Peritoneal Dialysis: A Primary Care Perspective

Abstract

As the population of chronic kidney disease (CKD) and end-stage renal disease (ESRD) grows at an alarming rate, primary care physicians will increasingly be involved in the management of these patients. Early recognition of CKD and timely referral to a nephrologist when glomerular filtration rate approaches 30 mL/min/1.73 m 2 is extremely important to improve ESRD outcome and appropriate selection of dialysis modality. Peritoneal dialysis (PD) remains a viable treatment option for ESRD patients. PD is less expensive dialysis modality and may provide a survival advantages over hemodialysis in first 2 to 4 years of treatment. Preserving residual renal function (RRF) is of paramount importance to prolong the survival outcomes in PD patients. Thus preservation of RRF is an important goal in the management of PD patients. Every effort should be made to avoid nephrotoxic drugs like aminoglycosides and nonsteroidal anti-inflammatory drugs, and limit the use of radiocontrast agents in PD patients with RRF. Judicious use of prophylactic antibiotics to prevent peritonitis would further help to reduce morbidity from PD. Protecting peritoneal membrane from long-term toxic and metabolic effects of the conventional glucose-based solutions is another objective to further improve PD outcome. Development of new, more biocompatible PD solutions holds promise for the future. One such solution, icodextrin, is now approved for use in the United States. Although extremely safe to use, it is associated with unique metabolic effects that may concern primary care physicians. They include false elevation of blood glucose, a reversible increase in serum alkaline phosphatase and a false decline in serum amylase. Monitoring of glycemia by assays that use glucose dehydrogenase pyrroloquinoline quinone enzymes should be avoided and serum amylase alone should not be relied on in diagnosing pancreatitis in patients on icodextrin. (

Preditores de peritonite em pacientes em um programa de diálise peritoneal

“…That percentage was proportionally higher than the NorthAmerican (8.8%)16 and national (10.6%) 17 means, similar to the mean in Holland (30%) 18 , and lower than the 74% reported in Mexico, the major user of PD worldwide. 7 This reflects our police of impartially presenting the available therapies, allowing patients and their families to freely choose in situations with no contraindication to any method.…”

Periton diyalizi hastalarının periton diyalizinden ayrılma nedenleri: tek merkez deneyimi

“…HD tedavisinde olduğu gibi makine gereksinimi olmaması, tedavinin doğası gereği sürekli tedavi imkanı sağlaması ve kalan böbrek fonksiyonlarını HD'ye göre daha uzun süre ile koruma imkanı vermesi nedeniyle PD tedavisi bazı avantajlara sahiptir. 3,4 PD tedavisinin bu avantajlarına karşın teknik yetersizlik, tekrarlayan peritonitler, ultrafiltrasyon ve diyaliz yetersizliği, hastanın kendi isteği ve KBH' da ideal tedavi olan böbrek nakli yapılması gibi nedenlerle tedaviden ayrılma görülebilmektedir. KBH' da kardiyovasküler sebeplerden sonra enfeksiyon nedenli ölümler ikinci sırada gelmektedir.…”

<p>Patient engagement activities with health care professionals in continuous ambulatory peritoneal dialysis therapy: an exploratory pilot study</p>

“…5 At stage V or end-stage renal disease (ESRD), patients have options for choosing one of the renal replacement therapies (RRTs) in the form of kidney transplantation, hemodialysis (HD), and peritoneal dialysis (PD) either with automated peritoneal dialysis or continuous ambulatory peritoneal dialysis (CAPD). 6,7 In Indonesia, data from nationwide household survey on basic health research showed that the prevalence of CKD increased from 0.2% in 2013 to 0.38% in 2018. 8,9 The major cause of CKD was hypertension, followed by diabetes.…”

“…CAPD therapy provides better quality of life than HD, allows for flexibility on schedules in conducting self-dialysis, there is less restriction on diet as well as fluid intake, guarantees better preservation of residual renal function, and is less expensive than HD. 2,6,14 A study by Novelia et al indicated that in terms of cost, the average total cost of HD in Indonesia was around IDR 133.4 million or about US$10,000 per patient per year, meanwhile CAPD modality was around IDR 81.7 million or about US$6,000 per patient per year. 11 In order to know which therapy is appropriate for ESRD patients and to obtain positive outcomes, they have to consult a doctor, preferably a nephrologist because the decision depends on patient's choice, medical, social, and geographical considerations.…”