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Hoekstra B, Amiri F, van Beenen S, Winkels B, van Leeuwen M, Hesseling L, Hoogsteen A. Training and education, what has changed this last decade? J Ren Care 2021; 47:250-254. [PMID: 34121339 DOI: 10.1111/jorc.12376] [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: 11/11/2020] [Revised: 02/18/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Dutch manual for the best care regarding training and education of our patients, as created by the special interest group for peritoneal dialysis (SIG PD), was revised. OBJECTIVES The aim of this paper is to describe topics learned from the manual revision, supported by noticed response changes in surveys from 2009 to 2019. DESIGN Quantitative nursing research, using similar surveys to compare training and education over the last decade. Additionally, a brief search for literature was performed. PARTICIPANTS Dutch dialysis nurses. APPROACH In 2009, nurses were approached through an online survey sent to all dialysis centres in the Netherlands. In 2019, a similar survey was distributed during our annual Dutch nephrology days. Both surveys were compared and conclusions were drawn. FINDINGS Retrieved information was divided into basic topics and compared. More important, our findings show that even after a decade, there is still no special education for the nurses and patient training is given based on experience alone. Furthermore, multiple nurses are involved in patient training, with varying materials. There are more home visits with training at home and retraining is more suitable. A growth in assisted PD implies more involvement by community nurses. Also, more acute PD is seen, with a different structure of training. CONCLUSIONS The manual was revised with input from our nurses and new guidelines, so we can uplift the education of peritoneal dialysis for the benefit of our patients, caretakers, and community nurses. As SIG PD we can support the dialysis nurses.
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Affiliation(s)
- Bettie Hoekstra
- Department of Nephrology, Maasstad Hospital, Rotterdam, The Netherlands.,Special Interest Group Peritoneal Dialysis, V&VN Dialysis & Nephrology, Utrecht, The Netherlands
| | - Fariba Amiri
- Special Interest Group Peritoneal Dialysis, V&VN Dialysis & Nephrology, Utrecht, The Netherlands.,OLVG, Amsterdam, The Netherlands
| | - Suzanne van Beenen
- Special Interest Group Peritoneal Dialysis, V&VN Dialysis & Nephrology, Utrecht, The Netherlands.,Antonius Hospital, Nieuwegein, The Netherlands
| | - Bieneke Winkels
- Special Interest Group Peritoneal Dialysis, V&VN Dialysis & Nephrology, Utrecht, The Netherlands.,Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Mieke van Leeuwen
- Special Interest Group Peritoneal Dialysis, V&VN Dialysis & Nephrology, Utrecht, The Netherlands.,LUMC, Leiden, The Netherlands
| | - Lilliane Hesseling
- Special Interest Group Peritoneal Dialysis, V&VN Dialysis & Nephrology, Utrecht, The Netherlands.,Zuyderland, Sittard, The Netherlands
| | - Anneke Hoogsteen
- Special Interest Group Peritoneal Dialysis, V&VN Dialysis & Nephrology, Utrecht, The Netherlands.,Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Monárrez-Espino J, Delgado-Valles JA, Ramírez-García G. Quality of life in primary caregivers of patients in peritoneal dialysis and hemodialysis. ACTA ACUST UNITED AC 2021; 43:486-494. [PMID: 34096964 PMCID: PMC8940119 DOI: 10.1590/2175-8239-jbn-2020-0229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) is gaining track as an efficient/affordable therapy in poor settings. Yet, there is little data regarding differences in quality of life (QoL) of primary caregivers (PCG) of patients in PD and hemodialysis (HD). AIM To compare the QoL of PCG of patients in PD and HD from an upper middle-income population in a Mexican city. METHODS Cross-sectional study was carried out with PCG of patients in PD (n=42) and HD (n=95) from 4 hospitals (response rate=70.2%). The SF 36-item QoL questionnaire, the Zarit burden interview, and the Goldberg anxiety/depression scale were used. Mean normalized scores for each QoL domain were compared by dialysis type. Adjusted odds were computed using logistic regression to determine the probability of low QoL (<70% of maximum possible score resulting from the added scores of the 8 dimensions). RESULTS The PD group had higher mean scores for emotional role functioning (+10.6; p=0.04), physical functioning (+9.2; p=0.002), bodily pain (+9.2; p=0.07), social functioning (+5.7; p=0.25), and mental health (+1.3; p=0.71); the HD group had higher scores for physical role functioning (+7.9, p=0.14), general health perception (+6.1; p=0.05), and vitality (+3.3; p=0.36). A non-significant OR was seen in multivariate regression (1.51; 95% CI 0.43-5.31). Zarit scores were similar, but workload levels were lower in the PD group (medium/high: PD 7.2%, HD 14.8%). Anxiety (HD 50.5%, PD 19%; p<0.01) and depression (HD 49.5%, PD 16.7%; p<0.01) were also lower in the PD group. CONCLUSION Adjusted analysis showed no differences in the probability of low QoL between the groups. These findings add to the value of PD, and strengthen its importance in resource-limited settings.
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Affiliation(s)
- Joel Monárrez-Espino
- Hospital Christus Muguerza, Departamento de Investigación, Chihuahua, México.,Universidad de Monterrey, San Pedro Garza García, México.,Claustro Universitario de Chihuahua, Grupo de Investigación en Salud Pública. Chihuahua, México
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Boyer A, Lanot A, Lambie M, Verger C, Guillouet S, Lobbedez T, Béchade C. Trends in Peritoneal Dialysis Technique Survival, Death, and Transfer to Hemodialysis: A Decade of Data from the RDPLF. Am J Nephrol 2021; 52:318-327. [PMID: 33906190 DOI: 10.1159/000515472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/24/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION There is limited information on the trends of peritoneal dialysis (PD) technique survival over time. This study aimed to estimate the effect of calendar time on technique survival, transfer to hemodialysis (HD) (and the individual causes of transfer), and patient survival. METHODS This retrospective, multicenter study, based on data from the French Language Peritoneal Dialysis Registry, analyzed 14,673 patients who initiated PD in France between January 1, 2005, and December 31, 2016. Adjusted Cox regressions with robust variance were used to examine the probability of a composite end point of either death or transfer to HD, death, and transfer to HD, accounting for the nonlinear impact of PD start time. RESULTS There were 10,201 (69.5%) cases of PD cessation over the study period: 5,495 (37.4%) deaths and 4,706 (32.1%) transfers to HD. The rate of PD cessation due to death or transfer to HD decreased over time (PR 0.96, 95% CI: 0.95-0.97). Compared to 2009-2010, starting PD between 2005 and 2008 or 2011 and 2016 was strongly associated with a lower rate of transfer to HD (PR 0.88, 95% CI: 0.81-0.96, and PR 0.91, 95% CI: 0.84-0.99, respectively), mostly due to a decline in the rate of infection-related transfers to HD (PR 0.96, 95% CI: 0.94-0.98). CONCLUSIONS Rates of the composite end point of either death or transfer to HD, death, and transfer to HD have decreased in recent decades. The decline in transfers to HD rates, observed since 2011, is mainly the result of a significant decline in infection-related transfers.
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Affiliation(s)
- Annabel Boyer
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
| | - Antoine Lanot
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
| | - Mark Lambie
- Renal Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
- Faculty of Medicine and Health Sciences, Keele University, Newcastle, United Kingdom
| | | | - Sonia Guillouet
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
| | - Thierry Lobbedez
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
| | - Clémence Béchade
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
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Ng JKC, Chan GCK, Chow KM, Fung W, Pang WF, Law MC, Leung CB, Li PKT, Szeto CC. Helper-assisted continuous ambulatory peritoneal dialysis: Does the choice of helper matter? Perit Dial Int 2021; 40:34-40. [PMID: 32063149 DOI: 10.1177/0896860819879873] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is an increasing number of elderly patients on continuous ambulatory peritoneal dialysis (CAPD) who could not perform dialysis exchange themselves and require assistance. We examine the outcome of Chinese CAPD patients who required helper-assisted dialysis and compare the outcome between different types of helper. METHODS We reviewed 133 incident patients on helper-assisted CAPD and 266 incident patients who performed self-CAPD exchanges (self-peritoneal dialysis (PD) group). Outcome measures included patient survival, peritonitis-free survival, and overall peritonitis rate. RESULTS At 24 months, patient survival of the helper-assisted and self-PD groups were 56.0% and 80.6%, respectively (p < 0.0001). Within the helper-assisted group, patient survival at 24 months was 55.5%, 63.2%, and 27.2% for the patients with domestic helper, family member, and nursing home staff as their helpers, respectively (p = 0.037). Peritonitis-free survival of the helper-assisted and self-PD groups were 54.2% and 64.9%, respectively (p = 0.039). Within the helper-assisted group, peritonitis-free survival at 24 months was 59.4%, 55.4%, and 37.2% for the patients with domestic helper, family member, and nursing home staff as their helpers, respectively (p = 0.06). There was no significant difference in peritonitis rate between patients with domestic helper, family member, and nursing home staff as their helpers (0.54, 0.57, and 0.94 episodes per patient-year, respectively, p = 0.2). CONCLUSIONS Helper-assisted CAPD patients had worse patient survival and peritonitis-free survival than the self-PD group. Assistance by nursing home staff was associated with worse patients' survival and peritonitis-free survival than assistance by family members or domestic maids.
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Affiliation(s)
- Jack Kit-Chung Ng
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Gordon Chun-Kau Chan
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Winston Fung
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wing-Fai Pang
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Man-Ching Law
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Chi Bon Leung
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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