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Kaiming Chow - One of the best experts on this subject based on the ideXlab platform.
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changes in the worldwide epidemiology of Peritoneal Dialysis
Nature Reviews Nephrology, 2017Co-Authors: Kaiming Chow, Moniek W M Van De Luijtgaarden, David W Johnson, Kitty J Jager, Rajnish Mehrotra, Sarala Naicker, Roberto Pecoitsfilho, Norbert LameireAbstract:As the global burden of chronic kidney disease continues to increase, so does the need for a cost-effective renal replacement therapy. In many countries, patient outcomes with Peritoneal Dialysis are comparable to or better than those with haemoDialysis, and Peritoneal Dialysis is also more cost-effective. These benefits have not, however, always led to increased utilization of Peritoneal Dialysis. Use of this therapy is increasing in some countries, including China, the USA and Thailand, but has proportionally decreased in parts of Europe and in Japan. The variable trends in Peritoneal Dialysis use reflect the multiple challenges in prescribing this therapy to patients. Key strategies for facilitating Peritoneal Dialysis utilization include implementation of policies and incentives that favour this modality, enabling the appropriate production and supply of Peritoneal Dialysis fluid at a low cost, and appropriate training for nephrologists to enable increased utilization of the therapy and to ensure that rates of technique failure continue to decline. Further growth in Peritoneal Dialysis use is required to enable this modality to become an integral part of renal replacement therapy programmes worldwide.
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Peritoneal Dialysis catheter insertion
Seminars in Nephrology, 2017Co-Authors: John H Crabtree, Kaiming ChowAbstract:The success of Peritoneal Dialysis as renal-replacement therapy depends on a well-functioning Peritoneal catheter. Knowledge of best practices in catheter insertion can minimize the risk of catheter complications that lead to Peritoneal Dialysis failure. The catheter placement procedure begins with preoperative assessment of the patient to determine the most appropriate catheter type, insertion site, and exit site location. Preoperative preparation of the patient is an instrumental step in facilitating the performance of the procedure, avoiding untoward events, and promoting the desired outcome. Catheter insertion methods include percutaneous needle-guidewire with or without image guidance, open surgical dissection, peritoneoscopic procedure, and surgical laparoscopy. The insertion technique used often depends on the geographic availability of material resources and local provider expertise in placing catheters. Independent of the catheter implantation approach, adherence to a number of universal details is required to ensure the best opportunity for creating a successful long-term Peritoneal access. Finally, appropriate postoperative care and catheter break-in enables a smooth transition to Dialysis therapy.
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telephone triage in Peritoneal Dialysis population
Hong Kong Journal of Nephrology, 2008Co-Authors: Kaiming Chow, Cheukchun Szeto, Manching Law, Janny Sukfun Fung, Meiyuk PoonAbstract:Background Information about telephone triage and advice calls regarding Dialysis patients is limited. Methods We performed a survey and evaluated nurse-led telephone triage of telephone calls made by Peritoneal Dialysis patients and/or caregivers during a 7-week period. Results A total of 204 telephone calls were received during the study period. Over half of the calls (54.9%) were made with reference to medical complaints or symptoms. One hundred and four calls were referred by the nurses to have home care. Emergency department attendance occurred after 7.4% of the telephone calls only. Despite relatively good agreement rate between nurses' assessment and patients' action (kappa = 0.703), fewer than 5 out of 10 patients referred by nurses to the emergency department followed the advice. Thirty-four (16.7%) patients showed discordant action from the advice given by the Dialysis nurses. Telephone calls related to non-renal causes were associated with increased rates of discordant action (odds ratio, 4.15; 95% confidence interval, 1.45–11.84). Conclusion The value of telephone triage is unlikely to be substantial reduction in emergency department utilization by Peritoneal Dialysis patients. It is in the interests of the health profession to explore the role of psychological support delivered by renal nurses who provide phone consultation to patients on Peritoneal Dialysis.
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feasibility of resuming Peritoneal Dialysis after severe peritonitis and tenckhoff catheter removal
Journal of The American Society of Nephrology, 2002Co-Authors: Cheukchun Szeto, Kaiming Chow, Chi Bon Leung, Teresa Yukhwa Wong, Angela Yeemoon Wang, Siufai LuiAbstract:ABSTRACT. Published guidelines suggest that after an episode of severe peritonitis that requires Tenckhoff catheter removal, Peritoneal Dialysis can be resumed after a minimum of 3 wk. However, the feasibility of resuming Peritoneal Dialysis after Tenckhoff catheter removal remains unknown. One hundred patients were identified with peritonitis that did not respond to standard antibiotic therapy in a specific center. Their clinical course was reviewed; in all of them, Tenckhoff catheters were removed and reinsertion was attempted at least 4 wk later. In 51 patients, the Tenckhoff catheter was successfully reinserted and Peritoneal Dialysis was resumed (success group). In the other 49 pateints, reinsertion failed and the patient was put on long-term hemoDialysis (fail group). The patients were followed for 18.5 ± 16.8 mo. The overall technique survival was 30.8% at 24 mo. In the success group, 11 patients were changed to long-term hemoDialysis within 8 mo after their return to continuous ambulatory Peritoneal Dialysis. In the fail group, 18 of the 20 deaths occurred within 12 mo after conversion to long-term hemoDialysis. After resuming Peritoneal Dialysis, there was a significant decline in net ultrafiltration volume (0.38 ± 0.16 to 0.21 ± 0.19 L; P = 0.03) and a trend of rise in dialysate-to-plasma ratios of creatinine at 4 h (0.664 ± 0.095 to 0.725 ± 0.095; P = 0.15). Forty-five patients (88.2%) required additional Dialysis exchanges or hypertonic dialysate to compensate for the loss of solute clearance or ultrafiltration, although there was no significant change in Dialysis adequacy or nutritional status. It was concluded that after an episode of severe peritonitis that required Tenckhoff catheter removal, only a small group of patients could return to Peritoneal Dialysis. An early assessment of Peritoneal function after Tenckhoff catheter reinsertion may be valuable.
Stephen P Haggerty - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic Peritoneal Dialysis catheter insertion using rectus sheath tunnel and selective omentopexy significantly reduces catheter dysfunction and increases Peritoneal Dialysis longevity
Surgery, 2016Co-Authors: Monika A Krezalek, Nicolas Bonamici, Brittany Lapin, Jo Ann Carbray, Jose Velasco, Woody Denham, John G Linn, Michael B Ujiki, Stephen P HaggertyAbstract:Background Success of Peritoneal Dialysis depends on the durability of the Peritoneal Dialysis catheter, which in turn depends on insertion technique. Catheter-related complications are among the main reasons for Peritoneal Dialysis failure. Techniques showing evidence of improved catheter function include rectus sheath tunnel, selective omentopexy, and adhesiolysis. Methods Single-institution retrospective review of consecutive Peritoneal Dialysis catheter insertions was performed between 2004 and 2014. Of 235 procedures, the open technique was utilized in 63, basic laparoscopy with selective adhesiolysis in 80, and advanced laparoscopy utilizing rectus sheath tunnel, selective omentopexy, and adhesiolysis in 92. Primary outcomes included catheter dysfunction, catheter dysfunction-free, and overall survival. Results Mechanical catheter dysfunction occurred in 4 patients (4.4%) in the advanced laparoscopy group, 14 (17.5%) in the basic laparoscopy group, and 20 (31.8%) in the open group ( P P = .031). Conclusion Advanced laparoscopic Peritoneal Dialysis catheter insertion using rectus sheath tunnel, selective omentopexy, and adhesiolysis is associated with decreased catheter dysfunction rates, improved dysfunction-free and overall catheter survival, and lowest rate of switch to hemoDialysis.
Bradley A Warady - One of the best experts on this subject based on the ideXlab platform.
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Peritoneal Dialysis in children with end stage renal disease
Nature Reviews Nephrology, 2011Co-Authors: Franz Schaefer, Bradley A WaradyAbstract:Peritoneal Dialysis is the preferred chronic Dialysis modality for most children owing to its almost universal applicability and superior compatibility with lifestyle over other modalities. Although technological advances and increasing clinical experience have impacted favorably on patient and technique survival, clinical research in pediatric Peritoneal Dialysis has been hampered by the low incidence of end-stage renal disease (ESRD) in the pediatric population. To overcome this limitation, several international registries have emerged in the past few years to complement other long-standing registries, which together have provided useful information regarding technique-specific complications and comorbidities associated with ESRD in children undergoing chronic Peritoneal Dialysis. In this Review, we summarize the most relevant findings from these studies, highlighting the substantial variation in patient conditions, Peritoneal Dialysis practices and management of comorbidities encountered in different parts of the world.
Dragan Vojvodic - One of the best experts on this subject based on the ideXlab platform.
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Aeromonas Sobria: a Rare Cause of Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis
Galician Medical Journal, 2017Co-Authors: Andreja Figurek, Vlastimir Vlatkovic, Dragan VojvodicAbstract:Peritonitis is a very common complication in patients treated with continuous ambulatory Peritoneal Dialysis. The most common causes are gram positive cocci (part of the normal skin flora), and then gram negative bacteria, while fungi are listed as a rare cause of peritonitis. Aeromonas species are identified as a rare cause of continuous ambulatory Peritoneal Dialysis-related peritonitis. Among them, Aeromonas hydrophila is somewhat more common, followed by Aeromonas caviae . Case presentation. We reported a case of continuous ambulatory Peritoneal Dialysis peritonitis caused by Aeromonas sobria that is extremely rare cause of this type of peritonitis. In our patient, pseudomembranous colitis occured as a complication and, reinfection – another episode of peritonitis with Klebsiella pneumoniae . Treatment with third-episode cephalosporins was successful and patient continued treatment with continuous ambulatory Peritoneal Dialysis. Conclusions. The rare causes of peritonitis should not be ignored, especially those which lead to increased morbidity and mortality of patients.
Joan Brown - One of the best experts on this subject based on the ideXlab platform.
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adequacy of continuous ambulatory Peritoneal Dialysis morbidity and mortality in chronic Peritoneal Dialysis
American Journal of Kidney Diseases, 1994Co-Authors: Brendan P Teehan, Charles R Schleifer, Joan BrownAbstract:Mortality for hemoDialysis patients tends to be in excess of 20% per year, and it is generally agreed that outcome for continuous ambulatory Peritoneal Dialysis patients is comparable. Several investigators have suggested recently that continuous ambulatory Peritoneal Dialysis, as commonly practiced, may not provide adequate therapy, especially for larger patients and for those with no residual renal function. Unfortunately, a dose-response curve relating the amount of Dialysis delivered and clinical outcome for continuous ambulatory Peritoneal Dialysis patients has not been constructed. Several methods of quantifying the dose of Peritoneal Dialysis are described. Both cross-sectional and longitudinal studies are reviewed. The conclusions of these studies are of limited value, however, because of their retrospective nature and the limited number of patients enrolled. Nevertheless, in aggregate, these studies suggest that survival may be improved by higher doses of Dialysis. They also suggest that while malnutrition is relatively common in this patient population, higher doses of Kt/V are associated with higher protein intake (as measured by protein catabolic rate). Serum albumin is recognized as a strong predictor of clinical outcome and the protein catabolic rate may correlate directly with Kt/V, but there are studies that support and others that refute a correlation between Kt/V and serum albumin. Definitive answers to these questions are likely to be available in the near future. Two large multicenter studies are currently under way. Preliminary results may be available in the near future.