Early Initiation of Dialysis and Late Implantation of Catheters Adversely Affect Outcomes of Patients on Chronic Peritoneal Dialysis

Objectives Predialysis nephrology care is thought to affect morbidity and mortality in hemodialysis patients. This study evaluated the impact of different patterns of predialysis care on outcomes of patients undergoing chronic peritoneal dialysis (PD). Design Retrospective cohort. Setting and Participants 275 patients enrolled from January 1997 to March 2005 in a medical center in North Taiwan who recently initiated dialysis were classified according to early or late referral to nephrologists (≥ 6 or <6 months of dialysis), planned or late implantation of Tenckhoff catheters (absence or presence of preceding emergent hemodialysis), and early or late start of dialysis [glomerular filtration rate (GFR) ≥ 5 or <5 mL/minute/1.73 m2]. Main Outcome Measures All-cause mortality and hospitalization. Results During a median follow-up of 2.5 years, 41 deaths, 38 transfers to hemodialysis, and 26 renal transplantations occurred. Late start of dialysis was associated with a significant survival benefit (log rank, p = 0.012) and, along with planned implantation of catheters, exhibited a reduced risk for all-cause hospitalization (log rank, p = 0.025, 0.013). The predictors of overall mortality included baseline GFR [hazard ratio (HR) 1.18, p = 0.023], age (HR 1.07, p < 0.001), and diabetes (HR 3.64, p = 0.001); whereas the risk factors for all-cause hospitalization included age (HR 1.02, p = 0.012), late implantation of catheters (HR 1.78, p = 0.011), and diabetes (HR 1.92, p = 0.005). The timing of nephrology referral did not affect either death or hospitalization. Conclusions Our data do not support earlier initiation of PD, but underscore the importance of planned implantation of catheters before commencement of chronic PD.

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Changes in Peritoneal Transport during the First Month of Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089501500103 ◽

1995 ◽

Vol 15 (1) ◽

pp. 12-17 ◽

Cited By ~ 30

Author(s):

Michael V. Rocco ◽

Jean R. Jordan ◽

John M. Burkart

Keyword(s):

Peritoneal Dialysis ◽

Medical Center ◽

Group Versus ◽

Dialysis Patients ◽

Dialysis Unit ◽

Peritoneal Transport ◽

Time Period ◽

Initiation Of Dialysis ◽

Calculated Mass

Objective To determine if peritoneal transport characteristics change during the initial month of peritoneal dialysis. Design Retrospective review of peritoneal equilibration test (PET) results in patients who received their first PET during the first two weeks of peritoneal dialysis (early PET group) versus patients who received their first PET between four and 28 weeks after the initiation of dialysis (late PET group). The initial PET values were compared to subsequent PET results obtained approximately seven months after the initial PET. Setting Peritoneal dialysis unit of a tertiary medical center. Outcome Measures PET results and calculated mass transfer area coefficient (MT AC) values. Patients Thirty-four peritoneal dialysis patients in the early PET group and 17 peritoneal dialysis patients in the late PET group. Results In the early PET group, there was a statistically significant increase from the initial to follow-up values for both dialysate-to-plasma (DIP) creatinine and MTAC creatinine (p < 0.01) as well as a significant decrease for four-hour dialysate to initial dialysate ratios (DID) glucose (p = 0.08) and MTAC glucose (p < 0.05). In the late PET group, there was no significant change in any of these parameters with time. However, in the late PET group, there was a significant decrease in DIP urea values with time (p < 0.01), but not with MTAC urea. In addition, there were no differences over time in either group for serum albumin or hematocrit values. Conclusion During the first two weeks of peritoneal dialysis, there tends to be a change in peritoneal transport characteristics in some patients. PET data obtained during this time period should be interpreted as preliminary.

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Impact of Moderate to Severe Renal Impairment on Mortality and Appropriate Shocks in Patients with Implantable Cardioverter Defibrillators

Cardiology Research and Practice ◽

10.4061/2010/150285 ◽

2010 ◽

Vol 2010 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Venkata M. Alla ◽

Kishlay Anand ◽

Mandeep Hundal ◽

Aimin Chen ◽

Showri Karnam ◽

...

Keyword(s):

Linear Models ◽

Severe Renal Impairment ◽

Medical Center ◽

Implantable Cardioverter Defibrillators ◽

Free Survival ◽

Kaplan Meier ◽

Appropriate Shocks ◽

The Impact ◽

Cardioverter Defibrillators

Background. Due to underrepresentation of patients with chronic kidney disease (CKD) in large Implantable-Cardioverter Defibrillator (ICD) clinical trials, the impact of ICD remains uncertain in this population.Methods. Consecutive patients who received ICD at Creighton university medical center between years 2000–2004 were included in a retrospective cohort after excluding those on maintenance dialysis. Based on baseline Glomerular filtration rate (GFR), patients were classified as severe CKD: GFR < 30 mL/min; moderate CKD: GFR: 30–59 mL/min; and mild or no CKD: GFR ≥ 60 mL/min. The impact of GFR on appropriate shocks and survival was assessed using Kaplan-Meier method and Generalized Linear Models (GLM) with log-link function.Results. There were 509 patients with a mean follow-up of 3.0 + 1.3 years. Mortality risk was inversely proportional to the estimated GFR: 2 fold higher risk with GFR between 30–59 mL/min and 5 fold higher risk with GFR < 30 mL/min. One hundred and seventy-seven patients received appropriate shock(s); appropriate shock-free survival was lower in patients with severe CKD (GFR < 30) compared to mild or no CKD group (2.8 versus 4.2 yrs).Conclusion. Even moderate renal dysfunction increases all cause mortality in CKD patients with ICD. Severe but not moderate CKD is an independent predictor for time to first appropriate shock.

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Sustained Increase in Peritoneal Dialysis Prevalence through a Structured PD Initiation Service

Peritoneal Dialysis International ◽

10.3747/pdi.2017.00261 ◽

2018 ◽

Vol 38 (5) ◽

pp. 374-376 ◽

Cited By ~ 1

Author(s):

Muhammad Masoom Javaid ◽

Behram Ali Khan ◽

Emily Xe Yeo ◽

Boon Wee Teo ◽

Srinivas Subramanian

Keyword(s):

Peritoneal Dialysis ◽

Rapid Expansion ◽

Dialysis Initiation ◽

Coordinated Care ◽

Timely Initiation ◽

Initiation Of Dialysis ◽

Patient Selection Criteria ◽

Dedicated Team ◽

Sustained Increase

A structured peritoneal dialysis (PD) initiation service provided by a dedicated team of nephrologists, interventionists, and PD nurses, taking patients through the stages of predialysis education and monitoring, dialysis catheter insertion, dialysis initiation, and follow-up in the immediate post-dialysis initiation period, can go a long way in expanding PD prevalence. The authors noticed a rapid expansion of their PD program following the introduction of such a service, and they share their experience in this article. A multidisciplinary team providing 1-stop coordinated care may help in alleviating the differences in patient selection criteria, minimize delays in PD catheter insertions, ensure timely initiation of dialysis, reduce the need to start dialysis urgently, actively identify and sort any teething issues, enhance patients’ confidence, and reduce technique failures.

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Ten Years’ Experience with Chronic Peritoneal Dialysis at a Community Hospital

Peritoneal Dialysis International ◽

10.1177/089686088000100705 ◽

1980 ◽

Vol 1 (7) ◽

pp. 124-129 ◽

Cited By ~ 3

Author(s):

S. Paul Handa ◽

Sheila Greer

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Chronic Renal Failure ◽

Kidney Transplant ◽

Community Hospital ◽

Patient Survival ◽

Chronic Peritoneal Dialysis ◽

Better Than

This paper describes the experience of a community hospital in the treatment of chronic renal failure with intermittent (IPD) and continuous ambulatory peritoneal dialysis (CAPD) in 61 adult patients over a 10 year period. In the earlier years of this decade, 14 patients, dialysed through temporary catheters, were transferred to hemodialysis or received a kidney transplant. Later, a long-term IPD and CAPD treatment through permanent peritoneal catheters was instituted in 25 and 22 patients respectively. Over a similar but not simultaneous follow-up period, the patient survival with CAPD was better than with IPD.

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Longitudinal Trends in Quality of Life and Physical Function in Frail Older Dialysis Patients: A Comparison of Assisted Peritoneal Dialysis and In-Center Hemodialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00086 ◽

2019 ◽

Vol 39 (2) ◽

pp. 112-118 ◽

Cited By ~ 5

Author(s):

Osasuyi Iyasere ◽

Edwina Brown ◽

Fabiana Gordon ◽

Helen Collinson ◽

Richard Fielding ◽

...

Keyword(s):

Quality Of Life ◽

Peritoneal Dialysis ◽

Mixed Model ◽

Rating Scale ◽

Depression Scale ◽

Dialysis Patients ◽

The Impact ◽

Assisted Peritoneal Dialysis

Background In-center hemodialysis (HD) has been the standard treatment for older dialysis patients, but reports suggest an associated decline in physical and cognitive function. Cross-sectional data suggest that assisted peritoneal dialysis (aPD), an alternative treatment, is associated with quality of life (QoL) outcomes that are comparable to in-center HD. We compared longitudinal changes in QoL between modalities. Methods We enrolled 106 aPD patients, matched with 100 HD patients from 20 renal centers in England and Northern Ireland. Patients were assessed quarterly for 2 years using the Hospital Anxiety and Depression Scale (HADS), SF-12 physical and mental scores, symptom score, Illness Intrusiveness Rating Scale (IIRS), Barthel's score, and the Renal Treatment Satisfaction Questionnaire (RTSQ). Mixed model analysis was used to assess the impact of dialysis modality on these outcomes during follow-up. P values were adjusted for multiple significance testing. Results Multivariate analysis showed no difference in any of the outcome measures between aPD and HD. Longitudinal trends in outcomes were also not significantly different. Higher age at baseline was associated with lower IIRS and RTSQ scores during follow-up. One-hundred and twenty-five (60.6%) patients dropped out of the study: 59 (28.6%) died, 61 (29.6%) withdrew during follow-up, and 5 (2.5%) were transplanted. Conclusions Quality of life outcomes in frail older aPD patients were equivalent to those receiving in-center HD. Assisted PD is thus a valid alternative to HD for older people with end-stage kidney disease (ESKD) wishing to dialyze at home.

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Impact of Pre-Dialysis Care on Clinical Outcomes in Peritoneal Dialysis Patients

American Journal of Nephrology ◽

10.1159/000444401 ◽

2016 ◽

Vol 43 (2) ◽

pp. 104-111 ◽

Cited By ~ 5

Author(s):

Dandara N. Spigolon ◽

Thyago P. de Moraes ◽

Ana E. Figueiredo ◽

Ana Paula Modesto ◽

Pasqual Barretti ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Proportional Hazards ◽

Patient Survival ◽

Serum Levels ◽

Cox Proportional Hazards ◽

Care Group ◽

Technique Survival ◽

Cox Proportional Hazards Models ◽

The Impact

Background: Structured pre-dialysis care is associated with an increase in peritoneal dialysis (PD) utilization, but not with peritonitis risk, technical and patient survival. This study aimed at analyzing the impact of pre-dialysis care on these outcomes. Methods: All incident patients starting PD between 2004 and 2011 in a Brazilian prospective cohort were included in this analysis. Patients were divided into 2 groups: early pre-dialysis care (90 days of follow-up by a nephrology team); and late pre-dialysis care (absent or less than 90 days follow-up). The socio-demographic, clinical and biochemical characteristics between the 2 groups were compared. Risk factors for the time to the first peritonitis episode, technique failure and mortality based on Cox proportional hazards models. Results: Four thousand one hundred seven patients were included. Patients with early pre-dialysis care presented differences in gender (female - 47.0 vs. 51.1%, p = 0.01); race (white - 63.8 vs. 71.7%, p < 0.01); education (<4 years - 61.9 vs. 71.0%, p < 0.01), respectively, compared to late care. Patients with early pre-dialysis care presented a higher prevalence of comorbidities, lower levels of creatinine, phosphorus, and glucose with a significantly better control of hemoglobin and potassium serum levels. There was no impact of pre-dialysis care on peritonitis rates (hazard ratio (HR) 0.88; 95% CI 0.77-1.01) and technique survival (HR 1.12; 95% CI 0.92-1.36). Patient survival (HR 1.20; 95% CI 1.03-1.41) was better in the early pre-dialysis care group. Conclusion: Earlier pre-dialysis care was associated with improved patient survival, but did not influence time to the first peritonitis nor technique survival in this national PD cohort.

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P1223PATIENT REMOTE MONITORING IN AUTOMATED PERITONEAL DIALYSIS: 2017-2019 CLINICAL EXPERIENCE IN A SINGLE CENTER

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1223 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Gianpaolo Amici ◽

Antonina Lo Cicero ◽

Mery Zuccolo ◽

Rosella Ferraro Mortellaro ◽

Dino Romanini ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Remote Patient Monitoring ◽

Automated Peritoneal Dialysis ◽

Telemedicine System ◽

Daily Monitoring ◽

Hill Area ◽

Remote Patient ◽

The Impact

Abstract Background and Aims We conducted an observational study in a group of patients in automated peritoneal dialysis (APD) to evaluate the impact of the introduction and the long-term use of a telemedicine system for remote patient monitoring (RPM, Claria Sharesource Baxter). Method From April 1 2017 to December 31 2019 (33 months) we followed 42 APD patients with RPM, sex F 20 M 22, age 70±14 years, on PD treatment for median 10 (IQR 3-23) months, distance from the center 18±14 km in mountain and hill area. Have been studied 505 months of RPM overall, per patient median 9 (IQR 3-19) months, corresponding to 11685 APD sessions overall, per patient median 206 (IQR 52-457) sessions. Results Have been registered 1125 alarms (red flags) overall, per patient median 9 (IQR 1-45) alarms, rate 2.2 alarms patient-month (0.1 alarms per session). Analyzing the causes of the alarms: “dwell time lost” (>45 min) 1006 (89%), “drain anticipation” (>2 times) 22 (2%), “fill or dwell bypass” (>3 times) 15 (1%), “various causes” (>10 times) 86 (8%). “Various causes” alarm group sums mainly slow drain for set kinking and insufficient drain volume. We count 195 remote modifications of dialysis program overall, median per patient 3 (IQR 1-7), rate 0.02 patient month with a ratio 0.2 modifications per alarm. Looking to program modification, the alarm type specifically linked to modifications has been insufficient drain volume of the “various causes” group (36 events, 18% of all modifications). We found a positive correlation between the number of treatments and alarms (r=0.534, p<0.001). In the observation period the overall hospitalization days were 403, rate 0.8 days patient month, ratio 0.02 hospitalization days per APD RPM session and ratio 0.4 hospitalization days per alarm. Conclusion The study shows that APD with RPM improves patients’ follow-up changing the organization of the center. In the long term the telemedicine system shows the advantages of a careful and daily monitoring. The rates of alarm, change of prescription and hospitalization resulted very low in our experience.

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Comorbidities in Chronic Pediatric Peritoneal Dialysis Patients: A Report of the International Pediatric Peritoneal Dialysis Network

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00124 ◽

2012 ◽

Vol 32 (4) ◽

pp. 410-418 ◽

Cited By ~ 28

Author(s):

Alicia M. Neu ◽

Anja Sander ◽

Dagmara Borzych–Dużałka ◽

Alan R. Watson ◽

Patricia G. Vallés ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Dialysis Initiation ◽

Dialysis Patients ◽

Pediatric Dialysis ◽

Hospitalization Rates ◽

Ocular Abnormality ◽

International Pediatric ◽

The Impact ◽

Pediatric Dialysis Patients

Background, Objectives, and Methods Hospitalization and mortality rates in pediatric dialysis patients remain unacceptably high. Although studies have associated the presence of comorbidities with an increased risk for death in a relatively small number of pediatric dialysis patients, no large-scale study had set out to describe the comorbidities seen in pediatric dialysis patients or to evaluate the impact of those comorbidities on outcomes beyond the newborn period. In the present study, we evaluated the prevalence of comorbidities in a large international cohort of pediatric chronic peritoneal dialysis (CPD) patients from the International Pediatric Peritoneal Dialysis Network registry and began to assess potential associations between those comorbidities and hospitalization rates and mortality. Results Information on comorbidities was available for 1830 patients 0 – 19 years of age at dialysis initiation. Median age at dialysis initiation was 9.1 years [interquartile range (IQR): 10.9], median follow-up for calculation of hospitalization rates was 15.2 months (range: 0.2 – 80.9 months), and total follow-up time in the registry was 2095 patient–years. At least 1 comorbidity had been reported for 602 of the patients (32.9%), with 283 (15.5%) having cognitive impairment; 230 (12.6%), motor impairment; 167 (9.1%), cardiac abnormality; 76 (4.2%), pulmonary abnormality; 212 (11.6%), ocular abnormality; and 101 (5.5%), hearing impairment. Of the 150 patients (8.2%) that had a defined syndrome, 85% had at least 1 nonrenal comorbidity, and 64% had multiple comorbidities. The presence of at least 1 comorbidity was associated with a higher hospitalization rate [hospital days per 100 observation days: 1.7 (IQR: 5.8) vs 1.2 (IQR: 3.9), p = 0.001] and decreased patient survival (4-year survival rate: 73% vs 90%, p < 0.0001). Conclusions Nearly one third of pediatric CPD patients in a large international cohort had at least 1 comorbidity, and multiple comorbidities were frequently reported among patients with a defined syndrome. Preliminary analysis suggests an association between comorbidity and poor outcome in those patients. As this powerful international registry matures, further multivariate analyses will be important to more clearly define the impact of comorbidities on hospital-ization rates and mortality in pediatric CPD patients.

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Impact of Global Economic Disparities on Practices and Outcomes of Chronic Peritoneal Dialysis in Children: Insights from the International Pediatric Peritoneal Dialysis Network Registry

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00126 ◽

2012 ◽

Vol 32 (4) ◽

pp. 399-409 ◽

Cited By ~ 48

Author(s):

Franz Schaefer ◽

Dagmara Borzych–Duzalka ◽

Marta Azocar ◽

Reyner Loza Munarriz ◽

Lale Sever ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Young Patients ◽

Economic Conditions ◽

Phosphate Binders ◽

Chronic Peritoneal Dialysis ◽

Technique Survival ◽

Wide Range ◽

Dialysis Vintage ◽

International Pediatric ◽

The Impact

Background, Objectives, and Methods The number of patients on chronic peritoneal dialysis (CPD) is increasing rapidly on a global scale. We analyzed the International Pediatric Peritoneal Dialysis Network (IPPN) registry, a global database active in 33 countries spanning a wide range in gross national income (GNI), to identify the impact of economic conditions on CPD practices and outcomes in children and adolescents. Results We observed close associations of GNI with the fraction of very young patients on dialysis, the presence and number of comorbidities, the prevalence of patients with unexplained causes of end-stage kidney disease, and the rate of culture-negative peritonitis. The prevalence of automated PD increased with GNI, but was 46% even in the lowest GNI stratum. The GNI stratum also affected the use of biocompatible peritoneal dialysis fluids, enteral tube feeding, calcium-free phosphate binders, active vitamin D analogs, and erythropoiesis-stimulating agents (ESAs). Patient mortality was strongly affected by GNI (hazard ratio per $10 000: 3.3; 95% confidence interval: 2.0 to 5.5) independently of young patient age and the number of comorbidities present. Patients from low-income countries tended to die more often from infections unrelated to CPD (5 of 9 vs 15 of 61, p = 0.1). The GNI was also a strong independent predictor of standardized height ( p < 0.0001), adding to the impact of congenital renal disease, anuria, age at PD start, and dialysis vintage. Patients from the lower economic strata (GNI < $18 000) had higher serum parathyroid hormone (PTH) and lower serum calcium, and achieved lower hemoglobin concentrations. No impact of GNI was observed with regard to CPD technique survival or peritonitis incidence. Conclusions We conclude that CPD is practiced successfully, albeit with major regional variation related to economic differences, in children around the globe. The variations encompass the acceptance of very young patients and those with associated comorbidities to chronic dialysis programs, the use of automated PD and expensive drugs, and the diagnostic management of peritonitis. These variations in practice related to economic difference do not appear to affect PD technique survival; however, economic conditions seem to affect mortality on dialysis and standardized height, a marker of global child morbidity.

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Effect of Timing of Dialysis Commencement on Clinical Outcomes of Patients with Planned Initiation of Peritoneal Dialysis in the Ideal Trial

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00046 ◽

2012 ◽

Vol 32 (6) ◽

pp. 595-604 ◽

Cited By ~ 20

Author(s):

David W. Johnson ◽

Muh Geot Wong ◽

Bruce A. Cooper ◽

Pauline Branley ◽

Liliana Bulfone ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Clinical Outcomes ◽

Residual Renal Function ◽

Early Initiation ◽

Dialysis Initiation ◽

Early Start ◽

Initiation Of Dialysis ◽

Late Initiation ◽

Late Start ◽

The Ideal

♦ BackgroundSince the mid-1990s, early dialysis initiation has dramatically increased in many countries. The Initiating Dialysis Early and Late (IDEAL) study demonstrated that, compared with late initiation, planned early initiation of dialysis was associated with comparable clinical outcomes and increased health care costs. Because residual renal function is a key determinant of outcome and is better preserved with peritoneal dialysis (PD), the present pre-specified subgroup analysis of the IDEAL trial examined the effects of early- compared with late-start dialysis on clinical outcomes in patients whose planned therapy at the time of randomization was PD.♦ MethodsAdults with an estimated glomerular filtration rate (eGFR) of 10 – 15 mL/min/1.73 m2who planned to be treated with PD were randomly allocated to commence dialysis at an eGFR of 10 – 14 mL/min/1.73 m2(early start) or 5 – 7 mL/min/1.73 m2(late start). The primary outcome was all-cause mortality.♦ ResultsOf the 828 IDEAL trial participants, 466 (56%) planned to commence PD and were randomized to early start ( n = 233) or late start ( n = 233). The median times from randomization to dialysis initiation were, respectively, 2.03 months [interquartile range (IQR):1.67 – 2.30 months] and 7.83 months (IQR: 5.83 – 8.83 months). Death occurred in 102 early-start patients and 96 late-start patients [hazard ratio: 1.04; 95% confidence interval (CI): 0.79 – 1.37]. No differences in composite cardiovascular events, composite infectious deaths, or dialysis-associated complications were observed between the groups. Peritonitis rates were 0.73 episodes (95% CI: 0.65 – 0.82 episodes) per patient–year in the early-start group and 0.69 episodes (95% CI: 0.61 – 0.78 episodes) per patient–year in the late-start group (incidence rate ratio: 1.19; 95% CI: 0.86 – 1.65; p = 0.29). The proportion of patients planning to commence PD who actually initiated dialysis with PD was higher in the early-start group (80% vs 70%, p = 0.01).♦ ConclusionEarly initiation of dialysis in patients with stage 5 chronic kidney disease who planned to be treated with PD was associated with clinical outcomes comparable to those seen with late dialysis initiation. Compared with early-start patients, late-start patients who had chosen PD as their planned dialysis modality were less likely to commence on PD.

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