Impact of contraindications, barriers to self-care and support on incident peritoneal dialysis utilization

Background Chronic renal failure and aging are suggested as risk factors for cognitive impairment (CI). We studied the prevalence of CI among peritoneal dialysis (PD) patients using Montreal Cognitive Assessment (MoCA), its impact on PD-related peritonitis in the first year, and the potential role of assisted PD. Methods One hundred fourteen patients were newly started on PD between February 2011 and July 2013. Montreal Cognitive Assessment was performed in the absence of acute illness. Data on patient characteristics including demographics, comorbidities, blood parameters, dialysis adequacy, presence of helpers, medications, and the number PD-related infections were collected. Results The age of studied patients was 59±15.0 years, and 47% were female. The prevalence of CI was 28.9%. Patients older than 65 years old (odds ratio [OR] 4.88, confidence interval [CI] 1.79 – 13.28 p = 0.002) and with an education of primary level or below (OR 4.08, CI 1.30 – 12.81, p = 0.016) were independent risk factors for CI in multivariate analysis. Patients with PD-related peritonitis were significantly older ( p < 0.001) and more likely to have CI as defined by MoCA ( p = 0.035). After adjustment for age, however, CI was not a significant independent risk factor for PD-related peritonitis among self-care PD patients (OR 2.20, CI 0.65 – 7.44, p = 0.20). When we compared patients with MoCA-defined CI receiving self-care and assisted PD, there were no statistically significant differences between the 2 groups in terms of age, MoCA scores, or comorbidities. There were also no statistically significant differences in 1-year outcome of PD-related peritonitis rates or exit-site infections. Conclusion Cognitive impairment is common among local PD patients. Even with CI, peritonitis rate in self-care PD with adequate training is similar to CI patients on assisted PD.

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Evaluation of A 12-Month Pilot of Long-Term and Temporary Assisted Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00201 ◽

2017 ◽

Vol 37 (3) ◽

pp. 307-313 ◽

Cited By ~ 9

Author(s):

Micheli U. Bevilacqua ◽

Linda Turnbull ◽

Sushila Saunders ◽

Lee Er ◽

Helen Chiu ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Cost Minimization ◽

Functional Limitations ◽

Self Care ◽

Cost Effective ◽

Term Care ◽

Technique Survival ◽

Temporary Support ◽

Program Costs

Background Peritoneal dialysis (PD) is challenging for patients with functional limitations, and assisted PD can support these patients, but previous reports of assisted PD have not examined the role of temporary assisted PD and had difficulty identifying adequate comparator cohorts. Methods Peritoneal Dialysis Assist (PDA), a 12-month pilot of long-term and temporary assisted PD was completed in multiple PD centers in British Columbia, Canada. Continuous cycler PD (CCPD) patients were identified for PDA by standardized criteria, and service could be long-term or temporary/respite. The PDA program provided daily assistance with cycler dismantle and setup, but patients remained responsible for cycler connections and treatment decisions. Outcomes were compared against both the general CCPD population and patients who met PDA criteria but were not enrolled (PDA-eligible). Results Fifty-three PDA patients had an 88% 1-year death- and transplant-censored technique survival that was similar to the general CCPD cohort (84%) and PDA-eligible cohort (86%). The PDA cohort had lower peritonitis rates (0.18 episodes/patient-year vs 0.22 and 0.36, respectively), but higher hospitalization (55% vs 34% and 35%, respectively). Long-term PDA cost approximately CDN$15,000/year in addition to existing dialysis costs. A total of 8/11 respite PDA patients (73%) returned to self-care PD after a median PDA use of 29 days, which costs $1,250/patient. Conclusions Peritoneal Dialysis Assist provides effective support to functionally-limited CCPD patients and yields acceptable clinical outcomes. The program costs less than transfer to HD or long-term care, which represents cost minimization for failing self-care PD patients. Respite PDA provides effective temporary support; most patients returned to self-care PD and service was cost-effective compared with alternatives of hospitalization or transfer to HD.

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Is Transition between Peritoneal Dialysis and Hemodialysis Really a Gradual Process?

Peritoneal Dialysis International ◽

10.3747/pdi.2011.00134 ◽

2013 ◽

Vol 33 (4) ◽

pp. 391-397 ◽

Cited By ~ 19

Author(s):

Lucie Boissinot ◽

Isabelle Landru ◽

Eric Cardineau ◽

Elie Zagdoun ◽

Jean-Philippe Ryckelycnk ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Median Duration ◽

Charlson Comorbidity Index ◽

Transition Period ◽

Self Care ◽

Interquartile Range ◽

Median Score ◽

Gradual Process ◽

Duration Of Hospitalization ◽

Comorbidity Index

BackgroundTransfer to hemodialysis (HD) is a frequent cause of peritoneal dialysis (PD) cessation. In the present study, we set out to describe the transition period between PD and HD.MethodsAll patients in 4 centers of Basse-Normandie who had been treated with PD for more than 90 days and who were permanently transferred to HD between 1 January 2005 and 31 December 2009 were retrospectively reviewed. The rate of unplanned HD start was evaluated.ResultsIn the 60 patients (39 men, 21 women) included in the study, median score on the Charlson comorbidity index at PD initiation was 5 [interquartile range (IQR): 3 – 7], median age at HD initiation was 62 years (IQR: 54 – 76 years), and median duration on PD was 22 months (IQR: 12 – 36 months). Among the 60 patients, 37 had an unplanned HD initiation. Peritonitis was the most frequent cause of unplanned HD start ( n = 20), and dialysis inadequacy ( n = 11), the main cause of planned HD start. During the transition period, all patients were hospitalized. Median duration of hospitalization was 4.5 days (IQR: 0 – 25.5 days). Within 2 months after HD initiation, 9 patients died. Two months after starting HD, 6 of the remaining 51 patients were being treated in a self-care HD unit and only 23 patients had a mature fistula.ConclusionsUnplanned HD start is a common problem in patients transferred from PD. Further studies are needed to improve the rate of planned HD start in PD patients transferred to HD.

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VIVÊNCIA DO FAMILIAR NA QUALIDADE DE CUIDADOR RESPONSÁVEL PELA DIÁLISE PERITONEAL DOMICILIAR: BASEADO NA TEORIA DO AUTOCUIDADO / EXPERIENCE OF THE FAMILY MEMBER AS THE CAREGIVER RESPONSIBLE FOR PERITONEAL DIALYSIS AT HOME: BASED ON THE THEORY OF SELF-CARE

Brazilian Journal of Development ◽

10.34117/bjdv6n10-200 ◽

2020 ◽

Vol 6 (10) ◽

pp. 76809-76827

Author(s):

Tamires de Nazaré Soares ◽

Kamille Giovanna Gomes Henriques ◽

Milene Gouvêa Tyll ◽

Amanda Christina Monteiro Souza ◽

Eliette Assunção e Silva ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Family Member ◽

Self Care ◽

Home Based ◽

The Family ◽

At Home

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"How We Speak, How We Think, What We Do: Leading Intersectional Feminist Conversations in Libraries" in Feminists Among Us Resistance and Advocacy in Library Leadership, ed. Shirley Lew and Baharak Yousefi, Library Juice Press, 2017

10.31229/osf.io/w54td ◽

2019 ◽

Author(s):

Rachel Fleming ◽

Kelly Rhodes

Keyword(s):

Self Care ◽

General State ◽

Vital Importance ◽

Diversity And Inclusion ◽

Library Leadership ◽

Care And Support ◽

Library Profession ◽

The Way

This chapter is an exploration of the general state of conversations about diversity and inclusion in libraries and the library profession as viewed by the authors. The authors explore strategies for building awareness and being intentional about what we do and don’t do within the library profession related to diversity and inclusion; discuss the importance of contextualizing conversations about diversity, inclusion, and oppression in the workplace; examine issues such as microaggressions and fragility; address how we deal with our own hang ups; discuss the vital importance of self-care and support; and identify suggestions for leading the way forward.

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Assessment for Assisted Peritoneal Dialysis by Peritoneal Dialysis Nurses: Results of a Cohort Study

American Journal of Nephrology ◽

10.1159/000503622 ◽

2019 ◽

Vol 50 (6) ◽

pp. 489-498 ◽

Cited By ~ 2

Author(s):

Sonia Guillouët ◽

Annabel Boyer ◽

Antoine Lanot ◽

Maxence Ficheux ◽

Thierry Lobbedez ◽

...

Keyword(s):

Peritoneal Dialysis ◽

National Level ◽

Self Care ◽

Subjective Assessment ◽

French Language ◽

Relative Risks ◽

Dialysis Nurses ◽

Selection Of Patients ◽

Assisted Peritoneal Dialysis ◽

Selection Of

Background: Selection of patients for assisted peritoneal dialysis (PD) is based on the nurse’s assessment of the patient. There is no data available about the nurse’s assessment of the PD patient at the initiation of PD to estimate the need for assisted PD at the national level. This study was carried out to evaluate the association between the nurse’s subjective assessment of the patient’s inability to be treated by self-care PD, the nurse evaluation of the patient disabilities and the utilization of nurse or family assisted PD. Methods: This was a retrospective study of patients starting PD between July 1, 2010 and 2015 and registered in the nurse section of the French Language PD Registry (RDPLF). Poisson regression and a linear regression model with a robust variance estimator were used for the statistical analysis to determine relative risks (RRs) and risk differences (RDs). Results: Of 4,101 PD patients, 403 were treated by family assisted PD, and 1,695 were treated by nurse-assisted PD. In the multivariate analysis, the nurse’s subjective assessment of the patient’s inability to be treated by self-care PD was associated with nurse-assisted PD (5.40 [4.58–6.35], 67% [64–70%]) and family assisted PD (11.11 [8.49–14.56], RD 62% [57–67%]). Nurse-assisted PD and family assisted PD were associated with functional impairment (RR 1.25 [95% CI 1.16–1.36], RD 14% [95% CI 10–19%] and RR 2.02 [95% CI 1.69–2.41], RD 27% [95% CI 20–34%] respectively), cognitive dysfunction (RR 1.23 [95% CI 1.15–1.32], RD 15% [95% CI 11–18%] and RR 1.73 [95% CI 1.39–2.16], RD 12% [95% CI 7–18%] respectively) and deafness (RR 1.10 [95% CI 1.04–1.16], RD 8% [95% CI 5–11%] and RR 1.46 [95% CI 1.22–1.74], RD 10% [95% CI 6–14%] respectively). Conclusion: Our results showed that the nurse’s subjective assessment of the patient’s inability to be treated by self-care PD and the patient’s disabilities were strongly associated with the utilization of nurse- and family assisted PD.

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