Epidemiology of peritoneal dialysis outcomes

Abstract

Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring.

Hydrothorax with Atypical Features as a Complication of Peritoneal Dialysis: A Case Report and Literature Review

“…1,2 The incidence of pleural effusions in the PD patient population is believed to range from 1.6% to 10%, with cases occurring more commonly in women than men. 3,4 The underlying etiology of PD-associated hydrothorax has not been fully elaborated, but high intra-abdominal hydrostatic pressure from large dialysate volumes likely leads to transudative leak of dialysate fluid, often through a pleuroperitoneal communication. 5,6 The pathophysiology of hydrothorax in peritoneal dialysis patients is commonly linked to congenital communications, diaphragmatic hernias, and fistulas, or acquired defects of subdiaphragmatic lymphatics, which serve as channels for the pleuroperitoneal leak.…”

“…1,2 There has been recent renewed interest in PD with novel reimbursement models supporting increased use, as well as emerging evidence that PD allows for comparable outcomes to hemodialysis (HD) with superior patient autonomy and at a lower cost. 3,4 Hydrothorax is a rarely encountered but potentially lethal complication of peritoneal dialysis, which currently lacks clearly defined gold standards for diagnosis and treatment, leading to divergent approaches from providers. The typical presentation is thought to be one of dyspnea and pleurisy.…”

Higher D‐dimer and activated partial thromboplastin time are poor prognostic factors in patients with peritoneal dialysis‐related peritonitis

“…PDRP is one of the standardized outcomes in Nephrology in Peritoneal Dialysis (SONG-PD), and it is critically important to all patients with PD [10]. Hyponatremia, a higher baseline level of red blood cell distribution width, and hypertriglyceridemia were risk factors for treatment failure in patients with PDRP [11][12][13].…”

Association between gut microbial diversity and technique failure in peritoneal dialysis patients

“…Compared with hemodialysis (HD), PD has many advantages, including lower cost, improved quality of life, preservation of residual kidney function (RKF) and less changes in hemodynamics [ 3–6 ]. However, with the extension of the PD treatment time, most PD patients lack the opportunities for kidney transplantation due to the shortage of organ donors, and often transfer to HD or directly die because of peritonitis, inadequate dialysis or other complications of PD [ 7 , 8 ]. These poor prognoses are collectively called PD technique failure which limits PD patients to stay on PD treatment for a long time, so it’s critical to identify factors associated with the technique failure and offer appropriate preventive strategies.…”