Peritoneal Dialysis–First Policy Made Successful: Perspectives and Actions

Li, Philip Kam-tao; Chow, Kai Ming

doi:10.1053/j.ajkd.2013.03.038

Cited by 106 publications

(122 citation statements)

References 96 publications

Supporting

Mentioning

121

Contrasting

Order By: Relevance

“…Peritoneal dialysis (PD) is the first-line RRT for patients with ESRD in Hong Kong (1). Despite well established guidelines for prevention (2) and treatment (3) of PD-related infections, peritonitis remains a major challenge to nephrologists and a significant cause of morbidity and mortality in patients on PD (4).…”

Section: Introductionmentioning

confidence: 99%

Peritonitis before Peritoneal Dialysis Training: Analysis of Causative Organisms, Clinical Outcomes, Risk Factors, and Long-Term Consequences

King-Wing

Chow

Kwan

et al. 2016

CJASN

Self Cite

View full text Add to dashboard Cite

Background and objectives Peritonitis before peritoneal dialysis (PD) training (pretraining peritonitis [PTP]) is an uncommon event. The study aim was to examine the causative organisms, clinical outcomes, risk factors, and long-term consequences of PTP.Design, setting, participants, & measurements In this single-center, retrospective, observational study involving all incident patients on PD who developed PTP between 1998 and 2012, we examined the causative organisms, primary response rate, complete cure rate, risk factors, and associations of PTP with peritoneal equilibration test (PET) and patient survival. For each patient in the PTP group, the patients who underwent catheter insertion immediately before and after the index case were identified as controls.Results Among 1252 incident patients on PD, 52 (4.2%) patients developed PTP, and 104 patients were identified as controls. The two groups were similar in age, sex distribution, comorbidities, and residual renal function, but the PTP group had significantly lower hemoglobin and serum albumin. Patients were followed up for a median of 37.5 months (interquartile range [IQR], 16.3-62.2 months). The most common causative organisms of PTP were Staphylococcus aureus (30.8%) and polymicrobial (21.2%); 25% had negative growth. The primary response and complete cure rates were 82.7% and 78.8%, respectively. In the PTP group, 7.7% of patients died, 9.6% of patients required catheter removal, and PD training was significantly delayed (median =42.0; IQR, 26.0-65.8 days versus 27.5; IQR, 23.0-35.0 days; P=0.01). Multivariate logistic regression analysis showed that serum albumin was the only predictor of PTP (adjusted odds ratio, 0.89 per 1-g/dl increase; 95% confidence interval, 0.82 to 0.97). There were no differences in PET results and dialysis adequacy (measured around 1 month after PD training). The PTP group had significantly worse patient survival (median =41.2; IQR, 21.8-60.5 months versus 55.8; IQR, 40.4-71.2 months; P=0.02). Technique failure occurred in 11.5% and 10.6% of patients in the PTP and control groups, respectively.Conclusions S. aureus is the most common causative organism of PTP. Nutritional interventions in patients who are hypoalbuminemic before catheter insertion deserve additional study.

show abstract

Section: Introductionmentioning

confidence: 99%

Peritonitis before Peritoneal Dialysis Training: Analysis of Causative Organisms, Clinical Outcomes, Risk Factors, and Long-Term Consequences

King-Wing

Chow

Kwan

et al. 2016

CJASN

Self Cite

View full text Add to dashboard Cite

show abstract

“…It has been suggested that underutilization of CAPD may be related to lack of expertise and absence of pragmatic strategies 102 as well as with government policy, economics, provider or health care professional education, and patientrelated factors. 103 USRDS data show that 93% of all incident dialysis patients start in-center HD even though there is lack of evidence for the discrepancy.…”

Section: Pd First Policy: Is This Feasible In Lmics?mentioning

confidence: 99%

“…Li and Chow have suggested that in order to achieve a successful CAPD first policy, inherent patient factors, patient selection strategies, and improving technique-related factors (such as training of physicians, nurses, patients, and caregivers) need to be given careful consideration. 102 The presence of several of these factors already creates a barrier to successful implementation of CAPD first policies in several LMICs. If these barriers could be overcome, then CAPD first should be the correct patient choice; however, there is insufficient data to support this approach from LMICs.…”

Section: Pd First Policy: Is This Feasible In Lmics?mentioning

confidence: 99%

Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

Wearne¹,

Kilonzo²,

Effa³

et al. 2017

IJNRD

View full text Add to dashboard Cite

Abstract:Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low-to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT) despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or regionally) in LMICs to improve uptake of patients treated with CAPD. Workforce training and retraining will be necessary to ensure that there is coordination of CAPD programs and increase the use of protocols designed to improve CAPD outcomes such as insertion of catheters, treatment of peritonitis, and treatment of complications associated with CAPD. Training of nephrology workforce in CAPD will increase workforce experience and make CAPD a more acceptable RRT modality with improved outcomes.

show abstract

“…It is used in more than 11% of the global dialysis population [5]. The number of patients on PD increased by 21.8 and 24.9 patients per million population in both developed and developing countries, respectively [6]. It has superior therapeutic outcomes to hemodialysis in the first few years of treatment [5].…”

Section: Case Presentationmentioning

confidence: 99%