MO706PATIENTS AND CENTER-RELATED FACTORS IN PERIOTONEAL CHOICE IN INCIDENT PATIENTS: A REGIONAL EXPERIENCE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Vincenzo Antonio Panuccio ◽  
Giovanna Parlongo ◽  
Rocco Tripepi ◽  
Giovanni Luigi Tripepi ◽  
Paola Cianfrone ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Venous Catheter ◽  
Dialysis Access ◽  
Related Factors ◽  
Early Referral ◽  
Dialysis Treatment ◽  
Outpatient Program ◽  
Dialytic Modality ◽  
Late Referral

Abstract Background and Aims Effective outpatient organization is essential in the management of patients with chronic kidney disease. Although peritoneal dialysis (PD) has many advantages it is still not popular. Method The aim of this study was to evaluate patient and center-related factors that affect the final choice of peritoneal dialysis (PD) versus hemodialysis (HD) in the Calabrian region (Italy). We analyzed 2 annual regional surveys performed by nephrologists (2017 and 2018) in incident dialysis patients. Collected factors included: early and late referral to the dialysis program, pre-dialysis participation in outpatient visits, first dialysis access [peritoneal catheter (PC), central venous catheter (CVC), arteriovenous fistula (AVF)], final dialysis treatment (HD or PD) and the care giver. Results The study sample included 296 incident patients (63% males) aged 66±15 years. Time to referral influenced the type of first dialysis access. Among patients with early referral, 35% initiated dialysis by a PC, 34% by AVF and 31% by CVC, while among those with late referral, only 5% started dialysis by a PC, 15% by AVF, and the majority (80%) by CVC (P<0.001). Time to referral was also associated with pre-dialysis visits (34%, 33% and 34% versus 5%, 22% and 73%, respectively, P<0.001). When evaluating clinical suitability for treatment modality, 54% of early referrals and 45% of late referrals were eligible for PD. The choice of dialytic modality was again related to time to referral: 38% with early referral chose PD compared to 15% of those with late referral (P<0.001). Furthermore, in patients who participated in the pre-dialysis program, 38% started PD versus 11% of patients that did not participate (P<0.001). The role of the caregiver remains uncertain. Conclusion These data confirm that a more attentive and dedicated organization of the pre-dialysis outpatient program would contribute to a greater expansion of the peritoneal dialysis program.

scholarly journals Brazilian dialysis survey 2019

2021 ◽  
Author(s):  
Precil Diego Miranda de Menezes Neves ◽  
Ricardo de Castro Cintra Sesso ◽  
Fernando Saldanha Thomé ◽  
Jocemir Ronaldo Lugon ◽  
Marcelo Mazza Nascimento
Keyword(s):  
Peritoneal Dialysis ◽  
Venous Catheter ◽  
Serum Levels ◽  
Absolute Number ◽  
Incidence Rates ◽  
Red Blood Cell Transfusion ◽  
Dialysis Access ◽  
Online Questionnaire ◽  
Dialysis Treatment ◽  
Number Of Patients

Abstract Introduction: National data on chronic dialysis treatment are essential for the development of health policies that aim to improve the treatment of patients. Objective: To present data from the Brazilian Dialysis Survey 2019, promoted by the Brazilian Society of Nephrology. Methods: Data collection from dialysis units in the country through a completed online questionnaire for 2019. Results: 314 (39%) centers responded the questionnaire. In July 2019, the estimated total number of patients on dialysis was 139,691. Estimates of the prevalence and incidence rates of patients undergoing dialysis treatment per million of the population (pmp) were 665 and 218, respectively, with mean annual increases of 25 pmp and 14 pmp for prevalence and incidence, respectively. The annual gross mortality rate was 18.2%. Of the prevalent patients, 93.2% were on hemodialysis and 6.8% on peritoneal dialysis; and 33,015 (23.6%) on the waiting list for transplantation. 55% of THE centers offered treatment with peritoneal dialysis. Venous catheters were used as access in 24.8% of THE patients on hemodialysis. 17% of the patients had K ≥ 6.0mEq/L; 2.5% required red blood cell transfusion in July 2019 and 10.8% of the patients had serum levels of 25-OH vitamin D < 20 ng/mL. Conclusion: The absolute number of patients, the incidence and prevalence rates in dialysis in the country continue to increase, as well as the percentage of patients using venous catheter as dialysis access. There was an increase in the number of patients on the list for transplantation and a tendency to reduce gross mortality.

scholarly journals Infrastructure Requirements for an Urgent-Start Peritoneal Dialysis Program

2013 ◽  
Vol 33 (6) ◽  
pp. 611-617 ◽  
Author(s):  
Arshia Ghaffari ◽  
Vijay Kumar ◽  
Steven Guest
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Treatment Approach ◽  
Clinical Pathways ◽  
Venous Catheter ◽  
Central Venous ◽  
Advanced Chronic Kidney Disease ◽  
Flow Disturbances ◽  
Late Referral ◽  
Subsequent Replacement

Patients with advanced chronic kidney disease nearing dialysis but without pre-established access almost uniformly initiate dialysis with a temporary central venous catheter. These catheters are associated with high rates of infection and flow disturbances, requiring removal and subsequent replacement. Many of these patients might be candidates for peritoneal dialysis (PD), but because of the absence of prior catheter placement, the default initial modality is hemodialysis. Recent reports, however, have demonstrated the feasibility of initiating PD urgently despite the late referral for access placement. Urgent-start PD clinical pathways require a unique infrastructure and treatment approach. This article reviews the salient features required to establish an urgent-start PD program.

scholarly journals Effects of Early Frequent Nephrology Care on Emergency Department Visits among Patients with End-stage Renal Disease

2019 ◽  
Vol 16 (7) ◽  
pp. 1158
Author(s):  
Yun-Yi Chen ◽  
Likwang Chen ◽  
Jenq-Wen Huang ◽  
Ju-Yeh Yang
Keyword(s):  
Emergency Department ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Lower Risk ◽  
Early Referral ◽  
Dialysis Treatment ◽  
Nephrology Care ◽  
Stage Renal Disease ◽  
End Stage ◽  
Late Referral

In this retrospective cohort study, we examined the association between predialysis nephrology care status and emergency department (ED) events among patients with end-stage renal disease. Data pertaining to 76,702 patients who began dialysis treatment between 1999 and 2010 were obtained from the National Health Insurance Research Database of Taiwan (NHIRD). The patients were divided into three groups based on the timing of the first nephrology care visit prior to the initiation of maintenance dialysis, and the frequency of nephrologist visits (i.e., early referral/frequent consultation, early referral/infrequent consultation, late referral). At 1-year post-dialysis initiation, a large number of the patients had experienced at least one all-cause ED visit (58%), infection-related ED visit (17%), or potentially avoidable ED visit (7%). Cox proportional hazard models revealed that patients who received early frequent care faced an 8% lower risk of all-cause ED visit (HR: 0.92; 95% CI: 0.90–0.94), a 24% lower risk of infection-related ED visit (HR: 0.76; 95% CI: 0.73–0.79), and a 24% lower risk of avoidable ED visit (HR: 0.76; 95% CI: 0.71–0.81), compared with patients in the late referral group. With regard to the patients undergoing early infrequent consultations, the only marginally significant association was for infection-related ED visits. Recurrent event analysis revealed generally consistent results. Overall, these findings indicate that continuous nephrology care from early in the predialysis period could reduce the risk of ED utilization in the first year of dialysis treatment.

scholarly journals Cost Analysis of Hemodialysis and Peritoneal Dialysis Access in Incident Dialysis Patients

2013 ◽  
Vol 33 (6) ◽  
pp. 662-670 ◽  
Author(s):  
Luis A. Coentrão ◽  
Carla S. Araújo ◽  
Carlos A. Ribeiro ◽  
Claúdia C. Dias ◽  
Manuel J. Pestana
Keyword(s):  
Peritoneal Dialysis ◽  
First Year ◽  
Dialysis Access ◽  
Demographic Information ◽  
Dialysis Treatment ◽  
Intention To Treat ◽  
The Mean ◽  
Adjusted Rate ◽  
Rate Ratios ◽  
Access Complications

BackgroundAlthough several studies have demonstrated the economic advantages of peritoneal dialysis (PD) over hemodialysis (HD), few reports in the literature have compared the costs of HD and PD access. The aim of the present study was to compare the resources required to establish and maintain the dialysis access in patients who initiated HD with a tunneled cuffed catheter (TCC) or an arteriovenous fistula (AVF) and in patients who initiated PD.MethodsWe retrospectively analyzed the 152 chronic kidney disease patients who consecutively initiated dialysis treatment at our institution in 2008 (HD-AVF, n = 65; HD-CVC, n = 45; PD, n = 42). Detailed clinical and demographic information and data on access type were collected for all patients. A comprehensive measure of total dialysis access costs, including surgery, radiology, hospitalization for access complications, physician costs, and transportation costs was obtained at year 1 using an intention-to-treat approach. All resources used were valued using 2010 prices, and costs are reported in 2010 euros.ResultsCompared with the HD-AVF and HD-TCC modalities, PD was associated with a significantly lower risk of access-related interventions (adjusted rate ratios: 1.572 and 1.433 respectively; 95% confidence intervals: 1.253 to 1.891 and 1.069 to 1.797). The mean dialysis access–related costs per patient–year at risk were €1171.6 [median: €608.8; interquartile range (IQR): €563.1 – €936.7] for PD, €1555.2 (median: €783.9; IQR: €371.4 – €1571.7) for HD-AVF, and €4208.2 (median: €1252.4; IQR: €947.9 – €2983.5) for HD-TCC ( p < 0.001). In multivariate analysis, total dialysis access costs were significantly higher for the HD-TCC modality than for either PD or HD-AVF (β = –0.53; 95% CI: –1.03 to –0.02; and β = –0.50; 95% CI: –0.96 to –0.04).ConclusionsCompared with patients initiating HD, those initiating PD required fewer resources to establish and maintain a dialysis access during the first year of treatment.

Who Should Place Peritoneal Dialysis Catheters?

2010 ◽  
Vol 30 (2) ◽  
pp. 142-150 ◽  
Author(s):  
John H. Crabtree
Keyword(s):  
Peritoneal Dialysis ◽  
Training Programs ◽  
The United States ◽  
Fellowship Training ◽  
Catheter Placement ◽  
Medical Society ◽  
Dialysis Access ◽  
Surgical Workforce ◽  
Surgeon Performance

BackgroundNephrologists are often thwarted in their attempts to grow their peritoneal dialysis programs because of suboptimal surgeon performance in placing catheters. A rallying call is heard among nephrologists to step up to the role of dialysis access providers.ObjectiveWhat factors influence the practicability of nephrologists becoming primary dialysis access providers? Why have surgeons failed their task and can anything motivate them to change their performance and improve outcomes?MethodsWhile the issues are universal, this analysis focuses on current practice data from the United States. Evidence reviewed includes dialysis center size and annual new starts, profile of specialties performing catheter placement, nephrology workforce capacity, catheter implantation methodology, resource utilization for peritoneal access, and surgeon performance.ResultsThe current nephrology workforce is running at maximum capacity and fellowship training programs will struggle to meet additional demands. Nephrology training programs are often deficient in providing adequate experience in peritoneal dialysis management. Only 2.3% of peritoneal catheters are placed by nephrologists. The best catheter outcomes are produced by laparoscopic methods used by surgeons. Compared to other catheter placement techniques, laparoscopy enables a larger candidate pool of patients. Nonetheless, suboptimal surgical performances are related to inadequate training, low procedure volume, and poor reimbursement.ConclusionsIt is improbable that nephrologists can expand the scope of their practice to assume the additional role of dialysis access providers. The performance of the existing surgical workforce can be enhanced through medical society-sponsored educational activities, channeling access procedures to designated surgeons, and improved remuneration through outcomes-based incentive programs.

Dialysis access: issues related to conversion from peritoneal dialysis to hemodialysis and vice versa

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S41-S46 ◽  
Author(s):  
Maurizio Gallieni ◽  
Antonino Giordano ◽  
Anna Ricchiuto ◽  
Davide Gobatti ◽  
Maurizio Cariati
Keyword(s):  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Venous Catheter ◽  
Infectious Complications ◽  
Dialysis Access ◽  
Central Venous ◽  
Treatment Start ◽  
Alternative Approach ◽  
Stage Renal Disease ◽  
End Stage

Hemodialysis (HD) and peritoneal dialysis (PD) represent two complementary modalities of renal replacement therapy (RRT) for end-stage renal disease patients. Conversion between the two modalities is frequent and more likely to happen from PD to HD. Every year, 10% of PD patients convert to HD, suggesting the need for recommendations on how to proceed with the creation of a vascular access in these patients. Criteria for selecting patients who would likely fail PD, and therefore take advantage of a backup access, are undefined. Creating backup fistulas at the time of PD treatment start to allow emergency access for HD has proved to be inefficient, but it may be considered in patients with progressive difficulty in achieving adequate depuration and/or peritoneal ultrafiltration. A big challenge is represented by patients switching from PD to HD for unexpected infectious complications. Those patients need to start HD with a central venous catheter (CVC), but an alternative approach might be using an early cannulation graft, provided that infection has been cleared by the circulation. An early cannulation graft might also be used to considerably shorten the time spent using a CVC. In patients who need a conversion from HD to PD, urgent-start PD is now an accepted and well-established approach.

scholarly journals Peritoneal Dialysis as an Urgent-Start Option for Incident Patients on Chronic Renal Replacement Therapy: World Experience and Review of Literature

2020 ◽  
Vol 49 (6) ◽  
pp. 652-657 ◽  
Author(s):  
Dayana Bittencourt Dias ◽  
Marcela Lara Mendes ◽  
Camila Albuquerque Alves ◽  
Jacqueline Teixeira Caramori ◽  
Daniela Ponce
Keyword(s):  
Peritoneal Dialysis ◽  
Observational Studies ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Cost Effective ◽  
Initial Time ◽  
Dialysis Access ◽  
Review Of Literature ◽  
Collective Experience ◽  
Cost Effective Alternative

Chronic kidney disease is a significant problem of public health worldwide, and up to 60% of patients start dialysis in an unplanned manner without a definitive dialysis access. Recently, peritoneal dialysis (PD) has emerged as an alternative to unplanned chronic dialytic method, and the world collective experience shows that PD can be an efficient, safe, and cost-effective alternative with comparable outcomes to the planned PD and urgent-start hemodialysis (HD). More importantly, as compared to urgent-start HD using a central venous catheter, urgent-start PD has significantly fewer incidences of catheter-related bloodstream infections, dialysis-related mechanical complications, and need for dialysis catheter reinsertions during the initial time of the therapy. An integrative review was conducted on PD urgent start compared to HD urgent start and to planned PD, identifying its potential advantages and limitations. Literature search was performed within multiple databases, and observational studies on clinical experience with urgent PD were reviewed and appraised.

Peritoneal Dialysis in Africa

2010 ◽  
Vol 30 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Hasan Abu-Aisha ◽  
Sarra Elamin
Keyword(s):  
Peritoneal Dialysis ◽  
South African ◽  
Rural Setting ◽  
North African ◽  
African Countries ◽  
Dialysis Treatment ◽  
Improved Sanitation ◽  
North African Countries ◽  
Living Circumstances

BackgroundAfrica is the world's second-largest and second most populous continent. It is also the poorest and most underdeveloped continent. Struggling to provide the essential health interventions for its occupants, the majority of African countries cannot regard renal replacement therapy a health priority.ReviewIn 2007, Africa's dialysis population constituted only 4.5% of the world's dialysis population, with a prevalence of 74 per million population (pmp), compared to a global average of 250 pmp. In almost half the African countries, no dialysis patients are reported. The prevalence of peritoneal dialysis (PD) was 2.2 pmp, compared to a global prevalence of 27 pmp, with the bulk of African PD patients (85%) residing in South Africa. In North African countries, which serve 93% of the African dialysis population, the contribution of PD to dialysis is only 0% – 3%. Cost is a major factor affecting the provision of dialysis treatment and many countries are forced to ration dialysis therapy. Rural setting, difficult transportation, low electrification rates, limited access to improved sanitation and improved water sources, unsuitable living circumstances, and the limited number of nephrologists are obstacles to the provision of PD in many countries.ConclusionThe potential for successful regular PD programs in tropical countries has now been well established. Cost is a major prohibitive factor but the role of domestic manufacture in facilitating widespread use of PD is evidenced by the South African example. Education and training are direly needed and these are areas where international societies can be of great help.

scholarly journals Success of Urgent-Start Peritoneal Dialysis in a Large Canadian Renal Program

2016 ◽  
Vol 36 (2) ◽  
pp. 171-176 ◽  
Author(s):  
Ali M.A. Alkatheeri ◽  
Peter G. Blake ◽  
Daryl Gray ◽  
Arsh K. Jain
Keyword(s):  
Peritoneal Dialysis ◽  
Venous Catheter ◽  
Infectious Complications ◽  
Outpatient Setting ◽  
Dialysis Access ◽  
Safe Alternative ◽  
Canadian Experience ◽  
Academic Center ◽  
Alternative Approach ◽  
A Minor

BackgroundMany patients start renal replacement therapy urgently on in-center hemodialysis via a central venous catheter, which is considered suboptimal. An alternative approach to manage these patients is to start them on peritoneal dialysis (PD). In this report, we describe the first reported Canadian experience with an urgent-start PD program. Additionally we reviewed the literature in this area.MethodsIn this prospective observational study, we report on our experience in a single academic center. This program started in July 2010. We included patients who initiated PD urgently, that is within 2 weeks of catheter insertion. We followed all incident PD patients until October 2013 for mechanical and infectious complications. Peritoneal dialysis catheters were inserted either percutaneously or laparoscopically and dialysis was initiated in either an inpatient or outpatient setting.ResultsThirty patients were started on urgent PD during our study period. Follow-up ranged from 28 to 1,050 days. Twenty insertions (66.7 %) were done percutaneously and 10 (33.3%) were laparoscopic. Dialysis was initiated within 2 weeks (range: 0 – 13 days, median = 6 days). Twenty-four patients (80%) started PD in an outpatient setting and 6 patients (20%) required immediate inpatient PD start. Three patients (10%) developed a minor peri-catheter leak during the first week of training that was managed conservatively. There were no episodes of peritonitis or exit-site/tunnel infection during the first 4 weeks post-insertion. Four patients (13.3 %) from the percutaneous insertion group and 2 patients (6.7%) from laparoscopic insertions developed catheter dysfunction due to migration, which was managed by repositioning, without need for catheter replacement or modality switch.ConclusionsOur results are consistent with other studies in this area and demonstrate that urgent-start PD is an acceptable and safe alternative to hemodialysis in patients who need to start dialysis urgently without established dialysis access.

scholarly journals Early Referral to Nephrological Care and the Uptake of Peritoneal Dialysis. An Analysis of German Claims Data

2021 ◽  
Vol 18 (16) ◽  
pp. 8359
Author(s):  
Isabell Schellartz ◽  
Sunita Mettang ◽  
Arim Shukri ◽  
Nadine Scholten ◽  
Holger Pfaff ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Peritoneal Dialysis ◽  
Claims Data ◽  
Multivariate Logistic Regression Model ◽  
Symptomatic Therapy ◽  
Multivariate Logistic Regression ◽  
Early Referral ◽  
Dialysis Treatment ◽  
The Impact ◽  
Nephrological Care

Background: Hemodialysis (HD) and peritoneal dialysis (PD) are medically equivalent alternatives for symptomatic therapy of end-stage renal disease (ESRD). An early referral (ER) of patients with chronic kidney disease (CKD) to a nephrological specialist is associated with a higher proportion of patients choosing PD. Germany historically shows a low PD uptake. This article is the first investigation into the impact of ER on the uptake of PD, using a large German claims database. Methods: Claims data of 4727 incident dialysis patients in 2015 and 2016 were analyzed. Accounting codes for nephrological care and dialysis modalities were identified. Their first documentation was defined as their first encounter with a nephrologist and their first dialysis treatment (HD or PD). ER was determined as receiving nephrological care at least six months before the first dialysis. A multivariate logistic regression model with adjusted odds ratios (AOR) investigates the impact of ER, outpatient dialysis start, age, comorbidities, and sex on the chance for PD. Results: Forty-three percent were referred to the nephrologist six months before their first dialysis (ER). Single tests, as well as the adjusted multivariate logistic regression, highlighted that ER significantly increases the chance for PD. In the multivariate model, the uptake of PD was associated with ER (AOR = 3.05; p < 0.001; 95% CI = 2.16–4.32), outpatient dialysis start (AOR = 0.71; p = 0.044; 95% CI = 0.51–0.99), younger age (AOR = 0.96; p < 0.001; 95% CI = 0.95–0.97), and fewer comorbidities (AOR = 0.85; p < 0.001; 95% CI = 0.44–1.58). Conclusions: ER of patients with CKD to a nephrologist increases PD uptake. It gives both nephrologists and patients enough time for patient education about different treatment options and can contribute to informed decisions about the dialysis treatment.

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