Reversing the Decreasing Peritoneal Dialysis Trend in Ontario

Oreopoulos, Dimitrios G.; Coleman, Sandra B.; Doyle, Ethel

doi:10.1177/089686080802800220

Perit Dial Int

2008

DOI: 10.1177/089686080802800220

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Reversing the Decreasing Peritoneal Dialysis Trend in Ontario

Dimitrios G. Oreopoulos

Sandra B. Coleman

Ethel Doyle

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Cited by 4 publications

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References 7 publications

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“…T he percentage of end-stage renal disease (ESRD) patients treated with peritoneal dialysis (PD) has declined in many developed countries since the mid-1990s (1,2). This decline has occurred despite the apparent cost advantages of PD and despite initiatives to grow the modality (3,4). Marked differences in PD utilization are evident both between and within countries, and it is widely believed that non-medical issues contribute to those disparities (5,6).…”

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Peritoneal Dialysis and the Process of Modality Selection

2012

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The process of modality selection and how it works is a critical determinant of peritoneal dialysis (PD) utilization. This very complex process has not been well analyzed. Here, we break it down into 6 steps and point out how problems at each step can significantly reduce the proportion of endstage renal disease patients initiating PD. It is important that any program wising it to grow its use of PD understand the steps and the points at which problems may be arising. Examples are presented. Perit Dial Int

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Peritoneal Dialysis and the Process of Modality Selection

2012

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Dialysis-associated peritonitis in children

2009

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Peritonitis remains a frequent complication of peritoneal dialysis in children and is the most common reason for technique failure. The microbiology is characterized by a predominance of Gram-positive organisms, with fungi responsible for less than 5% of episodes. Data collected by the International Pediatric Peritonitis Registry have revealed a worldwide variation in the bacterial etiology of peritonitis, as well as in the rate of culture-negative peritonitis. Risk factors for infection include young age, the absence of prophylactic antibiotics at catheter placement, spiking of dialysis bags, and the presence of a catheter exit-site or tunnel infection. Clinical symptoms at presentation are somewhat organism specific and can be objectively assessed with a Disease Severity Score. Whereas recommendations for empiric antibiotic therapy in children have been published by the International Society of Peritoneal Dialysis, epidemiologic data and antibiotic susceptibility data suggest that it may be desirable to take the patient- and center-specific history of microorganisms and their sensitivity patterns into account when prescribing initial therapy. The vast majority of patients are treated successfully and continue peritoneal dialysis, with the poorest outcome noted in patients with peritonitis secondary to Gram-negative organisms or fungi and in those with a relapsing infection.

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Nutritional management of encapsulating peritoneal sclerosis

Campbell

Summers

2014

Journal of Renal Nursing

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Encapsulating peritoneal sclerosis (EPS) is a complication of peritoneal dialysis. Although incidence is low, for patients who do develop the condition it can be debilitating and life-threatening. It has therefore received great interest and awareness from the renal community in the last 10 years. EPS is usually a progressive condition, with early clinical signs ranging from mild gastrointestinal (GI) symptoms and weight loss, to inflammation, severe GI symptoms and, eventually, encapsulation. Over time, the clinical picture deteriorates, affecting biochemistry, nutritional status, overall health and quality of life, which can eventually be fatal. A multidisciplinary approach and high index of suspicion are needed to identify patients at risk of developing EPS, so early diagnosis can be made and timely treatment initiated. Thorough nutritional assessment, monitoring and support are essential. This article raises awareness of EPS, describes how to optimise nutritional care, and hopes to improve patient outcomes through earlier identification and intervention of this potentially devastating disease.

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Reversing the Decreasing Peritoneal Dialysis Trend in Ontario

Cited by 4 publications

References 7 publications

Peritoneal Dialysis and the Process of Modality Selection

Peritoneal Dialysis and the Process of Modality Selection

Dialysis-associated peritonitis in children

Nutritional management of encapsulating peritoneal sclerosis

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