scholarly journals Longitudinal changes in the use of PD Assistance for patients maintained on Peritoneal Dialysis

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0006622020
Author(s):  
Jorge I. Fonseca-Correa ◽  
Janine F. Farragher ◽  
George Tomlinson ◽  
Matthew J. Oliver ◽  
Arsh Jain ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Functional Dependence ◽  
Outpatient Setting ◽  
Older Individuals ◽  
Study Objective ◽  
Home Dialysis ◽  
Observational Study Design ◽  
Unpaid Caregiver ◽  
Over Time

Background: Home dialysis therapies such as peritoneal dialysis (PD) offer flexibility and improved wellbeing, particularly for older individuals. However, a substantial proportion require assistance with personal care and healthcare related tasks. We hypothesized that patients and families would require less PD assistance as they became more familiar with PD-related tasks. The study objective was to assess whether the nature of, and need for, PD assistance decreased over time. Methods: Using a multicentred, prospective observational study design, patients aged ≥50 years were recruited from those starting PD. Patients underwent formal evaluation using validated components of a Comprehensive Geriatric Assessment at baseline, and were followed monthly and administered a questionnaire about the need for assistance with PD-related tasks. Results: A total of 111 patients (age 69 ± 10 years, 68% male, 56% diabetic) were followed for a total of 609 patient-months. Of those who needed help, 40% had help from a family member and 33% were helped by nurses. Both the quantity and nature of help received by patients remained generally stable throughout follow-up, and did not vary according to age, frailty, functional dependence or cognitive impairment (p=0.93). The proportion of patients needing help varied widely across the 13 different tasks, but appeared relatively stable across time. The paid/unpaid caregiver ratio for the different tasks did not change over time. Conclusions: Older patients initiating PD, in the outpatient setting, have a high need for assistance with PD-related tasks which appears to persist over the initial 6-month period.

PD Assistance and Relationship to Co-Existing Geriatric Syndromes in Incident Peritoneal Dialysis Therapy Patients

2019 ◽  
Vol 39 (4) ◽  
pp. 375-381 ◽  
Author(s):  
Janine F. Farragher ◽  
Matthew J. Oliver ◽  
Arsh K. Jain ◽  
Susan Flanagan ◽  
Kathleen Koyle ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Complex Disease ◽  
Functional Dependence ◽  
Treatment Strategies ◽  
Outpatient Setting ◽  
Cognitive Testing ◽  
Cognitive Changes ◽  
Study Objective ◽  
Home Dialysis ◽  
Observational Study Design

Background Home dialysis therapies, including peritoneal dialysis (PD), are preferred treatment strategies, offering flexibility and improved wellbeing. However, patients with complex disease and comorbidity may require assistance with personal care and healthcare-related tasks. The study objective was to formally assess the type and frequency of PD assistance received by patients over 50, and the relationship to observed frailty, functional status, and cognitive ability at the time of PD therapy initiation. Methods Using a multicentered, prospective observational study design, patients aged ≥ 50 years were recruited from those starting PD. Patients underwent formal evaluation using validated components of a Comprehensive Geriatric Assessment. The receipt and nature of assistance with PD tasks were assessed 1 month after dialysis start by questionnaire. Results A total of 121 patients (age 69 ± 10 years, 67% male, 54% diabetic) were recruited. A total of 75 (62%) patients received assistance for a variety of tasks from friends or family ( n = 41, 34%) or a paid caregiver ( n = 34, 28%) 1 month after starting dialysis. At baseline, there was a high prevalence of functional dependency (79/120, 66%), frailty (71/110, 65%), and impaired cognition (68/115, 59%). Only 5% were fully independent, clinically robust, and scored within the normal range on cognitive testing. Factors associated with PD assistance included comorbidity ( p < 0.03), cognitive impairment ( p < 0.0001), and functional dependence ( p < 0.02). Conclusion Older patients initiating PD in the outpatient setting have high rates of frailty, functional dependence, and cognitive changes at the time they initiate dialysis. More research is required to better understand how those factors contribute to the use of PD assistance.

Nutritional Status of Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)

1983 ◽  
Vol 3 (3) ◽  
pp. 138-141 ◽  
Author(s):  
Brigitte Heide ◽  
Andreas Pierratos ◽  
Ramesh Khanna ◽  
Jean Pettit ◽  
Raymond Ogilvie ◽  
...  
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Nutritional Status ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Protein Intake ◽  
Biochemical Parameters ◽  
Total Body Potassium ◽  
Total Body ◽  
Over Time

Nutritional follow-up of 20 CAPD patients for 18–24 months showed a decrease in total body nitrogen, increase in total body potassium and body weight, and a decrease in protein intake over time. There was no correlation between changes in TBN and the biochemical parameters measured. Serial dietetic assessments and measurements of total body nitrogen as well as adherence to an adequate protein intake will assist in the prevention of malnutrition in CAPD patients.

scholarly journals Home dialysis : what are the barriers . A French nephrologist survey

2019 ◽  
Vol 2 (2) ◽  
pp. 47-53
Author(s):  
Magalie Geneviève ◽  
Stanislas Bataille ◽  
Julie Beaume ◽  
Aldjia Hocine ◽  
Louis De Laforcade ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Life Quality ◽  
Reporting Rate ◽  
Third Party ◽  
Regulatory Evolution ◽  
Home Hemodialysis ◽  
Home Dialysis ◽  
Lack Of Information ◽  
Geographical Regions

Home dialysis, which includes Peritoneal Dialysis and Home Hemodialysis, provides lots of profit to patients suffering of Chronic Kidney Disease, especially in terms of comfort, life quality and autonomy. However, its use is marginal in France, with an inhomogenous distributaion according to geographical regions. We conducted a French national survey of nephrologists to assess the barriers to the development of home dialysis. After analyzing the responses of the 230 participating nephrologists, the main obstacles to the development of the two techniques were identified and classified according to their reporting rate. The major obstacles that emerge from the survey are : the lack of information among the general public, a lack of acknowledgement of nurses specializing in these techniques, the limited number of structures that practice dialysis at home, and information difficulties among patient about dialysis techniques. The specific peritoneal dialysis-related difficulties reported are : difficulties in management of follow-up care and rehabilitation, the fear of insufficient purification and the difficulties related to the dialysis catheter. Concerning home hemodialysis, the barriers concern fear of autopunction and the need for a third party. This study helps to identify the representations of nephrologists on the major obstacles to the development of home dialysis to develop lines of thought for its promotion, both in terms of training, institutional acknowledgement, and the necessary regulatory evolution.

scholarly journals Polycystic Ovarian Morphology in Normal Women Does Not Predict the Development of Polycystic Ovary Syndrome

2006 ◽  
Vol 91 (10) ◽  
pp. 3878-3884 ◽  
Author(s):  
M. K. Murphy ◽  
J. E. Hall ◽  
J. M. Adams ◽  
H. Lee ◽  
C. K. Welt
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Outpatient Setting ◽  
Ovary Syndrome ◽  
Ovarian Morphology ◽  
Menstrual History ◽  
Irregular Menses ◽  
Normal Women ◽  
Over Time

Abstract Context: Polycystic ovarian morphology (PCOM) is present in 25% of normal women in the absence of polycystic ovary syndrome (PCOS); however, the natural history of PCOM is unknown. Objective: We hypothesized that the presence of PCOM predisposes the development of PCOS. Design: The study was a longitudinal follow-up study over 8.2 ± 5.2 yr (mean ± sd; range 1.7–17.5 yr). Setting: The study took place in an outpatient setting. Subjects: Women who took part in a previous study as a normal control and had an ultrasound examination (n = 40) participated. Intervention: Subjects underwent an interval menstrual history, physical exam, blood sampling, and repeat ultrasound in the follicular phase. Main Outcome Measure: Development of PCOS was diagnosed by irregular menses and hyperandrogenism, in the absence of other disorders. Changes in ovarian morphology over time were evaluated. Results: At the baseline visit, 23 women (57.5%) had PCOM and 17 (42.5%) had normal ovarian morphology. One subject with PCOM developed irregular menses and presumptive PCOS. Eleven subjects with PCOM no longer met the criteria for PCOM at follow-up. There was no factor that predicted the change to normal ovarian morphology at the follow-up visit. Conclusions: These data suggest that PCOM in women with regular ovulatory cycles does not commonly predispose the development of PCOS. Although it is unusual to develop PCOM if the ovaries are normal on first assessment, ovaries in women with PCOM no longer meet the criteria for PCOM in approximately half of cases over time.

Peritoneal Defense Using Icodextrin Or Glucose for Daytime Dwell in Ccpd Patients

1999 ◽  
Vol 19 (4) ◽  
pp. 334-342 ◽  
Author(s):  
Nynke Posthuma ◽  
Pieter M. Ter Wee ◽  
Ab J.M. Donker ◽  
Hubertha A. Th. Dekker ◽  
Po L. Oe ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
White Cell Count ◽  
Peritoneal Macrophages ◽  
University Hospital ◽  
Coagulase Negative Staphylococci ◽  
Phagocytic Capacity ◽  
Significant Difference ◽  
Stable Clinical Condition ◽  
Over Time

Objective To investigate peritoneal defense during icodextrin use in continuous cyclic peritoneal dialysis (CCPD). Design In an open, prospective, 2-year follow-up study, CCPD patients were randomized to either glucose (Glu) or icodextrin (Ico) for their long daytime dwell. Setting University hospital and teaching hospital. Patients Both established and patients new to CCPD were included. A life expectancy of more than 2 years, a stable clinical condition, and written informed consent were necessary before entry. Patients aged under 18 years, those who had peritonitis in the previous month, and women of childbearing potential, unless taking adequate contraceptive precautions, were excluded. Thirty-eight patients (19 Glu, 19 Ico) started the study. The median follow-up was 16 and 17 months for Glu and Ico respectively (range 0.5 – 25 months and 5 – 25 months, respectively). Outcome Measures Peritoneal defense characteristics and peritoneal dialysis-related infections were recorded every 3 months. Results Total peritoneal white cell count tended to decrease over time in both groups. After 1 year, absolute numbers and percentages of effluent peritoneal macrophages (PMΦs) were significantly higher in Ico than in Glu patients; this difference in the percentage persisted after 2 years. Percentage of mesothelial cells increased over time in Ico patients. The phagocytic capacity of PMΦs decreased over time, resulting in a borderline significant difference for coagulase-negative staphylococci ( p = 0.05) and a significant difference for Escherichia coli ( p < 0.05) phagocytosis in favor of Ico patients. PMΦ oxidative metabolism remained stable over time without a difference between the groups. PMΦ cytokine production and effluent opsonic capacity also remained stable over time. Finally, 16 peritonitis episodes in Glu and 14 in Ico patients occurred. Glucose patients had 37 and Ico patients 32 exit-site infections during the study. Conclusion CCPD patients using Ico did equally as well as Glu-treated patients with respect to clinical infections and most peritoneal defense characteristics. However, in a few peritoneal defense tests, Ico-treated patients did better.

Psychological distress and frailty transitions over time in community-dwelling older adults

2016 ◽  
Vol 33 (2) ◽  
pp. 111-119 ◽  
Author(s):  
J. E. McHugh ◽  
M. Dowling ◽  
A. Butler ◽  
B. A. Lawlor
Keyword(s):  
Older Adults ◽  
Psychological Distress ◽  
Physical Health ◽  
Negative Symptoms ◽  
Community Dwelling ◽  
Ageing Population ◽  
Observational Study Design ◽  
Community Dwelling Older Adults ◽  
Over Time

ObjectivesPhysical health and, in particular, frailty may be associated with psychological factors among older adults. We aimed to investigate the relationships between aspects of psychological distress and progression of frailty over time among older adults.MethodsWe used a longitudinal observational study design with 624 participants aged over 60 years (mean age=72.75, s.d.=7.21, 68% female) completing a baseline comprehensive biopsychosocial geriatric assessment, and 447 returning for a follow-up assessment 2 years later. Aspects of psychological distress, physical health, and frailty were analysed for the purposes of this study. We employed a series of logistic regression analyses to determine psychological predictors of changing states of aspects of frailty over time.ResultsWith individual components of frailty, neuroticism and age predicted negative transitions of exhaustion and grip strength, respectively, whereas age alone was a predictor of transitions in overall frailty scores based on four components.ConclusionWe conclude that neuroticism and age may impact upon physical frailty and its progression over time in an ageing population. These findings may reflect the tendency for those with high levels of neuroticism to endorse negative symptoms, or alternatively, neuroticism may result in exhaustion via worry in an older population. Further research is required to further elucidate this relationship.

scholarly journals Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy

2016 ◽  
Vol 36 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Ozkan Ulutas ◽  
Janine Farragher ◽  
Ernest Chiu ◽  
Wendy L. Cook ◽  
Sarbjit V. Jassal
Keyword(s):  
Peritoneal Dialysis ◽  
Daily Living ◽  
Functional Disability ◽  
Functional Performance ◽  
Functional Dependence ◽  
Cross Sectional Study ◽  
Dialysis Therapy ◽  
Timed Up And Go ◽  
Cross Sectional ◽  
Home Dialysis

♦ BackgroundOlder in-center hemodialysis patients have a high burden of functional disability. However, little is known about patients on home chronic peritoneal dialysis (PD). As patients opting for home dialysis are expected to play a greater role in their own dialysis care, we hypothesized that a relatively low number of PD patients would require help with basic self-care tasks (ADL) and instrumental activities of daily living (IADL).♦ MethodsWe used a cross-sectional study design to measure the proportion of patients aged 65 years and older undergoing outpatient PD who needed help with day-to-day activities. Patients living in nursing homes were excluded from the study. Functional dependence in ADL and IADL tasks were measured by the Barthel and Lawton Scales. Physical performance measures used included the timed up-and-go (TUG) test, chair stands and Folstein mini-mental score (MMSE).♦ResultsA total of 74 of 76 (97%) eligible PD patients participated. Patients had a mean age of 76.2 ± 7.5 years. Thirty-six percent had impaired MMSE scores, 69% were unable to stand from a chair without the use of their arms and 51% had abnormal TUG scores. Only 8 patients (11%) were fully independent for both ADL and IADL activities. Dependence in one or more ADL activity was reported by 64% of participants, while 89% reported dependence in one or more IADL.♦ConclusionsImpaired physical and functional performance is common in older patients maintained on PD. Collaborative geriatric-renal programs may be beneficial within the dialysis community.

Assessment of the Effectiveness, Safety, and Biocompatibility of Icodextrin in Automated Peritoneal Dialysis

2000 ◽  
Vol 20 (2_suppl) ◽  
pp. 106-113 ◽  
Author(s):  
◽  
Nynke Posthuma ◽  
Pieter M. Ter Wee ◽  
Ab J. M. Donker ◽  
Po L. Oe ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Sodium ◽  
Average Concentration ◽  
Serum Osmolality ◽  
Type I ◽  
Change Over Time ◽  
Amino Terminal ◽  
Significant Difference ◽  
Over Time

Objective Our study assessed the efficacy, safety, and biocompatibility of icodextrin (I) solution compared to glucose (G) solution as the daytime dwell in continuous cycling peritoneal dialysis (CCPD). Design In a randomized, open, prospective, parallel group study of two years’ duration, either I or G was used for the long daytime dwell in CCPD patients. Method The study was carried out in a university hospital and teaching hospital. Established CCPD patients and patients new to the modality were both included. Clinic visits were made at three-month intervals. In all patients, clinical data were gathered; ultrafiltration (UF) was recorded; and serum, urine, and dialysate samples and effluents were collected. Peritoneal defense characteristics and mesothelial markers were determined. Every six months, peritoneal kinetics studies were performed, and serum samples for icodextrin metabolites were taken. Results Thirty-eight patients (19 G, 19 I) started the study. The median follow-up was 16 months and 17 months respectively (range: 0.5 – 26 months and 3 – 26 months, respectively). Daytime UF volumes increased significantly (p < 0.001), and 24-hour UF tended to increase from baseline in the I group. Dialysate creatinine clearance increased non significantly in both groups over time. In I patients, serum disaccharides (maltose) concentration increased from 0.05 ± 0.01 mg/mL [mean ± standard error of mean (SEM)] at baseline, to an average concentration in the follow-up visits of 1.15 ± 0.04 mg/mL (p < 0.001). At the same time, serum sodium levels decreased from 138.1 ± 0.7 mmol/L to an average concentration in the follow-up visits of 135.9 ± 0.8 mmol/L (p < 0.05). At 12 months, the serum sodium concentration increased to a non significant difference from baseline. Serum osmolality increased, but did not differ significantly from G users at any visit. During peritonitis (P), daytime dwell UF decreased significantly compared to non peritonitis (NP) episodes in G patients (p < 0.001), but remained stable in I patients. Total 24-hour UF also decreased in G patients (p < 0.001), but not in I patients. In these I patients, serum disaccharides increased from 0.05 ± 0.01 mg/mL to 1.26 ± 0.2 mg/mL during follow-up. During peritonitis, serum disaccharides concentration did not increase further (1.47 ± 0.2 mg/mL, p = 0.56). Thirty P episodes occurred during follow-up: 16 in G patients and 14 in I patients (1 per 17.6 months and 1 per 21.9 months, respectively). After one year, absolute number and percentage of effluent peritoneal macrophages (PMΦs) were significantly higher in I patients than in G patients. The difference in percentage persisted after two years. The phagocytic capacity of PMΦs decreased over time, resulting in a borderline significant difference for coagulase-negative staphylococci phagocytosis (p = 0.05) and a significant difference for E. coli phagocytosis (p < 0.05) in favor of I patients. PMΦ oxidative metabolism, PMΦ cytokine production, and effluent opsonic capacity remained stable over time with no difference between the groups. Mass transfer area coefficients (MTACs) and clearances were stable and appeared unaffected by G or I treatment. Effluent cancer antigen 125 (CA125) was stable in G users and tended to decrease in I users. Effluent interleukin-8 (IL-8), carboxy-terminal propeptide of type I procollagen (PICP), and amino-terminal propeptide of type III procollagen (PIIINP) did not change over time and did not differ between the groups. Conclusions The use of I for the long daytime dwell in CCPD led to an increase in total UF of at least 261 mL per day, which was maintained over at least 24 months. During I treatment, serum I metabolites increased significantly and serum sodium concentrations decreased initially. As a result, serum osmolality increased slightly. Clinical adverse effects did not accompany these findings. The UF gain in the I patients was even higher during P, without a further increase in serum I metabolites. CCPD patients using I did equally well as G-treated patients with regard to clinical infections and most peritoneal defense characteristics. However, in a few peritoneal defense tests, I-treated patients did better. Peritoneal transport variables did not change over time. Peritoneal membrane markers did not change throughout the study and did not differ between the groups.

scholarly journals Stability of thyroid function in older adults: the Birmingham Elderly Thyroid Study

2018 ◽  
Vol 68 (675) ◽  
pp. e718-e726 ◽  
Author(s):  
Lesley Roberts ◽  
Deborah McCahon ◽  
Oliver Johnson ◽  
M Sayeed Haque ◽  
James Parle ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Cost Savings ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Thyroid Function Tests ◽  
Older Individuals ◽  
Original Result ◽  
Over Time

BackgroundThyroid function tests (TFTs) are among the most requested tests internationally. However, testing practice is inconsistent, and potentially suboptimal and overly costly. The natural history of thyroid function remains poorly understood.AimTo establish the stability of thyroid function over time, and identify predictors of development of overt thyroid dysfunction.Design and settingLongitudinal follow-up in 19 general practices in the UK.MethodA total of 2936 participants from the Birmingham Elderly Thyroid Study (BETS 1) with a baseline TFT result indicating euthyroid or subclinical state were re-tested after approximately 5 years. Change in thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid status between baseline and follow-up was determined. Predictors of progression to overt dysfunction were modelled.ResultsParticipants contributed 12 919 person-years; 17 cases of overt thyroid dysfunction were identified, 13 having been classified at baseline as euthyroid and four as having subclinical thyroid dysfunction. Individuals with subclinical results at baseline were 10- and 16-fold more likely to develop overt hypothyroidism and hyperthyroidism, respectively, compared with euthyroid individuals. TSH and FT4 demonstrated significant stability over time, with 61% of participants having a repeat TSH concentration within 0.5 mIU/L of their original result. Predictors of overt hypothyroidism included new treatment with amiodarone (odds ratio [OR] 92.1), a new diagnosis of atrial fibrillation (OR 7.4), or renal disease (OR 4.8).ConclusionHigh stability of thyroid function demonstrated over the 5-year interval period should discourage repeat testing, especially when a euthyroid result is in the recent clinical record. Reduced repeat TFTs in older individuals is possible without conferring risk, and could result in significant cost savings.

scholarly journals A Virtual Multidisciplinary Care Program for Management of Advanced Chronic Kidney Disease: Matched Cohort Study

10.2196/17194 ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. e17194 ◽  
Author(s):  
Paulina Kaiser ◽  
Olivia Pipitone ◽  
Anthony Franklin ◽  
Dixie R Jackson ◽  
Elizabeth A Moore ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Health Program ◽  
Care Program ◽  
Multidisciplinary Care ◽  
Outpatient Setting ◽  
Dialysis Modality ◽  
Advanced Chronic Kidney Disease ◽  
Home Dialysis

Background It is not well established whether a virtual multidisciplinary care program for persons with advanced chronic kidney disease (CKD) can improve their knowledge about their disease, increase their interest in home dialysis therapies, and result in more planned outpatient (versus inpatient) dialysis starts. Objective We aimed to evaluate the feasibility and preliminary associations of program participation with disease knowledge, home dialysis modality preference, and outpatient dialysis initiation among persons with advanced CKD in a community-based nephrology practice. Methods In a matched prospective cohort, we enrolled adults aged 18 to 85 years with at least two estimated glomerular filtration rates (eGFRs) of less than 30 mL/min/1.73 m2 into the Cricket Health program and compared them with controls receiving care at the same clinic, matched on age, gender, eGFR, and presence of heart failure and diabetes. The intervention included online education materials, a virtual multidisciplinary team (nurse, pharmacist, social worker, dietician), and patient mentors. Prespecified follow-up time was nine months with extended follow-up to allow adequate time to determine the dialysis start setting. CKD knowledge and dialysis modality choice were evaluated in a pre-post survey among intervention participants. Results Thirty-seven participants were matched to 61 controls by age (mean 67.2, SD 10.4 versus mean 68.8, SD 9.5), prevalence of diabetes (54%, 20/37 versus 57%, 35/61), congestive heart failure (22%, 8/37 versus 25%, 15/61), and baseline eGFR (mean 19, SD 6 versus mean 21, SD 5 mL/min/1.73 m2), respectively. At nine-month follow-up, five patients in each group started dialysis (P=.62). Among program participants, 80% (4/5) started dialysis as an outpatient compared with 20% (1/5) of controls (OR 6.28, 95% CI 0.69-57.22). In extended follow-up (median 15.7, range 11.7 to 18.1 months), 19 of 98 patients started dialysis; 80% (8/10) of the intervention group patients started dialysis in the outpatient setting versus 22% (2/9) of control patients (hazard ratio 6.89, 95% CI 1.46-32.66). Compared to before participation, patients who completed the program had higher disease knowledge levels (mean 52%, SD 29% versus mean 94%, SD 14% of questions correct on knowledge-based survey, P<.001) and were more likely to choose a home modality as their first dialysis choice (36%, 7/22 versus 68%, 15/22, P=.047) after program completion. Conclusions The Cricket Health program can improve patient knowledge about CKD and increase interest in home dialysis modalities, and may increase the proportion of dialysis starts in the outpatient setting.

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