Unplanned vs. planned peritoneal dialysis as initial therapy for dialysis patients in chronic kidney replacement therapy

Background and objectivesThe prevalence of patients with ESKD who receive extracorporeal kidney replacement therapy is rising worldwide. We compared government reimbursement for hemodialysis and peritoneal dialysis worldwide, assessed the effect on the government health care budget, and discussed strategies to reduce the cost of kidney replacement therapy.Design, setting, participants, & measurementsCross-sectional global survey of nephrologists in 90 countries to assess reimbursement for dialysis, number of patients receiving hemodialysis and peritoneal dialysis, and measures to prevent development or progression of CKD, conducted online July to December of 2016.ResultsOf the 90 survey respondents, governments from 81 countries (90%) provided reimbursement for maintenance dialysis. The prevalence of patients per million population being treated with long-term dialysis in low- and middle-income countries increased linearly with Gross Domestic Product per capita (GDP per capita), but was substantially lower in these countries compared with high-income countries where we did not observe an higher prevalence with higher GDP per capita. The absolute expenditure for dialysis by national governments showed a positive association with GDP per capita, but the percent of total health care budget spent on dialysis showed a negative association. The percentage of patients on peritoneal dialysis was low, even in countries where peritoneal dialysis is better reimbursed than hemodialysis. The so-called peritoneal dialysis–first policy without financial incentive seems to be effective in increasing the utilization of peritoneal dialysis. Few countries actively provide CKD prevention.ConclusionsIn low- and middle-income countries, reimbursement of dialysis is insufficient to treat all patients with ESKD and has a disproportionately high effect on public health expenditure. Current reimbursement policies favor conventional in-center hemodialysis.

Download Full-text

Nierenersatzverfahren: Information, Aufklärung, Dokumentation

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0549-9578 ◽

2018 ◽

Vol 143 (12) ◽

pp. 863-870

Author(s):

Jan Galle ◽

Jana Reitlinger

Keyword(s):

Peritoneal Dialysis ◽

Kidney Transplantation ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Donation ◽

Living Donation ◽

Short Term ◽

Donor Kidney ◽

Kidney Replacement Therapy ◽

Caring Environment

AbstractIn renal replacement therapy, different methods are available: hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx). In addition, variants can be used: HD as a home HD or center HD, PD as a conventional PD or automated (cycler) PD, KTx as a potentially short-term predictable living donation or conventional donor kidney donation. The patient and his familiar or caring environment must be informed accordingly. This means first of all: information about which procedures of kidney replacement therapy are possible and can be offered. Then the specific risks associated with each procedure should be elucidated (e. g. HD and shunt bleeding, PD and peritonitis, KTx and infections/neoplasias). This necessarily includes a structured documentation of the educating center/doctor about the communicated information and decisions taken.

Download Full-text

SP500BIOIMPEDANCE SPECTROSCOPY BEFORE AND AFTER ASCITES PUNCTURE IN PATIENTS WITHOUT RENAL REPLACEMENT THERAPY: POTENTIAL IMPLICATIONS FOR USE OF THE BODY COMPOSITION MONITOR IN PERITONEAL DIALYSIS PATIENTS?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx151.sp500 ◽

2017 ◽

Vol 32 (suppl_3) ◽

pp. iii297-iii297

Author(s):

Amrei Simon ◽

Benjamin Schairer ◽

Carolin Berner ◽

Lorenzo Signorini ◽

Matthäus Ernstbrunner ◽

...

Keyword(s):

Body Composition ◽

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

The Body ◽

Dialysis Patients ◽

Body Composition Monitor ◽

Before And After

Download Full-text

Usefulness of peritoneal fluid amylase levels in the differential diagnosis of peritonitis in peritoneal dialysis patients.

Journal of the American Society of Nephrology ◽

10.1681/asn.v1101186 ◽

1991 ◽

Vol 1 (10) ◽

pp. 1186-1190

Author(s):

J Burkart ◽

S Haigler ◽

R Caruana ◽

B Hylander

Keyword(s):

Differential Diagnosis ◽

Peritoneal Dialysis ◽

Peritoneal Fluid ◽

Dialysis Patient ◽

Surgical Intervention ◽

Peritoneal Dialysis Patient ◽

Initial Therapy ◽

Amylase Level ◽

Dialysis Patients ◽

Technological Advances

Peritonitis continues to be a major cause of morbidity in peritoneal dialysis patients despite recent technological advances (Y systems) that have reduced peritonitis rates to much more acceptable levels. Most of the time when a peritoneal dialysis patient presents with peritonitis, it is infectious in origin. However, these patients occasionally develop other intra-abdominal pathology that requires more intensive medical care or, at times, surgical intervention. To help in the early differential diagnosis of the cause of peritonitis in these patients, peritoneal fluid amylase levels were prospectively obtained from 50 patients presenting to the hospital with peritonitis. Thirty-nine of them had typical infectious peritonitis, and their mean peritoneal fluid amylase level was 11.1 (range, 0 to 90). Six patients had pancreatitis and a mean peritoneal fluid amylase level of 550 U/L (range, 100 to 1,140 U/L). Five patients were found to have other intra-abdominal pathology, and their mean peritoneal fluid amylase level was 816 U/L (range, 142 to 1,746 U/L). In patients who did not respond to initial therapy, sequential peritoneal fluid amylase levels did not increase in patients with typical infectious peritonitis whereas it did increase in patients with other intra-abdominal pathology. In conclusion, it was found that peritoneal fluid amylase levels were helpful in the differential diagnosis of peritonitis in these patients. An elevated level (greater than 100 U/L) differentiated those patients with other intra-abdominal causes of peritonitis from those with typical infectious peritonitis.

Download Full-text

Peritonites in peritoneal dialysis patients

Revista dos Trabalhos de Iniciação Científica da UNICAMP ◽

10.20396/revpibic262018382 ◽

2018 ◽

Author(s):

Emanuelle Barbara Dias Tomaz ◽

Plínio Trabasso ◽

Gabriela Jorge Trigo Alves ◽

Rodrigo Bueno de Oliveira

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Kidney Disease ◽

Replacement Therapy ◽

Dialysis Patients ◽

Fungal Peritonitis ◽

Bacteria And Fungi ◽

Etiological Agents

Peritonitis is one of the most common complications of the population with chronic kidney disease on peritoneal dialysis. The most frequent etiological agents are bacteria and fungi, the latter being responsible for 2 to 5% of the total cases of this type of infection. Fungal peritonitis is severe and its occurrence requires immediate removal of the catheter and transfer of renal replacement therapy for hemodialysis. The present study aimed to retrospectively study the risk factors and clinical outcomes of patients at the Centro Integrado de Nefrologia (CIN) of the Hospital das Clínicas da UNICAMP, who presented bacterial or fungal peritonitis, comparing them to peritoneal dialysis patients who did not present peritonitis.

Download Full-text

COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa261 ◽

2020 ◽

Vol 35 (11) ◽

pp. 1973-1983 ◽

Cited By ~ 1

Author(s):

Luuk B Hilbrands ◽

Raphaël Duivenvoorden ◽

Priya Vart ◽

Casper F M Franssen ◽

Marc H Hemmelder ◽

...

Keyword(s):

Kidney Transplantation ◽

Replacement Therapy ◽

Kidney Transplant ◽

Clinical Decision Making ◽

Case Fatality ◽

Dialysis Patients ◽

Risk Of Death ◽

Increased Risk ◽

Kidney Replacement Therapy ◽

Related Mortality

Abstract Background. Patients on kidney replacement therapy comprise a vulnerable population and may be at increased risk of death from coronavirus disease 2019 (COVID-19). Currently, only limited data are available on outcomes in this patient population. Methods. We set up the ERACODA (European Renal Association COVID-19 Database) database, which is specifically designed to prospectively collect detailed data on kidney transplant and dialysis patients with COVID-19. For this analysis, patients were included who presented between 1 February and 1 May 2020 and had complete information available on the primary outcome parameter, 28-day mortality. Results. Of the 1073 patients enrolled, 305 (28%) were kidney transplant and 768 (72%) dialysis patients with a mean age of 60 ± 13 and 67 ± 14 years, respectively. The 28-day probability of death was 21.3% [95% confidence interval (95% CI) 14.3–30.2%] in kidney transplant and 25.0% (95% CI 20.2–30.0%) in dialysis patients. Mortality was primarily associated with advanced age in kidney transplant patients, and with age and frailty in dialysis patients. After adjusting for sex, age and frailty, in-hospital mortality did not significantly differ between transplant and dialysis patients [hazard ratio (HR) 0.81, 95% CI 0.59–1.10, P = 0.18]. In the subset of dialysis patients who were a candidate for transplantation (n = 148), 8 patients died within 28 days, as compared with 7 deaths in 23 patients who underwent a kidney transplantation <1 year before presentation (HR adjusted for sex, age and frailty 0.20, 95% CI 0.07–0.56, P < 0.01). Conclusions. The 28-day case-fatality rate is high in patients on kidney replacement therapy with COVID-19 and is primarily driven by the risk factors age and frailty. Furthermore, in the first year after kidney transplantation, patients may be at increased risk of COVID-19-related mortality as compared with dialysis patients on the waiting list for transplantation. This information is important in guiding clinical decision-making, and for informing the public and healthcare authorities on the COVID-19-related mortality risk in kidney transplant and dialysis patients.

Download Full-text

Optimizing Kidney Replacement Therapy During the COVID-19 Pandemic Across a Complex Healthcare System

Frontiers in Medicine ◽

10.3389/fmed.2020.604182 ◽

2020 ◽

Vol 7 ◽

Author(s):

Jane Akomeah ◽

Aljenica Apostol ◽

Esteen Barnes ◽

Chaim Charytan ◽

Uvannie Enriquez ◽

...

Keyword(s):

New York ◽

Peritoneal Dialysis ◽

Replacement Therapy ◽

Healthcare System ◽

Task Force ◽

Extreme Stress ◽

Equitable Sharing ◽

Kidney Replacement Therapy ◽

The Face ◽

Hospital Systems

The unprecedented surge of nephrology inpatients needing kidney replacement therapy placed hospital systems under extreme stress during the COVID-19 pandemic. In this article, we describe the formation of a cross campus “New-York Presbyterian COVID-19 Kidney Replacement Therapy Task Force” with intercampus physician, nursing, and supply chain representation. We describe several strategies including the development of novel dashboards to track supply/demand of resources, urgent start peritoneal dialysis, in-house preparation of kidney replacement fluid, the use of unconventional personnel resources to ensure the safe and continued provision of kidney replacement therapy in the face of the unanticipated surge. These approaches facilitated equitable sharing of resources across a complex healthcare-system and allowed for the rapid implementation of standardized protocols at each hospital.

Download Full-text

Patient Perspectives on Renal Replacement Therapy Modality Choice: A Multicenter Questionnaire Study on Bioethical Dimensions

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00285 ◽

2019 ◽

Vol 39 (6) ◽

pp. 519-526

Author(s):

Michael S. Balzer ◽

Christian Clajus ◽

Gabriele Eden ◽

Frank Euteneuer ◽

Hermann G. Haller ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Language Skills ◽

Tertiary Care ◽

Patient Perspectives ◽

Questionnaire Study ◽

Inclusion Criteria ◽

Dialysis Patients ◽

Tertiary Care Hospitals

Background Peritoneal dialysis (PD) incidence and prevalence in Germany are low compared with hemodialysis (HD), an underachievement with multifactorial causes. Patient perspectives on renal replacement therapy (RRT) choice play a growing role in research. To date, and to the best of our knowledge, the importance of bioethical dimensions in the context of RRT choice has not been analyzed. The aim of this multicenter questionnaire study was to delineate differences in patient perspectives of PD vs HD in terms of bioethical dimensions, thus helping nephrologists target potential PD candidates more efficiently. Methods A total of 121 stable outpatients from 2 tertiary care hospitals and 4 dialysis clinics were surveyed for bioethical dimensions (“autonomy,” “beneficence,” “non-maleficence,” “justice,” and “trust”) with ranking and Likert scale items. Inclusion criteria were RRT > 3 months, age ≥ 18 years, and sufficient cognitive and language skills. Results A surprisingly high percentage of patients felt excluded from the RRT choice process. Peritoneal dialysis patients were more critical of RRT. They used more versatile information sources on RRT, whereas HD patients were mainly informed by their nephrologist. Peritoneal dialysis patients felt more often dissatisfied with RRT than HD patients and had less trust in their co-patients. However, PD patients felt less autonomy impairment regarding body integrity, fluid balance, and dialysis in general. Conclusions Our study demonstrates that PD patients showed more scrutiny of their situation as patients, especially their co-patients. Their treatment empowered them toward feeling more autonomous than HD patients. These new insights into patient perspectives on RRT choice might facilitate modality choice for nephrologists.

Download Full-text

HOME DIALYSIS DURING COVID-19 OUTBREAK– IT IS WORTH TO CONSIDER

Wiadomości Lekarskie ◽

10.36740/wlek202010141 ◽

2020 ◽

Vol 73 (10) ◽

pp. 2316-2318

Author(s):

Paweł Żebrowski ◽

Jacek Zawierucha ◽

Wojciech Marcinkowski ◽

Tomasz Prystacki ◽

Inga Chomicka ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Medical Personnel ◽

Medical Facility ◽

Immune Disorders ◽

Dialysis Patients ◽

Home Hemodialysis ◽

Home Dialysis ◽

Number Of Patients

The epidemic with the new SARS-CoV-2 virus poses a serious threat to patients treated with renal replacement therapy. Besides clinical risk factors (such as numerous comorbidities, immune disorders), dialysis patients are additionally exposed to the virus through regular stays for several hours in a dialysis center and ambulance journeys. In such an epidemiological situation, it seems that peritoneal dialysis and home hemodialysis are good alternatives for treatment. Currently available telemedicine and medical technologies allow for effective renal replacement therapy also outside dialysis centers. Thanks to this, it is possible to limit the stay of patients in a medical facility to clinically justified situations. For this reason, increasing the number of patients treated with peritoneal dialysis, which is carried out at home and without contact with medical personnel, seems to be a good solution. Enabling patients to undergo home hemodialysis treatment, nowadays unavailable in Poland and establishing it as a guaranteed benefit in the health care system will enable renal replacement therapy to be adapted to the clinical condition and the need for isolation.

Download Full-text