Incremental peritoneal dialysis allows to reduce the time spent for dialysis, glucose exposure, economic cost, plastic waste and water consumption

Nardelli, Luca; Scalamogna, Antonio; Cicero, Elisa; Castellano, Giuseppe

doi:10.1007/s40620-022-01433-7

Cited by 7 publications

(15 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the last 2 years, numerous studies on green, sustainable, ecological, planet-friendly nephrology have been published. Although there are fewer original articles that test strategies and interventions than reviews, the time has come to shift our focus from diagnosing what can be done to taking the steps needed to make nephrology more environmentally sustainable [6 ▪▪ ,12–14].…”

Section: Diagnosis First; Now Action Is Neededmentioning

confidence: 99%

Roadmaps to green nephrology: a mediterranean point of view

Ben Hmida,

Torreggiani,

Berman-Parks

et al. 2023

Current Opinion in Nephrology &Amp; Hypertension

View full text Add to dashboard Cite

Purpose of review Green nephrology is a movement whose aim is to find ways to reduce the environmental impact of kidney care. The question is of particular concern in this field since haemodialysis is one of the major contributors to waste generation, energy use and water consumption in healthcare. Although several ways for improving sustainability have been advocated, they are all context sensitive. This review aims to analyse the interventions that have been proposed to improve the ecologic sustainability and reduce the carbon footprint of nephrology care adapting to specific settings, and taking advantage of local expertise. Recent findings Green hospitals are becoming a reality in several high-income settings, thanks to new building guidelines, with greater awareness of climate change and users’ demands. Water saving is feasible, and is increasingly done, in different ways (improving hardware, reducing and adapting dialysate flows). Recycling noncontaminated plastic waste is feasible, but is still rarely performed. However, ecological transition has been slow even in high-income countries, while in low and middle-income countries lack of resources limit the ability to cope with the planet's urgent needs. Conversely, where man-power cost is low, some time-consuming tasks, such as separation of various components for recycling may be affordable. Theoretically, implementation of all clinical tasks aiming to avoid or retard dialysis, should be a priority. Summary There is no single roadmap for achieving green nephrology. Each setting should start from those feasible interventions most in line with its specific needs and priorities.

show abstract

Section: Diagnosis First; Now Action Is Neededmentioning

confidence: 99%

Roadmaps to green nephrology: a mediterranean point of view

Ben Hmida,

Torreggiani,

Berman-Parks

et al. 2023

Current Opinion in Nephrology &Amp; Hypertension

View full text Add to dashboard Cite

show abstract

“…• Environmental: there is also potential environmental benefits due to fewer bags used and, consequently, lower plastic waste and lower water consumption. Nardeli et al found that IPD prescription of 1, 2 or 3 exchanges per day lead to reduction in plastic waste of 139.2, 100.8 or 56.6kg/patient-year and a reduction in water consume of 25.056, 18.144 or 10.196L/patient-year, respectively [13].…”

Section: Advantages Of Incremental Peritoneal Dialysismentioning

confidence: 99%

“…Nardeli et al found that IPD prescription of 1, 2, or 3 exchanges per day leads to reduction in plastic waste of 139.2, 100.8, or 56.6 kg/patient-year and a reduction in water consume of 25.056, 18.144, or 10.196 L/patient-year, respectively. 13 Metabolic: Systemic glucose absorption from PD solutions can lead to adverse metabolic effects. The lower dose of IPD may be associated with a lower systemic absorption of carbohydrates.…”

Section: Advantages Of Ipdmentioning

confidence: 99%

See 1 more Smart Citation

Incremental Peritoneal Dialysis—Definition, Prescription, and Clinical Outcomes

2022

View full text Add to dashboard Cite

Incremental peritoneal dialysis (IPD) is a strategy of renal replacement therapy that is based on the prescription of a lower dose rather than the standard full dose of peritoneal dialysis (PD). The clearance goals are achieved through the combination of residual kidney function (RKF) and peritoneal clearance. The dialysis prescription should be increased as the RKF declines. IPD has been associated with clinical, economic, and environmental advantages. We emphasize possible better quality of life, fewer mechanical symptoms, lower costs, slight adverse metabolic effects, and lesser plastic waste and water consumption. It has also been addressed the potential benefits for RKF preservation and the lower risk of peritonitis. There are some concerns regarding this strategy, such as inadequate clearance of uremic toxins and/or severe electrolyte disturbances due to undetected loss of RKF; lower clearance of medium-sized molecules (such as beta-2-microglobulin) which mostly depends on the total PD dwell time; and patients' reluctance to dose adjustments. Current clinical evidence is based on moderate to low quality studies and suggests that the outcomes of IPD will be at least identical to those of full dose. This review aims to discuss the definition and strategies to IPD prescription, as well as its advantages and disadvantages. It'll also be reviewed the current evidence regarding this strategy.

show abstract

“…Over the past three decades, considerable efforts have been made to prevent PD-related infections: improving connection methods, optimizing exit-site care, creating specific pathways for patient training [5][6][7][8]. Despite the adoption of these measures, approximately one third of PD failures are still secondary to peritonitis [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Utility of ultrasonographic examination in catheter-related infections in peritoneal dialysis: a clinical approach

2023

Self Cite

View full text Add to dashboard Cite

Peritoneal dialysis- (PD) related infections continue to be a major cause of morbidity and mortality in patients on renal replacement therapy via PD. However, despite the great efforts in the prevention of PD-related infectious episodes, approximately one third of technical failures are still caused by peritonitis. Recent studies support the theory that ascribes to exit-site and tunnel infections a direct role in causing peritonitis. Hence, prompt exit site infection/tunnel infection diagnosis would allow the timely start of the most appropriate treatment, thereby decreasing the potential complications and enhancing technique survival. Ultrasound examination is a simple, rapid, non-invasive and widely available procedure for tunnel evaluation in PD catheter-related infections. In case of an exit site infection, ultrasound examination has greater sensitivity in diagnosing simultaneous tunnel infection compared to the physical exam alone. This allows distinguishing the exit site infection, which will likely respond to antibiotic therapy, from infections that are likely to be refractory to medical therapy. In case of a tunnel infection, the ultrasound allows localizing the catheter portion involved in the infectious process, thus providing significant prognostic information. In addition, ultrasound performed after two weeks of antibiotic administration allows monitoring patient response to therapy. However, there is no evidence of the usefulness of ultrasound examination as a screening tool for the early diagnosis of tunnel infections in asymptomatic PD patients.

show abstract

Incremental peritoneal dialysis allows to reduce the time spent for dialysis, glucose exposure, economic cost, plastic waste and water consumption

Cited by 7 publications

References 35 publications

Roadmaps to green nephrology: a mediterranean point of view

Roadmaps to green nephrology: a mediterranean point of view

Incremental Peritoneal Dialysis—Definition, Prescription, and Clinical Outcomes

Utility of ultrasonographic examination in catheter-related infections in peritoneal dialysis: a clinical approach

Contact Info

Product

Resources

About