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Peritoneal Dialysis International
Number of Followers: 0  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0896-8608 - ISSN (Online) 1718-4304
Published by Sage Publications Homepage  [1162 journals]
  • Assessing transport across the peritoneal membrane: Precision medicine in
           dialysis

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      Authors: Olivier Devuyst
      Pages: 349 - 351
      Abstract: Peritoneal Dialysis International, Volume 41, Issue 4, Page 349-351, July 2021.

      Citation: Peritoneal Dialysis International
      PubDate: 2021-06-09T10:06:52Z
      DOI: 10.1177/08968608211022236
      Issue No: Vol. 41, No. 4 (2021)
       
  • ISPD recommendations for the evaluation of peritoneal membrane dysfunction
           in adults: Classification, measurement, interpretation and rationale for
           intervention

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      Authors: Johann Morelle, Joanna Stachowska-Pietka, Carl Öberg, Liliana Gadola, Vincenzo La Milia, Zanzhe Yu, Mark Lambie, Rajnish Mehrotra, Javier de Arteaga, Simon Davies
      Pages: 352 - 372
      Abstract: Peritoneal Dialysis International, Volume 41, Issue 4, Page 352-372, July 2021.
      Lay summaryPeritoneal dialysis (PD) uses the peritoneal membrane for dialysis. The peritoneal membrane is a thin layer of tissue that lines the abdomen. The lining is used as a filter to help remove extra fluid and poisonous waste from the blood. Everybody is unique. What is normal for one person’s membrane may be very different from another person’s. The kidney care team wants to provide each person with the best dialysis prescription for them and to do this they must evaluate the person’s peritoneal lining. Sometimes dialysis treatment itself can cause the membrane to change after some years. This means more assessments (evaluations) will be needed to determine whether the person’s peritoneal membrane has changed. Changes in the membrane may require changes to the dialysis prescription. This is needed to achieve the best dialysis outcomes. A key tool for these assessments is the peritoneal equilibration test (PET). It is a simple, standardized and reproducible tool. This tool is used to measure the peritoneal function soon after the start of dialysis. The goal is to understand how well the peritoneal membrane works at the start of dialysis. Later on in treatment, the PET helps to monitor changes in peritoneal function. If there are changes between assessments causing problems, the PET data may explain the cause of the dysfunction. This may be used to change the dialysis prescription to achieve the best outcomes. The most common problem with the peritoneal membrane occurs when fluid is not removed as well as it should be. This happens when toxins (poisons) in the blood cross the membrane more quickly than they should. This is referred to as a fast peritoneal solute transfer rate (PSTR). Since more efficient fluid removal is associated with better outcomes, developing a personal PD prescription based on the person’s PSTR is critically important. A less common problem happens when the membrane fails to work properly (also called membrane dysfunction) because the peritoneal membrane is less efficient, either at the start of treatment or developing after some years. If membrane dysfunction gets worse over time, then this is associated with progressive damage, scarring and thickening of the membrane. This problem can be identified through another change of the PET. It is called reduced ‘sodium dip’. Membrane dysfunction of this type is more difficult to treat and has many implications for the individual. If the damage is major, the person may need to stop PD. They would need to begin haemodialysis treatment (also spelled hemodialysis). This is a very important and emotional decision for individuals with kidney failure. Any decision that involves stopping PD therapy or transitioning to haemodialysis therapy should be made jointly between the clinical team, the person on dialysis and a caregiver, if requested. Although evidence is lacking about how often tests should be performed to determine peritoneal function, it seems reasonable to repeat them whenever there is difficulty in removing the amount of fluid necessary for maintaining the health and well-being of the individual. Whether routine evaluation of membrane function is associated with better outcomes has not been studied. Further research is needed to answer this important question as national policies in many parts of the world and the COVID-19 has placed a greater emphasis and new incentives encouraging the greater adoption of home dialysis therapies, especially PD. For Chinese and Spanish Translation of the Lay Summary, see Online Supplement Appendix 1.Key recommendationsGuideline 1:A pathophysiological taxonomy: A pathophysiological classification of membrane dysfunction, which provides mechanistic links to functional characteristics, should be used when prescribing individualized dialysis or when planning modality transfer (e.g. to automated peritoneal dialysis (PD) or haemodialysis) in the context of shared and informed decision-making with the person on PD, taking individual circumstances and treatment goals into account. (practice point)Guideline 2a:Identification of fast peritoneal solute transfer rate (PSTR): It is recommended that the PSTR is determined from a 4-h peritoneal equilibration test (PET), using either 2.5%/2.27% or 4.25%/3.86% dextrose/glucose concentration and creatinine as the index solute. (practice point) This should be done early in the course dialysis treatment (between 6 weeks and 12 weeks) (GRADE 1A) and subsequently when clinically indicated. (practice point)Guideline 2b:Clinical implications and mitigation of fast solute transfer: A faster PSTR is associated with lower survival on PD. (GRADE 1A) This risk is in part due to the lower ultrafiltration (UF) and increased net fluid reabsorption that occurs when the PSTR is above the average value. The resulting lower net UF can be avoided by shortening glucose-based exchanges, using a polyglucose solution (icodextrin), and/or prescribing higher glucose concentrations. (GRADE 1A) Compared to glucose, use of icodextrin can translate into improved fluid status and fewer episodes of fluid overload. (GRADE 1A) Use of automated PD and icodextrin may mitigate the mortality risk associated with fast PSTR. (practice point)Guideline 3:Recognizing low UF capacity: This is easy to measure and a valuable screening test. Insufficient UF should be suspected when either (a) the net UF from a 4-h PET is
      Citation: Peritoneal Dialysis International
      PubDate: 2021-02-10T09:23:08Z
      DOI: 10.1177/0896860820982218
      Issue No: Vol. 41, No. 4 (2021)
       
  • SGLT2 inhibition does not reduce glucose absorption during experimental
           peritoneal dialysis

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      Authors: Giedre Martus, Karin Bergling, Javier de Arteaga, Carl M Öberg
      Pages: 373 - 380
      Abstract: Peritoneal Dialysis International, Volume 41, Issue 4, Page 373-380, July 2021.
      Introduction:Unwanted glucose absorption during peritoneal dialysis (PD) remains a clinical challenge, especially in diabetic patients. Recent experimental data indicated that inhibitors of the sodium and glucose co-transporter (SGLT)-2 could act to reduce glucose uptake during PD, which raises the question of whether glucose absorption may also occur via intracellular or trans-cellular pathways.Methods:We performed PD in anesthetized Sprague-Dawley rats using a fill volume of 20 mL with either 1.5% glucose fluid or 4.25% glucose fluid for 120 min dwell time to evaluate the effects of SGLT2 inhibition by empagliflozin on peritoneal water and solute transport. To assess the diffusion capacity of glucose, we developed a modified equation to measure small solute diffusion capacity, taking convective- and free water transport into account.Results:SGLT2 inhibition markedly increased the urinary excretion of glucose and lowered plasma glucose after PD compared to sham groups. Glucose absorption for 1.5% glucose was 165 mg 95% CI (145–178) in sham animals and 157 mg 95% CI (137–172) for empagliflozin-treated animals. For 4.25% glucose, absorption of glucose was 474 mg 95% CI (425–494) and 472 mg 95% CI (420–506) for sham and empagliflozin groups, respectively. No significant changes in the transport of sodium or water across the peritoneal barrier could be detected.Conclusion:We could not confirm recent findings that SGLT2 inhibition reduced glucose absorption and increased osmotic water transport during experimental PD.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-04-13T06:54:48Z
      DOI: 10.1177/08968608211008095
      Issue No: Vol. 41, No. 4 (2021)
       
  • Optimization of bimodal automated peritoneal dialysis prescription using
           the three-pore model

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      Authors: Carl M Öberg
      Pages: 381 - 393
      Abstract: Peritoneal Dialysis International, Volume 41, Issue 4, Page 381-393, July 2021.
      Background:Previous studies suggested that automated peritoneal dialysis (APD) could be improved in terms of shorter treatment times and lower glucose absorption using bimodal treatment regimens, having ‘ultrafiltration (UF) cycles’ using a high glucose concentration and ‘clearance cycles’ using low or no glucose. The purpose of this study is to explore such regimes further using mathematical optimization techniques based on the three-pore model.Methods:A linear model with constraints is applied to find the shortest possible treatment time given a set of clinical treatment goals. For bimodal regimes, an exact analytical solution often exists which is herein used to construct optimal regimes giving the same Kt/V urea and/or weekly creatinine clearance and UF as a 6 × 2 L 1.36% glucose regime and an ‘adapted’ (2 × 1.5 L 1.36% + 3 × 3 L 1.36%) regime.Results:Compared to the non-optimized (standard and adapted regimes), the optimized regimens demonstrated marked reductions (>40%) in glucose absorption while having an identical weekly creatinine clearance (35 L) and UF (0.5 L). Larger fill volumes of 1200 mL/m2 (UF cycles) and 1400 mL/m2 (clearance cycles) can be used to shorten the total treatment time.Conclusion:These theoretical results imply substantial improvements in glucose absorption using optimized APD regimens while achieving similar water and solute removal as non-optimized APD regimens. While the current results are based on a well-established theoretical model for peritoneal dialysis, experimental and clinical studies need to be performed to validate the current findings.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-04-29T07:35:18Z
      DOI: 10.1177/08968608211010055
      Issue No: Vol. 41, No. 4 (2021)
       
  • An inhibitor of Krüppel-like factor 5 suppresses peritoneal fibrosis
           in mice

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      Authors: Kumiko Muta, Yuka Nakazawa, Yoko Obata, Hiro Inoue, Kenta Torigoe, Masayuki Nakazawa, Katsushige Abe, Akira Furusu, Masanobu Miyazaki, Kazuo Yamamoto, Takehiko Koji, Tomoya Nishino
      Pages: 394 - 403
      Abstract: Peritoneal Dialysis International, Volume 41, Issue 4, Page 394-403, July 2021.
      Back ground:Krüppel-like transcription factor 5 (KLF5) is a transcription factor regulating cell proliferation, angiogenesis and differentiation. It has been recently reported that Am80, a synthetic retinoic acid receptor α-specific agonist, inhibits the expression of KLF5. In the present study, we have examined the expression of KLF5 in fibrotic peritoneum induced by chlorhexidine gluconate (CG) in mouse and evaluated that Am80, as an inhibitor of KLF5, can reduce peritoneal fibrosis.Methods:Peritoneal fibrosis was induced by intraperitoneal injection of CG into peritoneal cavity of ICR mice. Am80 was administered orally for every day from the start of CG injection. Control mice received only a vehicle (0.5% carboxymethylcellulose solution). After 3 weeks of treatment, peritoneal equilibration test (PET) was performed and peritoneal tissues were examined by immunohistochemistry.Results:The expression of KLF5 was less found in the peritoneal tissue of control mice, while KLF5 was expressed in the thickened submesothelial area of CG-injected mice receiving the vehicle. Am80 treatment reduced KLF5 expression and remarkably attenuated peritoneal thickening, accompanied with the reduction of type III collagen expression. The numbers of transforming growth factor β-positive cells, α-smooth muscle actin-positive cells and infiltrating macrophages were significantly decreased in Am80-treated group. PET revealed the increased peritoneal permeability in CG mice, whereas Am80 administration significantly improved the peritoneal high permeability state.Conclusions:These results indicate the involvement of KLF5 in the progression of experimental peritoneal fibrosis and suggest that Am80 may be potentially useful for the prevention of peritoneal fibrosis through inhibition of KLF5 expression.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-02-01T10:33:04Z
      DOI: 10.1177/0896860820981322
      Issue No: Vol. 41, No. 4 (2021)
       
  • Peritoneal physicochemical transport mechanisms: Hypotheses, models and
           controversies

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      Authors: Matthew B Wolf
      Pages: 413 - 416
      Abstract: Peritoneal Dialysis International, Volume 41, Issue 4, Page 413-416, July 2021.
      This study answers criticisms by Waniewski et al. of the recent paper by Wolf on peritoneal transport kinetic models. Their criticisms centre on the accuracy of the data used for model fits, the hypothesis presented, which involves changes in glucose membrane parameters at high peritoneal glucose concentration and on the necessary techniques required to achieve accurate model parameter estimation. In response, this article shows that (1) the mean values previously captured from graphical depictions of Heimburger et al. are not different than those captured from the recent Waniewski et al. graphs, (2) a much simpler hypothesis is proposed, which centres on intraperitoneal pressure-induced lymph flow during the dialysis dwell and (3) the finding that the new model predictions, with only two constant parameter values, as estimated by the Powell algorithm, give a closer fit than the Waniewski model, which uses many time-varying parameters. The current findings again bring into question of the validity of their vasodilation hypothesis, leading to transient changes in capillary surface area during the dwell.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-03-30T09:49:06Z
      DOI: 10.1177/08968608211002414
      Issue No: Vol. 41, No. 4 (2021)
       
  • Home-to-home dialysis transition: A 24-year single-centre experience

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      Authors: Mohamed Ahmed Elbokl, Claire Kennedy, Joanne M Bargman, Marg McGrath-Chong, Christopher T Chan
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Home dialysis (peritoneal dialysis (PD) and home haemodialysis (HHD)) are ideal options for kidney replacement therapy (KRT). Occasionally, because of technique failure, patients are required to transition out of home dialysis, and the most common option tends to be to in-centre HD. There are few published studies on home-to-home transition (PD to HHD or HHD to PD) and dynamics during the transition period. We present a retrospective review of 28 patients who transitioned from a home-to-home dialysis modality at our centre over a 24-year period. We observed a total of 911 home dialysis patients with technique failure (826 PD patients and 85 HHD patients) with only 28 patients (3% of the total with technique failure) having successful home-to-home transition. During the transition period, 11 patients (39%) were hospitalized and 13 patients (46%) required variable periods of in-centre HD. After a median follow-up of 48 months following dialysis modality transition, four patients switched to in-centre HD permanently (home dialysis technique survival of 86% censored for death and kidney transplantation) and four patients died resulting in a patient survival of 86% (censored for switch to in-centre HD and transplantation). In our centre, home-to-home transition is a feasible strategy with comparable patient and technique survival. A significant proportion of patients switching from a home-to-home dialysis modality required variable intervals of hospitalization and in-centre HD during transitions. Future efforts should be directed towards assessment and home dialysis education during the entire process of dialysis transition.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-07-06T09:51:39Z
      DOI: 10.1177/08968608211029213
       
  • Key elements in selection of pre-dialysis patients for home dialysis

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      Authors: Anna A Bonenkamp, Tom D Y Reijnders, Anita van Eck van der Sluijs, E Christiaan Hagen, Alferso C Abrahams, Frans J van Ittersum, Brigit C van Jaarsveld
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background:Most pre-dialysis patients are medically eligible for home dialysis, and home dialysis has several advantages over incentre dialysis. However, accurately selecting patients for home dialysis appears to be difficult, since uptake of home dialysis remains low. The aim of this study was to investigate which medical or psychosocial elements contribute most to the selection of patients eligible for home dialysis.Methods:All patients from a Dutch teaching hospital, who received treatment modality education and subsequently started dialysis treatment, were included. The pre-dialysis programme consisted of questionnaires for the patient, nephrologist and social worker, followed by an assessment of eligibility for home dialysis by a multidisciplinary team. Clinimetric assessment and logistic regression were used to identify domains and questions associated with home dialysis treatment.Results:A total of 135 patients were included, of whom 40 were treated with home dialysis and 95 with incentre haemodialysis. The key elements associated with long-term home dialysis treatment were part of the domains ‘suitability of the housing’, ‘self-care’, ‘social support’ and ‘patient capacity’, with adjusted odds ratios ranging from 0.13 for negative to 18.3 for positive associations.Conclusion:The assessment of contraindications by a nephrologist followed by the assessment of possibilities by a social worker or dialysis nurse who investigates four key elements, ideally during a home visit, and subsequent detailed education offered by specialized nurses is an optimal way to select patients for home dialysis.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-07-05T10:11:08Z
      DOI: 10.1177/08968608211023263
       
  • The use of implicit persuasion in decision-making about treatment for
           end-stage kidney disease

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      Authors: Sandra van Dulmen, Emma Peereboom, Lotte Schulze, Karen Prantl, Maarten Rookmaaker, Brigit C van Jaarsveld, Alferso C Abrahams, Ruud Roodbeen
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background:There are various options for managing end-stage kidney disease. Each option impacts the lives of patients differently. When weighing the pros and cons of the different options, patients’ values, needs and preferences should, therefore, be taken into account. However, despite the best intentions, nephrologists may, more or less deliberately, convey a treatment preference and thereby steer the decision-making process. Being aware of such implicit persuasion could help to further optimise shared decision-making (SDM). This study explores verbal acts of implicit persuasion during outpatient consultations scheduled to make a final treatment decision. These consultations mark the end of a multi-consultation, educational process and summarise treatment aspects discussed previously.Methods:Observations of video-recorded outpatient consultations in nephrology (n = 20) were used to capture different forms of implicit persuasion. To this purpose, a coding scheme was developed.Results:In nearly every consultation nephrologists used some form of implicit persuasion. Frequently observed behaviours included selectively presenting treatment options, benefits and harms, and giving the impression that undergoing or foregoing treatment is unusual. The extent to which nephrologists used these behaviours differed.Conclusion:The use of implicit persuasion while discussing different kidney replacement modalities appears diverse and quite common. Nephrologists should be made aware of these behaviours as implicit persuasion might prevent patients to become knowledgeable in each treatment option, thereby affecting SDM and causing decisional regret. The developed coding scheme for observing implicit persuasion elicits useful and clinically relevant examples which could be used when providing feedback to nephrologists.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-07-02T09:40:30Z
      DOI: 10.1177/08968608211027019
       
  • Effect of social deprivation on peritoneal dialysis uptake: A mediation
           analysis with the data of the REIN registry

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      Authors: Mathilde Beaumier, Eve Calvar, Ludivine Launay, Clémence Béchade, Antoine Lanot, Nicole Schauder, Fatouma Touré, Mathilde Lassalle, Cécile Couchoud, Valérie Châtelet, Thierry Lobbedez
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background:Social deprivation could act as a barrier to peritoneal dialysis (PD). The objective of this study was to assess the association between social deprivation estimated by the European deprivation index (EDI) and PD uptake and to explore the potential mediators of this association.Methods:From the Renal Epidemiology and Information Network registry, patients who started dialysis in 2017 were included. The EDI was calculated based on the patient’s address. The event of interest was the proportion of PD 3 months after dialysis initiation. A mediation analysis with a counterfactual approach was carried out to evaluate the direct and indirect effect of the EDI on the proportion of PD.Results:Among the 9588 patients included, 1116 patients were on PD; 2894 (30.2%) patients belonged to the most deprived quintile (Q5). PD was associated with age >70 years (odds ratio (OR) 0.79 [95% confidence interval (CI): 0.69–0.91]), male gender (0.85 [95% CI: 0.74–0.97]), cardiovascular disease (OR 0.86 [95% CI: 0.86–1.00]), chronic heart failure (OR 1.34 [95% CI: 1.13–1.58]), active cancer (OR 0.67 [95% CI: 0.53–0.85]) and obesity (OR 0.75 [95% CI: 0.63–0.89]). In the mediation analysis, Q5 had a direct effect on PD proportion OR 0.84 [95% CI: 0.73–0.96]. The effect of Q5 on the proportion of PD was mediated by haemoglobin level at dialysis initiation (OR 0.96 [95% CI: 0.94–0.98]) and emergency start (OR 0.98 [95% CI: 0.96–0.99]).Conclusion:Social deprivation, estimated by the EDI, was associated with a lower PD uptake. The effect of social deprivation was mediated by haemoglobin level, a proxy of predialysis care and emergency start.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-07-01T09:30:54Z
      DOI: 10.1177/08968608211023268
       
  • Preliminary safety study of the Automated Wearable Artificial Kidney
           (AWAK) in Peritoneal Dialysis patients

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      Authors: Htay Htay, Sheena K Gow, Mathini Jayaballa, Elizabeth L Oei, Choong-Meng Chan, Sin-Yan Wu, Marjorie WY Foo
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background:Regeneration of peritoneal dialysis (PD) fluid using sorbent technology can provide flexibility and improve quality of life. This study examined the safety and efficacy of the automated wearable artificial kidney (AWAK) device in PD patients.Methods:This pilot study included prevalent PD patients from a single center in Singapore between 2016 and 2018. Participants underwent up to nine AWAK therapies over 72 h and were followed up for 1 month. Primary outcomes were serious adverse events (SAEs) and completion of nine therapies without device deficiency. Secondary outcomes were weekly peritoneal Kt/V urea, solutes clearance and adverse events (AEs).Results:Twenty-one patients were screened and 15 were included in the study. Device alterations were required to overcome issues including flow occlusions initially, which resulted in three cohorts (n = 2, 2 and 11 respectively). No SAEs were observed during the study and at the follow-ups. Common AEs were abdominal pain/discomfort (60%) and bloatedness (47%). The median estimated peritoneal weekly Kt/V urea was 3.0 (interquartile range: 2.2–4.8). There were significant reductions in pre- and post-study median serum urea (20.8 vs. 14.9 mmol/L; p = 0.001), creatinine (976.0 vs. 667.5 µmol/L; p = 0.001), phosphate (1.7 vs. 1.5 mmol/L; p = 0.03), and β2-microglobulin (29114.0 vs. 26339.0 µg/L; p = 0.048). Fluid reabsorption occurred among patients with residual kidney function. However, median body weights were not significantly different pre- and post-study (66.4 vs. 65.7 kg; p = 0.83).Conclusions:This preliminary study demonstrated that no SAEs were observed with the AWAK-PD device; however, 60% of participants developed abdominal pain/discomfort. Further device enhancements are needed to improve ultrafiltration and reduce AEs.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-06-09T09:43:29Z
      DOI: 10.1177/08968608211019232
       
  • Impact of peritoneal dialysis-related peritonitis on PD discontinuation
           and mortality: A population-based national cohort study

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      Authors: Mu-Chi Chung, Tung-Min Yu, Ming-Ju Wu, Ya-Wen Chuang, Chih-Hsin Muo, Cheng-Hsu Chen, Shih-Ting Huang, Chi-Yuan Li, Jeng-Jer Shieh, Peir-Haur Hung, Chi-Jung Chung
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background:The impact of peritoneal dialysis-associated peritonitis (PD peritonitis) on long-term outcomes is uncertain. This nationwide retrospective study was conducted in Taiwan to understand the incidence, risk factors and long-term outcomes of PD peritonitis.Methods:A total of 11,202 incident adult peritoneal dialysis (PD) patients from 2000 to 2010 were collected from a Longitudinal Health Insurance Database and followed up until the end of 2011. Definition of peritonitis, the primary outcome, simultaneously met the diagnosis of peritonitis (International Classification of Diseases, Ninth Revision, Clinical Modification 567) and antibiotic use. Secondary outcomes included the impact of peritonitis on PD discontinuation and survival. Cox proportional hazards models with and without time-dependent variables were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).Results:There were 7634 peritonitis episodes in 4245 patients during the follow-up period. The overall incidence of peritonitis was 0.18 episodes per patient-year. Peritonitis-associated risk factors included older age, female gender, chronic heart failure, cerebrovascular disease, liver cirrhosis and lower monthly income. In an adjusted Cox hazard proportional regression with the time-dependent model, peritonitis patients had a higher risk of PD discontinuation (HR 2.71, 95% CI 2.52–2.92) and mortality (HR 1.68, 95% CI 1.57–1.81) compared to patients without peritonitis. The adjusted HRs for mortality increased with each prior episode: one episode, two episodes and more than two episodes (all p < 0.05). The adjusted HRs for PD discontinuation also increased with the frequency of peritonitis. These negative effects were greatest during the first year and persisted significantly after 5 years. In a sensitivity analysis in which peritonitis within 30 days of death or PD discontinuation was excluded, peritonitis patients still had significantly increased risk of PD discontinuation and mortality compared to patients without peritonitis.Conclusions:Although peritonitis incidence was low, our findings reveal that peritonitis carried acute and long-term sequelae of higher PD discontinuation and lower patient survival.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-06-08T10:26:38Z
      DOI: 10.1177/08968608211018949
       
  • Overcoming barriers and building a strong peritoneal dialysis programme
           – Experience from three South Asian countries

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      Authors: Klara Paudel, Ahad Qayyum, Abdul WM Wazil, Sanjib K Sharma, Kalpana Shrestha, Stanley Fan, Agnes Haris, Fredric O Finkelstein, Nishanthe Nanayakkara
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      The development of peritoneal dialysis (PD) programmes in lower-resource countries is challenging. This article describes the learning points of establishing PD programmes in three countries in South Asia (Nepal, Sri Lanka and Pakistan). The key barriers identified were government support (financial), maintaining stable supply of PD fluids, lack of nephrologist and nurse expertise, nephrology community bias against PD, lack of nephrology trainee awareness and exposure to this modality. To overcome these barriers, a well-trained PD lead nephrologist (PD champion) is needed, who can advocate for this modality at government, professional and community levels. Ongoing educational programmes for doctors, nurses and patients are needed to sustain the PD programmes. Support from well-established PD centres and international organisations (International Society of Peritoneal Dialysis (ISPD), International Society of Nephrology (ISN), International Pediatric Nephrology Association (IPNA) are essential.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-06-02T09:39:26Z
      DOI: 10.1177/08968608211019986
       
  • Risk of peritonitis after gastroscopy in peritoneal dialysis patients

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      Authors: Gordon Chun-Kau Chan, Sunny Hei Wong, Jack Kit-Chung Ng, Philip Kam-Tao Li, Cheuk-Chun Szeto, Kai-Ming Chow
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background:Peritonitis is a common and serious complication of peritoneal dialysis (PD). Translocation of gut bacteria to peritoneum is an important mechanism, which may be enhanced by gastrointestinal endoscopy.Methods:In this retrospective observational cohort study, we identified 450 gastroscopies performed in PD patients within a single centre between 2014 and 2019. Gastroscopy-related peritonitis was defined by peritonitis within 1 week after endoscopy.Results:A total of 408 endoscopic episodes in 216 patients were analysed after excluding 42 cases with either pre-existing peritonitis before endoscopy, or concomitant biliary, small bowel or large bowel endoscopy. There were 16 episodes of peritonitis within 1 week of endoscopy (3.9%). One-quarter of cases were polymicrobial (four episodes, 25.0%). Logistic regression model showed that patient’s age, number of endoscopic biopsies, and histamine-2 receptor blocker use were independently associated with peritonitis, while prior antibiotics exposure was associated with lower risk of peritonitis, odds ratio 0.23 (95% confidence interval 0.06–0.95; p = 0.04).Conclusion:Peritonitis can complicate gastroscopy in PD patients and occurs more often in elderly or after repeated biopsy procedures.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-05-25T09:19:41Z
      DOI: 10.1177/08968608211018608
       
  • Mortality, hospitalization and transfer to haemodialysis and hybrid
           therapy, in Japanese peritoneal dialysis patients

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      Authors: Hideki Kawanishi, Mark R Marshall, Junhui Zhao, Keith McCullough, Bruce Robinson, Ronald L Pisoni, Jeffrey Perl, Tadashi Tomo, Jun Minakuchi
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background and objectives:Survival of peritoneal dialysis (PD) patients in Japan is high, but few reports exist on cause-specific mortality, transfer to haemodialysis (HD) or hybrid dialysis and hospitalisation risks. We aimed to identify reasons for transfer to HD, hybrid dialysis and hospitalisation in the Japan Peritoneal Dialysis and Outcomes Practice Patterns Study.Methods:This observational study included 808 adult PD patients across 31 facilities in Japan in 2014–2017. Information on all-cause and cause-specific mortality and hospitalisation and permanent transfer to HD and PD/HD hybrid therapy were prospectively collected and rates calculated.Results:Median follow-up time was 1.66 years where 162 patients transferred to HD, 79 transferred to hybrid dialysis and 74 patients died. All-cause and cardiovascular disease (CVD)-related mortality rates were 5.1 and 1.7 deaths/100 patient-years, respectively. Rates of transfer to HD and hybrid therapy were 11.2 and 5.5 transfers/100 patient-years, respectively. Among HD transfers, 40% were due to infection (including peritonitis), while 20% were due to inadequate solute/water clearance. Eighty-one percent of hybrid dialysis transfers were due to inadequate solute/water clearance. All--cause, peritonitis-related and CVD-related hospitalisation rates were 120.4, 21.1 and 15.6/100 patient-years, respectively. Median hospital length of stay was 19 days.Conclusions:Mortality, hospitalisation and transfer to HD/hybrid dialysis rates are relatively low in Japan compared to many other countries with hybrid transfers, accounting for one-third of dialysis transfers from PD. Further study is needed to explain the high inter-facility variation in hospitalisation rates and how to further reduce hospitalisation rates for Japanese PD patients.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-05-18T09:45:21Z
      DOI: 10.1177/08968608211016127
       
  • Avoid sharp objects when unpacking peritoneal dialysis equipment – A
           rare case of severe pneumoperitoneum in automated peritoneal dialysis
           (APD)

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      Authors: Christian Daugaard Peters, Petra R Trojaner Rössel
      Abstract: Peritoneal Dialysis International, Ahead of Print.

      Citation: Peritoneal Dialysis International
      PubDate: 2021-05-17T10:24:37Z
      DOI: 10.1177/08968608211014560
       
  • Hyaluronan reduces colitis-induced intraperitoneal inflammation during
           peritoneal dialysis

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      Authors: Jasiński Tomasz, Bręborowicz Andrzej
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background:Peritoneal dialysis induces the inflammatory response within the peritoneal cavity, which contributes to the progressive damage of the peritoneum. Due to close contact of the peritoneal cavity and the intestines, there is the possibility that the visceral disorders can affect the intraperitoneal inflammation during peritoneal dialysis.Objectives:Study of the effect of acute colitis on the intraperitoneal inflammation in conditions of peritoneal dialysis and evaluation of the protective effect of hyaluronan in that scenario.Methods:In rats with the dextran sulphate-induced colitis, 6-h peritoneal dialysis was performed with dianeal 2.5% +/− hyaluronan 10 mg/dL. In the control group, rats without colitis were studied. Peritoneal permeability and dialysate inflammation were studied at the end of the dialysate exchange.Results:In rats with colitis, intraperitoneal inflammatory reaction was increased as compared with the control group and reflected by the following studied parameters: dialysate cell count (+26%, p < 0.01), number of neutrophils (+75%, p < 0.01), generation of free radicals in the leukocytes (+70%, p < 0.05), dialysate level of elastase (+102%, p < 0.01), tumor necrosis factor α (+48%, p < 0.01) and monocyte chemoattractant protein-1 (+42%, p < 0.01). Drained dialysate volume was lower (−21%, p < 0.01) and peritoneal permeability increased in rats with colitis (+55%, p < 0.01). In animals with the hyaluronan supplemented dialysis fluids, the intensity of the intraperitoneal inflammation was reduced.Conclusions:Visceral inflammation during colitis induces the inflammatory reaction within the peritoneal cavity that may accelerate damage to the peritoneum. Supplementation of the dialysis fluid with hyaluronan reduces the intensity of that effect.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-05-17T09:57:32Z
      DOI: 10.1177/08968608211014568
       
  • Use of cyanoacrylate glue to seal an early pericatheter leak

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      Authors: Vishal Pooniya, S Namrata Rao, Abhilash Chandra, Sanjeet Singh
      Abstract: Peritoneal Dialysis International, Ahead of Print.

      Citation: Peritoneal Dialysis International
      PubDate: 2021-05-12T10:09:54Z
      DOI: 10.1177/08968608211014645
       
  • Growing home dialysis: The Ontario Renal Network Home Dialysis Initiative
           2012–2019

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      Authors: Peter G Blake, Brendan B McCormick, Leena Taji, James KH Jung, Jane Ip, Joanie Gingras, Phil Boll, Phil McFarlane, Andreas Pierratos, Anas Aziz, Angie Yeung, Monisha Patel, Rebecca Cooper
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      The Ontario Renal Network (ORN), a provincial government agency in Ontario, Canada, launched an initiative in 2012 to increase home dialysis use province-wide. The initiative included a new modality-based funding formula, a standard mandatory informatics system, targets for prevalent home dialysis rates, the development of a ‘network’ of renal programmes with commitment to home dialysis and a culture of accountability with frequent meetings between ORN and each renal programme leadership to review their results. It also included funding of home dialysis coordinators, encouragement and funding of assisted peritoneal dialysis (PD), and support for catheter insertion and urgent start PD. Between 2012 and 2017, home dialysis use rose from 21.9% to 26.5% and then between 2017 and 2019 stabilised at 26% to 26.5%. Over 7 years, the absolute number of people on home dialysis increased 40% from 2222 to 3105, while the number on facility haemodialysis grew 11% from 7935 to 8767. PD prevalence rose from 16.6% to 20.9%, a relative increase of 25%. The initiative showed that a sustained multifaceted approach can increase home dialysis utilisation.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-05-10T09:45:24Z
      DOI: 10.1177/08968608211012805
       
  • Outcome measures for technique survival reported in peritoneal dialysis: A
           systematic review

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      Authors: Emma Elphick, Matthew Holmes, Matthew Tabinor, Yeoungjee Cho, Thu Nguyen, Tess Harris, Angela Yee Moon Wang, Arsh K Jain, Daniela Ponce, Josephine SF Chow, Annie-Claire Nadeau-Fredette, Adrian Liew, Neil Boudville, Allison Tong, David W Johnson, Simon J Davies, Jeffrey Perl, Karine E Manera, Mark Lambie
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background:Peritoneal dialysis (PD) technique survival is an important outcome for patients, caregivers and health professionals, however, the definition and measures used for technique survival vary. We aimed to assess the scope and consistency of definitions and measures used for technique survival in studies of patients receiving PD.Method:MEDLINE, EMBASE and CENTRAL databases were searched for randomised controlled studies (RCTs) conducted in patients receiving PD reporting technique survival as an outcome between database inception and December 2019. The definition and measures used were extracted and independently assessed by two reviewers.Results:We included 25 RCTs with a total of 3645 participants (41–371 per trial) and follow up ranging from 6 weeks to 4 years. Terminology used included ‘technique survival’ (10 studies), ‘transfer to haemodialysis (HD)’ (8 studies) and ‘technique failure’ (7 studies) with 17 different definitions. In seven studies, it was unclear whether the definition included transfer to HD, death or transplantation and eight studies reported ‘transfer to HD’ without further definition regarding duration or other events. Of those remaining, five studies included death in their definition of a technique event, whereas death was censored in the other five. The duration of HD necessary to qualify as an event was reported in only four (16%) studies. Of the 14 studies reporting causes of an event, all used a different list of causes.Conclusion:There is substantial heterogeneity in how PD technique survival is defined and measured, likely contributing to considerable variability in reported rates. Standardised measures for reporting technique survival in PD studies are required to improve comparability.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-04-22T06:57:51Z
      DOI: 10.1177/0896860821989874
       
  • A systematic review of peritoneal dialysis-related peritonitis rates over
           time from national or regional population-based registries and databases

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      Authors: Mark R Marshall
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Peritoneal dialysis (PD)-related peritonitis is one of the top priorities for care and research among PD stakeholders. This study summarizes PD peritonitis rates from available population-based national or regional registries around the world, examining trends over time. This is a systematic review of PD peritonitis rates in patients treated with PD for kidney failure, from census-based national or provincial/statewide/provider registries or databases. MEDLINE (via PubMed) was searched from inception to August 2020, and inquiries made to national registry personnel using the International Comparisons section of the 2018 United States Renal Data System Annual Data Report as a contact list. Quantitative synthesis was done using weighted random-effects Poisson regression. Of 81 countries that reported utilization of PD, 19 did not have a traditional dialysis registry (governed by either professional societies or government entities), and only 33 monitored PD peritonitis rates correctly and accessibly. There is wide variation in PD peritonitis rates between countries, although the global average has been decreasing over time, from 0.600 episodes/patient-year in 1992 to 0.303 in 2019. Other sources of variability include the continent in which the country is nested and the size of its PD population. PD peritonitis, despite its importance for PD stakeholders, is under-monitored. While the global rate is decreasing over time, the presence and extent of this improvement varies from country to country. There is an opportunity for better monitoring, research into underachieving and overachieving nations and development of international clinical support networks.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-04-08T07:22:43Z
      DOI: 10.1177/0896860821996096
       
  • Vascular endothelial growth factor-mediated peritoneal neoangiogenesis in
           peritoneal dialysis

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      Authors: Yingfeng Shi, Yan Hu, Binbin Cui, Shougang Zhuang, Na Liu
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Peritoneal dialysis (PD) is an important renal replacement therapy for patients with end-stage renal diseases, which is limited by peritoneal neoangiogenesis leading to ultrafiltration failure (UFF). Vascular endothelial growth factor (VEGF) and its receptors are key angiogenic factors involved in almost every step of peritoneal neoangiogenesis. Impaired mesothelial cells are the major sources of VEGF in the peritoneum. The expression of VEGF will be up-regulated in specific pathological conditions in PD patients, such as with non-biocompatible peritoneal dialysate, uremia and inflammation, and so on. Other working cells (i.e. vascular endothelial cells, macrophages and adipocytes) can also stimulate the secretion of VEGF. Meanwhile, hypoxia and activation of complement system further aggravate peritoneal injury and contribute to neoangiogenesis. There are several signalling pathways participating in VEGF-mediated peritoneal neoangiogenesis including tumour growth factor-β, Wnt/β-catenin, Notch and interleukin-6/signal transducer and activator of transcription 3. Moreover, VEGF is highly expressed in dialysate effluent of long-term PD patients and is associated with peritoneal transport function, which supports its role in the alteration of peritoneal structure and function. In this review, we systematically summarize the angiogenic effect of VEGF and evaluate it as a potential target for the prevention of peritoneal neoangiogenesis and UFF. Preservation of the peritoneal membrane using targeted therapy of VEGF-mediated peritoneal neoangiogenesis may increase the longevity of the PD modality for those who require life-long dialysis.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-04-07T07:59:36Z
      DOI: 10.1177/08968608211004683
       
  • Disseminated cryptococcal disease presenting as peritonitis in a patient
           on automated peritoneal dialysis: Could it have been prevented'

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      Authors: Francesca Heard, Jenny Allen, Annie Joseph
      Abstract: Peritoneal Dialysis International, Ahead of Print.

      Citation: Peritoneal Dialysis International
      PubDate: 2021-04-07T07:58:56Z
      DOI: 10.1177/08968608211004678
       
  • Validity and reliability of high-resolution ultrasound imaging for the
           assessment of regional body composition in stage 5 chronic kidney disease
           patients undergoing continuous ambulatory peritoneal dialysis

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      Authors: Louise J Geneen, Jodie Kinsella, Tobia Zanotto, Patrick F Naish, Thomas H Mercer
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background:Accurate measurement of muscle mass is an important research and clinical tool. High-resolution ultrasound (US) has shown potential as a method to assess muscle and fat mass at specific anatomical sites. However, there is limited evidence for the reliability of US to measure muscle size in patients receiving continuous ambulatory peritoneal dialysis (CAPD). Therefore, we examined the validity and reliability of an US method compared to a gold standard comparison for the assessment of a quadriceps muscle in this clinical population.Methods:Twenty people receiving CAPD (mean age = 56.5 ± 16.7 years) at a single dialysis unit were assessed on two occasions, 7 days apart. Measures of the mid-thigh, such as vastus lateralis (VL) anatomical cross-sectional area (ACSA), VL muscle thickness and subcutaneous fat thickness were compared for US reliability and validity compared to magnetic resonance imaging (MRI) measures.Results:US had high validity against gold standard MRI measures, with intraclass correlation coefficients (ICC) equating to VL ACSA of 0.95, VL thickness of 0.99 and fat thickness of 0.98. The US measurements also exhibited high intra-rater reliability (ICCs: VL thickness = 0.98, total muscle thickness = 0.97 and fat thickness = 0.99) in measuring body composition at the mid-VL site in the study population.Conclusions:Valid assessment of regional body composition can be achieved via high-resolution US in patients receiving CAPD. The validity and reliability of the US in repeated measures (in comparison to the gold standard MRI) warrant further investigation in the wider chronic kidney disease population.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-03-30T09:48:26Z
      DOI: 10.1177/08968608211002384
       
  • The peritoneal dialysis orders objective structured clinical examination
           (OSCE): A formative assessment for nephrology fellows

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      Authors: Lisa K Prince, Brian C Y’Barbo, Robert Nee, and Christina M Yuan
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background:Peritoneal dialysis (PD) management is a fundamental nephrology skill, especially with the recent emphasis on home dialysis. We report a prospective multicentre cohort study of a formative objective structured clinical examination (OSCE) assessing competence in managing PD-associated bacterial peritonitis, using the unified model of construct validity.Methods:The OSCE was developed by the principal investigators and reviewed by two subject matter experts. The test committee (eight nephrologists and one PD nurse) assessed test item difficulty/relevance and determined passing score. There were 22 test items (7 evidence-based/standard-of-care questions). Passing score was 16/22 (73%). No item had median relevance less than ‘important’, and all were easy to medium difficulty. Content validity index was 0.91. Preliminary validation (16 board-certified volunteers): mean score was 19 ± 2, with 94% (15/16) passing. Kappa = 0.85 [95% confidence interval (CI) 0.77–0.94]. Cronbach’s α = 0.70.Results:Eighty-seven fellows (16 programmes) were tested; 67% passed. Fellows scored significantly less than validators: 17 ± 3 versus 19 ± 2, p < 0.001 [95% CI 1.2–3.6]. Eighty-six per cent of evidence-based/standard-of-care questions were answered correctly by validators versus 54% by fellows; p < 0.001. Ninety-three per cent of fellows recognized that sufficient criteria were present to diagnose peritonitis, but only 17% correctly indicated all three. Seventy-seven per cent recognized peritonitis-associated ultrafiltration failure, but only 17% prescribed 21 days of antibiotic treatment for gram-negative peritonitis. Eighty-five per cent of fellows surveyed agreed/strongly agreed that the OSCE was useful in self-assessing proficiency. Second-year in-training examination and OSCE scores were positively correlated (Pearson’s r = 0.57, p < 0.00).Conclusions:The OSCE may be used to formatively assess fellow proficiency in managing PD-associated peritonitis.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-03-29T09:36:45Z
      DOI: 10.1177/08968608211000542
       
  • Implementation of PDOPPS in a middle-income country: Early lessons from
           Thailand

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      Authors: Talerngsak Kanjanabuch, Pongpratch Puapatanakul, Guttiga Halue, Pichet Lorvinitnun, Kittisak Tangjittrong, Krit Pongpirul, Surapong Narenpitak, Chanchana Boonyakrai, Sajja Tatiyanupanwong, Rutchanee Chieochanthanakij, Worapot Treamtrakanpon, Uraiwan Parinyasiri, Niwat Lounseng, Phichit Songviriyavithaya, Suchai Sritippayawan, Jeffrey Perl, Roberto Pecoits-Filho, Bruce Robinson, Simon J Davies, David W Johnson, Kriang Tungsanga
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background:Despite the implementation of a ‘Peritoneal Dialysis (PD) First’ policy in Thailand since 2008, nationwide PD practices and patients’ outcomes have rarely been reported.Methods:As part of the multinational PD Outcomes and Practice Patterns Study (PDOPPS), PD patients from 22 PD centres from different geographic regions, sizes and affiliations, representing Thailand PD facilities, have been enrolled starting in May 2016. Demographic, clinical and laboratory data and patients’ outcomes were prospectively collected and analysed.Results:The pilot and implementation phases demonstrated excellent concordance between study data and validation data collected at enrolment. In the implementation phase, 848 PD patients (including 262 (31%) incident PD patients) were randomly sampled from 5090 patients in participating centres. Almost all participants (95%) performed continuous ambulatory PD (CAPD), and a high proportion had hypoalbuminemia (67%, serum albumin < 3.5 g/dL), anaemia (42%, haemoglobin
      Citation: Peritoneal Dialysis International
      PubDate: 2021-03-12T05:24:32Z
      DOI: 10.1177/0896860821993950
       
  • Eligibility and patient barriers to peritoneal dialysis in patients with
           advanced chronic kidney disease

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      Authors: Saleem Abdulkarim, Jasmit Shah, Ahmed Twahir, Ahmed P Sokwala
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Introduction:The burden of chronic kidney disease (CKD) is increasing in Kenya and is a significant cause of morbidity and mortality. While definitive treatment is renal transplantation, many patients require kidney replacement therapy with haemodialysis (HD) or peritoneal dialysis (PD). The predominant modality utilized in Kenya is currently HD. There is a need to explore why PD remains underutilized and whether patient factors may be contributory to barriers that limit the uptake of PD.Methods:This was a descriptive cross-sectional study where patients with advanced CKD were assessed by a multidisciplinary team for PD eligibility using a standardized tool. Contraindications and barriers to the modality were recorded as was the presence or absence of support for the provision of PD. Demographic and clinical data were recorded using a standardized questionnaire. The impact of support on PD eligibility was determined.Results:We found that 68.9% patients were eligible for PD. Surgery-related abdominal scarring was the most common contraindication. Barriers to PD were identified in 45.9% and physical barriers were more common than cognitive barriers. Presence of support was associated with a significant increase in PD eligibility (p < 0.001).Conclusion:The rate of eligibility for PD in this study was similar to that found in other populations. Surgical-related factors were the most commonly identified contraindication. Physical and cognitive barriers were commonly identified and may be overcome by the presence of support for PD.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-03-05T09:38:54Z
      DOI: 10.1177/0896860821998200
       
  • Age dependence of brachial cuff-based ambulatory PWV in end-stage kidney
           disease patients undergoing long-term peritoneal dialysis

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      Authors: Vasilios Vaios, Panagiotis I Georgianos, Georgia Vareta, Dimitrios Divanis, Evangelia Dounousi, Theodoros Eleftheriadis, Aikaterini Papagianni, Pantelis E Zebekakis, Vassilios Liakopoulos
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background:The newly introduced device Mobil-O-Graph (IEM, Stolberg, Germany) combines brachial cuff oscillometry and pulse wave analysis, enabling the determination of pulse wave velocity (PWV) via complex mathematic algorithms during 24-h ambulatory blood pressure monitoring (ABPM). However, the determinants of oscillometric PWV in the end-stage kidney disease (ESKD) population remain poorly understood.Methods:In this study, 81 ESKD patients undergoing long-term peritoneal dialysis underwent 24-h ABPM with the Mobil-O-Graph device. The association of 24-h oscillometric PWV with several demographic, clinical and haemodynamic parameters was explored using linear regression analysis.Results:In univariate analysis, among 21 risk factors, 24-h PWV exhibited a positive relationship with age, body mass index, overhydration assessed via bioimpedance spectroscopy, diabetic status, history of dyslipidaemia and coronary heart disease, and it had a negative relationship with female sex and 24-h heart rate. In stepwise multivariate analysis, age (β: 0.883), 24-h systolic blood pressure (BP) (β: 0.217) and 24-h heart rate (β: −0.083) were the only three factors that remained as independent determinants of 24-h PWV (adjusted R 2 = 0.929). These associations were not modified when all 21 risk factors were analysed conjointly or when the model included only variables shown to be significant in univariate comparisons.Conclusion:The present study shows that age together with simultaneously assessed oscillometric BP and heart rate are the major determinants of Mobil-O-Graph-derived PWV, explaining >90% of the total variation of this marker. This age dependence of oscillometric PWV limits the validity of this marker to detect the premature vascular ageing, a unique characteristic of vascular remodelling in ESKD.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-03-03T10:42:37Z
      DOI: 10.1177/0896860821996927
       
  • Diagnostic capability of ultrasound in peritoneal catheter malfunction
           compared to videolaparoscopy

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      Authors: Matthias Zeiler, Antonio Federico, Paolo Lentini, Roberto Dell’Aquila, Stefano Santarelli, Antonio Granata
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Background:The approach to peritoneal catheter malfunction consists usually in a diagnostic and therapeutic sequence of laxative prescription, abdominal radiography, brushing of the catheter, guide-wire manipulation or fluoroscopy and in the end of a videolaparoscopy (VLS) rescue intervention. Ultrasound (US) is able to find out major causes of peritoneal catheter malfunction, however without a clearly defined diagnostic value. The aim of the study was to validate the diagnostic capability of US in catheter malfunction compared to the diagnostic reference of VLS.Methods:US scans of the subcutaneous and intraperitoneal segment of the catheter were performed prior to a VLS intervention in 40 adult patients presenting persistent catheter malfunction within a prospective multicentre study. Laxative prescription and brushing of the catheter lumen were undertaken prior to US scan. US diagnosis was compared to the corresponding at VLS, kappa coefficient calculated and the causes of mismatch analysed.Results:In US, causes of persistent malfunction were catheter dislocation combined with omental wrapping in 21 cases, omental wrapping without dislocation in 11 cases, dislocation only in 4 cases, adherences to non-omental structures in 3 cases and entrapment in the lateral inguinal fossa in 1 case. The US diagnosis corresponded to the respective at VLS in 36 of 40 cases, resulting in a kappa coefficient of 0.89 (95% CI: 0.78–1.00). The discrepancies were due to improper visualization of the catheter between omentum and intestinal loops, resulting in an erroneous US diagnosis of omental wrapping.Conclusions:This study suggests that US might have a pivotal role in the diagnostic approach to peritoneal catheter dysfunction.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-02-16T09:57:40Z
      DOI: 10.1177/0896860821993946
       
  • Percutaneous reduction of omental prolapse following temporary peritoneal
           dialysis in a child

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      Authors: Subrahmanian Sathiavageesan, Arun Karki, Melchizedek Kamalanathan, Ranjitha Ramajayam
      Abstract: Peritoneal Dialysis International, Ahead of Print.

      Citation: Peritoneal Dialysis International
      PubDate: 2021-02-16T09:45:17Z
      DOI: 10.1177/0896860821992603
       
  • Barriers to and constraints of acute peritoneal dialysis in acute kidney
           injury: A nationwide survey

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      Authors: Worapot Treamtrakanpon, Talerngsak Kanjanabuch, Tanawin Nopsopon, Piyatida Chuengsaman, Phongsak Dandecha, Sarinya Boongird, Kamol Khositrangsikun, Laddaporn Wongluechai, Sajja Tatiyanupanwong, Pongpratch Puapatanakul, Nattachai Srisawat, Somchai Eiam-Ong, David W Johnson, Suchai Sritippayawan, Surasak Kantachuvesiri
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      This national survey of barriers to and constraints of acute peritoneal dialysis (aPD) in acute kidney injury (AKI) was performed by distributing an online questionnaire to all medical directors of public dialysis units registered with the Nephrology Society of Thailand during September–November 2019. One hundred and thirteen adult facilities responded to the survey covering 75 from 76 provinces (99%) of Thailand. aPD was performed in 66 centres (58%). In facilities where aPD practice was available, the utilization rate was relatively low (
      Citation: Peritoneal Dialysis International
      PubDate: 2021-02-16T09:41:17Z
      DOI: 10.1177/0896860821989878
       
  • Ecological momentary assessment to explore fatigue, mood and physical
           

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      Authors: Brett Tarca, Shilpanjali Jesudason, Richard Le Leu, Michelle Ovenden, Monique Borlace, Anthony Meade, Paul N Bennett, Thomas P Wycherley, Terry Boyle, Katia E Ferrar
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Introduction:Fatigue is a frequent and debilitating symptom for people with end-stage kidney disease (ESKD) receiving dialysis. Ecological momentary assessment (EMA) allows real-time data capture of day-to-day and diurnal variations. EMA has been used to study haemodialysis-related fatigue but not in people receiving peritoneal dialysis who are unique in their physical, environmental and logistical characteristics. The aim of this study is to explore the real-time associations between fatigue and mood (EMA mobile application) and objective physical activity levels (accelerometry) in people with EKSD receiving peritoneal dialysis.Method:A 7-day intensive longitudinal study will be conducted. People receiving peritoneal dialysis within South Australia will be invited to participate. Five times throughout the day, participants will be prompted to answer 18 questions relating to fatigue (Visual Analogue Scale to Evaluate Fatigue Severity) and a single question for mood (Visual Analogue Mood Scale). Participants will continuously wear a GENEActiv accelerometer to capture physical activity levels during the 7-day period. At the completion of the data collection, participants will answer questions to evaluate the feasibility and acceptability of using EMA.Discussion:This study will be the first to explore the real-time relationships between fatigue, mood and physical activity in people with ESKD receiving peritoneal dialysis. Understanding the fluctuations people experience and the relationships between mood and physical activity and fatigue will inform clinical management and well-being intervention development.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-02-11T09:58:51Z
      DOI: 10.1177/0896860821992243
       
  • Omental wrap: Radiographic diagnosis confirmed surgically – Report
           of two cases in Grenada

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      Authors: Sanae Ogura, Germaine Bristol, Max Burchman, Linwald Fleary, Terron Hosten, Richard Amerling
      Abstract: Peritoneal Dialysis International, Ahead of Print.
      Omental wrapping is a common cause of peritoneal catheter malfunction. This diagnosis should be confirmed by radiography before proceeding with surgical omentectomy. We report two cases of peritoneal dialysis (PD) catheter outflow obstruction from our developing PD program in Grenada, in which contrast studies accurately diagnosed omental wrap, allowing for prompt surgical correction. In both cases, the contrast study indicated the presence of omental wrapping, confirmed at time of surgical correction. Radiographic features of omental wrap are distinctive, which allows for reliable differentiation from other causes of obstruction. Radiographic contrast study reliably diagnoses the cause of peritoneal catheter obstruction, permitting prompt diagnosis and treatment. This is vital for regions with limited access to haemodialysis.
      Citation: Peritoneal Dialysis International
      PubDate: 2021-01-06T03:51:30Z
      DOI: 10.1177/0896860820982221
       
 
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