scholarly journals KDOQI US Commentary on the 2020 ISPD Practice Recommendations for Prescribing High-Quality Goal-Directed Peritoneal Dialysis

2020 ◽  
Author(s):  
Isaac Teitelbaum ◽  
Joel Glickman ◽  
Alicia Neu ◽  
Joanna Neumann ◽  
Matthew B. Rivara ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
High Quality ◽  
Practice Recommendations

scholarly journals International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis

2020 ◽  
Vol 40 (3) ◽  
pp. 244-253 ◽  
Author(s):  
Edwina A Brown ◽  
Peter G Blake ◽  
Neil Boudville ◽  
Simon Davies ◽  
Javier de Arteaga ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
International Society ◽  
High Quality ◽  
Practice Recommendations

scholarly journals Recommandations de pratique de la Société internationale de dialyse péritonéale: prescrire une dialyse péritonéale de haute qualité dirigée par un objectif

2020 ◽  
Vol 3 (1) ◽  
pp. 5-18
Author(s):  
Max Dratwa ◽  
Christian Verger
Keyword(s):  
Peritoneal Dialysis ◽  
Open Access ◽  
International Society ◽  
High Quality ◽  
Creative Commons ◽  
Practice Recommendations

En Janvier 2020 la Société Internationale de Dialyse Péritonéale a publié en "open access" ses dernières recommandations pour prescrire une dialyse péritonéale de haute qualité dirigée par un objectif . Ces recommandations sont un guide important pour les équipes médicales, infirmières de tous les pays.  Elles sont d'emblée traduite en pluiseurs langus afin d'assurer la meilleure diffusion possible. Comme lors de précédents récommandations  le Registre de Dialyse Péritonéale de Langue Française  (RDPLF) a assuré la traduction de ce texte. Pour toute référence dans une publication, il est indispensable que seul le texte original soit cité :International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysisEdwina A Brown, Peter G Blake, Neil Boudville et al. https://journals.sagepub.com/doi/10.1177/0896860819895364Au nom de la communauté néphrologique francophone nous remercions chaleureusement l'ISPD de nous avoir accordé l'autorisation de réaliser cette traduction. Cette traduction adhère au copyright de la version originale anglaise. Ce(tte) œuvre est mise à disposition selon les termes de la Licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.

Volume management as a key dimension of a high-quality PD prescription

2020 ◽  
Vol 40 (3) ◽  
pp. 282-292 ◽  
Author(s):  
Angela Yee-Moon Wang ◽  
Jie Dong ◽  
Xiao Xu ◽  
Simon Davies
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Clinical Care ◽  
Small Sample ◽  
Volume Status ◽  
Volume Control ◽  
High Quality ◽  
Volume Management ◽  
Residual Kidney Function

Background: Appropriate volume control is one of the key goals in a peritoneal dialysis (PD) prescription. As such it is an important component of the International Society of Peritoneal Dialysis (ISPD) guideline for “High-quality PD prescription” necessitating a review of the literature on volume management. The workgroup recognized the importance of including within its scope measures of volume status and blood pressure in prescribing high-quality PD therapy. Methods: A Medline and PubMed search for publications addressing volume status and its management in PD since the publication of the 2015 ISPD Adult Cardiovascular and Metabolic Guidelines, from October 2014 through to July 2019, was conducted. Results: There were no randomized controlled trials on blood pressure intervention and six randomized trials of bioimpedance-guided volume management. Generally, all studies were of small sample size, short duration, and used surrogate markers as primary outcomes. As a consequence, only “practice points” were drawn. High-quality goal-directed PD prescription should aim to achieve and maintain clinical euvolemia taking residual kidney function and its preservation into account, so that both fluid removal from peritoneal ultrafiltration and urine output are considered and residual kidney function is not compromised. Blood pressure should be included as a key objective parameter in assessing the quality of PD prescription but there is currently no evidence for a specific target in PD. Clinical examination remains the keystone of routine clinical care. Conclusions: High-quality goal-directed PD prescription should include volume management as one of the key dimensions.

scholarly journals An Environmental Scan and Evaluation of Home Dialysis Quality Indicators Currently Used in Canada

2020 ◽  
Vol 7 ◽  
pp. 205435812097739
Author(s):  
Lisa Dubrofsky ◽  
Ali Ibrahim ◽  
Karthik Tennankore ◽  
Krishna Poinen ◽  
Sachin Shah ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Peritoneal Dialysis ◽  
Quality Indicators ◽  
Patient Centered ◽  
High Quality ◽  
Home Dialysis ◽  
Environmental Scan ◽  
Starting Point

Background: Quality indicators are important tools to measure and ultimately improve the quality of care provided. Performance measurement may be particularly helpful to grow disciplines that are underutilized and cost-effective, such as home dialysis (peritoneal dialysis and home hemodialysis). Objective: To identify and catalog home dialysis quality indicators currently used in Canada, as well as to evaluate these indicators as a starting point for future collaboration and standardization of quality indicators across Canada. Design: An environmental scan of quality indicators from provincial organizations, quality organizations, and stakeholders. Setting: Sixteen-member pan-Canadian panel with expertise in both nephrology and quality improvement. Patients: Our environmental scan included indicators relevant to patients on home dialysis. Measurements: We classified existing indicators based on the Institute of Medicine (IOM) and Donabedian frameworks. Methods: To evaluate the indicators, a 6-person subcommittee conducted a modified version of the Delphi consensus technique based on the American College of Physicians/Agency for Healthcare Research and Quality criteria. We shared these consensus ratings with the entire 16-member panel for further examination. We rated items from 1 to 9 on 6 domains (1-3 does not meet criteria to 7-9 meets criteria) as well as a global final rating (1-3 unnecessary to 7-9 necessary) to distinguish high-quality from low-quality indicators. Results: Overall, we identified 40 quality indicators across 7 provinces, with 22 (55%) rated as “necessary” to distinguish high quality from poor quality care. Ten indicators were measured by more than 1 province, and 5 of these indicators were rated as necessary (home dialysis prevalence, home dialysis incidence, anemia target achievement, rates of peritonitis associated with peritoneal dialysis, and home dialysis attrition). None of these indicators captured the IOM domains of timely, patient-centered, or equitable care. Limitations: The environmental scan is a nonexhaustive list of quality indicators in Canada. The panel also lacked representation from patients, administrators, and allied health professionals. Conclusions: These results provide Canadian home dialysis programs with a starting point on how to measure quality of care along with the current gaps. This work is an initial and necessary step toward future collaboration and standardization of quality indicators across Canada, so that home dialysis programs can access a smaller number of highly rated balanced indicators to motivate and support patient-centered quality improvement initiatives.

Swimming on Peritoneal Dialysis: Recommendations from Australian PD Units

2019 ◽  
Vol 39 (6) ◽  
pp. 527-531 ◽  
Author(s):  
Anna Lee
Keyword(s):  
Peritoneal Dialysis ◽  
Cross Section ◽  
Best Practice ◽  
Sea Water ◽  
Risk Of Infection ◽  
Exit Site ◽  
Practice Recommendations ◽  
Increased Risk ◽  
Almost All ◽  
Infective Complications

Background There is no evidence to support the need for protection of the peritoneal dialysis (PD) catheter and exit site for people on PD who want to swim. Swimming with a PD catheter is perceived to potentially put that person at increased risk of infection. Objectives of this study were to determine the proportion of Australian PD units supporting swimming for people on PD, recommendations made to protect the PD catheter, and exit site and any subsequent infective complications. Method Phone surveys were conducted with PD nurses from a cross section of 39 Australian PD units. Results Almost all units reported that patients on PD do swim despite only 77% of units advocating swimming. Swimming in sea water (85%) or a private swimming pool (90%) is mostly recommended. Covering the exit site and PD catheter is recommended with a waterproof film dressing or colostomy bag. Performing routine exit-site care after swimming is recommended (100%). There were 7 reported exit-site infections and 2 episodes of peritonitis perceived to be associated with swimming with a PD catheter. Conclusion Most PD units in Australia report that patients on PD swim. Swimming is recommended in either sea water or private swimming pools. The PD catheter and exit site should be covered with either a clear waterproof dressing or colostomy bag. Routine exit-site care should be performed after swimming. Infections were rarely reported in those who swim. Until further research is available, best practice recommendations are warranted for the safety of those on PD who want to swim.

Prescribing high-quality peritoneal dialysis: Moving beyond urea clearance

2020 ◽  
Vol 40 (3) ◽  
pp. 293-301
Author(s):  
Tamara Glavinovic ◽  
Helen Hurst ◽  
Alastair Hutchison ◽  
Lina Johansson ◽  
Nicola Ruddock ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Poor Correlation ◽  
Potential Importance ◽  
Urea Clearance ◽  
High Quality ◽  
Dialysis Adequacy ◽  
Electrolyte Disturbances ◽  
History Of ◽  
Primary Measure ◽  
Multidimensional Concept

Urea removal in peritoneal dialysis (PD) has been a primary measure of dialysis adequacy, but its utility remains limited due to its poor correlation with the clearance of other important uraemic retention solutes and the low certainty of evidence relating peritoneal urea clearance and survival of individuals doing PD. Indeed, clearances of other uraemic solutes, electrolyte imbalances, hypoalbuminaemia and nutritional status, may provide a more holistic measure of dialysis adequacy when evaluating individuals on PD in addition to focusing on person-centred outcomes. Here, we review the history of the urea and creatinine-centric approach to dialysis adequacy and explore the potential importance of other uraemic retention solutes, electrolyte disturbances, phosphorus control, peritoneal protein losses and hypoalbuminaemia, as well as nutritional management to promote a broader multidimensional concept of clearance for PD.

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