Evaluation of need for peritoneal dialysis training in Morocco.

Update on Peritoneal Dialysis: Core Curriculum 2016

Background and Aims Peritoneal dialysis (PD) offers greater flexibility, a better quality of life, a lower risk of infections, better preservation of residual kidney function, and lower healthcare costs in comparison to in-centre hemodialysis (HD). Despite the known advantages associated with PD, over 35% of patients transition from PD to HD annually in the UK. The most common reasons for PD dropouts include mechanical failure, infection, inadequate clearance and death whilst receiving PD. We conducted a retrospective observational study at our centre investigating the characteristics of patients who dropped out of their PD regimens and the reasons for PD dropout over a 3-year follow-up period. Method There were 114 adult patients under the care of the renal medicine department at Northern Care Alliance NHS Foundation Trust who dropped out of PD between January 2022 and September 2024. Specific patient characteristics and the reasons for PD dropout were evaluated over this time period. Data collated include patient demographic characteristics, Charlson comorbidity index (CCI) scores prior to PD catheter insertion, issues identified during home visit assessments prior to PD initiation, and attendance to dialysis education visits. PD catheter-related information including the catheter insertion method (i.e. medical vs surgical insertion), whether an elective outpatient vs inpatient procedure was received, and the occurrence of acute complications post PD catheter insertion (e.g. catheter malposition) were recorded. In this study, continuous variables are expressed as median (interquartile range) with p values calculated via the Kruskal–Wallis H test or Mann–Whitney U test. Categorical variables are expressed as numbers (percentage) with p values calculated by the Chi-squared test. Comparisons were made between PD dropouts after catheter removal due to ’undesirable cause’ (UC) (i.e. infection and/or PD catheter dysfunction) versus ’natural causes’ (NC) (i.e. death, receipt of kidney transplantation or patient choice). Logistic regression statistics were applied to represent the findings of this comparative analysis. Results There were 43 patients in 2022, 42 patients in 2023, and 29 patients in 2024 who dropped out of PD. The cohort’s median age was 55.3 years, in which patients were predominantly male (69%) and of White ethnicity (81.3%). Patient characteristics relating to the pre-PD assessments—including CCI scores, issues identified during home visit assessments prior to PD initiation, and attendance to dialysis education visits—were similar between 2022 and 2024. The rates of medical PD catheter insertion (81.4% in 2022 vs 81% in 2023 vs 75.9% in 2024, P = 0.826) and elective outpatient catheter insertion (70% in 2022 vs 76.2% in 2023 vs 79.3% in 2024, P = 0.630) were similar across the 3 years. No differences were observed in terms of peri-operative characteristics relating to PD catheter insertion between 2022 and 2024, including constipation issues post-procedure, pre-procedure CCI scores or the number of medications received. There were an increased proportion of patients who dropped out of PD due to availability for kidney transplantation between 2022 and 2024 (21% in 2022 vs 28.6% in 2023 vs 48% in 2024, P = 0.005). Nevertheless, PD dropouts because of UC appeared similar over the years (35% in 2022 vs 43% in 2023 vs 31% in 2024, P = 0.564). Of the 114 patients, 42 had PD drop off due to UC and 72 had a NC. A comparison between the two groups showed a higher proportion of patients who had an emergency PD catheter insertion as inpatients eventually dropped off PD due to an UC (40.5% UC vs 16.7% NC, P = 0.005) (Table 1). Binary logistic regression analysis noted emergency inpatient catheter insertion as a significant predictor of UC for PD removal/drop out (OR 3.40, 95% CI 1.41–8.14, P = 0.006). Conclusion Our study highlights emergency inpatient PD catheter insertion as a risk factor that predicts for future ’undesirable‘ PD dropout. This study’s findings strengthen the stance that meticulous pre-procedure assessments in advanced kidney care services and dialysis preparation clinics are warranted to prevent ’undesirable‘ PD dropouts.

Growing a peritoneal dialysis program: A single‐center experience

The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented strain on health care resources in the United States. Initial reports of AKI rates from Wuhan, China ranged between 3% and 9%, although rates as high as 15% have been reported (1,2). For AKI requiring RRT, intermittent hemodialysis (HD) and continuous RRT (CRRT) have been mainstays of therapy in the United States. However, shortages in supplies, staffing, and available equipment among critically ill patients with COVID-19, particularly in the New York City area, have demanded alternative strategies such as acute peritoneal dialysis treatment for AKI (AKI-PD) that are being implemented. Here, we will review the rationale for the use of AKI-PD and describe potential advantages, criteria for patient selection, and practical considerations on the basis of initial experiences to consider when prescribing and delivering peritoneal dialysis (PD). PD was routine for AKI treatment worldwide well into the 1980s. However, by the 1990s with the development of the central venous catheter for HD and the advent of CRRT, PD became rarely used in higher-resource countries to treat adult patients with AKI (3). The utility and efficacy of PD to treat patients with AKI were re-examined after the publication of a series of articles from Brazil, including a randomized trial, demonstrating that PD provided acceptable care, was not inferior to daily HD in treating acutely ill patients with AKI in terms of patient mortality, and was associated with a shorter duration of AKI and need for RRT (4,5). These findings were confirmed in a randomized trial from Saudi Arabia comparing PD with hemodiafiltration (6). AKI-PD expanded dramatically in lower-resource countries with the advent of the Saving Young Lives Program in 2012, which promoted the use of PD because of minimal infrastructural requirements, including a lack of need for water …

Objectives: The increasing prevalence of patients with end-stage renal disease (ESRD) is driving up the costs of dialysis care dramatically. The National Institute of Clinical Excellence (NICE) has projected significant cost savings by increasing the proportion of patients on peritoneal dialysis (PD). This study investigates the five-year budget impact on UK national healthcare spending on dialysis of changing the distribution of adult patients undergoing peritoneal dialysis and in-center hemodialysis (ICHD). Methods: An Excel®-based budget impact model was constructed to assess dialysis-associated costs when changing adult patients between PD and ICHD. The model incorporates the current modality distribution in the UK and accounts for dialysis payments, drug costs (including ESAs), and the costs and probabilities of adverse events including access failure, access infection, pneumonia, and cardiovascular events. Data from the UK Renal Registry reports were used to estimate the size of the UK adult dialysis patient population for the next five years. The baseline scenario assumed a stable distribution of PD (15%) and ICHD (82%) over five years; the remaining 3% is assumed to be home hemodialysis. Alternative scenarios included: 1). increasing the prevalence of PD by 1.5% each year for five years; 2). increasing the prevalence of PD by 3.0% each year for five years; 3). decreasing the prevalence of PD by 1.5% each year for five years. All three scenarios were accompanied by commensurate changes in ICHD, assuming no change in home hemodialysis. Differences among scenarios were evaluated in terms of costs to UK National Health Services (NHS). Results: Under the current UK national tariff, an increase in the prevalent PD population from 15% in 2013 to 21% or 27% in 2017 is predicted to result in fiveyear cumulative savings for NHS of £28.3 million and £78.9 million, respectively. If the prevalent PD population were to decrease from 15% in 2013 to 9.0% by 2017, the total NHS payment for adult dialysis patients would increase by £73.0 million over the next five years. Conclusions: Under the current UK national tariff, incentives to increase the proportion of patients on PD could help reduce dialysis-associated costs. The main driver of the savings comes from the reduction of the estimated transportation costs. Budget Impact Analysis of Peritoneal Dialysis vs. Conventional In-center Hemodialysis in the United Kingdom Frank Xiaoqing Liu1, Robert Leipold2, Murat Arici3, Usman Farooqui3 1 Baxter Healthcare Corporation, Deerfield, IL 60015 USA; 2 United BioSource Corporation, Bethesda, MD 20814 USA; 3 Baxter Healthcare Ltd., Compton, RG20 7QW United Kingdom. Poster No. SP442

In advanced stages of chronic kidney disease (CKD), where kidney function has severely declined, renal replacement therapy becomes essential. This scoping review aims to compare the impact of two common dialysis modalities—hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD)—on various aspects of patients' quality of life, including physical, emotional, and social dimensions. This review was conducted using the Population and Concept (PC) framework, which is commonly applied in scoping reviews, and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines for reporting. A comprehensive literature search was performed across four databases: PubMed, ProQuest, ScienceDirect, and Google Scholar. The search focused on full-text, English-language articles published within the last ten years. Inclusion criteria included studies involving adult CKD patients undergoing HD or CAPD with quality of life as the primary outcome. Studies were excluded if they involved pediatric populations, case reports, or were not peer-reviewed. Nineteen studies met the eligibility criteria and were included in this review. The findings suggest that CAPD therapy is potentially associated with better physical quality of life compared to HD. However, results regarding emotional and social aspects were mixed, with some studies indicating comparable outcomes between modalities, while others showed conflicting results. Further research is warranted, particularly regarding emotional well-being and social support in CAPD patients. While CAPD may offer certain advantages in physical quality of life, comprehensive comparisons across emotional and social domains remain inconclusive. Limitations of this review include the small number of eligible studies, variation in study designs, and heterogeneity in patient populations. These limitations highlight the need for more robust and standardized research in this area.

The Economics of Home Dialysis: Acting for the Individual While Planning Responsibly for the Population

A clinical study to investigate gum infection in patients on kidney dialysis

POS-668 BARRIERS AND OPPORTUNITIES TO INCREASE PD INCIDENCE AND PREVALENCE: LESSONS FROM A EUROPEAN SURVEY

Background: At present, patients with end-stage renal failure (ESRD) face the question of how to achieve adequate dialysis to maintain their survival with the best quality of life as long as possible. Therefore, the choice of suitable dialysis methods and dialysis dose is important. Objective: To find suitable dialysis methods and an appropriate dialysis dose for patients with ESRD. Methods: Our research compares the long-term clinical effects between the patients undergoing continuous ambulatory peritoneal dialysis (CAPD), daytime ambulatory peritoneal dialysis (DAPD), and hemodialysis (HD). Thirty-two patients subjected to peritoneal dialysis were selected and divided into group A (n = 16) and group B(n = 16), group A was treated by using the traditional CAPD pattern; group B was treated by using DAPD. Forty-six patients of renal failure at final stage were divided into group A (n = 23) and group B (n = 23), group A was treated by using a HD method, group B was treated by using a DAPD method. Results: When the same dialysis dose was applied, the patients with long-term DAPD treatment can obtain satisfactory clinical therapeutic efficacy for the period of maintenance dialysis, thoroughness of dialysis, maintenance of nutritional status, blood pressure regulation, reduction in incidence rate of peritoneal infection, maintenance of relatively high activity in daily life and alleviation in depression, comparable to patients treated with traditional CAPD or HD methods. Conclusion: The long-term clinical effects of DAPD are comparable to CAPD or HD. Keywords: CAPD, continuous ambulatory peritoneal dialysis, DAPD, daytime ambulatory peritoneal dialysis,end-stage renal failure, hemodialysis

The use of peritoneal dialysis (PD) has become wide spread since the introduction of continuous ambulatory PD more than 25 years ago. Over this time, many advances have been made and PD is an alternative to hemodialysis (HD), with excellent comparable survival, lower cost, and improved quality of life. The percentage of prevalent PD patients in the United States is approximately 7%, which is significantly lower compared with the 15% PD prevalence from the mid-1980s. Despite comparable survival of HD and PD and improved PD technique survival over the last few years, the percentage of patients performing PD in the United States has declined. The increased numbers of in-center HD units, physician comfort with the modality, perceived superiority of HD, and reimbursement incentives have all contributed to the underutilization of PD. In addition to a higher transplantation rate among patients treated with PD in the United States, an important reason for the low PD prevalence is the transfer to HD. There are various reasons for the transfer (e.g., episodes of peritonitis, membrane failure, patient fatigue, etc.). This review discusses the various factors that contribute to PD underutilization and the rationale and strategies to implement "PD first" and how to maintain it. The PD first concept implies that when feasible, PD should be offered as the first dialysis modality. This concept of PD first and HD second must not be seen as a competition between therapies, but rather that they are complementary, keeping in mind the long-term goals for the patient.

<h3>Summary</h3> The use of peritoneal dialysis (PD) has become wide spread since the introduction of continuous ambulatory PD more than 25 years ago. Over this time, many advances have been made and PD is an alternative to hemodialysis (HD), with excellent comparable survival, lower cost, and improved quality of life. The percentage of prevalent PD patients in the United States is approximately 7%, which is significantly lower compared with the 15% PD prevalence from the mid-1980s. Despite comparable survival of HD and PD and improved PD technique survival over the last few years, the percentage of patients performing PD in the United States has declined. The increased numbers of in-center HD units, physician comfort with the modality, perceived superiority of HD, and reimbursement incentives have all contributed to the underutilization of PD. In addition to a higher transplantation rate among patients treated with PD in the United States, an important reason for the low PD prevalence is the transfer to HD. There are various reasons for the transfer (<i>e.g.</i>, episodes of peritonitis, membrane failure, patient fatigue, etc.). This review discusses the various factors that contribute to PD underutilization and the rationale and strategies to implement “PD first” and how to maintain it. The PD first concept implies that when feasible, PD should be offered as the first dialysis modality. This concept of PD first and HD second must not be seen as a competition between therapies, but rather that they are complementary, keeping in mind the long-term goals for the patient.

MON-070 NON-INFECTIOUS COMPLICATIONS OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS IN BANGLADESH: A SINGLE CENTRE EXPERIENCE

Perceived knowledge among patients cared for by nephrologists about chronic kidney disease and end-stage renal disease therapies

Over a period of 5 years, 26 children with end-stage renal disease were started on maintenance continuous ambulatory peritoneal dialysis (CAPD) program in King Khalid University Hospital, Riyadh. A...