Peritoneal Dialysis Recipients Research Articles

Pregnancy in Patients Receiving Home Dialysis.

Pregnancy is an important goal for many women with CKD or kidney failure, but important barriers exist, particularly as CKD stage progresses. Women with advanced CKD often have a limited fertility window and may miss their opportunity for a pregnancy if advised to defer until after kidney transplantation. Pregnancy rates in women with advanced kidney failure or receiving dialysis remain low, and despite the improved outcomes in recent years, these pregnancies remain high risk for both mother and baby with high rates of preterm birth due to both maternal and fetal complications. However, with increased experience and advances in models of care, this paradigm may be changing. Intensive hemodialysis regimens have been shown to improve both fertility and live birth rates. Increasing dialysis intensity and individualizing dialysis prescription to residual renal function, to achieve highly efficient clearances, has resulted in improved live birth rates, longer gestations, and higher birth weights. Intensive hemodialysis regimens, particularly nocturnal and home-based dialysis, are therefore a potential option for women with kidney failure desiring pregnancy. Global initiatives for the promotion and uptake of home-based dialysis are gaining momentum and may have advantages in this unique patient population. In this article, we review the epidemiology and outcomes of pregnancy in hemodialysis and peritoneal dialysis recipients. We discuss the role home-based therapies may play in helping women achieve more successful pregnancies and outline the principles and practicalities of management of dialysis in pregnancy with a focus on delivery of home modalities. The experience and perspectives of a patient are also shared.

Bowel health in chronic kidney disease: Patient perceptions differ from clinical definitions.

The bowel health of those with chronic kidney disease (CKD) can be affected by medications, fluid/dietary allowances, reduced activity and pre-existing medical conditions. Patient perceptions of their bowel health can differ from those of health care professionals and the burden of gastrointestinal symptoms could be inaccurately reported. Adults with CKD, including those undergoing haemodialysis, peritoneal dialysis and kidney transplant from four South Australian hospitals enrolled in the study. Participants completed a five-item questionnaire, to investigate their perception of bowel health compared with clinical criteria for 'normal and abnormal' bowel health using the Bristol Stool Form Scale, bowel frequency and reported symptoms. A total of 324 individuals completed the questionnaire. Of those with clinically defined 'abnormal' bowel health (n = 180), 50.6% perceived their bowels as 'normal' or 'more normal than abnormal'. Only 6% of this clinically 'abnormal' group perceived their bowel health as abnormal. Of those with clinically defined 'normal' bowel health (n = 144), 16% perceived their bowel health as 'abnormal', 'more abnormal than normal' or 'variable'. Fifty-seven percent of patients with clinically defined 'abnormal' bowel health were not taking any treatments. Peritoneal dialysis recipients were the highest users of treatments to improve bowel function, with 62% using 1 or more treatment. It is common for patients with CKD to experience signs and symptoms of abnormal bowel health. There is a disconnect between patient perceptions and clinical definitions of normal or abnormal bowel health. Clinical care team members must carefully obtain and clarify patient-reported symptoms related to bowel function in order to help ensure recommendations and use of appropriate treatments.

Tuberculous Meningitis in PD Patients

Tuberculous meningitis is a very rare, but serious extrapulmonary complication of mycobacterial infections in immuno compromised patients, such as peritoneal dialysis recipients. A retrospective study of 455 peritoneal dialysis patients was made to determine the incidence and understand the demographic features of patients that lead to the development of Tuberculous meningitis on the basis of CSF for cell count, routine, ADA estimation, ZN Stain, culture&PCR. Between Jan 2000 and March 2017 4.39% patients of the total patients studied had Tuberculous meningitis. CSF smear was positive for AFB in 22.2% patients, CSF culture isolated AFB in 52.8% patients, PCR was found positive in 36.1% cases, and 4.39% patients were found to be having CSF ADA above cut off value. Pearson correlation indicates that lymphocyte counts and protein levels both increase as ADA increases, however sugar decreases as ADA, lymphocyte counts and protein increase in Tuberculous meningitis patients which is also proven by regression analysis. Outcome analysis revealed 30% mortality rate in diagnosed Tuberculous meningitis cases while maximum loss of life (36.36%) was seen in diabetic patients. It is concluded that the incidence of Tuberculous meningitis in peritoneal dialysis recipients was 4.39% and mortality rate was 30%. The rapid diagnosis of Tubercular meningitis is fundamental to clinical outcome. The present study clearly states that ADA is a rapid and fairly specific method for the diagnosis of Tuberculous meningitis. The early diagnosis and treatment help in achieving an improved outcome for PD patients. However, other techniques like AFB smear, PCR for M.tuberculosis and rapid culture would be required for confirmation of the diagnosis.