|
1
|
Kiourtidis K, Nikolaidou S, Rouka E, Lange J, Griva K, Liakopoulos V, Zarogiannis SG. Assessment of the perceptions of health-related quality of life in Greek patients undergoing automated peritoneal dialysis with remote monitoring: A qualitative study. Ther Apher Dial 2024; 28:923-930. [PMID: 38923684 DOI: 10.1111/1744-9987.14180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/27/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND This study aimed to explore in depth the lived experience and quality of life outcomes in patients receiving automated peritoneal dialysis (APD) treatment. METHODS The study adhered to the standards of the Consolidated Criteria for Reporting Qualitative Research. A total of 19 APD patients were recruited and assessed using in-depth semi-structured interviews on various aspects of life with respect to APD modality. The interviews were transcribed verbatim and analyzed using Interpretive Phenomenological Analysis. RESULTS Study findings generated five superordinate themes: (a) treatment-free daily routine, (b) sleep disturbances, (c) remote care, (d) limitations of peritoneal dialysis, and (e) the dimension of chronic disease. Further analysis of the material revealed the relationship of these themes with individual patient characteristics. CONCLUSIONS Overall, our findings suggest that APD characteristics contribute to the perceptions of quality of life in patients under dialysis considerably.
Collapse
Affiliation(s)
- Kyriakos Kiourtidis
- Primary Health Care Postgraduate Program, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, Larissa, Greece
| | - Sofia Nikolaidou
- Primary Health Care Postgraduate Program, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, Larissa, Greece
| | - Erasmia Rouka
- Department of Nursing, School of Health Sciences, University of Thessaly, GAIOPOLIS, Larissa, Greece
| | | | - Konstantina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sotirios G Zarogiannis
- Primary Health Care Postgraduate Program, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, Larissa, Greece
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, Larissa, Greece
| |
Collapse
|
|
2
|
Borràs Sans M, Ponz Clemente E, Rodríguez Carmona A, Vera Rivera M, Pérez Fontán M, Quereda Rodríguez-Navarro C, Bajo Rubio MA, de la Espada Piña V, Moreiras Plaza M, Pérez Contreras J, Del Peso Gilsanz G, Prieto Velasco M, Quirós Ganga P, Remón Rodríguez C, Sánchez Álvarez E, Vega Rodríguez N, Aresté Fosalba N, Benito Y, Fernández Reyes MJ, García Martínez I, Minguela Pesquera JI, Rivera Gorrín M, Usón Nuño A. Clinical guideline on adequacy and prescription of peritoneal dialysis. Nefrologia 2024; 44 Suppl 1:1-27. [PMID: 39341764 DOI: 10.1016/j.nefroe.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 10/01/2024] Open
Abstract
In recent years, the meaning of adequacy in peritoneal dialysis has changed. We have witnessed a transition from an exclusive achievement of specific objectives -namely solute clearances and ultrafiltration- to a more holistic approach more focused to on the quality of life of these patients. The purpose of this document is to provide recommendations, updated and oriented to social and health environment, for the adequacy and prescription of peritoneal dialysis. The document has been divided into three main sections: adequacy, residual kidney function and prescription of continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. Recently, a guide on the same topic has been published by a Committee of Experts of the International Society of Peritoneal Dialysis (ISPD 2020). In consideration of the contributions of the group of experts and the quasi-simultaneity of the two projects, references are made to this guide in the relevant sections. We have used a systematic methodology (GRADE), which specifies the level of evidence and the strength of the proposed suggestions and recommendations, facilitating future updates of the document.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Usón Nuño
- Hospital Universitari Arnau de Vilanova, Lleida, Spain
| |
Collapse
|
|
3
|
Sanchez JE, Ulloa C, Bueno CM, Astudillo E, Rodríguez-Suárez C. Impact of peritoneal dialysis strategy on technique and patient survival. Clin Kidney J 2023; 16:2523-2529. [PMID: 38046044 PMCID: PMC10689157 DOI: 10.1093/ckj/sfad155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Indexed: 12/05/2023] Open
Abstract
Background The aim of this study was to evaluate the impact of peritoneal dialysis (PD) strategy on technique and patient survival. Methods This was a retrospective, single-center study conducted on consecutive patients with chronic kidney disease who underwent PD between January 2009 and December 2019. The study sample was stratified into four different groups according to PD technique [automated (APD) or manual (CAPD)] and icodextrin use (yes versus no). The primary endpoints were survival of both technique and patient. Results A total of 531 patients were included in the analysis. Mean ± standard deviation age was 60.6 ± 14.6 years, 68.4% (363) were men and 34.8% (185) had diabetes. The median technique survival time was 19 (15) months. A total of 185 (34.8%), 96 (18.1%), 99 (18.7%) and 151 (28.4%) patients were included in the CAPD/No-Icodextrin, CAPD/Icodextrin, APD/No-Icodextrin and APD/Icodextrin study groups, respectively. Throughout the study, 180 (33.9%) patients underwent renal transplant, 71 (13.4%) were changed to hemodialysis and 151 (28.4%) died. Age [hazard ratio (HR) 0.975, 95% confidence interval (CI) 0.960-0.990, P = .001] and incidence of early peritoneal infection (HR 2.440, 95% CI 1.453-4.098, P = .001) were associated with technique survival, while age (HR 1.029, 95% CI 1.013-1.045, P < .001), Charlson Index (HR 1.192, 95% CI 1.097-1.295, P < 0.001), use of icodextrin (HR 0.421, 95% CI 0.247-0.710, P < .001) and APD/Icodextrin (HR 0.499, 95% CI 0.322-0.803, P = .005) were associated with patient survival. Conclusions Icodextrin use and APD/Icodextrin had a positive impact on patient survival, while older age and higher Charlson Index had a negative one. Age and incidence of early peritoneal infection significantly impacted on technique survival.
Collapse
Affiliation(s)
| | - Catalina Ulloa
- Fundación Hospital de Jove, Division of Nephrology, Gijón, Spain
| | | | - Elena Astudillo
- Hospital Universitario Central de Asturias, Department of Nephrology, Oviedo, Spain
| | | |
Collapse
|
|
4
|
Fidan C, Ağırbaş İ. The effect of renal replacement therapy on health-related quality of life in end-stage renal disease: a meta-analysis. Clin Exp Nephrol 2023; 27:829-846. [PMID: 37466815 DOI: 10.1007/s10157-023-02377-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND End-stage renal disease (ESRD) patients judge health-related quality of life (HRQoL) as an essential outcome. In meta-analysis studies, there is ongoing debate regarding the impact of renal replacement therapy (RRT) methods on HRQoL in ESRD patients. Hence, the main objective of this study was to examine the influence of RRT method utilization on HRQoL in individuals with ESRD. Additionally, the secondary objective was to explore the impact of RRT method use on HRQoL, considering various moderator variables. METHODS RRT methods called hemodialysis (HD), peritoneal dialysis (PD), home dialysis (HoD), and kidney transplantation (KT) are used to treat ESRD. HD was defined as in-center HD (ICHD) and home HD (HHD). HoD was defined as HHD and PD. The estimated Hedges' g were conducted by random effect meta-analysis. RESULTS A total of 111 publications, including 50.151 patients, were included. KT was better at improving patients' HRQoL than other methods. PD was better at improving patients' HRQoL than HD. HoD was better at improving patients' HRQoL than ICHD. Sensitivity analyses yielded similar results. Publication bias was not tested. The subgroup and meta-regression analyses showed that the moderating variables had a statistically significant effect on the HRQoL of patients with ESRD. CONCLUSION For the treatment of ESRD, either KT, PD, or HoD can be used in terms of HRQoL. We need to improve the factors affecting the HRQoL of ESRD patients undergoing HD and ICHD. Healthcare professionals should consider the factors that influence HRQoL and choose an RTT method for each ESRD patient.
Collapse
Affiliation(s)
- Cuma Fidan
- Department of Healthcare Management, Health Sciences Faculty, Mus Alparslan University, 49250, Mus, Turkey.
| | - İsmail Ağırbaş
- Department of Healthcare Management, Ankara University, Ankara, Turkey
| |
Collapse
|
|
5
|
Luo PT, Li W, Li XY, Zhang Y, Du B, Cui WP. Impact of peritoneal dialysis modality on patient and PD survival: A systematic review. Perit Dial Int 2023; 43:128-138. [PMID: 36476184 DOI: 10.1177/08968608221140788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We conducted a systematic review and meta-analysis to determine the effect of the peritoneal dialysis (PD) modality, automated peritoneal dialysis (APD) or continuous ambulatory peritoneal dialysis (CAPD), on all-cause mortality (ACM) and PD failure. Studies were identified in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure, Weipu and Wanfang databases from database inception until April 1, 2021. The inclusion and exclusion criteria were based on the Population, Intervention, Comparison, Outcome, and Study (PICOS) design. Adjusted hazard ratios (HRs) with 95% confidence intervals (CI) were used to pool outcome estimates. Seventeen studies (more than 230,000 patients) were included. Our meta-analysis showed that compared with CAPD, APD demonstrated a significantly lower ACM risk (HR 0.87 [95% CI 0.77-0.99], p = 0.04), especially in studies involving an as-treated analysis (HR 0.75 [95% CI, 0.63-0.90], p = 0.00), published in Asia (HR 0.76 [95% CI, 0.67-0.86], p < 0.001) or Europe (HR 0.81 [95% CI, 0.74-0.89], p < 0.00), or published after 2012 (HR 0.82 [95% CI, 0.68-0.99], p = 0.04). However, APD was as effective as CAPD for PD survival (HR, 0.87 [95% CI, 0.75 to 1.00], p = 0.05 or HR, 0.90 [95% CI, 0.60 to 1.35], p = 0.61). Our results demonstrate a significant survival benefit for APD and provide evidence for increasing the global use of APD, especially in developing nations, where APD use has been hampered by a lack of reimbursement for care.
Collapse
Affiliation(s)
- Pei-Ting Luo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Wei Li
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Xin-Yang Li
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yu Zhang
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Bing Du
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Wen-Peng Cui
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| |
Collapse
|
|
6
|
Sun H, Zhuang Y, Gao L, Xu N, Xiong Y, Yuan M, Lu J, Ye J. Impact of dialysis modality conversion on the health-related quality of life of peritoneal dialysis patients: a retrospective cohort study in China. PeerJ 2022; 10:e12793. [PMID: 35111408 PMCID: PMC8772444 DOI: 10.7717/peerj.12793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/22/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To analyze the health-related quality of life associated with the conversion of dialysis modality among end-stage renal disease patients in China. METHODS Patients were recruited from hospitals and a dialysis center in Kunshan, China. Patients converting from continuous ambulatory peritoneal dialysis to automated peritoneal dialysis were recruited as the observation group (n = 64), and patients continuing with continuous ambulatory peritoneal dialysis treatment were included in the control group (n = 64) after matching in this retrospective cohort study. Their health-related quality of life was measured using the kidney disease quality of life instrument in 2019 and 2020, respectively. Baseline socio-demographic characteristics and clinical data were collected in 2019. The before-and-after cross-group comparisons of subscale scores of two groups were conducted using a Student's t-test. Multiple linear regression models were fitted to identify the factors associated with the change of each scale. RESULTS The health-related quality of life scores of the two groups was comparable in baseline, while the observation group had higher scores in Physical Component Summary (51.92 ± 7.50), Kidney Disease Component Summary (81.21 ± 8.41), Symptoms (90.76 ± 6.30), Effects (82.86 ± 11.42), and Burden (69.04 ± 15.69) subscales after one year. In multivariate regression analysis, the change of Physical Component Summary was significantly associated with conversion to APD (β = 11.54, 95% CI [7.26-15.82]); the change of Mental Component Summary with higher education (β = - 5.96, 95% CI [-10.18--1.74]) and CCI (>2) (β = 5.39, 95% CI [1.05-9.73]); the change of Kidney Disease Component Summary with conversion to APD (β = 15.95, 95% CI [10.19-21.7]) and age (>60 years) (β = - 7.36, 95% CI [-14.11--0.61]); the change of Symptoms with CCI (>2) (β = 7.96, 95% CI [1.49-14.44]); the change of Effects with conversion to APD (β = 19.23, 95% CI [11.57-26.88]); and the change of Burden with conversion to APD (β = 22.40, 95% CI [13.46-31.34]), age (>60 years) (β = - 12.12, 95% CI [-22.59--1.65]), and higher education (β = - 10.38, 95% CI [-19.79--0.98]). CONCLUSIONS The conversion of dialysis modality had a significant impact on the scores of most subscales. Patients converting from continuous ambulatory peritoneal dialysis to automated peritoneal dialysis generally had improved health-related quality of life scores.
Collapse
Affiliation(s)
- Heqi Sun
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China
| | - Ye Zhuang
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China
| | - Lanying Gao
- Department of Nephrology, The First People’s Hospital of Kunshan, Suzhou, China
| | - Ningze Xu
- School of Public Health, Fudan University, Shanghai, China
| | - Yan Xiong
- Department of Nephrology, The First People’s Hospital of Kunshan, Suzhou, China
| | - Min Yuan
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China
| | - Jun Lu
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China
| | - Jianming Ye
- Department of Nephrology, The First People’s Hospital of Kunshan, Suzhou, China
| |
Collapse
|
|
7
|
Jung HY, Jeon Y, Kim YS, Kim DK, Lee JP, Yang CW, Ko EJ, Ryu DR, Kang SW, Park JT, Lim JH, Choi JY, Cho JH, Kim CD, Kim YL, Park SH. Outcomes of Remote Patient Monitoring for Automated Peritoneal Dialysis: A Randomized Controlled Trial. Nephron Clin Pract 2021; 145:702-710. [PMID: 34515160 DOI: 10.1159/000518364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We hypothesize that remote patient monitoring (RPM) for automated peritoneal dialysis (APD) and feedback could enhance patient self-management and improve outcomes. The aim of this study was to evaluate the efficacy of RPM-APD compared to traditional APD (T-APD) without RPM. METHODS In this multicenter, randomized controlled trial, patients on APD were randomized to T-APD (n = 29) or RPM-APD (n = 28) at 12 weeks and followed until 25 weeks. Health-related quality of life (HRQOL), patient and medical staff satisfaction with RPM-APD, and dialysis-related outcomes were compared between the 2 groups. RESULTS We found no significant differences in HRQOL scores at the time of enrollment and randomization between RPM-APD and T-APD. At the end of the study, the RPM-APD group showed better HRQOL for the sleep domain (p = 0.049) than the T-APD group and the T-APD group showed better HRQOL for the sexual function domain (p = 0.030) than the RPM-APD group. However, we found no significant interactions between the time and groups in terms of HRQOL. Different HRQOL domains significantly improved over time in patients undergoing RPM-APD (effects of kidney disease, p = 0.025) and T-APD (burden of kidney disease, p = 0.029; physical component summary, p = 0.048). Though medical staff satisfaction with RPM-APD was neutral, most patients were quite satisfied with RPM-APD (median score 82; possible total score 105 on 21 5-item scales) and the rating scores were maintained during the study period. We found no significant differences in dialysis adherence, accuracy, adequacy, overhydration status, blood pressure, or the number of unplanned visits between the 2 groups. DISCUSSION/CONCLUSION Although HRQOL and dialysis-related outcomes were comparable between RPM-APD and T-APD, RPM-APD was positive in terms of patient satisfaction. Further long-term and large-scale studies will be required to determine the efficacy of RPM-APD. TRIAL REGISTRATION CRIS identifier: KCT0003390, registered on December 14, 2018 - retrospectively registered, https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=12348.
Collapse
Affiliation(s)
- Hee-Yeon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea,
| | - Yena Jeon
- Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chul Woo Yang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Eun Jeong Ko
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Ji-Young Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sun-Hee Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| |
Collapse
|
|
8
|
Yoshida H, Tsuruya K. Difference in perception of advantages and disadvantages of automated peritoneal dialysis for patients undergoing peritoneal dialysis: a conjoint analysis. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00368-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In Japan, only less than 3% of patients undergoing maintenance dialysis select peritoneal dialysis (PD) as the mode of renal replacement therapy. Half of patients undergoing PD use a cycler for automated PD (APD). However, it remains unclear what patients undergoing PD regard as the benefits of APD. The purpose of this study was to objectively clarify what patients undergoing PD regard as the advantages and disadvantages of APD.
Methods
We designed case simulations that varied according to 6 characteristics of PD, such as the adequacy of dialysis and frequency of bag exchange, and created 16 simulation cards for conjoint analysis. For each case vignette, the respondents were asked to indicate whether they would receive this modality of PD on a 5-point scale.
Results
Thirty-two patients undergoing PD were recruited for this study and completed conjoint analysis simulation questionnaires. The factor with the highest importance in evaluating the modality of PD was the frequency of bag exchange among all participants. When participants were divided into those undergoing APD and continuous ambulatory PD (CAPD), the factor was different between them; that is, the low frequency of bag exchange is regarded as an advantage of APD for patients undergoing APD, while the large-sized cycler device is regarded as a disadvantage of APD for those undergoing CAPD.
Conclusions
The perception of advantages and disadvantages of APD differed between patients undergoing APD and CAPD; the former focus on the frequency of bag exchange, whereas the latter focused the size of device.
Collapse
|
|
9
|
Liu X, Qin A, Zhou H, He X, Cader S, Wang S, Tang Y, Qin W. Novel Predictors and Risk Score of Treatment Failure in Peritoneal Dialysis-Related Peritonitis. Front Med (Lausanne) 2021; 8:639744. [PMID: 33842502 PMCID: PMC8033636 DOI: 10.3389/fmed.2021.639744] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/18/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: Peritonitis is a severe complication in peritoneal dialysis (PD). This study was performed to identify predictors and establish a risk score for treatment failure in peritonitis patients. Methods: A single-center, retrospective observational study was conducted. The basic demographic characteristics, clinical and laboratory data of all patients with peritonitis during the study period were documented and analyzed. Multivariate logistic regression was applied to examine independent predictors of treatment failure, and a risk prediction score was established. Results: Three hundred fourteen episodes experienced by 241 patients were included in the final analysis. Logistic regression analysis indicated that PD duration (OR 1.017; P 0.005), fibrinogen (OR 1.327; P 0.021), high-density lipoprotein (OR 0.443; P 0.032), fungal infection (OR 63.413; P < 0.001), intestinal obstruction (OR 5.186, P 0.007), and diabetes mellitus (OR 2.451; P 0.018), hemodialysis history (OR 2.804, P 0.006) were independent predictors of treatment failure. The risk prediction score system showed a good calibration (P > 0.05) and discrimination (AUROC 0.80, P < 0.001). Conclusions: Fibrinogen, PD duration, fungal infection, hemodialysis history, concurrent intestinal obstruction, or diabetes mellitus were independent risk factors for a poor peritonitis outcome, while the high-density lipoprotein was a protective factor. This novel risk prediction score system may be used to predict a high risk of treatment failure effectively.
Collapse
Affiliation(s)
- Xiang Liu
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Aiya Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Huan Zhou
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xueqin He
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Shamlin Cader
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Sirui Wang
- Outpatient Department, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Tang
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
|
10
|
Teitelbaum I, Glickman J, Neu A, Neumann J, Rivara MB, Shen J, Wallace E, Watnick S, Mehrotra R. KDOQI US Commentary on the 2020 ISPD Practice Recommendations for Prescribing High-Quality Goal-Directed Peritoneal Dialysis. Am J Kidney Dis 2020; 77:157-171. [PMID: 33341315 DOI: 10.1053/j.ajkd.2020.09.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/29/2022]
Abstract
The recently published 2020 International Society for Peritoneal Dialysis (ISPD) practice recommendations regarding prescription of high-quality goal-directed peritoneal dialysis differ fundamentally from previous guidelines that focused on "adequacy" of dialysis. The new ISPD publication emphasizes the need for a person-centered approach with shared decision making between the individual performing peritoneal dialysis and the clinical care team while taking a broader view of the various issues faced by that individual. Cognizant of the lack of strong evidence for the recommendations made, they are labeled as "practice points" rather than being graded numerically. This commentary presents the views of a work group convened by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) to assess these recommendations and assist clinical providers in the United States in interpreting and implementing them. This will require changes to the current clinical paradigm, including greater resource allocation to allow for enhanced services that provide a more holistic and person-centered assessment of the quality of dialysis delivered.
Collapse
Affiliation(s)
- Isaac Teitelbaum
- Division of Nephrology, Department of Medicine, University of Colorado, Aurora, CO
| | - Joel Glickman
- Division of Nephrology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alicia Neu
- Division of Pediatric Nephrology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | | | - Matthew B Rivara
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Jenny Shen
- Division of Nephrology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Eric Wallace
- Division of Nephrology, Department of Medicine, University of Alabama, Birmingham, AL
| | - Suzanne Watnick
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA; Northwest Kidney Centers, Seattle, WA
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.
| |
Collapse
|
|
11
|
Kokubu M, Matsui M, Uemura T, Morimoto K, Eriguchi M, Samejima K, Akai Y, Tsuruya K. Relationship between initial peritoneal dialysis modality and risk of peritonitis. Sci Rep 2020; 10:18763. [PMID: 33127929 PMCID: PMC7599327 DOI: 10.1038/s41598-020-75918-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/02/2020] [Indexed: 01/31/2023] Open
Abstract
Peritonitis is a critical complication of peritoneal dialysis (PD). Investigators have reported the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) versus automated peritoneal dialysis (APD), but the available evidence is predominantly based on observational studies which failed to report on the connection type. Our understanding of the relationship between peritonitis risk and PD modality thus remained insufficient. We studied 285 participants who began PD treatment between 1997 and 2014 at three hospitals in Nara Prefecture in Japan. We matched 106 APD patients with 106 CAPD patients based on their propensity scores. The primary outcome was time to first episode of peritonitis within 3 years after PD commencement. In total, PD peritonitis occurred in 64 patients during the study period. Patients initiated on APD had a lower risk of peritonitis than did those initiated on CAPD in both the unadjusted and adjusted models. The hazard ratio (HR) and 95% confidence interval (CI) for the primary endpoint were 0.30 (0.17–0.53) in the fully adjusted model including connection type. In the matched cohort, APD patients had a significantly lower risk of peritonitis than did CAPD patients (log-rank: p < 0.001, HR 0.32, 95% CI 0.16–0.59). The weighting-adjusted analysis of the inverse probability of treatment yielded a similar result (HR 0.35, 95% CI 0.18–0.67). In conclusion, patients initiated on APD at PD commencement had a reduced risk of peritonitis compared with those initiated on CAPD, suggesting APD may be preferable for prevention of peritonitis among PD patients.
Collapse
Affiliation(s)
- Maiko Kokubu
- Department of Nephrology, Nara Prefecture General Medical Center, 2-897-5 Shichijo-nishimachi, Nara, 630-8581, Japan
| | - Masaru Matsui
- Department of Nephrology, Nara Prefecture General Medical Center, 2-897-5 Shichijo-nishimachi, Nara, 630-8581, Japan.
| | - Takayuki Uemura
- Department of Nephrology, Nara Prefecture General Medical Center, 2-897-5 Shichijo-nishimachi, Nara, 630-8581, Japan
| | - Katsuhiko Morimoto
- Department of Nephrology, Nara Prefecture Seiwa Medical Center, Nara, 636-0802, Japan
| | - Masahiro Eriguchi
- Department of Nephrology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Kenichi Samejima
- Department of Nephrology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Yasuhiro Akai
- Department of Nephrology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| |
Collapse
|
|
12
|
Roumeliotis A, Roumeliotis S, Leivaditis K, Salmas M, Eleftheriadis T, Liakopoulos V. APD or CAPD: one glove does not fit all. Int Urol Nephrol 2020; 53:1149-1160. [PMID: 33051854 PMCID: PMC7553382 DOI: 10.1007/s11255-020-02678-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/03/2020] [Indexed: 12/16/2022]
Abstract
The use of Automated Peritoneal Dialysis (APD) in its various forms has increased over the past few years mainly in developed countries. This could be attributed to improved cycler design, apparent lifestyle benefits and the ability to achieve adequacy and ultrafiltration targets. However, the dilemma of choosing the superior modality between APD and Continuous Ambulatory Peritoneal Dialysis (CAPD) has not yet been resolved. When it comes to fast transporters and assisted PD, APD is certainly considered the most suitable Peritoneal Dialysis (PD) modality. Improved patients’ compliance, lower intraperitoneal pressure and possibly lower incidence of peritonitis have been also associated with APD. However, concerns regarding increased cost, a more rapid decline in residual renal function, inadequate sodium removal and disturbed sleep are APD’s setbacks. Besides APD superiority over CAPD in fast transporters, the other medical advantages of APD still remain controversial. In any case, APD should be readily available for all patients starting PD and the most important indication for its implementation remains patient’s choice.
Collapse
Affiliation(s)
- Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Konstantinos Leivaditis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece.
| |
Collapse
|
|
13
|
Perl J, Fuller DS, Bieber BA, Boudville N, Kanjanabuch T, Ito Y, Nessim SJ, Piraino BM, Pisoni RL, Robinson BM, Schaubel DE, Schreiber MJ, Teitelbaum I, Woodrow G, Zhao J, Johnson DW. Peritoneal Dialysis-Related Infection Rates and Outcomes: Results From the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Am J Kidney Dis 2020; 76:42-53. [PMID: 31932094 DOI: 10.1053/j.ajkd.2019.09.016] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/24/2019] [Indexed: 01/29/2023]
Abstract
RATIONALE & OBJECTIVE Peritoneal dialysis (PD)-related peritonitis carries high morbidity for PD patients. Understanding the characteristics and risk factors for peritonitis can guide regional development of prevention strategies. We describe peritonitis rates and the associations of selected facility practices with peritonitis risk among countries participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). STUDY DESIGN Observational prospective cohort study. SETTING & PARTICIPANTS 7,051 adult PD patients in 209 facilities across 7 countries (Australia, New Zealand, Canada, Japan, Thailand, United Kingdom, United States). EXPOSURES Facility characteristics (census count, facility age, nurse to patient ratio) and selected facility practices (use of automated PD, use of icodextrin or biocompatible PD solutions, antibiotic prophylaxis strategies, duration of PD training). OUTCOMES Peritonitis rate (by country, overall and variation across facilities), microbiology patterns. ANALYTICAL APPROACH Poisson rate estimation, proportional rate models adjusted for selected patient case-mix variables. RESULTS 2,272 peritonitis episodes were identified in 7,051 patients (crude rate, 0.28 episodes/patient-year). Facility peritonitis rates were variable within each country and exceeded 0.50/patient-year in 10% of facilities. Overall peritonitis rates, in episodes per patient-year, were 0.40 (95% CI, 0.36-0.46) in Thailand, 0.38 (95% CI, 0.32-0.46) in the United Kingdom, 0.35 (95% CI, 0.30-0.40) in Australia/New Zealand, 0.29 (95% CI, 0.26-0.32) in Canada, 0.27 (95% CI, 0.25-0.30) in Japan, and 0.26 (95% CI, 0.24-0.27) in the United States. The microbiology of peritonitis was similar across countries, except in Thailand, where Gram-negative infections and culture-negative peritonitis were more common. Facility size was positively associated with risk for peritonitis in Japan (rate ratio [RR] per 10 patients, 1.07; 95% CI, 1.04-1.09). Lower peritonitis risk was observed in facilities that had higher automated PD use (RR per 10 percentage points greater, 0.95; 95% CI, 0.91-1.00), facilities that used antibiotics at catheter insertion (RR, 0.83; 95% CI, 0.69-0.99), and facilities with PD training duration of 6 or more (vs <6) days (RR, 0.81; 95% CI, 0.68-0.96). Lower peritonitis risk was seen in facilities that used topical exit-site mupirocin or aminoglycoside ointment, but this association did not achieve conventional levels of statistical significance (RR, 0.79; 95% CI, 0.62-1.01). LIMITATIONS Sampling variation, selection bias (rate estimates), and residual confounding (associations). CONCLUSIONS Important international differences exist in the risk for peritonitis that may result from varied and potentially modifiable treatment practices. These findings may inform future guidelines in potentially setting lower maximally acceptable peritonitis rates.
Collapse
Affiliation(s)
- Jeffrey Perl
- Arbor Research Collaborative for Health, Ann Arbor, MI; St Michael's Hospital, Toronto, Canada.
| | | | | | - Neil Boudville
- Medical School, University of Western Australia, Perth, Australia
| | - Talerngsak Kanjanabuch
- Center of Excellence in Kidney Metabolic Disorders and Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Sharon J Nessim
- Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Canada
| | | | | | | | | | | | | | - Graham Woodrow
- Renal Unit, St James's University Hospital, Leeds, United Kingdom
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| |
Collapse
|
|
14
|
Aguiar R, Pei M, Qureshi AR, Lindholm B. Health-related quality of life in peritoneal dialysis patients: A narrative review. Semin Dial 2018; 32:452-462. [PMID: 30575128 DOI: 10.1111/sdi.12770] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Health-related quality of life (HRQOL) is an important aspect of patients´ health that should be an integral part of the evaluation of patient-centered outcomes, not least because HRQOL associates with patients´ morbidity and mortality. This applies also to chronic kidney disease patients, including those dependent on renal replacement therapies, the type of which may influence patients´ perception of HRQOL. Several studies have addressed HRQOL in chronic kidney disease patients undergoing renal replacement therapies, especially transplanted patients and hemodialysis patients, while publications concerning peritoneal dialysis (PD) patients are scarcer. This review describes some of the methods used to assess HRQOL, factors influencing HRQOL in PD patients, HRQOL in PD vs hemodialysis, and the relation between HRQOL and patient outcomes. We conclude that assessment of HRQOL-often neglected at present-should be included as a standard measure of patient-centered outcomes and when monitoring the quality and effectiveness of renal care including PD treatment.
Collapse
Affiliation(s)
- Rute Aguiar
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden.,Nephrology, Hospital Espírito Santo, Évora, Portugal
| | - Ming Pei
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden.,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Abdul Rashid Qureshi
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| |
Collapse
|
|
15
|
Li X, Xu H, Chen N, Ni Z, Chen M, Chen L, Dong J, Fang W, Yu Y, Yang X, Chen J, Yu X, Yao Q, Sloand JA, Marshall MR. The Effect of Automated versus Continuous Ambulatory Peritoneal Dialysis on Mortality Risk in China. Perit Dial Int 2018; 38:S25-S35. [PMID: 30315042 DOI: 10.3747/pdi.2017.00235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/15/2018] [Indexed: 12/12/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Nan Chen
- Department of Nephrology, Ruijin Hospital, the Medical School affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Zhaohui Ni
- Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Menghua Chen
- Department of Nephrology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, PR China
- Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People's Republic of China, Beijing, PR China
| | - Wei Fang
- Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Yusheng Yu
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xueqing Yu
- Institute of Nephrology, Guangdong Medical University, Dongguan, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | | | - Mark R. Marshall
- Baxter Healthcare (Asia) Pte Ltd, Singapore
- and Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
|
16
|
Wang C, Fu X, Yang Y, Deng J, Zhang HQ, Deng HM, Lu J, Peng Y, Liu H, Liu FY, Liu Y. A Comparison between Intermittent Peritoneal Dialysis and Automatic Peritoneal Dialysis on Urgent Peritoneal Dialysis. Am J Nephrol 2017; 45:540-548. [PMID: 28531901 DOI: 10.1159/000477178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/27/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Urgent-start dialysis is a major problem for incident dialysis population. Urgent start on hemodialysis is associated with an increased risk of infectious or mechanical complications, and its mortality is equal to or higher than that of urgent start on peritoneal dialysis (PD). However, compared to patients starting PD in a planned setting, those on urgent-started PD have an increased risk of mechanical complications and lower technique survival. METHODS In this study, 101 adult incident dialysis patients (≥18 years old) who underwent Tenckhoff catheter implantation were enrolled. All of the patients were grouped according to the urgent PD mode: the intermittent PD (IPD) or automatic PD (APD) group, and patients were followed for 1 year. The paired or independent t test was used to analyze the change of laboratory variables. Pearson chi-square test was applied to compare the short outcome between the 2 groups. RESULTS When PD was treated for 7 days and 1 month, the APD group has the lower serum potassium and phosphorus levels than the IPD group. The incidence of catheter dysfunction was significantly lower in the APD group. The morbidity of infection associated with PD in the first year was lower in the APD group despite no significant difference existing. The technique survival and patient survival rate have no evident difference between the 2 groups. CONCLUSION Compared to IPD, urgent start on APD could reduce the risk of mechanical complication, which could be considered a gentle, safe, and feasible alternative to urgent start on IPD.
Collapse
Affiliation(s)
- Chang Wang
- Department of Nephrology, The Second Xiangya Hospital, Changsha, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
17
|
Kang SH, Do JY, Lee SY, Kim JC. Effect of dialysis modality on frailty phenotype, disability, and health-related quality of life in maintenance dialysis patients. PLoS One 2017; 12:e0176814. [PMID: 28467472 PMCID: PMC5415130 DOI: 10.1371/journal.pone.0176814] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 04/18/2017] [Indexed: 11/18/2022] Open
Abstract
Background Health-related quality of life (HRQoL) surveys are needed to evaluate regional and ethnic specificies. The aim of the present study was to evaluate the differences in HRQoL, frailty, and disability according to dialysis modality in the Korean population. Patients and methods We enrolled relatively stable maintenance dialysis patients. A total of 1,616 patients were recruited into our study. The demographic and laboratory data collected at enrollment included age, sex, comorbidities, frailty, disability, and HRQoL scales. Results A total of 1,250 and 366 participants underwent hemodialysis (HD) and peritoneal dialysis (PD), respectively. The numbers of participants with pre-frailty and frailty were 578 (46.2%) and 422 (33.8%) in HD patients, and 165 (45.1%) and 137 (37.4%) in PD patients, respectively (P = 0.349). Participants with a disability included 195 (15.6%) HD patients and 109 (29.8%) PD patients (P < 0.001). On multivariate analysis, the mean physical component scale (PCS) and mental component scale (MCS), symptom/problems, and sleep scores were higher in HD patients than in PD patients. Cox regression analyses showed that an increased PCS in both HD and PD patients was positively associated with patient survival and first hospitalization–free survival. An increased MCS in both HD and PD patients was positively associated with first hospitalization–free survival only. Conclusion There was no significant difference in frailty between patients treated with the two dialysis modalities; however, disability was more common in PD patients than in HD patients. The MCS and PCS were more favorable in HD patients than in PD patients. Symptom/problems, sleep, quality of social interaction, and social support were more favorable in HD patients than in PD patients; however, patient satisfaction and dialysis staff encouragement were more favorable in PD patients than in HD patients.
Collapse
Affiliation(s)
- Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - So-Young Lee
- Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Jun Chul Kim
- Division of Nephrology, Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
- * E-mail:
| |
Collapse
|
|
18
|
Tang CH, Wu YT, Huang SY, Chen HH, Wu MJ, Hsu BG, Tsai JC, Chen TH, Sue YM. Economic costs of automated and continuous ambulatory peritoneal dialysis in Taiwan: a combined survey and retrospective cohort analysis. BMJ Open 2017; 7:e015067. [PMID: 28325860 PMCID: PMC5372017 DOI: 10.1136/bmjopen-2016-015067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Taiwan succeeded in raising the proportion of peritoneal dialysis (PD) usage after the National Health Insurance (NHI) payment scheme introduced financial incentives in 2005. This study aims to compare the economic costs between automated PD (APD) and continuous ambulatory PD (CAPD) modalities from a societal perspective. DESIGN AND SETTING A retrospective cohort of patients receiving PD from the NHI Research Database was identified during 2004-2011. The 1:1 propensity score matched 1749 APD patients and 1749 CAPD patients who were analysed on their NHI-financed medical costs and utilisation. A multicentre study by face-to-face interviews on 117 APD and 129 CAPD patients from five hospitals located in four regions of Taiwan was further carried out to collect data on their out-of-pocket payments, productivity losses and quality of life with EuroQol-5D-5L. OUTCOME MEASURES The NHI-financed medical costs, out-of-pocket payments and productivity losses of APD and CAPD patients. RESULTS The total NHI-financed medical costs per patient-year after 5 years of follow-up were significantly higher with APD than CAPD (US$23 005 vs US$19 237; p<0.01). In terms of dialysis-related costs, APD had higher costs resulting from the use of APD machines (US$795) and APD sets (US$2913). Significantly lower productivity losses were found with APD (US$2619) than CAPD (US$6443), but the out-of-pocket payments were not significantly different. The differences in NHI-financed medical costs and productivity losses between APD and CAPD remained robust in the bootstrap analysis. The total economic costs of APD (US$30 401) were similar to those of CAPD (US$29 939), even after bootstrap analysis (APD, US$28 399; CAPD, US$27 960). No discernable differences were found in the results of mortality and quality of life between the APD and CAPD patients. CONCLUSIONS APD had higher annual dialysis-related costs and lower annual productivity losses than CAPD, which made the economic costs of APD very close to those of CAPD in Taiwan.
Collapse
Affiliation(s)
- Chao-Hsiun Tang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ting Wu
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Siao-Yuan Huang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Hsi-Hsien Chen
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital and Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, College of Life Science, National Chung Hsing University, Taichung, Taiwan
| | - Bang-Gee Hsu
- Division of Nephrology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jer-Chia Tsai
- Department of Internal Medicine, Faculty of Renal Care, Kaohsiung Medical University Hospital and, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tso-Hsiao Chen
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yuh-Mou Sue
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
|
19
|
Mizuno M, Suzuki Y, Sakata F, Ito Y. Which clinical conditions are most suitable for induction of automated peritoneal dialysis? RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0057-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
|
20
|
El-Reshaid W, Al-Disawy H, Nassef H, Alhelaly U. Comparison of peritonitis rates and patient survival in automated and continuous ambulatory peritoneal dialysis: a 10-year single center experience. Ren Fail 2016; 38:1187-92. [PMID: 27435043 DOI: 10.1080/0886022x.2016.1209025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In this retrospective study, peritonitis rates and patient survival of 180 patients on CAPD and 128 patients on APD were compared in the period from January 2005 to December 2014 at Al-Nafisi Center in Kuwait. All patients had prophylactic topical mupirocin at catheter exit site. Patients on CAPD had twin bag system with Y transfer set. The peritonitis rates were 1 in 29 months in CAPD and 1 in 38 months in APD (p < 0.05). Percentage of peritonitis free patients over 10-year period in CAPD and APD were 49 and 60%, respectively (p < 0.05). Time to develop peritonitis was 10.25 ± 3.1 months in CAPD compared to 16.1 ± 4 months in APD (p < 0.001). Relapse and recurrence rates were similar in both groups. Median patient survival in CAPD and APD groups with peritonitis was 13.1 ± 1 and 14 ± 1.4 months respectively (p = 0.3) whereas in peritonitis free patients it was 15 ± 1.4 months in CAPD and 23 ± 3.1 months in APD (p = 0.025). APD had lower incidence rate of peritonitis than CAPD. Patient survival was better in APD than CAPD in peritonitis free patients but was similar in patients who had peritonitis.
Collapse
Affiliation(s)
- Wael El-Reshaid
- a Department of Medicine, Faculty of Medicine , Kuwait University , Kuwait , Kuwait
| | - Hanan Al-Disawy
- b Division of Nephrology , Al-Nafisi Renal Centre , Kuwait, Kuwait
| | | | - Usama Alhelaly
- b Division of Nephrology , Al-Nafisi Renal Centre , Kuwait, Kuwait
| |
Collapse
|
|
21
|
Li PKT, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, Fish DN, Goffin E, Kim YL, Salzer W, Struijk DG, Teitelbaum I, Johnson DW. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int 2016; 36:481-508. [PMID: 27282851 PMCID: PMC5033625 DOI: 10.3747/pdi.2016.00078] [Citation(s) in RCA: 629] [Impact Index Per Article: 69.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Beth Piraino
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Javier de Arteaga
- Department of Nephrology, Hospital Privado and Catholic University, Cordoba, Argentina
| | - Stanley Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | - Ana E Figueiredo
- Nursing School-FAENFI, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas N Fish
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Eric Goffin
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Belgium
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - William Salzer
- University of Missouri-Columbia School of Medicine, Department of Internal Medicine, Section of Infectious Disease, MI, USA
| | - Dirk G Struijk
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
|
22
|
de Oliveira MP, Kusumota L, Haas VJ, Ribeiro RDCHM, Marques S, Oller GASADO. Health-related quality of life as a predictor of mortality in patients on peritoneal dialysis. Rev Lat Am Enfermagem 2016; 24:e2687. [PMID: 27192413 PMCID: PMC4862750 DOI: 10.1590/1518-8345.0786.2687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/17/2015] [Indexed: 12/16/2022] Open
Abstract
Objective: to characterize deaths that occurred, and the association between
socio-demographic, clinical, laboratory variables and health-related quality of
life and the outcome of death in patients on peritoneal dialysis, over a two year
period after an initial assessment. Method: observational, prospective population study with 82 patients on peritoneal
dialysis. The instruments used for the first stage of data collection were the
mini-mental state examination, a sociodemographic, economic, clinical and
laboratory questionnaire and the Kidney Disease and Quality of Life-Short Form.
After two years, data for characterization and occurrence of death in the period
were collected. The relative risk of death outcome was calculated through
statistical analysis; the risk of death was estimated by the survival Kaplan-Meier
curve, and determined predictors of death by the Cox Proportional Hazards Model.
Results: of the 82 original participants, 23 had as an outcome death within two years. The
increased risk for the outcome of death was associated with a lower mean score of
health-related quality of life in the physical functioning domain. Conclusion: the worst health-related quality of life in the physical functioning domain, could
be considered a predictor of death.
Collapse
Affiliation(s)
| | - Luciana Kusumota
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Vanderlei José Haas
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | | | - Sueli Marques
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | |
Collapse
|
|
23
|
Jung HY, Jang HM, Kim YW, Cho S, Kim HY, Kim SH, Bang K, Kim HW, Lee SY, Jo SK, Lee J, Choi JY, Cho JH, Park SH, Kim CD, Kim YL. Depressive Symptoms, Patient Satisfaction, and Quality of Life Over Time in Automated and Continuous Ambulatory Peritoneal Dialysis Patients: A Prospective Multicenter Propensity-Matched Study. Medicine (Baltimore) 2016; 95:e3795. [PMID: 27227956 PMCID: PMC4902380 DOI: 10.1097/md.0000000000003795] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Health-related quality of life (HRQOL) is an important clinical outcome for dialysis patients. However, relative superiority in HRQOL between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) are not clearly known. We compared HRQOL over time between APD and CAPD patients and evaluated factors associated with HRQOL.All 260 incident patients initiating APD or CAPD at multiple centers throughout Korea were prospectively enrolled in this study between October 2010 and February 2013. HRQOL, depressive symptoms, and renal treatment satisfaction were assessed 1 and 12 months after the start of dialysis by the Kidney Disease Quality of Life Short Form 36 (KDQOL-36), the Beck Depression Inventory (BDI), and the Renal Treatment Satisfaction Questionnaire (RTSQ), respectively.Of 196 patients who completed all questionnaires and did not change the peritoneal dialysis (PD) modality during the 1-year follow-up period, 160 were matched. APD patients showed better baseline HRQOL than CAPD patients for the symptoms, patient satisfaction, pain, and social function domains. There were no differences in HRQOL between the 2 groups at 12 months, and CAPD patients had significantly greater improvements in symptoms (P = 0.02), the mental composite summary (P = 0.03), and health status domains (P = 0.03) than APD patients. There were similar improvements in depressive symptoms (P = 0.01) and patient satisfaction with treatment (P = 0.01) in CAPD and APD patients. Interestingly, depressive symptoms, not PD modality, was the most influential and consistent factor for HRQOL. Despite the spontaneous improvement of depressive symptoms, considerable PD patients still had depressive symptoms at the 1-year appointment.APD has no advantage over CAPD for HRQOL. Considering the substantial negative effect of depressive symptoms on HRQOL, it is important to evaluate PD patients for depression and to treat those with depression to improve their HRQOL.
Collapse
Affiliation(s)
- Hee-Yeon Jung
- From the Department of Internal Medicine, Kyungpook National University School of Medicine (H-YJ, J-YC, J-HC, S-HP, C-DK, Y-LK), Department of Statistics (HMJ), BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University (Y-LK), Department of Internal Medicine, Daegu Fatima Hospital, Daegu (S-HK), Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan (YWK), Department of Internal Medicine, College of Medicine, The Sungkyunkwan University of Korea, Samsung Changwon Hospital, Changwon (SC), Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju (H-YK), Department of Internal Medicine, Eulji University Hospital, Daejeon (KB), Department of Internal Medicine, Jeju National University, School of Medicine, Jeju National University Hospital, Jeju (HWK), Department of Internal Medicine, Eulji Medical Centerl (SYL), Department of Internal Medicine, Korea University Anam Hospital, Seoul (SKJ), and Department of Internal Medicine, St. Carollo Hospital, Suncheon (JL), Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
24
|
Kumnig M, Jowsey-Gregoire SG. Key psychosocial challenges in vascularized composite allotransplantation. World J Transplant 2016; 6:91-102. [PMID: 27011907 PMCID: PMC4801807 DOI: 10.5500/wjt.v6.i1.91] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/16/2015] [Accepted: 01/08/2016] [Indexed: 02/05/2023] Open
Abstract
Psychosocial factors are important elements in the assessment and follow-up care for vascularized composite allotransplantation (VCA) and require multidisciplinary evaluation protocols. This review will highlight differences between VCA with solid organ transplantation (SOT), provide information on the psychosocial selection of VCA candidates, ethical issues, psychological outcomes, and on the need for multicenter research. VCA is primarily a life-enhancing procedure to improve recipients' quality of life and psychological well-being and it represents a potential option to provide reproduction in case of penile or uterine transplantation. The risk benefit ratio is distinctly different than SOT with candidates desiring life enhancing outcomes including improved body image, return to occupations, restored touch, and for uterine transplant, pregnancy. The Chauvet Workgroup has been convened with membership from a number of transplant centers to address these issues and to call for multicenter research. A multicenter research network would share similar evaluation approaches so that meaningful research on psychosocial variables could inform the transplant community and patients about factors that increase risk of non-adherence and other adverse psychosocial and medical outcomes.
Collapse
|
|
25
|
Diffusion-weighted imaging of the kidneys and its relationship with residual renal function in continuous ambulatory peritoneal dialysis patients. AJR Am J Roentgenol 2015; 204:1008-12. [PMID: 25905935 DOI: 10.2214/ajr.13.12440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective of our study was to prospectively evaluate renal diffusion as shown by diffusion-weighted imaging (DWI) and its relationship with the residual renal function (RRF) in continuous ambulatory peritoneal dialysis (CAPD) patients. SUBJECTS AND METHODS Forty CAPD patients and 40 healthy volunteers were recruited, and all underwent conventional and fat-saturated echo-planar DWI with three b values (0, 300, 600 s/mm(2)). The renal parenchymal thickness and apparent diffusion coefficients (ADCs) were measured, and both were compared between the two groups. The relationships between ADC values and clinical indexes--which included RRF, serum creatinine value, cystatin C value, and urine output--were analyzed. RESULTS Compared with the renal parenchymal thickness and ADC values in control subjects, these values in CAPD patients were significantly decreased (p < 0.0001). In CAPD patients, the ADC values were positively correlated with RRF (r = 0.447, p = 0.004). A mild linear correlation was also found between the ADC values and cystatin C value (r = -0.352, p = 0.026). CONCLUSION The renal diffusion function as shown by DWI is impaired in CAPD patients and correlates with RRF.
Collapse
|
|
26
|
Nongnuch A, Assanatham M, Panorchan K, Davenport A. Strategies for preserving residual renal function in peritoneal dialysis patients. Clin Kidney J 2015; 8:202-11. [PMID: 25815178 PMCID: PMC4370298 DOI: 10.1093/ckj/sfu140] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/11/2014] [Indexed: 12/19/2022] Open
Abstract
Although there have been many advancements in the treatment of patients with chronic kidney disease (CKD) over the last 50 years, in terms of reducing cardiovascular risk, mortality remains unacceptably high, particularly for those patients who progress to stage 5 CKD and initiate dialysis (CKD5d). As mortality risk increases exponentially with progressive CKD stage, the question arises as to whether preservation of residual renal function once dialysis has been initiated can reduce mortality risk. Observational studies to date have reported an association between even small amounts of residual renal function and improved patient survival and quality of life. Dialysis therapies predominantly provide clearance for small water-soluble solutes, volume and acid-base control, but cannot reproduce the metabolic functions of the kidney. As such, protein-bound solutes, advanced glycosylation end-products, middle molecules and other azotaemic toxins accumulate over time in the anuric CKD5d patient. Apart from avoiding potential nephrotoxic insults, observational and interventional trials have suggested that a number of interventions and treatments may potentially reduce the progression of earlier stages of CKD, including targeted blood pressure control, reducing proteinuria and dietary intervention using combinations of protein restriction with keto acid supplementation. However, many interventions which have been proven to be effective in the general population have not been equally effective in the CKD5d patient, and so the question arises as to whether these treatment options are equally applicable to CKD5d patients. As strategies to help preserve residual renal function in CKD5d patients are not well established, we have reviewed the evidence for preserving or losing residual renal function in peritoneal dialysis patients, as urine collections are routinely collected, whereas few centres regularly collect urine from haemodialysis patients, and haemodialysis dialysis patients are at risk of sudden intravascular volume shifts associated with dialysis treatments. On the other hand, peritoneal dialysis patients are exposed to a variety of hypertonic dialysates and episodes of peritonitis. Whereas blood pressure control, using an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), and low-protein diets along with keto acid supplementation have been shown to reduce the rate of progression in patients with earlier stages of CKD, the strategies to preserve residual renal function (RRF) in dialysis patients are not well established. For peritoneal dialysis patients, there are additional technical factors that might aggravate the rate of loss of residual renal function including peritoneal dialysis prescriptions and modality, bio-incompatible dialysis fluid and over ultrafiltration of fluid causing dehydration. In this review, we aim to evaluate the evidence of interventions and treatments, which may sustain residual renal function in peritoneal dialysis patients.
Collapse
Affiliation(s)
- Arkom Nongnuch
- Renal Unit, Department of Medicine, Faculty of Medicine , Ramathibodi Hospital , Mahidol University , Bangkok , Thailand ; UCL Centre for Nephrology, Royal Free Hospital , University College London Medical School , London , UK
| | - Montira Assanatham
- Renal Unit, Department of Medicine, Faculty of Medicine , Ramathibodi Hospital , Mahidol University , Bangkok , Thailand
| | - Kwanpeemai Panorchan
- UCL Centre for Nephrology, Royal Free Hospital , University College London Medical School , London , UK ; Bumrungrad International Hospital , Bangkok , Thailand
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital , University College London Medical School , London , UK
| |
Collapse
|
|
27
|
Eloot S, Vanholder R, Dequidt C, Van Biesen W. Removal of Different Classes of Uremic Toxins in APD vs CAPD: A Randomized Cross-Over Study. Perit Dial Int 2014; 35:436-42. [PMID: 24584609 DOI: 10.3747/pdi.2013.00202] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/13/2013] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ AIM In this study, we investigated, and this for the different classes of uremic toxins, whether increasing dialysate volume by shifting from continuous ambulatory peritoneal dialysis (CAPD) to higher volume automated peritoneal dialysis (APD) increases total solute clearance. ♦ METHODS Patients on peritoneal dialysis were randomized in a cross-over design to one 24-hour session of first a CAPD regimen (3*2 L of Physioneal 1.36% and 1*2 L of icodextrin) or APD (consisting of 5 cycles of 2 L Physioneal 1.36 and 1 cycle of 2 L Extraneal), and the other week the alternate regime, each patient serving as his/her own control. Dialysate, blood and urine samples were collected and frozen for later batch analysis of concentrations of urea, creatinine, phosphorus, uric acid, hippuric acid, 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid, indoxyl sulfate, indole acetic acid, and p-cresyl sulfate. For the protein-bound solutes, total and free fractions were determined. Total, peritoneal and renal clearance (K) and mass removal (MR) of each solute were calculated, using validated models. ♦ RESULTS In 15 patients (11 male, 3 diabetics, 56 ± 16 years, 8 on CAPD, time on peritoneal dialysis 12 ± 14 months, and residual renal function of 9.9 ± 5.4 mL/min) dialysate over plasma ratio for creatinine (D/Pcrea) was 0.62 ± 0.10. Drained volume and obtained ultrafiltration were higher with APD vs CAPD (13.3 ± 0.5 L vs 8.5 ± 0.7 L and 1.3 ± 0.5 L vs 0.5 ± 0.7 L), whereas urine output was lower (1.0 ± 0.5 L vs 1.4 ± 0.6 L). Total clearance and MR tended to be higher for CAPD vs APD for all small and water soluble solutes, but mainly because of higher renal contribution, with no difference in the peritoneal contribution. For the protein-bound solutes, no differences in clearance or mass removal were observed. ♦ CONCLUSION Although the drained dialysate volume nearly doubled, APD did not result in better peritoneal clearance or solute removal vs classic CAPD. APD resulted in better ultrafiltration, but at the expense of residual urinary output and clearance.
Collapse
Affiliation(s)
- Sunny Eloot
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Gent, Belgium
| | - Raymond Vanholder
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Gent, Belgium
| | - Clement Dequidt
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Gent, Belgium
| | - Wim Van Biesen
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Gent, Belgium
| |
Collapse
|
|
28
|
Katavetin P, Theerasin Y, Treamtrakanpon W, Saiprasertkit N, Kanjanabuch T. Treatment failure in automated peritoneal dialysis and double-bag continuous ambulatory peritoneal dialysis. Nephrology (Carlton) 2014; 18:545-8. [PMID: 23730742 DOI: 10.1111/nep.12107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2013] [Indexed: 11/29/2022]
Abstract
AIM Automated peritoneal dialysis (APD) and double-bag continuous ambulatory peritoneal dialysis (CAPD) are the two current standard modalities of peritoneal dialysis (PD). Outcomes of these two modalities have not been well described. METHODS A single-centre, retrospective review was carried out to compare the treatment failure rate of APD and double-bag CAPD. Treatment failure was a combined endpoint including death and technique failure. Cox regression was used to compare risk (hazard ratio, HR) of treatment failure in APD and CAPD. RESULTS There were 121 patients included in this study, 55 with APD and 66 with CAPD. APD patients had significantly lower risk of treatment failure (death and technique failure) than CAPD patients (HR 0.58, 95% confidence interval [CI]: 0.37-0.91, P=0.02). The lower risk of treatment failure in APD compared to CAPD was mainly caused by the significantly lower risk of technique failure (HR 0.30, 95%CI: 0.10-0.93, P=0.04). The mortality rates of the two modalities were not significantly different (HR 0.69, 95%CI: 0.42-1.12, P=0.13). CONCLUSION Our data suggest that APD may have lower risk of treatment failure compared with double-bag CAPD. These potential benefits of APD might justify the use of this modality despite its higher cost.
Collapse
Affiliation(s)
- Pisut Katavetin
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | | | | | | | | |
Collapse
|
|
29
|
Griva K, Yu Z, Chan S, Krisnasamy T, Yamin RBA, Zakaria FB, Wu SY, Oei E, Foo M. Age is not a contraindication to home-based dialysis - Quality-of-Life outcomes favour older patients on peritoneal dialysis regimes relative to younger patients. J Adv Nurs 2014; 70:1902-14. [PMID: 24495288 DOI: 10.1111/jan.12355] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
Abstract
AIM To compare Quality of Life, anxiety and depression between older (≥65 years) and younger (<65 years) patients across automated peritoneal dialysis and continuous ambulatory peritoneal dialysis. BACKGROUND There is a lack of studies as to whether the different peritoneal dialysis modalities confer similar outcomes in older and younger patients. DESIGN Cross-sectional. METHODS A total of 201 patients completed the Kidney Disease Quality of Life Short-Form, World Health Organization Quality of Life Instrument, Short Form and Hospital Anxiety and Depression Scale. Comorbidity and biochemical values were abstracted from medical records. RESULTS Older patients reported significantly better quality of life than younger patients in the Kidney Disease Quality of Life Short-Form effects of kidney disease and patient satisfaction and the World Health Organization Quality of Life Instrument overall Quality-of-Life/health despite worse clinical profile. Quality of life outcomes were comparable between automated peritoneal dialysis and continuous ambulatory peritoneal dialysis with the exception of the Kidney Disease Quality of Life Short-Form symptoms in favour of automated peritoneal dialysis. Levels of anxiety and depression were equivalent for older and younger patients across peritoneal dialysis modalities. The observed quality-of-life advantages for older patients persisted after case-mix adjustments and extended to more quality-of-life domains and depression and anxiety. CONCLUSION Our findings of superior quality of life in patients aged ≥ 65 support the expansion of peritoneal dialysis use in older patients. Patients across different age groups should be given non-biased information about both peritoneal dialysis modalities and individual preferences should be elicited and carefully considered by healthcare providers.
Collapse
Affiliation(s)
- Konstadina Griva
- Department of Psychology, National University of Singapore, Singapore
| | | | | | | | | | | | | | | | | |
Collapse
|
|
30
|
Bieber SD, Burkart J, Golper TA, Teitelbaum I, Mehrotra R. Comparative outcomes between continuous ambulatory and automated peritoneal dialysis: a narrative review. Am J Kidney Dis 2014; 63:1027-37. [PMID: 24423779 DOI: 10.1053/j.ajkd.2013.11.025] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/25/2013] [Indexed: 12/30/2022]
Abstract
Automated methods for delivering peritoneal dialysis (PD) to persons with end-stage renal disease continue to gain popularity worldwide, particularly in developed countries. However, the endeavor to automate the PD process has not been advanced on the strength of high-level evidence for superiority of automated over manual methods. This article summarizes available studies that have shed light on the evidence that compares the association of treatment with continuous ambulatory PD or automated PD (APD) with clinically meaningful outcomes. Published evidence, primarily from observational studies, has been unable to demonstrate a consistent difference in residual kidney function loss rate, peritonitis rate, maintenance of euvolemia, technique survival, mortality, or health-related quality of life in individuals undergoing continuous ambulatory PD versus APD. At the same time, the future of APD technology appears ripe for further improvement, such as the incorporation of voice commands and expanded use of telemedicine. Given these considerations, it appears that patient choice should drive the decision about PD modality.
Collapse
|
|
31
|
Kim CH, Oh HJ, Lee MJ, Kwon YE, Kim YL, Nam KH, Park KS, An SY, Ko KI, Koo HM, Doh FM, Han SH, Yoo TH, Kim BS, Kang SW, Choi KH. Effect of peritoneal dialysis modality on the 1-year rate of decline of residual renal function. Yonsei Med J 2014; 55:141-8. [PMID: 24339299 PMCID: PMC3874913 DOI: 10.3349/ymj.2014.55.1.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The effect of different peritoneal dialysis (PD) modalities on the decline in residual renal function (RRF) is unclear due to inconsistencies among studies. In particular, the effect of automated peritoneal dialysis (APD) modalities [continuous cyclic peritoneal dialysis (CCPD) and nightly intermittent peritoneal dialysis (NIPD)] on RRF has not been examined in a large cohort. MATERIALS AND METHODS We conducted a single-center retrospective study to investigate the association between PD modalities and decline in RRF in 142 incident PD patients [34 on CCPD, 36 on NIPD, and 72 on continuous ambulatory peritoneal dialysis (CAPD)]. RRF was measured within 2 months from PD start and at 1 year after PD initiation. RESULTS The RRF at 1 year after PD initiation was 1.98±2.20 mL/min/1.73 m² in CCPD patients and 3.63±3.67 mL/min/1.73 m² in NIPD patients, which were moderately lower than 4.23±3.51 mL/min/1.73 m² in CAPD patients (p=0.064). Moreover, there was no significant difference in the 1-year rate of decline of RRF between CCPD and NIPD patients, although APD patients had a faster 1-year RRF decline rate than CAPD patients (CCPD and NIPD vs. CAPD: -45.68 and -36.69 vs. 1.17%/year, p=0.045). APD was associated with a more rapid decline in RRF in patients with end-stage renal disease undergoing PD, although multivariate analysis attenuated the significance of this finding (β=-31.50; 95% CI, -63.61 to 0.62; p=0.052). CONCLUSION Our results suggest that CAPD might be more helpful than APD for preserving RRF during the first year of dialysis therapy, although there was no significant difference in the 1-year rate of decline of RRF between the two APD modalities.
Collapse
Affiliation(s)
- Chan Ho Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
32
|
Kwan BCH, Chow KM, Ma TKW, Yu V, Law MC, Leung CB, Li PKT, Szeto CC. Automated peritoneal dialysis in Hong Kong: there are two distinct groups of patients. Nephrology (Carlton) 2013; 18:356-64. [PMID: 23469775 DOI: 10.1111/nep.12049] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2013] [Indexed: 11/30/2022]
Abstract
AIM To compare the clinical outcome between continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) in specific subgroups of patients. METHODS We reviewed the clinical outcome of 90 consecutive incident APD patients and 180 CAPD patients in our centre. RESULTS The median follow up was 21.9 months (inter-quartile range, 9.5 to 46.5 months). The APD group was younger and had a lower Charlson's score than the CAPD group. Furthermore, the APD group had a highly skewed distribution of the Charlson's score, indicating the possibility of two different groups of patients. Multivariate analysis showed that in addition to the treatment mode (APD vs CAPD) and Charlson's score, there was a significant interaction between the two (P = 0.043) on patient survival. For patients with Charlson's score ≤6, the APD group had a significantly better patient survival than the CAPD group (78.3% vs. 65.4% at 5 years, P = 0.039), while for patients with Charlson's score ≥7, the APD group had a worse patient survival than the CAPD group (16.3% vs. 48.4% at 5 years, P = 0.028). Similarly, Charlson's score and its interaction with treatment mode, but not the APD group per se, were independent predictors of technique survival (P = 0.013). For patients with Charlson's score ≥7, the APD group had a significantly lower technique survival than the CAPD group (8.8% vs. 34.3%, P = 0.001), while for patients with Charlson's score ≤6, the technique survival was similar (44.4% vs. 42.5%, P = 0.15). Peritonitis-free survival was 35.2% and 32.2% for APD and CAPD groups, respectively (P = 0.021), and the difference was not affected by Charlson's score. CONCLUSIONS Comorbid diseases had a significant interaction with the mode of PD on patient and technique survival of incident PD patients. Our result suggests that APD may offer benefit in, and only in, young patients with minimal comorbid diseases.
Collapse
Affiliation(s)
- Bonnie Ching-Ha Kwan
- Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | | | | | | | | | | |
Collapse
|
|
33
|
Préservation de la fonction rénale résiduelle en dialyse. Nephrol Ther 2013; 9:403-7. [DOI: 10.1016/j.nephro.2013.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 05/02/2013] [Indexed: 11/20/2022]
|
|
34
|
Vychytil A. [Peritoneal dialysis from the beginnings up to today: which developments of the last decades were important?]. Wien Med Wochenschr 2013; 163:255-65. [PMID: 23591854 DOI: 10.1007/s10354-013-0191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 03/13/2013] [Indexed: 11/25/2022]
Abstract
During the past years new developments in peritoneal dialysis (PD) technique have resulted in continuous improvement of patient outcome. The importance of salt and fluid balance, residual renal function and peritoneal glucose load are of increasing interest, whereas small solute clearances have lost importance. In patients with high peritoneal transport rates automated PD (APD) is indicated. However, APD can also be chosen as initial PD treatment since recent studies show comparable or even better survival as compared to continuous ambulatory PD patients. Alternative PD solutions improve peritoneal ultrafiltration (icodextrin), reduce peritoneal glucose load (amino acid solution, icodextrin) and protect the peritoneal membrane (solutions with low concentration of glucose degradation products). Infection risk can be reduced when using antibiotic creams, but resistances should be considered. Ongoing studies will clarify if non-antibiotic agents, e.g. medihoney, are effective in preventing PD-associated infections. Due to these improvements PD and hemodialysis have become equivalent treatments.
Collapse
Affiliation(s)
- Andreas Vychytil
- Abteilung für Nephrologie und Dialyse, Klinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.
| |
Collapse
|
|
35
|
Klarić D, Knotek M. Long-term effects of peritonitis on peritoneal dialysis outcomes. Int Urol Nephrol 2012; 45:519-25. [PMID: 22893493 DOI: 10.1007/s11255-012-0257-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/13/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE Prevalence of peritoneal dialysis is low in part because of the perceived high risk for complications such as peritonitis. However, in the most recent era, peritonitis incidence and its effects on patient outcomes may have diminished. The aim of this study was to analyze peritonitis incidence and its impact on patient and technique survival, as well as on the kidney transplantation rate and outcome. METHODS All peritoneal dialysis patients from a county hospital between year 2001 and 2011 were retrospectively included. Patients were divided into two groups with respect to peritonitis. The primary composite end-point consisted of a 3-year patient mortality or technique loss. Secondary end-points were patient survival and probability of kidney transplantation with respect to peritonitis history. RESULTS Among 85 study patients, there were 61 peritonitis episodes. The incidence of peritonitis was 0.339 ± 0.71 episode per patient per 12 months or one episode per 29.3 ± 22.2 patient-months. The time to peritonitis was shorter, and peritonitis was more likely in patients on continuous ambulatory peritoneal dialysis than in automated peritoneal dialysis patients. Patient and technique survival and transplantation rate were similar in the group with and without peritonitis history. The primary end-point was recorded in 35 % of patients with peritonitis history and in 54 % of those without peritonitis (p = 0.04). In a multivariate analysis, the only variable significantly associated with the primary end-point and with patient survival was patient age at start of peritoneal dialysis. CONCLUSIONS In contemporary peritoneal dialysis patients, timely treated peritonitis may not be associated with adverse patient and technique outcomes. The transplantation rate is unaffected by the peritonitis history. Peritoneal dialysis may be promoted as the first dialysis method in appropriate patients.
Collapse
Affiliation(s)
- Dragan Klarić
- Department of Medicine, Renal Division, Zadar County Hospital, Zadar, Croatia
| | | |
Collapse
|
|
36
|
Herget-Rosenthal S, von Ostrowski M, Kribben A. Definition and risk factors of rapidly declining residual renal function in peritoneal dialysis: an observational study. Kidney Blood Press Res 2012; 35:233-41. [PMID: 22223267 DOI: 10.1159/000332887] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 09/05/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is critical to preserve residual renal function (RRF) in peritoneal dialysis (PD), as RRF is associated with lower morbidity and mortality. There is no uniform definition of RRF, and rapidly declining RRF has rarely been studied and predominately limited to single factor analysis and not corrected for lead-time bias. METHODS An observational study in 71 incident PD patients. RRF was defined as urine output (UO) ≥500 ml/day and renal glomerular filtration rate (rGFR) ≥2 ml/min/1.73 m(2), rapid declining RRF as UO <500 ml/day and rGFR <2 ml/min/1.73 m(2) occurring within 6 months which were separately evaluated. Independent risk factors associated with rapid RRF decline were identified while correcting for lead-time bias. RESULTS RRF declined rapidly by both definitions in 65% patients 2.5 years after PD start. Both definitions of RRF decline were consistent in 96%. Nephrotoxic drugs, renal transplant failure and absent angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) were independent risk factors associated with rapidly declining RRF defined both by definitions, intravascular radiocontrast additionally for UO decline. CONCLUSIONS Most PD patients demonstrated rapid RRF decline, independent of its definition. Both definitions are highly consistent and interchangeable. Nephrotoxic drugs and radiocontrast were identified as risk factors of acute, absent ACEI or ARB, and renal transplant failure of chronic renal injury.
Collapse
|