Care Of Peritoneal Dialysis Patients Research Articles

#1608 Use of intraperitoneal hydration by peritoneal dialysis fluid as a complementary palliative therapy in peritoneal dialysis patients

Abstract Background and Aims End life care should manage pain, other distressing symptoms and guarantee sufficient hydration. It should also involve psychological, social and spiritual support. Palliative care in peritoneal dialysis is a new and growing clinical question. There are several open questions: Should we stop peritoneal dialysis totally? Should we go on with peritoneal dialysis in a reduced fashion? Hereby we report a new application of CAPD exchanges, intraperitoneal hydration, in end life care of peritoneal dialysis patients. Method In seven peritoneal dialysis patients (2 female, 3 male, age 82 to 90 years) affected by severe heart failure (3 patients), dementia (2 patients) and malnutrition-inflammation syndrome (2 patients) we applied the concept of intraperitoneal hydration as a complementary palliative care. Peritoneal dialysis was switched into a single CAPD bag therapy utilizing a glucose concentration of 1.36% or 1.5%. Depending on the clinical hydration status 1000 ml of dialysis fluid was loaded daily or each other day without prior drainage. None of the patients was on intravenous therapy. Results The duration of the intraperitoneal hydration therapy varied between 5 and 16 days. In two cases, therapy was performed initially at the hospital ward and hereafter at a nursing home, whereas in the latter 5 cases at the patient's home by family members. No case of hypervolemia occurred. The intraperitoneal hydration therapy was well accepted by the family members. Conclusion The transformation of peritoneal dialysis from ultrafiltration and depuration into hydration without depuration seems to be a feasible approach. This approach should be kept in mind in special conditions such as end life palliative care and hypohydration.

Developing a theory to help guide End-Stage Renal Disease Patients to adapt to Peritoneal Dialysis: A grounded theory study.

The aim of this study was to develop a theory to help guide patients with end-stage renal disease to adapt to peritoneal dialysis. Taiwan ranks first worldwide in end-stage renal disease incidence and dialysis prevalence. Many patients cannot accept long-term dialysis treatment and thus face several physical and psychological suffering. No theory has yet been developed to help guide patients with end-stage renal disease to adapt to peritoneal dialysis. A grounded theory approach was used in this study. A theoretical sampling was performed after interviewing 25 patients who had adapted to peritoneal dialysis at a medical centre in Taiwan from January 2018 to September 2018; data saturation was achieved. Data were analysed using open, axial and selective coding and while using the constant comparison technique. COREQ reporting guidelines were utilised. A substantive theory was developed to help guide patients with end-stage renal disease to adapt to peritoneal dialysis. The core category that emerged from the data collected was 'Confronting peritoneal dialysis to live and co-exist with peritoneal dialysis'. Other key categories linked to and embraced in this core category were as follows: positive self-regulation, regulation of daily life and the process of adaptation to dialysis method. The results could help healthcare professionals to better understand the process of end-stage renal disease patients' adaptation to peritoneal dialysis, thereby facilitating patients' adaptation to dialysis in their daily life, enhancing their quality of life and improving the quality of medical care. Healthcare professionals could use this theory as reference when providing care for peritoneal dialysis patients to assist them in adapting to life with peritoneal dialysis as soon as possible through positive self-regulation, daily life adjustments and the process of adapting to the dialysis method.

Health-related quality of life and adequacy of dialysis for the individual maintained on peritoneal dialysis.

The goal of care of the peritoneal dialysis (PD) patient should be directed at adjusting therapy to maximize the patient's health-related quality of life (HRQOL). Incorporating the routine assessments of HRQOL into the care of PD patients is important and should serve as an essential marker of the adequacy of dialysis and help the dialysis staff design the optimal treatment regimen for each patient. HRQOL is best assessed with patient-reported outcome measures (PROMs). How best to incorporate these PROMs into the routine care of the PD patient is not clear in terms of the best instruments to use, frequency of measurements, patient acceptability, and how to translate these assessments into improvements in patient care. Nevertheless, incorporating routine assessments of HRQOL into the care of PD patients is essential if the dialysis team is to provide optimal care; it is an area that is receiving increasing attention and is ripe for further study and investigation.

Application of mobile medical APP in continuing nursing care of peritoneal dialysis patients

目的 评价移动医疗APP在腹膜透析患者延续护理中的临床价值。 方法 选取2016年12月至2017年12月在绍兴市人民医院腹膜透析患者79例，采用随机数字表法分成观察组40例和对照组39例。对照组出院后通过腹透门诊、微信群、QQ群、电话随访、家庭访视等传统方法进行管理，观察组在传统方法上增加腹透之家APP进行管理。干预6个月后，分别评价两组的治疗依从性、门诊随访和临床监测指标完成情况及容量、营养状况。 结果 6个月后，观察组患者的监测血压、监测体质量、控制水盐和按时腹透依从性好的分别为62.50%(25/40)、82.50%(33/40)、72.50%(29/40)、85.00%(34/40)，优于对照组的43.59%(17/39)、48.72%(19/39)、46.15%(18/39)、58.97%(23/39)，差异均有统计学意义(χ2＝6.177、10.463、6.023、7.076，均P<0.05)；观察组门诊随访和临床监测指标完成好的为90.00%(36/40)、72.50%(29/40)，较对照组的66.67%(26/39)、46.15%(18/39)明显提高，差异均有统计学意义(χ2＝6.371、6.404，均P<0.05)；观察组的收缩压、舒张压和血白蛋白值分别为(134.5±12.0)mmHg、(81.6±6.3)mmHg、(34.6±3.5)g/L，优于对照组的(141.7±13.2)mmHg、(86.8±9.9)mmHg、(32.8±3.6)g/L，差异均有统计学意义(t＝2.542、2.772、2.179，均P<0.05)。 结论 移动医疗APP对提高腹膜透析患者自我管理能力，提高依从性和疾病认知力，改善容量和营养状况具有重要的临床价值。

Research progress of methods and evaluation tools of transitional care among peritoneal dialysis patients

Peritoneal dialysis is a successful renal replacement therapy for end-stage kidney failure patients. Transitional care can reduce the incidence of peritonitis of peritoneal dialysis patients and improve patients' quality of life. This paper reviewed the methods and evaluation tools of transitional care among peritoneal dialysis patients both here and abroad so as to provide a reference for hospitals and communities to spread transitional care of peritoneal dialysis patients. Key words: Review; Peritoneal dialysis; Kidney failure, chronic; Transitional care

Clinical practice guidelines for the provision of renal service in Hong Kong: Accreditation of Renal Unit

Clinical practice guidelines for the provision of renal service in Hong Kong: Accreditation of Renal Unit

32 Years' Experience of Peritoneal Dialysis-Related Peritonitis in a University Hospital

Peritonitis in peritoneal dialysis (PD) patients can lead to technique failure and contributes to infection-related mortality. Peritonitis prevention and optimization of treatment are therefore important in the care for PD patients. In the present study, we analyzed the incidence of peritonitis, causative pathogens, clinical outcomes, and trends in relation to three major treatment changes that occurred from 1979 onward: use of a disconnect system since 1988, daily mupirocin at the exit-site since 2001, and exclusive use of biocompatible dialysis solutions since 2004. In this analysis of prospectively collected data, we included peritonitis episodes from the start of PD at our center in August 1979 to July 2010. Incident PD patients were allocated to one of four groups: Group 1 - 182 patients experiencing 148 first peritonitis episodes between 1979 and 1987, before the introduction of the disconnect system; Group 2 - 352 patients experiencing 239 first episodes of peritonitis between 1988 and 2000, before implementation of daily mupirocin application at the catheter exit-site; Group 3 - 79 patients experiencing 50 first peritonitis episodes between 2001 and 2003, before the switch to biocompatible solutions; and Group 4-118 patients experiencing 91 first peritonitis episodes after 2004. Cephradine was used as initial antibiotic treatment. In 32 years, 731 adult patients started PD, and 2234 episodes of peritonitis in total were diagnosed and treated. Of those episodes, 88% were cured with medical treatment only, and 10% resulted in catheter removal. In 3% of the episodes, the patient died during peritonitis. Median time to a first peritonitis episode increased from 40 days for group 1 to 150 for group 2, 269 for group 3, and 274 for group 4. The overall peritonitis rate and the gram-positive and gram-negative peritonitis rates showed a time-trend of decline. However, the duration of antibiotic treatment increased over time, with groups 3 and 4 having the longest duration of treatment, accompanied by a higher percentage of antibiotic switch. Increased resistance to cephradine was found for coagulase-negative Staphylococcus. Peritonitis rates declined significantly over the years because of several changes in PD treatment. However, the need to change the initial antibiotic increased because of diminished antibiotic susceptibility rates over time. Nevertheless, the cure rate was high and remained stable during the entire period analyzed, and the death rate remained low. Consequently, peritonitis is a manageable complication of PD that cannot be considered a contraindication to this mode of renal replacement therapy.

N-Acetylcysteine Improves Residual Renal Function in Peritoneal Dialysis Patients: A Pilot Study

Preservation of peritoneal membrane function and residual renal function is important for the optimal care of peritoneal dialysis patients. N-Acetylcysteine may ameliorate oxidative stress, which is thought to be involved in peritoneal membrane dysfunction. In addition, N-acetylcysteine may have a positive effect on renal function in the setting of nephrotoxic contrast media administration. The aim of this study was to investigate the effect of N-acetylcysteine on peritoneal and residual renal function in peritoneal dialysis patients. Ten prevalent peritoneal dialysis patients were administered oral N-acetylcysteine 1200 mg twice daily for 4 weeks. At baseline and at the end of treatment, peritoneal membrane function and residual renal function were assessed using a 4.25% dextrose peritoneal equilibration test and 24-hour dialysate and urine collection for calculation of peritoneal and residual renal Kt/V and mean urea and creatinine residual renal clearance. No significant changes were demonstrated in peritoneal membrane function, including dialysate-to-plasma creatinine ratio, sodium sieving, and net ultrafiltration. Residual renal function improved significantly: urine volume increased from 633 ± 426 to 925 ± 552 mL/24 hours (p = 0.022), residual renal Kt/V increased from 0.56 ± 0.41 to 0.75 ± 0.47 (p = 0.037), and mean residual urea and creatinine clearance increased from 4.96 ± 3.96 to 5.95 ± 4.08 mL/min/1.73 m(2) (p = 0.059). N-acetylcysteine may improve residual renal function in patients treated with peritoneal dialysis.

Growing a peritoneal dialysis program: A single‐center experience

Growing a peritoneal dialysis program: A single‐center experience