Peritoneal Dialysis Membrane Evaluation in Clinical Practice

Pathophysiology of peritoneal ultrafiltration is analyzed in the present study. Peritoneal equilibration test is the easiest procedure to study in detail the possible causes of failure to control the ultrafiltration rate in patients undergoing peritoneal dialysis. Membrane failure, reduction in peritoneal blood flow, excessive lymphatic reabsorption catheter malposition, and fluid sequestration are the most common causes of ultrafiltration loss. Pharmacologic manipulation of peritoneal membrane, correction of mechanical inconvenients, reduction in peritonitis rate and in the level of immunostimulation of the mesotelial macrophages, together with a careful policy in terms of glucose concentration in the dialysate and dwell times may contribute not only to treat different forms of ultrafiltration loss but also to prevent their incidence.

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Impact of Peritoneal Dialysis Dose Guidelines on Clinical Outcomes

Peritoneal Dialysis International ◽

10.1177/089686080502503s24 ◽

2005 ◽

Vol 25 (3_suppl) ◽

pp. 95-98 ◽

Cited By ~ 7

Author(s):

David N. Churchill

Keyword(s):

Clinical Trials ◽

Peritoneal Dialysis ◽

Clinical Practice ◽

Adverse Effects ◽

Randomized Clinical Trials ◽

Intervention Group ◽

The United States ◽

Dialysis Dose ◽

Middle Molecules ◽

The Impact

The objective was to review the rationale for the Kidney Disease Outcomes Quality Initiative (K/DOQI) recommendations for adequacy of peritoneal dialysis and to evaluate the impact of these recommendations on clinical practice and patient survival. The K/DOQI recommendations were based on large observational studies; the target weekly Kt/V value of 2.0 assumed equivalence of peritoneal and renal clearances. This assumption is no longer considered correct. The impact on clinical practice was evaluated by an examination of temporal trends before and after publication of the guidelines in 1997. In the United States and The Netherlands, there had been a trend toward increased delivered total Kt/V prior to 1997, and there was no acceleration in this trend after 1997. Two randomized clinical trials have implemented these guidelines with increased peritoneal Kt/V (or creatinine clearance) used to achieve the K/DOQI target in the intervention group. This was not associated with improved survival, compared to a lower Kt/V, in either of the randomized clinical trials. Among the explanations for the failure to improve outcome are potential adverse effects of increasing the dialysis dose. These include increased intraperitoneal pressure associated with increased exchange volume, failure to increase clearance of middle molecules, and increased exposure to glucose. Strategies that increase peritoneal clearance without exposure to these potential adverse effects include more-frequent exchanges rather than increased exchange volume, and decreased exposure to glucose and glucose degradation products. Pending such studies, current K/DOQI guidelines should be updated in a timely manner.

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Peritoneal Dialysis in the Pacific

Peritoneal Dialysis International ◽

10.1177/089686089601601s86 ◽

1996 ◽

Vol 16 (1_suppl) ◽

pp. 448-451 ◽

Cited By ~ 1

Author(s):

Margaret J. King

Keyword(s):

Peritoneal Dialysis ◽

Clinical Practice ◽

Medical Condition ◽

Tertiary Education ◽

Research Quality ◽

Exit Site Infection ◽

Home Dialysis ◽

The Pacific ◽

Number Of Patients ◽

Management Issues

Peritoneal dialysis (PD) in the Pacific is the predominant dialysis modality for home dialysis patients. Patient location, age, personal preference, and medical condition are all taken into consideration. However, with the steadily increasing number of patients on PD, financial constraints are now affecting the nurse-patient ratios. As a consequence, PD nurses are constantly seeking new and improved clinical practice regimes with which they can provide and maintain quality, cost-effective nursing care. To enable PD nurses to provide such care, they are now, more than ever, Involved in patient, professional, and management issues. These patient issues include, but are not limited to: the elderly, the diabetic, the indigenous patient, and their carers, peritonitis, exit-site infection, and adequate dialysis. Professional issues include the development of standards of clinical practice, nursing research, quality improvement, and tertiary education. Management issues are constantly encroaching into the clinical practice setting, therefore the PD nurse must now justify spending, develop strategic plans, and meet annual budgets. In conclusion, it can be seen that PD nurses in the Pacific are faced with similar patient-care, professional, and management issues as their counterparts throughout the world.

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Peritoneal Morphology after Long-Term Peritoneal Dialysis with Biocompatible Fluid: Recent Clinical Practice in Japan

Peritoneal Dialysis International ◽

10.3747/pdi.2010.00234 ◽

2012 ◽

Vol 32 (2) ◽

pp. 159-167 ◽

Cited By ~ 35

Author(s):

Nobuhiro Ayuzawa ◽

Yoshitaka Ishibashi ◽

Yutaka Takazawa ◽

Haruki Kume ◽

Toshiro Fujita

Keyword(s):

Peritoneal Dialysis ◽

Clinical Practice ◽

University Hospital ◽

Dialysis Therapy ◽

Compact Zone ◽

Peritoneal Biopsy ◽

The Mean ◽

The Impact ◽

Peritoneal Morphology

♦BackgroundMorphology changes of the peritoneal membrane after long-term peritoneal dialysis (PD) consist of denudation of peritoneal mesothelial cells, interstitial sclerosis, and hyalinizing vasculopathy. Those changes are considered to be the result of uremia and bioincompatible effects of conventional acidic lactate-buffered dialysate with glucose degradation products (GDPs). In the last decade, biocompatible dialysate with neutral pH and low GDPs has become widely used. Clinical practice has been modified in Japan, especially for anuric patients, and now includes the use of hybrid therapy. The impact on peritoneal morphology has not been well reported.♦ ObjectiveThe aim of the present study was to investigate the long-term effect on peritoneal morphology and function of biocompatible fluid use and current clinical practice in Japan, including hybrid dialysis therapy.♦MethodsWe evaluated peritoneal biopsy specimens from patients who had undergone PD for more than 3 years. We used the average peritoneal thickness (APT) of the submesothelial compact zone as a marker of interstitial sclerosis and the lumen/vessel diameter ratio (L/V ratio) at postcapillary venules as a marker of hyalinizing vasculopathy. Demography and other data for the patients, including dialysate-to-plasma (D/P) ratio of creatinine, were obtained at baseline and every 6 months by peritoneal equilibration test.♦ResultsBetween 2002 and 2009, 110 patients started PD therapy with biocompatible dialysate at Tokyo University Hospital. Among them, 11 patients (8 men, 3 women; age: 54.2 ± 11.8 years; 1 with diabetes mellitus) were enrolled into this morphology study. The mean duration of PD in this group was 61 ± 11.3 months, and the mean time to peritoneal biopsy was 58 ± 15.1 months. The median APT was 180 μm (96 – 1424 μm), and the median L/V ratio was 0.66 (0.46 – 0.74). No obvious correlations between APT, L/V ratio, and PD duration were detected. The D/P creatinine of the 11 patients was maintained at a favorably low value, comparable with that of the other 99 patients.♦ConclusionsPeritoneal dialysis therapy using biocompatible dialysate in conjunction with modification of clinical practice may minimize the progression of peritoneal interstitial sclerosis and hyalinizing vasculopathy, preserving favorable peritoneal function for more than 3 years.

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Clinical practice guidelines for peritoneal dialysis in patients with chronic kidney disease stage 5 (CKD 5)

Nephrology ◽

10.18565/nephrology.2019.1.6-16 ◽

2019 ◽

Vol 1_2019 ◽

pp. 6-16

Author(s):

E.V. Shutov Shutov ◽

O.N. Kotenko Kotenko

Keyword(s):

Chronic Kidney Disease ◽

Peritoneal Dialysis ◽

Clinical Practice ◽

Kidney Disease ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Chronic Kidney Disease Stage ◽

Disease Stage

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Physical activity and exercise in peritoneal dialysis: International Society for Peritoneal Dialysis and the Global Renal Exercise Network practice recommendations

Peritoneal Dialysis International ◽

10.1177/08968608211055290 ◽

2021 ◽

pp. 089686082110552

Author(s):

Paul N Bennett ◽

Clara Bohm ◽

Oksana Harasemiw ◽

Leanne Brown ◽

Iwona Gabrys ◽

...

Keyword(s):

Physical Activity ◽

Peritoneal Dialysis ◽

Clinical Practice ◽

International Society ◽

Patient Reported Outcome ◽

Adverse Outcomes ◽

Abdominal Pressure ◽

Patient Reported ◽

Peritoneal Space ◽

Physical Activity And Exercise

Life participation requiring physical activity and physical function is a key patient-reported outcome for people receiving peritoneal dialysis (PD). Clinician guidance is required from multidisciplinary sources regarding exercise and activity advice to address the specific needs of this group. From August 2020 through to June 2021, the Global Renal Exercise Network and the International Society for Peritoneal Dialysis reviewed the published literature and international clinical experience to develop a set of clinical practice points. A set of questions relevant to physical activity and exercise were developed from the perspective of a person receiving PD and were the basis for the practice point development. The GRADE framework was used to evaluate the quality of evidence and to guide clinical practice points. The review of the literature found sparse quality evidence, and thus the clinical practice points are generally based on the expert consensus of people receiving PD, PD exercise expert clinicians and experienced PD exercise researchers. Clinical practice points address timing of exercise and activity (post-catheter insertion, peritoneal space empty or full), the uptake of specific activities (work, sex, swimming, core exercise), potential adverse outcomes related to activity and exercise (exit site care, perspiration, cardiovascular compromise, fatigue, intra-abdominal pressure), the effect of exercise and activity on conditions of interest (mental health, obesity, frailty, low fitness) and exercise nutrition.

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