Combined therapy using peritoneal dialysis and hemodialysis may increase the indications for peritoneal dialysis in the United States

Chronic kidney disease (CKD) is a clinical syndrome arising from progressive kidney injury, formerly known as chronic renal failure, chronic renal disease, and chronic renal insufficiency. It is classified into five stages based primarily on glomerular filtration rate (GFR). This article discusses the epidemiology of CKD and end-stage renal disease (ESRD), as well as etiology and genetics, pathophysiology, and pathogenesis. The section on diagnosis looks at clinical manifestations and physical findings, laboratory (and other) tests, imaging studies, and biopsy. A short section on differential diagnosis is followed by a discussion of treatment, including hemodialysis and peritoneal dialysis. Long-term complications of patients on dialysis include cardiovascular disease, renal osteodystrophy, dialysis-related amyloidosis, and acquired cystic disease (renal cell carcinoma). The final section addresses prognosis and socioeconomic burden. Figures include the classification system for CKD, prevalence of CKD in the United States, rising prevalence, risk of, and leading causes of ESRD in the United States, plus the changing prevalence of ESRD over time, clinical manifestations of uremia, and an overview of hemodialysis circuit. Tables look at the burden of CKD relative to other chronic disorders, the specific hereditary causes of kidney disease, and situations when serum creatinine does not accurately predict GFR. Other tables list equations for estimating GFR, the causes of CKD without shrunken kidneys, and clinical features distinguishing chronic kidney disease from acute kidney injury. ESRD and indications for initiation of dialysis are presented, as well as typical composition of dialysate and reasons for failure of peritoneal dialysis. This chapter contains 71 references.

Download Full-text

Chronic Kidney Failure and Dialysis

10.2310/im.1168 ◽

2017 ◽

Author(s):

Raghu V Durvasula ◽

Jonathan Himmelfarb

Keyword(s):

United States ◽

Chronic Kidney Disease ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Renal Disease ◽

Chronic Renal Disease ◽

Clinical Manifestations ◽

Kidney Injury ◽

The United States ◽

Clinical Syndrome

Chronic kidney disease (CKD) is a clinical syndrome arising from progressive kidney injury, formerly known as chronic renal failure, chronic renal disease, and chronic renal insufficiency. It is classified into five stages based primarily on glomerular filtration rate (GFR). This article discusses the epidemiology of CKD and end-stage renal disease (ESRD), as well as etiology and genetics, pathophysiology, and pathogenesis. The section on diagnosis looks at clinical manifestations and physical findings, laboratory (and other) tests, imaging studies, and biopsy. A short section on differential diagnosis is followed by a discussion of treatment, including hemodialysis and peritoneal dialysis. Long-term complications of patients on dialysis include cardiovascular disease, renal osteodystrophy, dialysis-related amyloidosis, and acquired cystic disease (renal cell carcinoma). The final section addresses prognosis and socioeconomic burden. Figures include the classification system for CKD, prevalence of CKD in the United States, rising prevalence, risk of, and leading causes of ESRD in the United States, plus the changing prevalence of ESRD over time, clinical manifestations of uremia, and an overview of hemodialysis circuit. Tables look at the burden of CKD relative to other chronic disorders, the specific hereditary causes of kidney disease, and situations when serum creatinine does not accurately predict GFR. Other tables list equations for estimating GFR, the causes of CKD without shrunken kidneys, and clinical features distinguishing chronic kidney disease from acute kidney injury. ESRD and indications for initiation of dialysis are presented, as well as typical composition of dialysate and reasons for failure of peritoneal dialysis. This chapter contains 71 references.

Download Full-text

Acid–Base Disturbances

The Brigham Intensive Review of Internal Medicine ◽

10.1093/med/9780199358274.003.0059 ◽

2014 ◽

pp. 594-602

Author(s):

Julian L. Seifter

Keyword(s):

United States ◽

Cardiovascular Disease ◽

Peritoneal Dialysis ◽

Renal Transplantation ◽

End Stage Renal Disease ◽

The United States ◽

Cardiovascular Complications ◽

Diabetic Patients ◽

Stage Renal Disease ◽

End Stage

According to projections from the United States Renal Data Service (USRDS), 〉600,000 individuals in the United States will have end-stage renal disease (ESRD) by 2010. The leading cause of ESRD in the United State is diabetes, followed by hypertension. As the care of diabetic patients has improved, particularly in the area of cardiovascular disease, they are living through their cardiovascular complications long enough to develop ESRD. As a consequence, since the inception of the Medicare ESRD program. the dialysis population has gradually become older with increasing numbers of comorbid conditions. Renal replacement therapy in the form of hemodialysis or peritoneal dialysis may serve as a bridge to the best form of renal replacement, renal transplantation. The demand for suitable kidneys for transplantation far exceeds the supply, leaving many patients on dialysis for extended periods of time.

Download Full-text

A Survey of Home Visits at Peritoneal Dialysis Centers in the United States

Peritoneal Dialysis International ◽

10.1177/089686089801800523 ◽

1998 ◽

Vol 18 (5) ◽

pp. 528-531 ◽

Cited By ~ 8

Author(s):

Judith Bernardini ◽

Carol Dacko

Keyword(s):

United States ◽

Peritoneal Dialysis ◽

Home Visit ◽

Mail Survey ◽

Home Visits ◽

The United States ◽

Licensed Practical Nurse ◽

Practical Nurse ◽

Number Of Patients ◽

Federal Administration

Objective To determine the frequency and characteristics of home visits in centers that provide training for peritoneal dialysis (PD). Design Mail survey sent to all dialysis centers in the United States providing home PD, using the Health Care Federal Administration (HCFA) Renal Provider list. Results Surveys were mailed to 1247 centers; 13 were undeliverable, resulting in 1234 surveys successfully delivered; 670 (54%) of those surveyed responded. Of those responding, 525 (78.4%) reported home visits were part of the care of home PD patients: 11% made a single home visit, 52% made an initial home visit with at least one followup visit, and 16% made visits only as needed. No home visits were made by 21% of responding centers. A registered nurse (RN) alone made the home visit in 61% of the centers, while a multidisciplinary team accompanied the RN in 35% of centers; 3% of visits were made by a licensed practical nurse, and 1% by the physician. Half of the visits required 0.5 -1 hour, while 41% required 1 -2 hours. Travel time was most often an hour or less one way. Staff were reimbursed for travel expenses by 90% of the centers. The 525 centers making home visits were not different than the 145 centers not making home visits in number of patients per center, number of RNs, rural or urban location, or affiliation with a university. Interpretation of the HCFA regulations concerning home visits was the most important factor influencing centers making home visits. Conclusions Home visits to continuous ambulatory PD and continuous cycling PD patients in the United States are common. Nearly 80% of centers responding to the survey include home visits in the care of their home peritoneal dialysis patients.

Download Full-text

A Survey of Home Visits at Peritoneal Dialysis Centers in the United States

Peritoneal Dialysis International ◽

10.1177/089686089801800512 ◽

1998 ◽

Vol 18 (5) ◽

pp. 528-531 ◽

Cited By ~ 2

Author(s):

Judith Bernardini ◽

Carol Dacko

Keyword(s):

United States ◽

Peritoneal Dialysis ◽

Home Visit ◽

Mail Survey ◽

Home Visits ◽

The United States ◽

Licensed Practical Nurse ◽

Practical Nurse ◽

Number Of Patients ◽

Federal Administration

Objective To determine the frequency and characteristics of home visits in centers that provide training for peritoneal dialysis (PD). Design Mail survey sent to all dialysis centers in the United States providing home PD, using the Health Care Federal Administration (HCFA) Renal Provider list. Results Surveys were mailed to 1247 centers; 13 were undeliverable, resulting in 1234 surveys successfully delivered; 670 (54%) of those surveyed responded. Of those responding, 525 (78.4%) reported home visits were part of the care of home PD patients: 11% made a single home visit, 52% made an initial home visit with at least one followup visit, and 16% made visits only as needed. No home visits were made by 21% of responding centers. A registered nurse (RN) alone made the home visit in 61% of the centers, while a multidisciplinary team accompanied the RN in 35% of centers; 3% of visits were made by a licensed practical nurse, and 1% by the physician. Half of the visits required 0.5 -1 hour, while 41% required 1 -2 hours. Travel time was most often an hour or less one way. Staff were reimbursed for travel expenses by 90% of the centers. The 525 centers making home visits were not different than the 145 centers not making home visits in number of patients per center, number of RNs, rural or urban location, or affiliation with a university. Interpretation of the HCFA regulations concerning home visits was the most important factor influencing centers making home visits. Conclusions Home visits to continuous ambulatory PD and continuous cycling PD patients in the United States are common. Nearly 80% of centers responding to the survey include home visits in the care of their home peritoneal dialysis patients.

Download Full-text

Utilization of peritoneal dialysis in the United States: Reasons for underutilization, specifically in New York State and the boroughs of New York City

Seminars in Dialysis ◽

10.1111/sdi.12868 ◽

2020 ◽

Vol 33 (2) ◽

pp. 140-147

Author(s):

Ernie Yap ◽

Marcia Joseph ◽

Shuchita Sharma ◽

Osama El Shamy ◽

Alan D. Weinberg ◽

...

Keyword(s):

United States ◽

New York ◽

New York City ◽

Peritoneal Dialysis ◽

York City ◽

New York State ◽

The United States ◽

York State

Download Full-text

Geographical Variation in Peritoneal Dialysis Catheter Insertion and Initiation within the United States

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00006 ◽

2016 ◽

Vol 36 (6) ◽

pp. 691-693

Author(s):

Achint Patel ◽

Harshil Shah ◽

Shanti Patel ◽

Girish N. Nadkarni ◽

Jaime Uribarri

Keyword(s):

United States ◽

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Geographical Variation ◽

The United States ◽

Catheter Insertion ◽

Peritoneal Dialysis Catheter ◽

The West ◽

Esrd Patients

Peritoneal dialysis (PD) is an effective but underutilized renal replacement therapy modality. There are limited data regarding geographical variation in PD catheter insertion and utilization of PD as a first renal replacement therapy in the United States. We explored the variation in catheter insertion and initiation of PD utilizing 2 large, nationally representative databases. The incidence of catheter insertion differed significantly by geographical region, being highest in the South (7.30/100 end-stage renal disease [ESRD] patients; 95% confidence [CI] interval 6.78 – 7.81) and lowest in the West (5.91/100 ESRD patients; 95% CI 5.43 – 6.38). Peritoneal dialysis initiation also differed by region, being highest in the West (7.10/100 ESRD patients; 95% CI 6.83 – 7.30) and lowest in the Northeast (5.12/100 ESRD patients; 95% CI 4.87 – 5.30). Interestingly, the Northeast region, with the lowest rate of PD utilization, had the highest number of nephrologists per population (3.95/100,000 persons), and the West, with the highest PD utilization, had the lowest number of nephrologists (2.54/100,000 persons). Reasons for this variation should be explored further and efforts should be made to standardize PD implementation throughout the United States.

Download Full-text