scholarly journals A 2-year follow-up study of patients on automated peritoneal dialysis

2013 ◽  
Vol 23 (5) ◽  
pp. 327
Author(s):  
R Ram ◽  
P Charan ◽  
KV Dakshinamurty ◽  
CShyam Sunder Rao ◽  
GDiwaker Naidu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Automated Peritoneal Dialysis ◽  
Follow Up Study

False Elevation of Blood Glucose Levels Measured by GDH-PQQ-BASED Glucometers Occurs during all Daily Dwells in Peritoneal Dialysis Patients Using Icodextrin

2010 ◽  
Vol 30 (3) ◽  
pp. 329-335 ◽  
Author(s):  
Chiu-Yeh Tsai ◽  
Su-Chu Lee ◽  
Chi-Chih Hung ◽  
Jia-Jung Lee ◽  
Mei-Chuan Kuo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Blood Glucose ◽  
Glucose Dehydrogenase ◽  
Serum Glucose ◽  
Monitoring Systems ◽  
Self Monitoring ◽  
Glucose Levels ◽  
Follow Up Study ◽  
Blood Glucose Levels

♦ ObjectiveFalse elevation of blood glucose levels measured by glucose dehydrogenase pyrroloquinoline quinone (GDH-PQQ)-based glucose self-monitoring systems; glucometer) in peritoneal dialysis (PD) patients using icodextrin solution has been well documented. However, adverse hypoglycemic events caused by misreadings for blood glucose are still being reported. We aimed to study blood glucose levels measured simultaneously using different methods in PD patients with switching of icodextrin, and throughout daily exchanges either using icodextrin or not.♦ DesignWe recruited 100 PD patients, including 40 using icodextrin; 128 hemodialysis patients served as a reference. Fasting serum glucose was measured using our laboratory reference method (LAB) and 2 glucose self-monitoring systems based on glucose dehydrogenase nicotinamide adenine dinucleotide (GDH-NAD) and GDH-PQQ respectively. 80 PD patients had a second follow-up study. A time course study was performed in 16 PD patients through measuring fingertip glucose using the 2 glucose self-monitoring systems during daily exchanges.♦ ResultThe differences in measured serum glucose levels in (PQQ minus LAB) versus (NAD minus LAB) were markedly increased in PD patients using icodextrin compared to other patient groups, and was further confirmed by the follow-up study in patients that switched to icodextrin. The high serum glucose levels measured by the GDH-PQQ-based glucose self-monitoring system were present throughout all exchanges during the day in patients using icodextrin solution.♦ ConclusionsFalse elevation of blood glucose measured by GDH-PQQ-based glucose self-monitoring systems exists in patients using icodextrin. To avoid misinterpretation of hyperglycemia and subsequent over-injection of insulin, GDH-PQQ-based glucose self-monitoring systems should not be used in PD patients.

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

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.

A pilot project evaluating a fixed drainage system (U-Drain) for automated peritoneal dialysis

2021 ◽  
pp. 089686082110359
Author(s):  
Dimitrios Poulikakos ◽  
Joanne Martin ◽  
Joanne Collier ◽  
David Lewis
Keyword(s):  
At Risk ◽  
Peritoneal Dialysis ◽  
Drainage System ◽  
Pilot Project ◽  
Automated Peritoneal Dialysis ◽  
Time Saving ◽  
Staff Members ◽  
Delays In Diagnosis ◽  
Healthcare Assistant

U-Drain is a fixed drainage system for automated peritoneal dialysis (APD) connecting the dialysis effluent outflow directly to the household drainage system thus avoiding the need for drain bags, with considerable potential advantages for patient convenience and reduction of plastic clinical waste. Here we present a pilot project reporting on U-Drain patient and staff experience based on questionnaires and on the safety of the technology derived from analysis of characteristics of peritonitis episodes. Overall, 15 patients were included in the pilot project and were followed up over 3 years; 11 patients completed a questionnaire exploring their experiences of APD and U-Drain. A family member 55%, carer 10%, healthcare assistant 10% and patient themselves 25% would normally carry the full drainage bags for disposal. Following the installation of U-Drain, 90% of patients reported that the system saved them time setting up and clearing the machine after dialysis, 80% noted a reduction in storage space required for consumables and all patients noted a reduction in non-recyclable waste requiring disposal. All patients who completed the questionnaire were very satisfied with the installation. All staff members who completed the questionnaire reported that their role was easier and the system was time saving. In total, there were 8 peritonitis episodes, including 2 recurrent infections due to biofilm, over 313 patient months follow up. There was no increase in incidence of peritonitis infection (0.3 episodes per year at risk) compared to that in the unit’s population (0.64, 0.42 and 0.5 episodes per year at risk for the years 2017, 2018 and 2019, respectively) or delays in diagnosis. Approximately 0.8 kg of non-recyclable clinical waste was saved per treatment day from domestic waste by avoiding the use of PD drain bags. This pilot demonstrates increased patient satisfaction and acceptable safety profile of U-Drain technology.

scholarly journals Impact of Intra-Abdominal Adhesion on Dialysis Outcome in Peritoneal Dialysis Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Ben-Chung Cheng ◽  
Nai-Wen Tsai ◽  
Yun-Ru Lai ◽  
Chin-Cheng Huang ◽  
Cheng-Hsien Lu
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Surgery ◽  
Therapeutic Option ◽  
Technical Failure ◽  
Previous Abdominal Surgery ◽  
Follow Up Study ◽  
Risk Patients ◽  
Technical Failures

Background.Peritoneal dialysis (PD) is an increasingly popular therapeutic option for patients with advanced renal failure. However, intra-abdominal adhesions (IAA) represent a major unsolved problem in adequate PD performance. In this study, we investigated the role of previous abdominal surgery on the presence of subsequent IAA as well as outcomes in those patients with PD who had subsequent IAA.Methods.Two hundred and two patients who received continuous ambulatory peritoneal dialysis were prospectively enrolled in this study. We compared the PD adequacy indices and outcomes for technical failure in patients with and without subsequent IAA at presentation and a minimum of 2 years of follow-up.Results.Subsequent IAA accounted for 19% (38/202) of patients. Patients who had previous abdominal surgery had higher risks of subsequent IAA especially those patients who had higher mean ages (P=0.023). PD adequacy indices including both 24-hour dialysate volume and peritoneal WCcr L/week/1.73 m2were significantly lower in patients who had, as compared to those who did not have subsequent IAA (P=0.003 and 0.018, respectively). Although patients who had subsequent IAA had decreased PD adequacy, the development of technical failures during PD maintenance did not show significant differences at the 2-year minimum follow-up study.Conclusions.Subsequent IAA is not rare, especially in high-risk patients including those with previous abdominal surgery and higher mean ages. Although decreased PD adequacy after IAA was found, the development of technical failures was not significantly different at the 2-year minimum follow-up study.

scholarly journals The Effect of Automated versus Continuous Ambulatory Peritoneal Dialysis on Mortality Risk in China

2018 ◽  
Vol 38 (2_suppl) ◽  
pp. 25-35 ◽  
Author(s):  
Xuemei Li ◽  
Hong Xu ◽  
Nan Chen ◽  
Zhaohui Ni ◽  
Menghua Chen ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Competing Risks ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Mortality Risk ◽  
Proportional Hazards ◽  
Robust Regression ◽  
Cox Proportional Hazards ◽  
Automated Peritoneal Dialysis ◽  
Risk Of Death

Background There is an emerging practice pattern of automated peritoneal dialysis (APD) in China. We report on outcomes compared to continuous ambulatory peritoneal dialysis (CAPD) in a Chinese cohort. Methods Data were sourced from the Baxter Healthcare (China) Investment Co. Ltd Patient Support Program database, comprising an inception cohort commencing PD between 1 January 2005 and 13 August 2015. We used time-dependent cause-specific Cox proportional hazards and Fine-Gray competing risks (kidney transplantation, change to hemodialysis) models to estimate relative mortality risk between APD and CAPD. We adjusted or matched for age, gender, employment, insurance, primary renal disease, size of PD program, and year of dialysis inception. We used cluster robust regression to account for center effect. Results We modeled 100,351 subjects from 1,178 centers over 240,803 patient-years. Of these, 368 received APD at some time. Compared with patients on CAPD, those on APD were significantly younger, more likely to be male, employed, self-paying, and from larger programs. Overall, APD was associated with a hazard ratio (HR) for death of 0.79 (95% confidence interval [CI] 0.64 – 0.97) compared with CAPD in Cox proportional hazards models, and 0.76 (0.62 – 0.95) in Fine-Gray competing risks regression models. There was prominent effect modification by follow-up time: benefit was observed only up to 4 years follow-up, after which risk of death was similar. Conclusion Automated peritoneal dialysis is associated with an overall lower adjusted risk of death compared with CAPD in China. Analyses are limited by the likelihood of important selection bias arising from group imbalance, and residual confounding from unavailability of important clinical covariates such as comorbidity and Kt/V.

A Comparative Analysis on the Incidence of Peritonitis and Exit-Site Infection in Capd and Automated Peritoneal Dialysis

1999 ◽  
Vol 19 (3) ◽  
pp. 253-258 ◽  
Author(s):  
Ana Rodríguez–Carmona ◽  
Miguel Pérez Fontán ◽  
Teresa García Falcón ◽  
Constantino Fernández Rivera ◽  
Francisco Valdés
Keyword(s):  
Peritoneal Dialysis ◽  
Tertiary Care Hospital ◽  
Clinical Course ◽  
Tertiary Care ◽  
Care Hospital ◽  
Site Infection ◽  
Automated Peritoneal Dialysis ◽  
Exit Site ◽  
Exit Site Infection

Objective To compare the incidence of peritonitis and exit-site infection in an ample group of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis in a single center during a 10-year period. Design Nonrandomized, prospective study. Setting Public, tertiary care hospital providing peritoneal dialysis care to a population of (approximately) 750 000 people. Patients We studied 213 patients on CAPD and 115 on automated peritoneal dialysis (APD) starting therapy between January 1989 and August 1998, with a minimum follow-up of 3 months. Main Outcome Measures Using a multivariate approach, we compared the incidence, clinical course, and outcome of peritonitis and exit-site infections in both groups, controlling for other risk factors for the complications studied. Results The incidence of peritonitis was higher in CAPD than in APD (adjusted difference 0.20 episodes/ patient/year, 95% confidence interval 0.08 – 0.32). There was a trend for CAPD patients to present earlier with peritonitis than APD patients, yet the incidence of and survival to the first exit-site infection were similar in both groups. The etiologic spectrum of infections displayed minor differences between groups. Automated PD patients were more frequently hospitalized for peritonitis, but otherwise, the complications and outcome of peritonitis and exit-site infections did not differ significantly between patients on CAPD and those on APD. Conclusions Automated PD is associated with a lower incidence of peritonitis than is CAPD, while exit-site infection is similarly incident under both modes of therapy. The etiologic spectrum, complications, and outcome of peritonitis and exit-site infection do not differ markedly between CAPD and APD. Prevention of peritonitis should be included among the generic advantages of APD over CAPD.

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