Peritoneal Dialysis: Key Therapy in Kidney Failure in Small Sized Dogs

Peritoneal dialysis is the method of treatment of terminal-stage chronic kidney failure. Nowadays, this method is complementary to haemodialysis. It is based on the principles of the diffusion of solutes and ultrafiltration of fluids across the peritoneal membrane, which acts as a filter. The dialysate is introduced into the peritoneum via the previously positioned peritoneal catheter. The peritoneal dialysis is carried out on daily basis, at home by the patient, and the ?exchange? is repeated 4-5 times during the 24 hours. The first steps in peritoneal dialysis at the Department for Haemodialysis of the Clinical Centre of Vojvodina date back to 1973. Until 1992, the patients were subjected to this program only sporadically. Since 1998 the peritoneal dialysis method has been performed at the Clinic for Nephrology and Clinical Immunology. In the period 1998-2008 ninety nine peritoneal catheters were placed. Chronic glomerulonephritis, nephroangiosclerosis and diabetes were identified as the most common causes of chronic renal failure. Two methods of catheter placement were applied: the standard open surgery method (majority of patients) and laparoscopy. Most of the patients were subjected to continuous ambulatory peritoneal dialysis, whereas four patients received automatic dialysis. Transplantation was performed in 10 patients, i.e. cadaveric transplantation and living-related donor transplantation, each in 5 patients. Peritoneal dialysis was available as a service outside our institution as well. A ten-year experience in peritoneal dialysis gained at our Centre has proved the advantages and qualities of this method, strongly supporting its wider application in the treatment of terminal-stage chronic kidney failure.

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Morphine-6-Glucuronide might Mediate the Prolonged Opioid Effect of Morphine in Acute Renal Failure

Human & Experimental Toxicology ◽

10.1177/096032719000900509 ◽

1990 ◽

Vol 9 (5) ◽

pp. 317-321 ◽

Cited By ~ 45

Author(s):

Egil Bodd ◽

Dag Jacobsen ◽

Ellen Lund ◽

Åse Ripel ◽

Jørg Mørland ◽

...

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Kidney Failure ◽

Acute Kidney Failure ◽

Morphine Treatment ◽

Time Curve ◽

Concentration Time ◽

Toxic Metabolites ◽

Elimination Half ◽

Ethylene Glycol Poisoning

1 A 43-year-old male developed acute kidney failure due to ethylene glycol poisoning. He was treated with bicarbonate to combat metabolic acidosis, ethanol as an antimetabolite and haemodialysis to remove the glycol and its toxic metabolites. He was kept on a respirator and sedated with morphine. Peritoneal dialysis was given for 36 d. Following sedation with morphine for 11 d, the patient was given naloxone and then extubated. The antidote had to be continued for 14 d to prevent respiratory depression, until kidney function improved. 2 Only morphine-6-glucuronide (M-6-G) was found in the plasma and CSF at concentrations which might explain the opioid effects observed in the patient during the days after the cessation of morphine treatment. The ratio of the area under the concentration-time curve (AUC) of morphine-3-glucuronide (M-3-G) to M-6-G was 2:1. The elimination half-lives of M-3-G and M-6-G were 55 and 82 h, respectively. The clearance data indicate that most of the glucuronides were eliminated by peritoneal dialysis during renal failure. 3 The data suggest that M-6-G exerts opioid effects and is retained in acute kidney failure. Morphine should therefore not be used preferentially as a sedative/analgesic in pronounced kidney failure.

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Comparison of Hemodialysis and Peritoneal Dialysis — a Cost–Utility Analysis

Peritoneal Dialysis International ◽

10.1177/089686080202200107 ◽

2002 ◽

Vol 22 (1) ◽

pp. 39-47 ◽

Cited By ~ 75

Author(s):

Karin Sennfält ◽

Martin Magnusson ◽

Per Carlsson

Keyword(s):

Quality Of Life ◽

Health Care ◽

Peritoneal Dialysis ◽

Kidney Failure ◽

Quality Adjusted Life Year ◽

Cost Utility ◽

Age Group ◽

The Cost ◽

Quality Adjusted Life

Objective Our aim was to compare both health-related quality of life and costs for hemodialysis (HD) and peritoneal dialysis (PD) in a defined population. Design Decision-tree modeling to estimate total costs and effects for two treatment strategies, HD and PD, among patients with chronic kidney failure, for 5 years following the start of treatment. Courses of events and health-care consumption were mapped in a retrospective matched-record study. Data on health status were obtained from a matched population by a quality-of-life questionnaire (EuroQol). The study has a societal perspective. Setting All dialysis departments in the southeastern health-care region of Sweden. Patients 136 patients with kidney failure, comprising 68 matched pairs, were included in a retrospective record study; 81 patients with kidney failure, comprising 27 matched triplets, were included in a prospective questionnaire study. Main Outcome Measures Cost per life year and cost per quality-adjusted life year. Results The cost per quality-adjusted life year for PD was lower in all analyzed age groups. There was a 12% difference in the age group 21 – 40 years, a 31% difference in the age group 41 – 60 years, and an 11% difference in the age group 61+ years. Peritoneal dialysis and HD resulted in similar frequencies of transplantation (50% and 41%, respectively) and expected survival (3.58 years and 3.56 years, respectively) during the first 5 years after the initiation of treatment. Conclusion The cost–utility ratio is most favorable for PD as the primary method of treatment for patients eligible for both PD and HD.

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The ERA-EDTA Registry Annual Report 2018: a summary

Clinical Kidney Journal ◽

10.1093/ckj/sfaa271 ◽

2020 ◽

Author(s):

Anneke Kramer ◽

Rianne Boenink ◽

Vianda S Stel ◽

Carmen Santiuste de Pablos ◽

Filip Tomović ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Kidney Transplantation ◽

Kidney Transplant ◽

Kidney Failure ◽

Survival Probability ◽

Living Donor ◽

Annual Report ◽

Deceased Donor ◽

Aggregated Data ◽

Kidney Replacement Therapy

Abstract Background The ERA-EDTA Registry collects data on kidney replacement therapy (KRT) via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article summarizes the 2018 ERA-EDTA Registry Annual Report, and describes the epidemiology of KRT for kidney failure in 34 countries. Methods Individual patient data on patients undergoing KRT in 2018 was provided by 34 national or regional renal registries and aggregated data by 17 registries. The incidence and prevalence of KRT, the kidney transplantation activity and the survival probabilities of these patients were calculated. Results In 2018, the ERA-EDTA Registry covered a general population of 636 million people. Overall, the incidence of KRT for kidney failure was 129 per million population (pmp), 62% of patients were men, 51% were ≥65 years of age and 20% had diabetes mellitus as cause of kidney failure. Treatment modality at the onset of KRT was haemodialysis for 84%, peritoneal dialysis for 11% and pre-emptive kidney transplantation for 5% of patients. On 31 December 2018, the prevalence of KRT was 897 pmp, with 57% of patients on haemodialysis, 5% on peritoneal dialysis, and 38% living with a kidney transplant. The transplant rate in 2018 was 35 pmp: 68% received a kidney from a deceased donor, 30% from a living donor, and for 2% the donor source was unknown. For patients commencing dialysis during 2009-2013, the unadjusted 5-year survival probability was 42.6%. For patients receiving a kidney transplant within this period the unadjusted 5-year survival probability was 86.6% for recipients of deceased donor grafts, and 93.9% for recipients of living donor grafts.

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Percutaneous Versus Surgical Insertion of Peritoneal Dialysis Catheters: A Systematic Review and Meta-Analysis

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211052731 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110527

Author(s):

Anirudh Agarwal ◽

Reid H. Whitlock ◽

Ryan J. Bamforth ◽

Thomas W. Ferguson ◽

Jenna M. Sabourin ◽

...

Keyword(s):

Systematic Review ◽

Peritoneal Dialysis ◽

Kidney Failure ◽

Meta Analysis ◽

Infectious Complications ◽

Risk Of Bias ◽

Catheter Insertion ◽

Early Complications ◽

Exit Site ◽

Percutaneous Insertion

Background: Home-based peritoneal dialysis (PD) is an alternative to facility-based hemodialysis and has lower costs and greater freedom for patients with kidney failure. For a patient to undergo PD, a safe and reliable method of accessing the peritoneum is needed. However, different catheter insertion techniques may affect patient health outcomes. Objective: To compare the risk of infectious and mechanical complications between surgical (open and laparoscopic) PD catheter insertion and percutaneous catheter insertion. Design: Systematic review and meta-analysis. Setting: We searched for observational studies and randomized controlled trials (RCTs) in CENTRAL, EMBASE, MEDLINE, PubMed, and SCOPUS from inception until June 2018. Data were extracted by 2 independent reviewers based on a preformed template. Patients: Adult (aged 18+) patients with kidney failure who underwent a PD catheter insertion procedure. Measurements: We analyzed leak, malfunction, and bleed as early complications (occurring within 1 month of catheter insertion). Infectious complications (exit-site infections, tunnel infections, and peritonitis) were presented as both early complications and with the longest duration of follow-up. Methods: Random effects meta-analyses with the generic inverse variance method to estimate pooled rate ratios and 95% confidence intervals. We quantified heterogeneity by using the I2 statistic for inconsistency and assessed heterogeneity using the χ2 test. Sensitivity analysis was performed by removing studies at high risk of bias as measured with the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Results: Twenty-four studies (22 observational, 2 RCTs) with 3108 patients and 3777 catheter insertions were selected. Data from 2 studies were unable to be extracted and were qualitatively assessed. In the remaining 22 studies, percutaneous insertion was associated with a lower risk of both exit-site infections (risk ratio [RR] = 0.36, 95% confidence interval [CI] = 0.24-0.53, I2 = 0%) and peritonitis (RR = 0.52, 95% CI = 0.36-0.77, I2 = 3%) within 1 month of the procedure. There was no difference in mechanical complication rates between the 2 techniques. Limitations: Lack of consistency in the time periods for the various outcomes reported, risk of bias concerns with respect to population comparability, and the inability to analyze individual component causes of primary nonfunction (catheter obstruction, catheter migration, and leak). Conclusions: Our meta-analysis suggests differences in early infectious complications in favor of percutaneous insertion and no significant differences in mechanical complications compared with surgical insertion. These findings have implications on the direction of PD programs in terms of maximizing operating room resources.

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Peritoneal Dialysis or Haemodialysis for Kidney Failure?

Journal of Nepal Medical Association ◽

10.31729/jnma.3434 ◽

2018 ◽

Vol 56 (210) ◽

pp. 556-557 ◽

Cited By ~ 1

Author(s):

Badri Man Shrestha

Keyword(s):

Peritoneal Dialysis ◽

Kidney Failure

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Dialysis Outcomes in a Middle-Income Country: An Updated Comparison of Patient Mortality between Hemodialysis and Peritoneal Dialysis

Blood Purification ◽

10.1159/000520518 ◽

2021 ◽

pp. 1-11

Author(s):

Rafael M. Sanabria ◽

Jasmin I. Vesga ◽

David W. Johnson ◽

Angela S. Rivera ◽

Giancarlo Buitrago ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Mortality Rate ◽

Kidney Failure ◽

Middle Income Country ◽

Dialysis Modality ◽

Middle Income ◽

Cumulative Mortality ◽

Parametric Survival Model ◽

Parametric Survival

Introduction: Comparisons of survival between dialysis modalities is of great importance to patients with kidney failure, their families, and healthcare systems. Objective: This study’s objective was to compare mortality of patients on chronic hemodialysis (HD) or peritoneal dialysis (PD) and identify variables associated with mortality. Methods: This retrospective cohort study included adult incident patients with kidney failure treated with HD or PD by the Baxter Renal Care Services network in Colombia. The study was conducted between January 1, 2008, and December 31, 2013 (recruitment period), with follow-up until December 31, 2018. The outcome was the cumulative mortality rate at 1, 2, 3, 4, and 5 years. Propensity score matching (PSM) and the Gompertz parametric survival model were used to compare mortality in HD versus PD. Results: The analysis included 12,499 patients, of whom 57.4% were on PD at inception. The overall mortality rate was 14.0 events per 100 patient-years (95% confidence interval [CI], 13.61–14.42). Using an intention-to-treat approach, crude mortality rates were significantly lower in patients receiving HD (HD: 12.3 deaths per 100 patient-years [95% CI, 11.7–12.8] vs. PD: 15.5 [14.9–16.1], p < 0.01). Using a Gompertz parametric survival model, dialysis modality was not significantly associated with mortality (hazard ratio HD vs. PD 1.0, 95% CI, 0.9–1.1). After PSM, the mortality cumulative incidence functions between HD and PD were not statistically significantly different (p = 0.88). Conclusions: The present study in a large cohort of incident dialysis patients with at least 5 years follow-up and using PSM methods showed no differences in cumulative mortality between HD and PD patients. This evidence from a middle-income country may facilitate the process of dialysis modality selection globally.

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