Strategic Analytics to Drive Provincial Dialysis Capacity Planning

2017 ◽  
pp. 171-197
Author(s):  
Neal Kaw ◽  
Somayeh Sadat ◽  
Ali Vahit Esensoy ◽  
Zhihui (Amy) Liu ◽  
Sarah Jane Bastedo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Capacity Planning ◽  
Dialysis Patient ◽  
Mathematical Optimization ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Patients ◽  
Home Dialysis ◽  
Chronic Dialysis Patient ◽  
Dialysis Facilities ◽  
User Friendly

This chapter discusses applications of analytics at the strategic level of health system planning in the province of Ontario, Canada. To supplement the strategic priorities of the Ontario Renal Plan I, a roadmap developed by the Ontario Renal Network to guide its directions in coordinating renal care province-wide, an interactive user-friendly analytical capacity planning model was developed to forecast the growth of the prevalent chronic dialysis patient population and estimate consequent future need for hemodialysis stations at Ontario's dialysis facilities. The model also projects operational funding to care for dialysis patients, vascular surgeries to achieve arteriovenous fistula targets, peritoneal dialysis catheter insertions to achieve peritoneal dialysis prevalence targets, and incident dialysis patients to be sent home to achieve prevalent home dialysis targets. The model uses a variety of analytical methods, including time series analysis, mathematical optimization, geo-spatial analysis and Monte Carlo simulation.

Hemoperitoneum in a Peritoneal Dialysis Patient: Ruptured Ectopic Pregnancy

2018 ◽  
Vol 38 (6) ◽  
pp. 455-456 ◽  
Author(s):  
Orly F. Kohn ◽  
Sandra Culbertson ◽  
Yolanda T. Becker
Keyword(s):  
Differential Diagnosis ◽  
Peritoneal Dialysis ◽  
Ectopic Pregnancy ◽  
Dialysis Patient ◽  
Surgical Intervention ◽  
Peritoneal Dialysis Patient ◽  
Dialysis Patients ◽  
Childbearing Age ◽  
Life Threatening ◽  
High Index Of Suspicion

Hemoperitoneum is a well-recognized complication in female peritoneal dialysis (PD) patients of childbearing age. Bloody effluent is commonly of minor nature, presenting during menstruation or midcycle, resolving after a few rapid exchanges without a need for further intervention. One must remain vigilant, however, and consider a broader differential diagnosis when hemoperitoneum is persistent or severe, as it indicates a serious and potentially life-threatening etiology. We report 2 episodes of hemoperitoneum in a PD patient occurring more than 1.5 years apart, with different underlying etiologies. The more dramatic second episode was due to a ruptured ectopic pregnancy, a condition which had not been reported as a cause of hemoperitoneum in dialysis patients to date and requires a high index of suspicion and prompt surgical intervention.

Prevention of peritoneal dialysis catheter infections in Saudi peritoneal dialysis patients: the emergence of high-level mupirocin resistance

2013 ◽  
Vol 36 (7) ◽  
pp. 473-483 ◽  
Author(s):  
Abdullah K. Al-Hwiesh ◽  
Ibrahiem Saeed Abdul-Rahman ◽  
Fahd Abdulaziz Al-Muhanna ◽  
Mohammed Hamad Al-Sulaiman ◽  
Mohammed Shami Al-Jondebi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Dialysis Patients ◽  
Mupirocin Resistance ◽  
High Level ◽  
Catheter Infections

Comparison of Psychological Adjustment to Continuous Ambulatory Peritoneal Dialysis and Home Hemodialysis

1981 ◽  
Vol 2 (2) ◽  
pp. 82-84 ◽  
Author(s):  
Howard J. Burton ◽  
Atara Kaplan De-Nour ◽  
John A. Conley ◽  
George A. Wells ◽  
Lokky Wais
Keyword(s):  
Peritoneal Dialysis ◽  
Psychological Adjustment ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Sexual Satisfaction ◽  
Dialysis Patients ◽  
Home Hemodialysis ◽  
Home Dialysis ◽  
Household Members ◽  
Demographic Background

Two groups of home dialysis patients (40 on CAPD and 37 on home hemo dialysis) matched for length of time on dialysis, and for demographic background were studied and compared. The CAPD patients were significantly more satisfied with the support received from household members and from spouses, more satisfied with the relations with spouses, more understood by them and more understanding of their spouses. Sexual satisfaction declined in both groups. However, sexual satisfaction was slightly higher in the CAPD group and these patients experienced slightly less difficulty in adjusting to the decline; none of these differences were statistically significant.

Renal Transplantation in Patients on Peritoneal Dialysis

1985 ◽  
Vol 5 (3) ◽  
pp. 157-160 ◽  
Author(s):  
Neal R. Glass ◽  
Douglas T. Miller ◽  
Hans W. Sollinger ◽  
Stephen W. Zimmerman ◽  
David Simpson ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Dialysis Patients ◽  
Oral Steroids ◽  
Historical Group ◽  
Group 3 ◽  
Group 2 ◽  
High Doses

The authors reviewed the course of 56 peritoneal dialysis patients after renal transplantation to determine the influence of this mode of dialysis on the results of transplantation. Three subgroups were analyzed separately because of marked differences in results. Group 1 was a historical group of 13 diabetic and two nondiabetic recipients of cadaveric grafts transplanted before 1982 who received standard immunosuppression with steroids and azathioprine only, and antirejection therapy with steroids and/or antithymocytic globulin (ATG). In this group results were poor: only 100/o of grafts and 670/o of patients survived two years or more. Group 2, the current group of cadaveric recipients, consists of 11 diabetic and nine nondiabetic patients transplanted since 1982; these patients received standard immunosuppression with low-dose steroids, azathioprine, and a two-week course of prophylactic ATG beginning within one day of transplantation; rejection was treated with high doses of oral steroids. In this second group, results were good: 630/o of the grafts are functioning and 100% of patients have survived for up to two years. Group 3, consisting of 21 recipients of living donor kidneys, had excellent results with 1000/o graft and patient survival up to five years. Rejection (N = 11), death (N = 5) and renovascular problems (N = 3) caused the 19 graft losses. In most patients the dialysis catheters were removed three weeks to three months after transplantation when renal function was stable. There were two minor complications and no infections related to the catheters. We conclude that: a) excellent transplant results can be achieved in peritoneal dialysis patients, most of whom are diabetic and receive cadaveric grafts, b) the peritoneal dialysis catheter is not a significant source of peritransplant morbidity and therefore c) peritoneal dialysis is appropriate for patients awaiting renal transplantation and should not bias against their selection for transplantation. The published literature on kidney transplantation in patients on peritoneal dialysis is sparse, suggesting that it is not, and perhaps should not be common practice to transplant these patients. This study and review of the literature was undertaken 1) to characterize peritoneal dialysis patients undergoing renal transplantation at our center, 2) to determine the results of transplantation in this group, 3) to evaluate the risk to these patients from the peritoneal dialysis catheter itself and 4) to compare our experience with the literature concerning renal transplantation of peritoneal dialysis patients.

scholarly journals Pleuroperitoneal Leak: An Unusual Cause of Acute Shortness of Breath in a Peritoneal Dialysis Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
D. P. Ramaema ◽  
P. Mpikashe
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Dialysis Patient ◽  
Peritoneal Dialysis Patient ◽  
Shortness Of Breath ◽  
Pleural Effusions ◽  
Dialysis Patients ◽  
Case Presentation ◽  
Peritoneal Scintigraphy ◽  
Uncommon Complication

Introduction. Pleuroperitoneal leak is an uncommon complication of continuous ambulatory peritoneal dialysis (CAPD), with an estimated incidence of 1.6%. It should be suspected in these patients when they present with recurrent unilateral pleural effusions and/or acute shortness of breath following dialysate infusion.Case Presentation. We present the case of a 25-year-old female patient who had acute hydrothorax as a result of pleuroperitoneal leak complicating continuous ambulatory peritoneal dialysis (CAPD), which was confirmed on peritoneal scintigraphy.Conclusion. Continuous ambulatory peritoneal dialysis patients presenting with acute shortness of breath and/or recurrent unilateral pleural effusion should be investigated with peritoneal scintigraphy to exclude pleuroperitoneal leak.

scholarly journals Assisted peritoneal dialysis across Europe: Practice variation and factors associated with availability

2021 ◽  
pp. 089686082110498
Author(s):  
Anita van Eck van der Sluijs ◽  
Brigit C van Jaarsveld ◽  
Jennifer Allen ◽  
Karmela Altabas ◽  
Clémence Béchade ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Practice Variation ◽  
Dialysis Patients ◽  
Home Dialysis ◽  
Factors Associated ◽  
Western European ◽  
End Stage ◽  
Dedicated Team

Background: In Europe, the number of elderly end-stage kidney disease patients is increasing. Few of those patients receive peritoneal dialysis (PD), as many cannot perform PD autonomously. Assisted PD programmes are available in most European countries, but the percentage of patients receiving assisted PD varies considerably. Hence, we assessed which factors are associated with the availability of an assisted PD programme at a centre level and whether the availability of this programme is associated with proportion of home dialysis patients. Methods: An online survey was sent to healthcare professionals of European nephrology units. After selecting one respondent per centre, the associations were explored by χ 2 tests and (ordinal) logistic regression. Results: In total, 609 respondents completed the survey. Subsequently, 288 respondents from individual centres were identified; 58% worked in a centre with an assisted PD programme. Factors associated with availability of an assisted PD programme were Western European and Scandinavian countries (OR: 5.73; 95% CI: 3.07–10.68), non-academic centres (OR: 2.01; 95% CI: 1.09–3.72) and centres with a dedicated team for education (OR: 2.87; 95% CI: 1.35–6.11). Most Eastern & Central European respondents reported that the proportion of incident and prevalent home dialysis patients was <10% (72% and 63%), while 27% of Scandinavian respondents reported a proportion of >30% for both incident and prevalent home dialysis patients. Availability of an assisted PD programme was associated with a higher incidence (cumulative OR: 1.91; 95% CI: 1.21–3.01) and prevalence (cumulative OR: 2.81; 95% CI: 1.76–4.47) of patients on home dialysis. Conclusions: Assisted PD was more commonly offered among non-academic centres with a dedicated team for education across Europe, especially among Western European and Scandinavian countries where higher incidence and prevalence of home dialysis patients was reported.[Formula: see text]

scholarly journals Foreign body ingestion-related peritonitis in an elderly peritoneal dialysis patient

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110564
Author(s):  
Taghavi Maxime ◽  
Bellavia Salvatore ◽  
Thibaut Véronique³ ◽  
De Pelsemaeker Marie-Caroline ◽  
Mesquita Maria do Carmo Filomena ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Foreign Body ◽  
Dialysis Patient ◽  
Foreign Bodies ◽  
Peritoneal Dialysis Patient ◽  
Medication Administration ◽  
Abdominal Sepsis ◽  
Dialysis Patients ◽  
Accidental Ingestion ◽  
Ileal Perforation

Among peritoneal dialysis patients, peritoneal dialysis-related peritonitis is a well-known complication, but it can also be non-peritoneal dialysis-related (e.g. ruptured appendix). Ileal perforation by foreign bodies such as blister pill packs can be seen in the emergency room. Differentiating this from peritoneal dialysis-related peritonitis can be difficult, since they can have both identical presentations. Computed tomography can be of value in detecting abscess, thickening of the digestive wall or adhesions, and exclude other causes of intra-abdominal sepsis. Because of the aging population, ingestion of foreign body can be expected to rise. We therefore recommend that blister pill packs should not be divided into single-dose pieces, and we invite elderly patient’s entourage to check medication administration. Furthermore, manufacturing efforts are highly recommended to improve blister pill pack’s design, to avoid accidental ingestion. We report the case of an elderly peritoneal dialysis patient who presented with peritonitis due to ileal perforation because of blister pill pack ingestion.

Continuous Ambulatory Peritoneal Dialysis Catheter Infections: Diagnosis and Management

1994 ◽  
Vol 14 (3) ◽  
pp. 248-254 ◽  
Author(s):  
Michael J. Flanigan ◽  
Linda A. Hochstetler ◽  
Donita Langholdt ◽  
Victoria S. Lim
Keyword(s):  
Peritoneal Dialysis ◽  
Antibiotic Therapy ◽  
Minimal Risk ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Exit Site ◽  
Gram Negative ◽  
Home Dialysis ◽  
Serous Discharge ◽  
Catheter Infections

Purpose To develop diagnostic and treatment strategies for peritoneal dialysis catheter exit-site and tunnel infections. Population All consenting peritoneal dialysis patients performing home dialysis through the University of Iowa Hospitals and Clinics Home Dialysis Training Center. This is a state-owned teaching hospital serving a rural population of approximately one million people in Iowa and western Illinois. Methods Four dialysis nurses collected information on a prospectively designed data acquisition tool. Patients were randomly assigned to one of two treatment groups, intraperitoneal vancomycin plus oral rifampin or oral trimethoprim/ sulfamethoxazole (TMP/SMX), and their initial antibiotic therapy determined by that assignment. If the infection was gram -negative, the initial antibiotics were discontinued and an alternative therapy begun. Therapy was initiated by the nursing staff and required physician notification within 48 hours. Results There were 126 recorded catheter infections (exit-site, tunnel, or cuff infection) resulting in a rate of 0.67 episodes per patient year of exposure. Staphylococcus aureus was isolated from the majority (60%) of these events. Pseudomonas aeruginosa was the next most common isolate and accounted for 21% of infections. Rubor, dolor, and turgor are the classic signs of inflammation, and at least one of these was present in 79% of the episodes. Isolated pericatheter erythema or serous discharge was associated with a minimal risk «2%) of catheter loss. The presence of a purulent exit-site discharge identified patients who had a 30% chance of failing systemic antibiotic therapy and a 20% risk of catheter loss. The concurrent presence of exit-site tenderness or swelling identified the most severe infections. Staphylococcal infections responded equally well to local cleaning and vancomycin plus rifampin (86% cured) or oral trimethoprim/sulfamethoxazole (89% cured) therapy. Gram-negative infections were frequent (27%) and appeared to respond best to a combination of tobramycin and ciprofloxacin. Conclusion Exit-site/tunnel inflammation is detectable by patients and can be used to guide therapy. An isolated finding of erythema or serous discharge is not indicative of an acute infection and may not require systemic antibiotics. The presence of purulence identifies patients at risk for catheter loss, and these patients benefit from systemic therapy. The combination of a purulent exit-site discharge plus pericatheter tenderness or swelling identifies patients likely to suffer treatment failure and require subsequent catheter removal. The cure rate of gram -positive catheter infections treated with vancomycin plus rifampin was indistinguishable from that achieved with oral trimethoprim/sulfamethoxazole (p = 0.99).

scholarly journals A surgical girdle postoperatively may prevent pain and tunnel infections of peritoneal dialysis patients

2019 ◽  
Vol 43 (4) ◽  
pp. 225-228
Author(s):  
Christina Nilsson ◽  
Wolfgang Sperker ◽  
Claudia Schien ◽  
Malin Isaksson ◽  
Bernd G Stegmayr
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Analogue Scale ◽  
Exposure Period ◽  
Acute Onset ◽  
The Other ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Dialysis Patients ◽  
Retrospective Questionnaire

Aim: When performing acute onset dialysis after insertion of catheters for peritoneal dialysis, pain exists and tunnel infections may develop. This study investigated whether patients benefit from the use of a surgical girdle and specific dressing postoperatively to prevent pain and tunnel infections. Materials and Methods: In 85 consecutive patients, the development of tunnel infections was followed. The patients used a surgical girdle when they were in supine position from day 1 to day 3. The peritoneal dialysis catheter was fixed in a curvature avoiding stretch in the exit. A total of 53 patients participated in a retrospective questionnaire to evaluate abdominal pain within the first 3 days after surgery either with or without girdle. A visual analogue scale from 0 to 10 was used. Results: In 23 patients, data on pain both with and without the girdle could be recorded. Pain was relieved more when using the girdle versus no girdle (median day 1 3.0 vs 4.0, p < 0.001, n = 30, Wilcoxon paired). The development of tunnel infections during the latest 7-year period (exposure period 1487 months) showed a total of three episodes (one every 495 months) of which one caused a subsequent peritonitis, while the other two resolved after antibiotic therapy. Peritonitis episodes appeared at a mean of 37-month interval. Conclusion: The use a surgical girdle for 3 days postoperatively and a fixation of the peritoneal dialysis catheter in a curved loop relieves the pain and results in few tunnel infections and subsequent episodes of peritonitis.

The Use of Community Nurses for Home Peritoneal Dialysis: Is it Cost -Effective?

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 479-482 ◽  
Author(s):  
Gillian Brunier ◽  
Barbara Gray ◽  
Nancy Coulis ◽  
Judy Savage ◽  
Arif Manuel ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Family Members ◽  
Cost Effective ◽  
Peritoneal Dialysis Patient ◽  
Severe Disabilities ◽  
Dialysis Patients ◽  
Home Dialysis ◽  
Complex Needs ◽  
Stage Renal Disease ◽  
End Stage

In the late 1970s, continuous ambulatory peritoneal dialysis was first introduced as a mode of treatment for patients with end-stage renal disease. Since that time many patients, themselves or with the help of family members, have routinely performed the therapy at home. There are now 2935 home peritoneal dialysis patients in Canada (36% of the total dialysis population}. Today, however, the average patient on dialysis is likely to be older and have other complicating illnesses; moreover, patients may live alone, or have family members who are working. Over the past three years, through the use of innovative assistive devices and strong educational links with community nursing agencies, we have been able to manage peritoneal dialysis patients with complex needs in the home. We performed a retrospective analysis of 18 patients, with severe comorbid conditions, who were managed in the home with the help of community nurses. We will show that this is an economic, efficient, and effective method of caring for home dialysis patients with severe disabilities. Home care agencies need our support so that they can continue to help us manage the complex peritoneal dialysis patient in the 1990s.

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