International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis

Abstract

The International Society for Peritoneal Dialysis last published a guideline on prescribing peritoneal dialysis (PD) in 2006. This focused on clearance of toxins and used a measure of waste product removal by dialysis using urea as an example. This guideline suggested that a specific quantity of small solute removal was needed to achieve dialysis 'adequacy'. It is now generally accepted, however, that the well-being of the person on dialysis is related to many different factors and not just removal of specific toxins. This guideline has been written with the focus on the person doing PD. It is proposed that dialysis delivery should be 'goal-directed'. This involves discussions between the person doing PD and the care team (shared decision-making) to establish care goals for dialysis delivery. The aims of these care goals are (1) to allow the person doing PD to achieve his/her own life goals and (2) to promote the provision of high-quality dialysis care by the dialysis team. Key recommendations 1. PD should be prescribed using shared decision-making between the person doing PD and the care team. The aim is to establish realistic care goals that (1) maintain quality of life for the person doing PD as much as possible by enabling them to meet their life goals, (2) minimize symptoms and treatment burden while (3) ensuring high-quality care is provided.

Increasing Peritoneal Dialysis Use in Response to the COVID-19 Pandemic: Will It Go Viral?

“…Recently updated International Society for Peritoneal Dialysis guidelines for prescribing PD have stated that the prescription should focus on the patient's well-being and enable achievement of the patient's goals, de-emphasizing small-solute clearance alone as a measure of high-quality dialysis. 7 The relaxed requirements for PD adequacy measures and reporting during this period also provide a unique opportunity for reappraisal of these and other quality improvement measures. If routine blood work for a patient receiving PD before the pandemic has been stable, within target, and the person is clinically well, frequency of blood work may also be reconsidered, particularly in the face of recent evidence in the hemodialysis population that did not demonstrate deleterious consequences with regular but less-frequent blood sampling.…”

The Role of Incremental Peritoneal Dialysis in the Era of the Advancing American Kidney Health Initiative

“…The International Society for Peritoneal Dialysis (ISPD) recently released 2020 guidelines for prescribing high-quality, goal-directed PD (3). Key to the 2020 ISPD guidelines is a focus on shared decision making between the person performing PD, the caregiver (if any), and the care team to achieve realistic care goals that maximize patient satisfaction and provide highquality care (3). The ISPD suggests using innovative PD care delivery strategies, such as incremental PDa strategy with the potential to improve patient experience while lowering complication rates and costs.…”

“…For this to occur, the expansion of patient-centered strategies such as incremental PD should be explored, along with parallel efforts to overcome barriers to kidney transplantation and home HD (1,2). This perspective aims to provide an overview of incremental PD, including advantages and limitations of implementing this strategy to help achieve the AAKH goal of optimizing patient-centered home therapies in the United States (2,3).…”

The osmo-metabolic approach: a novel and tantalizing glucose-sparing strategy in peritoneal dialysis

“…Glucose absorption may play a distinct role in the longitudinal changes to the structure and function of the peritoneal membrane observed in some patients [18]. For example, in keeping with the relevance of sodium removal/balance in PD patients, preserving the integrity of the peritoneal membrane function would be key to guarantee an adequate dialytic sodium removal particularly in APD patients [19,20], and to achieve a better control of volemia and blood pressure [21]. Moreover, excessive intraperitoneal absorption of glucose from the dialysate has many potential systemic metabolic effects, including insulin resistance, new onset diabetes, and cardiovascular disease, which can be attributed to a combination of the effects of carbohydrate and caloric uptake, as well as hyperglycemia [17,22].…”