scholarly journals Implementation of Urgent Start Peritoneal Dialysis Reduces Hemodialysis Catheter Use and Hospital Stay in Patients with Unplanned Dialysis Start

2019 ◽  
Vol 44 (6) ◽  
pp. 1383-1391 ◽  
Author(s):  
Ferruh Artunc ◽  
Sandra Rueb ◽  
Karolin Thiel ◽  
Christian Thiel ◽  
Katarzyna Linder ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Hospital Stay ◽  
Patient Flow ◽  
Venous Catheter ◽  
University Hospital ◽  
Hemodialysis Catheter ◽  
Catheter Implantation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Unplanned Dialysis

Background: Unplanned start of renal replacement therapy is common in patients with end-stage renal disease and often accomplished by hemodialysis (HD) using a central venous catheter (CVC). Urgent start using peritoneal dialysis (PD) could be an alternative for some of the patients; however, this requires a hospital-based PD center that offers a structured urgent start PD (usPD) program. Methods: In this prospective study, we describe the implementation of an usPD program at our university hospital by structuring the process from presentation to PD catheter implantation and start of PD within a few days. For clinical validation, we compared the patient flow before (2013–2015) and after (2016–2018) availability of usPD. Results: In the 3 years before the availability of usPD, 14% (n = 12) of incident PD patients (n = 87) presented in an unplanned situation and were initially treated with HD using a CVC. In the 3 years after implementation of the usPD program, 18% (n = 18) of all incident PD patients (n = 103) presented in an unplanned situation of whom n = 12 (12%) were treated with usPD and n = 6 (6%) with initial HD. usPD significantly reduced the use of HD by 57% (p = 0.0005). Hospital stay was similar in patients treated with usPD (median 9 days) compared to those with elective PD (8 days), and significantly lower than in patients with initial HD (26 days, p = 0.0056). Conclusions: Implementation of an usPD program reduces HD catheter use and hospital stay in the unplanned situation.

scholarly journals A Treatable Encephalopathy in a Peritoneal Dialysis Patient - Cefepime- Induced Encephalopathy

2019 ◽  
Vol 10 (02) ◽  
pp. 324-326 ◽  
Author(s):  
Ching Soong Khoo ◽  
Tze Yuan Tee ◽  
Hui Jan Tan ◽  
Raymond Azman Ali
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Hospital Stay ◽  
End Stage Renal Disease ◽  
Dialysis Patient ◽  
Length Of Hospital Stay ◽  
Peritoneal Dialysis Patient ◽  
Stage Renal Disease ◽  
End Stage ◽  
Reversible Encephalopathy

ABSTRACTWe report a patient with end-stage renal disease on peritoneal dialysis, who developed encephalopathy after receiving a few doses of cefepime. He recovered clinically and electroencephalographically after having discontinued the culprit agent and undergone hemodialysis. This case highlights the importance of promptly recognizing this reversible encephalopathy, which can lead to the avoidance of unnecessary workup, reduce the length of hospital stay, and thereby improve the patients’ outcome.

Assisted Automated Peritoneal Dialysis (Aapd) for the Functionally Dependent and Elderly Patient

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 60-63 ◽  
Author(s):  
Johan V. Povlsen ◽  
Per Ivarsen
Keyword(s):  
Nursing Home ◽  
Peritoneal Dialysis ◽  
International Standards ◽  
University Hospital ◽  
Automated Peritoneal Dialysis ◽  
Technique Survival ◽  
Acute Peritonitis ◽  
Data Files ◽  
Stage Renal Disease ◽  
End Stage

♦ Objective To describe basic demographics and clinical outcomes among elderly end-stage renal disease (ESRD) patients physically dependent on a caregiver and maintained on an assisted automated peritoneal dialysis (AAPD) program. ♦ Design Retrospective single-center study based on patient records and data files. ♦ Setting University Hospital. ♦ Patients 64 physically dependent AAPD patients followed for 1.012 treatment months. Assistance and care was delivered by 52 briefly trained teams of visiting nurses or nursing home staff. ♦ Result Crude 1-year survival was 58% and 2-year survival was 48%. Crude 1- and 2-year survivals, excluding deaths within 90 days, were 66% and 54% respectively. We found no significant effect on survival by main causes of ESRD, gender, age, late referral, need for acute start, social isolation, physical dependency on help at inclusion, or residence in a nursing home. 10% of patient-days on AAPD were spent in hospital. 13 (20%) of the patients were converted permanently to hemodialysis due to PD technique failure. The incidence of peritonitis was 1 in every 25.3 treatment-months. ♦ Conclusions AAPD may be a feasible and safe option for renal replacement therapy for frail, elderly, and physically dependent patients with ESRD. Despite the special patient selection for this AAPD program, we achieved results of international standards for patient survival, PD technique survival, and incidence of acute peritonitis. These results do not justify withholding dialysis from this group of patients.

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 Hybrid dialysis: a promising strategy to reduce hospital access during the SARS-CoV-2 pandemic

2020 ◽  
Vol 13 (10) ◽  
pp. e236411
Author(s):  
Giacomo Mori ◽  
Gaetano Alfano ◽  
Francesco Fontana ◽  
Riccardo Magistroni
Keyword(s):  
Peritoneal Dialysis ◽  
Venous Catheter ◽  
Chronic Obstructive ◽  
Central Venous Catheter Placement ◽  
Obstructive Pulmonary Disease ◽  
Haemodialysis Session ◽  
Promising Strategy ◽  
Hospital Access ◽  
Stage Renal Disease ◽  
End Stage

In March 2020, a 74-year-old man affected by end-stage renal disease and on peritoneal dialysis was referred to an emergency room in Modena, Northern Italy, due to fever and respiratory symptoms. After ruling out COVID-19 infection, a diagnosis of chronic obstructive pulmonary disease exacerbation was confirmed and he was thus transferred to the nephrology division. Physical examination and blood tests revealed a positive fluid balance and insufficient correction of the uraemic syndrome, although peritoneal dialysis prescription was maximised. After discussion with the patient and his family, the staff decided to start hybrid dialysis, consisting of once-weekly in-hospital haemodialysis and home peritoneal dialysis for the remaining days. He was discharged at the end of the antibiotic course, after an internal jugular vein central venous catheter placement and the first haemodialysis session. This strategy allowed improvement of depuration parameters and avoidance of frequent access to the hospital, which is crucial in limiting exposure to SARS-CoV-2 in an endemic setting.

scholarly journals A Modified Method in Laparoscopic Peritoneal Catheter Implantation: The Combination of Preperitoneal Tunneling and Pelvic Fixation

ISRN Surgery ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Mehmet Emin Gunes ◽  
Gungor Uzum ◽  
Oguz Koc ◽  
Yiğit Duzkoylu ◽  
Meltem Kucukyilmaz ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Survival Rates ◽  
Peritoneal Catheter ◽  
Catheter Survival ◽  
Pelvic Fixation ◽  
Duration Of Hospital Stay ◽  
Catheter Implantation ◽  
Stage Renal Disease ◽  
End Stage

Introduction. Continuous ambulatory peritoneal dialysis (CAPD) is widely accepted for the management of end-stage renal disease (ESRD). Although not as widely used as hemodialysis, CAPD has clear advantages, especially those related to patient satisfaction and simplicity. Peritoneal dialysis (PD) catheter insertion can be accomplished by several different techniques. In this study, we aimed to evaluate our results obtained with peritoneal dialysis catheter placement by combination of pelvic fixation plus preperitoneal tunneling. Material and Methods. Laparoscopic peritoneal catheter implantation by combining preperitoneal tunneling and pelvic fixation methods was performed in 82 consecutive patients with end-stage renal disease. Sex, age, primary disease etiology, complications, mean duration of surgery, mean duration of hospital stay, morbidity, mortality, and catheter survival rates and surgical technique used were assessed. Analysis of catheter survival was performed using the Kaplan-Meier method. Results. Mean follow-up period was 28.35 ± 14.5 months (range of 13–44 months). Mean operative time was 28 ± 6 minutes, and mean duration of hospital stay was 3 ± 1 days. There were no conversions from laparoscopy to other insertion methods. None of the patients developed serious complications during surgery or the postoperative period. No infections of the exit site or subcutaneous tunnel, hemorrhagic complications, abdominal wall hernias, or extrusion of the superficial catheter cuff was detected. No mortality occurred in this series of patients. Catheter survival was found to be 92% at 3 years followup. Conclusions. During one-year followup, we had seven patients of migrated catheters due to separation of pelvic fixation suture from peritoneal surface, but they were reimplanted and fixated again laparoscopically with success. Over a three-year followup period, catheter survival was found to be 92%. In the literature, similar catheter survival rates without combination of the two techniques are reported. As a conclusion, although laparoscopic placement of PD catheters avoids many perioperative and early complications, as well as increasing catheter free survival period and quality of life, our results comparing to other studies in the literature indicate that different laparoscopic placement methods are still in debate, and further studies are necessary to make a more accurate decision.

scholarly journals An institutional experience in insertion of hemodialysis catheter and peritoneal dialysis catheter for children with end stage renal disease

2019 ◽  
Vol 6 (5) ◽  
pp. 1802
Author(s):  
Anit Joseph K. ◽  
Vivek P. Sarma ◽  
Aravind C. S. ◽  
Sethunath S. ◽  
Sivakumar K. ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Image Guidance ◽  
Catheter Insertion ◽  
Dialysis Catheter ◽  
Hemodialysis Catheter ◽  
Stage Renal Disease ◽  
Operative Notes ◽  
End Stage

Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are major health care problems worldwide even in Pediatric population. The etiology of CKD in children with ESRD is varied. Most of them are started on peritoneal dialysis or hemodialysis before being considered for renal transplantation.The aims and objective of this study was to analyzed the patient group, methodology, results and outcomes of hemodialysis catheter insertion and continuous ambulatory peritoneal dialysis (CAPD) catheter insertion for children with ESRD. The etiology of ESRD in children with CKD is also reviewed.Methods: All children with ESRD who underwent CAPD catheter and haemodialysis catheter insertion over a period of 5 years were included in the study. CAPD catheters were inserted by open and laparoscopic assisted methods. The procedures were done without image guidance due to logistical constraints in a limited resource scenario. Analysis of all relevant case records, operative notes and postoperative events were done.Results: A total of 40 patients who underwent CAPD and hemodialysis catheter insertions were analysed. The primary cases (no previous insertion of dialysis catheter) included 29 and secondary cases (history of previous insertion of dialysis catheter) were 7. Re-insertions (of the same type of dialysis catheter) were 2 in each group. No significant complications occurred in either group.Conclusions: Dialysis catheters for ESRD in Paediatric population can be inserted safely even without image guidance and with very few complications.

Inflammatory Demyelinating Neuropathy in Patients with End-Stage Renal Disease Receiving Continuous Ambulatory Peritoneal Dialysis (Capd)

1998 ◽  
Vol 18 (2) ◽  
pp. 172-176 ◽  
Author(s):  
Marcell Toepfer ◽  
Helmut Schiffl ◽  
Harald Fricke ◽  
Hans Lochmüller ◽  
Eckhard Held ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Peripheral Neuropathy ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Spinal Fluid ◽  
University Hospital ◽  
Demyelinating Neuropathy ◽  
Protein Levels ◽  
Demyelinating Peripheral Neuropathy ◽  
Stage Renal Disease ◽  
End Stage

Objective To report on 3 patients with inflammatory demyelinating peripheral neuropathy in strong temporal coincidence with the initiation of peritoneal dialysis (PD) therapy. Setting Nephrology and Neurology Department of the University Hospital, Munich, Germany. Patients Three patients with end-stage renal failure presented with the clinical picture of inflammatory demyelinating peripheral neuropathy within 4 to 10 weeks after start of continuous ambulatory peritoneal dialysis (CAPD). They had acute or subacute onset of lower extremity or generalized weakness, diminished reflexes, elevated spinal fluid protein levels, and signs of demyelinating neuropathy on electrophysiological testing. Measures Clinical follow-up, nerve conduction studies, cerebral spinal fluid (CSF). Results All patients did not improve under intensified PD therapy but took profit from immunomodulatory therapy. One bed-bound patient improved after change to hemodialysis and showed complete remission after renal transplantation. Conclusion Because of strong temporal coincidence, a causal relationship between CAPD and inflammatory demyelinating peripheral neuropathies can be suspected in these 3 patients.

Analysis of Patient Flow into Dialysis: Role of Education in Choice of Dialysis Modality

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 56-59 ◽  
Author(s):  
Belén Marrón ◽  
Juan Carlos Martínez Ocaña ◽  
Mercedes Salgueira ◽  
Guillermina Barril ◽  
José M. Lamas ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Flow ◽  
Treatment Options ◽  
Clinical Status ◽  
Esrd Patient ◽  
Dialysis Modality ◽  
Medical Visits ◽  
Stage Renal Disease ◽  
End Stage

♦ Background Despite advances in predialysis care, morbidity and mortality remain high. ♦ Objectives To analyze end-stage renal disease (ESRD) patient demographics and clinical data on education on dialysis treatment options, type of chronic renal replacement therapy (RRT), and effects of planned versus non-planned dialysis start. ♦ Methods 621 patients, from 24 Spanish hospitals, who started RRT in 2002. Peritoneal or vascular access at dialysis initiation was considered “planned.” ♦ Results 304 (49%) patients were non-planned and half of them had prior nephrology follow-up. Of the patients with ≥3 months nephrology follow-up (76% of all), only half were educated on dialysis modalities. Dialysis education was associated with planned start in 73.4% versus 26% in non-educated patients ( p < 0.05), shorter follow-up (55 vs 65 months, p = 0.033), more medical visits in the prior year (6.5 vs 4.4, * p < 0.001), more patients starting peritoneal dialysis (31% vs 8.3%*), and more specific follow-up by ESRD unit versus general nephrology care (63% vs 26%*). Non-planned start was associated with older age (63 vs 60.6 years, p = 0.06), fewer medical visits (4.6 vs 6.4*), less education about modality options, and greater use of hemodialysis (92% vs 75%*). Planned patients had better biochemical parameters at start of dialysis. ♦ Conclusion Despite nephrology follow-up, half the patients did not have a planned dialysis start. Planned start was associated with better clinical status. More patients chose peritoneal dialysis when educated about dialysis modality options. ESRD-specific units were more likely to provide patient education.

scholarly journals Analysis of Hospitalization after Peritoneal Dialysis Catheter Implantation

2016 ◽  
Vol 36 (5) ◽  
pp. 540-546 ◽  
Author(s):  
Zi Li ◽  
Zita Abreu ◽  
Todd Penner ◽  
Lian He ◽  
Xihui Liu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Hospital Stay ◽  
General Anesthesia ◽  
Disease Patient ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Cardiac Morbidity ◽  
Single Night ◽  
Stage Renal Disease ◽  
End Stage

BackgroundImplantation of the peritoneal dialysis catheter (PDC), usually an elective procedure, may necessitate unexpected hospitalization and even transfer to intensive care due to the multiple comorbidities and inherent instability of the end-stage renal disease patient. Information on hospitalization after PDC implantation is limited and details about the reason for hospitalization are lacking.MethodsWe performed a cohort study in consecutive patients who underwent PDC implantation at a single institution from September 2007 to September 2013. Clinical characteristics of enrolled patients, technique of the implantation procedure, and all-cause unexpected hospitalization and morbidity within 14 days after implantation were analyzed.ResultsExcluding the patients with pre-arranged admission, a total of 246 patients receiving 252 PDC implantations during the 6 years were studied. After 39 procedures (15.5%), patients had an unexpected hospital stay or re-admission due to operative complications (33.3%), worsening of disease (35.9%), or a single-night hospital stay for observation (30.8%). Compared with discharged patients, the patients with unexpected hospitalization were older ( p = 0.001), experienced higher rates of previous episodes of heart failure ( p = 0.006) and heart disease ( p < 0.001), had more use of general anesthesia (GA) ( p = 0.046), underwent more added procedures during the implantation ( p = 0.02), and had more episodes of flow obstruction and peritonitis after implantation ( p = 0.012 and p < 0.001, respectively). Using a multivariable logistic regression, we showed that age, cardiac morbidity, use of general anesthesia, PDC flow problems and peritonitis after implantation were independent predictors of all-cause unexpected hospitalization.ConclusionsFor the first time, our study analyzed the predictors of unplanned hospitalization after PDC implantation and identified the salient risk factors. Increased focus to identify patients at greatest risk for hospitalization, evaluation of processes of care, and implementation of preventive strategies may be helpful to reduce unplanned hospitalization after catheter insertion.

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