Types Of Renal Replacement Therapy Research Articles

Dose in continuous renal replacement therapy.

Continuous renal replacement therapy (CRRT) is one of the most used types of renal replacement therapies for the treatment of critically ill patients with acute kidney injury (AKI). Recent practice clinical guidelines based on recent clinical trials recommend a prescribed dose of 20-25 mL/kg/h of effluent since these trials could not find differences between high-intensity versus low-intensity CRRT dose and different outcomes as mortality and recovery of renal function. Nevertheless, the results of these recent trials do not mean that CRRT dose is not important, and on the contrary, these trials inform us that dose needs to be continuously assessed and modified according to clinical, metabolic, and physiological needs of each patient. Dose prescription in CRRT needs to be a dynamic and precise process, in which evidence-based quality measures will be used to guide CRRT dose prescription that will match daily patients needs. Delivered dose should be routinely monitored to ensure that it will be achieved. Quality measures for monitoring delivered dose of CRRT have been proposed, but they still need validation, before be implemented into clinical practice.

Global Perspectives in Acute Kidney Injury: Spain.

Global Perspectives in Acute Kidney Injury: Spain.

INVESTIGATION OF PARAMETERS AFFECTING SELF-MANAGEMENT POWER IN KIDNEY TRANSPLANT RECIPIENTS

OBJECTIVE: Kidney transplantation is one of the types of renal replacement therapy that can be performed in patients with end-stage renal disease. The power to perform activities that require the patient to maintain his life and health is called self-management power. Better health outcomes are inevitable in patients with high self-management power. In this study, we aimed to investigate the parameters affecting the self-management power in kidney transplant recipients.MATERIAL AND METHODS: All kidney transplant recipients who were followed up from the nephrology outpatient clinic and applied to the nephrology outpatient clinic between July 2022 and September 2022 were interviewed. Self-management power was assessed using the self-care agency scale. Parameters correlated with self-management power were evaluated by linear regression analysis.RESULTS: The study was conducted with 128 kidney transplant recipients. The mean age of the patients was 44.63±13.5 years. The mean self-management power score was 112.86±14.6. A correlation was found between self-management power and age, number of drugs used, time after transplantation, and number of chronic diseases. Age was found to be the strongest parameter affecting self-management power in the linear regression model.CONCLUSIONS: Both graft and patient survival can be improved with a good knowledge of the factors that affect self-management in kidney transplant recipients. Some demographic and clinical factors may affect the power of self-management. Although the success in kidney transplantation is mostly attributed to the transplantation center, it should be kept in mind that the self-management power of the patient can also contribute to this success, and approaches that can improve the sef-management power should be applied.

Annals for Educators - January 2023.

Annals for Educators - January 2023.

Гиперпластические процессы эндометрия у пациенток с хронической болезнью почек: выбор тактики ведения

This article provides a literature review demonstrating modern paradigms concerning etiology, pathogenesis and management of endometrial hyperplasia processes in female patients with chronic kidney disease (CKD). Endometrial hyperplasia (EH) is a pathological process with various phenotypic cell changes and a characteristic predominance of glands over the stromal and epithelial components in the endometrium. Untimely diagnosis and treatment of EH can cause the pathology progression and the development of endometrium malignant transformation. Endometrial cancer (EC) refers to one of the most common malignant tumor forms of the female reproductive system, and EH, as a rule, is its precursor. In the gynecological morbidity structure, EH is 10 to 55%, and its incidence is steadily increasing. EH occurs as a result of excessive estrogen stimulation, when it is not compensated by the progesterone action. In addition, patients with CKD develop "immunosuppressive states" due to the use of various types of renal replacement therapy (hemodialysis, peritoneal dialysis, taking immunosuppressive drugs in patients with kidney transplant). Every year there are more and more such female patients. Over the past decade, there has been no reference in the Russian literature concerning a systematic approach to the diagnosis and treatment of EH in female patients with CKD. Considering that these were female patients of the reproductive period to a greater extent, who wanted to perform the childbearing function in the future, therefore, this problem is very relevant for the world medical community. KEYWORDS: endometrial hyperplasia, abnormal uterine bleeding, chronic kidney disease, hemodialysis, kidney transplant, peritoneal dialysis, immunosuppression. FOR CITATION: Dobrokhotova Yu.E., Lysenko M.A., Grabovsky V.M., Shevchenko N.A., Zapolskaya N.P. Endometrial hyperplasia process in female patients with chronic kidney disease: the choice of treatment tactics. Russian Journal of Woman and Child Health. 2023;6(4):380–384 (in Russ.). DOI: 10.32364/2618-8430-2023-6-4-9.

Kidney replacement therapy and global issues: world experience and our challenges

The problem of renal replacement therapy (RRT) is relevant in today’s world due to a large number of people with chronic kidney disease (CKD). According to current data, about 10–11 % of people suffer from CKD, of which up to 5 % need RRT. Unfortunately, the number of people with CKD in the world is increasing, which determines the growing need for RRT. There are three types of RRT, namely: hemodialysis, peritoneal dialysis, and kidney transplantation. Kidney transplantation is the most effective method of RRT, but its possibilities in the world are limited. Therefore, most people receive hemo- or peritoneal dialysis. But the long-term effects of choosing a dialysis method are not always predictable. The peritoneal dialysis and hemodialysis show similar effectiveness during the first two years. Subsequent studies comparing the efficacy of the two methods do not provide a clear picture due to differences in patient initial parameters and differences in treatment initiation time. It is clear that peritoneal dialysis can have significant advantages in low-income countries due to the resource costs of the latter. The known benefits of peritoneal dialysis, such as flexibility of use, high quality of life, and preservation of residual renal function, increase its attractiveness, especially for young people with stage 5 CKD. The main strategies today are timely detection and prevention of CKD, control of comorbidities, as well as the development of documents and recommendations for standardization and improving the quality of renal replacement therapy.

On improving the organization of rendering specialized nephrological care to the population

The article discusses specialized nephrological care, which includes the diagnosis and treatment of acute and chronic kidney diseases, as well as the management ofpatients with end-stage renal disease receiving various types of renal replacement therapy.

Impact of prolonged duration of different types of renal replacement therapies on serum levels of endothelin-1 and pulmonary function tests.

This study was carried out to investigate the impact of duration of different renal replacement therapies such as hemodialysis and continuous ambulatory peritoneal dialysis on potential overproduction of endothelin-1 (ET-1) and pulmonary function tests in these patients. The study included 26 patients (14 males, mean age 54.9±16.2 years) with end stage renal diseases (ESRD) receiving regular hemodialysis (HD) and 23 patients (10 males, mean age 55.8±15.8 years) with ESRD treated with continuous ambulatory peritoneal dialysis (CAPD). The spirometry values were recorded before the onset of HD and prior to emptying the peritoneal cavity in CAPD patients and ET-1 was measured using the enzyme immunoassay (EIA) methodology. Two groups of patients (groups 1 and 2) were further divided into subgroups (group A and group B). Groups A (1-A and 2-A) included patients treated with any type of renal replacement therapy (RRT) (HD or CAPD) less than 5 years, and groups B (1-B and 2-B) included patients treated with any type of RRT (HD or CAPD) longer than 5 years. Patients treated with HD or CAPD for more than five years were found to have significantly higher serum levels of ET-1 (HD = 41.49±21.28 vs. 185.13±73.67, p<0.01; PD = 51.24±32.11 vs. 139.53±42.42, p<0.01, respectively). Values of most pulmonary function parameters differed significantly between groups treated longer or shorter than 5 years: FVC (HD = 108.4±13.34 vs. 80.82±11.26, p<0.01; CAPD = 97.20±18.99 vs. 73.25±10.73, p<0.01, respectively), FEV1 (HD = 108.33±15.8 vs. 76.73±4.9, p<0.01; CAPD = 100.67±18.31 vs. 66.75±6.25, p<0.01, respectively). Prolonged duration of any type of renal replacement therapy is associated with higher serum levels of ET-1 and with lower pulmonary function tests in ESRD patients.

MO028AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE: REGISTRY OF NORTHERN CYPRUS

Abstract Background and Aims Autosomal dominant polycystic kidney disease (ADPCK) is the most prevelant inherited kidney disease in adults, and the fourth common cause for renal replacement therapy worldwide and preventive measures should be taken to slow the decline in renal functions. From previous studies we already know that hereditary kidney diseases such as medullary kidney disease and tubular kidney diseases are frequent in Cyprus. In this study, we aim to find out the situation for ADPKC in North Cyprus and declare the overall magnitude of the problem in our region. Method From January 2004 to January 2021, we collected data from all patients with ADPCK irrespective of whether they were on RRT or not and who were followed in nephrology departments within Northern Cyprus. Clinical and demographic data of all the patients aged above 18 were collected. The affected families and their route of inheritance were determined. Need for renal replacement therapy (RRT) and types of RRT were noted. RRT rate and death rate were calculated. Results We collected information from a total of 79 patients with the diagnosis of ADPCK; 3 patients were excluded due to lost to follow up. There was no family history in 11% of patients. Inheritence was maternal in 53% and paternal in 42% whereas both maternal and paternal inheritence route were identified in 5%. 68 patients with family history were grouped in 24 families (2.8 patients/ family). The demographic and clinical data can be seen on Table 1. At some point during follow up 31 patients started with RRT. Mean age for RRT was 55 years (23-81). 5 (16%) patients initiated RRT with peritoneal dialysis, wheras 23 (74%) with hemodialysis, and 3 (10%) had preemptive renal transplantation. At the end of follow up period we found out that 35% (11/31) of patients who had RRT had transplantation, 32% (10/31) experienced peritoneal dialysis whereas 77% (24/31) experienced hemodialysis. 18 out of 76 (24%) patients died during the follow up period. The mean age of death was 71 years (53-81). Conclusion The prevalance of the disease when living patients were considered was 1.3 cases/10000 inhabitants which is low when compared with other studies. Hence ADPCK was not a common diagnosis in North Cyprus as other hereditary kidney diseases. This may show that some patients are underdiagnosed in the population. The frequency of patients without family history was high and also the number of patients per family was low when compared with other studies; these findings may also indicate an underdiagnosed problem. The patients were diagnosed late at a mean age of 47 Hence we need to perform further studies on ADPCK in our population since identifiying ADPCK patients and their families may help to adress the needs adequately, to plan lifelong supportive measures and to decrease high mortality rate of these patients.

POS-685 STRUCTURE OF RENAL REPLACEMENT THERAPY IN THE KINGDOM OF SAUDI ARABIA

Renal replacement therapy (RRT) is the mainstay in the clinical management and treatment of patients with chronic renal disease and end-stage renal disease (ESRD) aimed to support, maintain and improved the quality of life and may even decreased the mortality of patients having the disease, and with the increasing demand on renal replacement therapy in Kingdom it is imperative to improve the facilities, patient quality care and even types of RRT in the Kingdom. A review of renal replacement therapy in the Kingdom of Saudi Arabia published by Saudi Center for Organ Transplantation (SCOT) data in 2019; based on the cross-sectional study of annual questionnaires from all the dialysis centers in the Kingdom and annual post-transplantation follow-up from the accredited renal transplant centers in KSA. Renal replacement therapy (RRT) in the Kingdom were composed of 3 modalities: hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx). In 2019, a total of 28,256 patients were on RRT with 19,522 patients on HD, 1,546 on PD and, 7,188 patients with post-renal transplant follow-up. The prevalence and incidence rate of patients on dialysis were 631 and 142 per million population (PMP) respectively. Mortality rate on patients on dialysis were 8.2% this year. Kidney transplantation from deceased and living donors was the highest kidney transplants performed with a total of 1,121 kidneys transplanted, 140 (12%) from deceased and 981 (88%) kidneys from living donation making the Saudi Arabia the 2nd highest kidney transplant from living donor rate worldwide 29.37 pmp and 3rd highest living organ donors rate worldwide with 36.59 pmp (IRODAT: 2019). Graft loss and mortality rate on the same year were also recorded on living kidney recipients with 6 (0.6%) recipients loss their graft and 2 (0.2%) recipients died on the same year, while recipients from deceased donors, graft loss were 4 (2.8%) and a mortality rate were 2 (1.4%). Renal replacement therapy is the cornerstone in clinical management of patients with end-stage renal disease. Hemodialysis is the most common modality of renal replacement therapy providing greater convenience and accessibility, followed by peritoneal dialysis which needs to be encouraged, other modality such as home hemodialysis should be explored and considered. While, the Kingdom has reached a milestone in kidney transplantation making it one of the highest living organ donors rate worldwide, Saudi Arabia is still working on to improve its deceased organ donation which has a great potential in buffering the increasing demand of kidney transplant. Mortality rate post-renal transplant at one year was also considerably low with 4 deaths (0.3%) from both living and deceased kidney transplant at the same year.

Renal Replacement Modality Affects Uremic Toxins and Oxidative Stress

Nowadays, the high prevalence of kidney diseases and their related complications, including endothelial dysfunction and cardiovascular disease, represents one of the leading causes of death in patients with chronic kidney diseases. Renal failure leads to accumulation of uremic toxins, which are the main cause of oxidative stress development. The renal replacement therapy appears to be the best way to lower uremic toxin levels in patients with end-stage renal disease and reduce oxidative stress. At this moment, despite the increasing number of recognized toxins and their mechanisms of action, it is impossible to determine which of them are the most important and which cause the greatest complications. There are many different types of renal replacement therapy, but the best treatment has not been identified yet. Patients treated with diffusion methods have satisfactory clearance of small molecules, but the clearance of medium molecules appears to be insufficient, but treatment with convection methods cleans medium molecules better than small molecules. Hence, there is an urgent need of new more validated, appropriate, and reliable information not only on toxins and their role in metabolic disorders, including oxidative stress, but also on the best artificial renal replacement therapy to reduce complications and prolong the life of patients with chronic kidney disease.

ColistinDose, a Mobile App for Determining Intravenous Dosage Regimens of Colistimethate in Critically Ill Adult Patients: Clinician-Centered Design and Development Study.

BackgroundDetermining a suitable dose of intravenous colistimethate is challenging because of complicated pharmacokinetics, confusing terminology, and the potential for renal toxicity. Only recently have reliable pharmacokinetic/pharmacodynamic data and dosing recommendations for intravenous colistimethate become available.ObjectiveThe aim of this work was to develop a clinician-friendly, easy-to-use mobile app incorporating up-to-date dosing recommendations for intravenous colistimethate in critically ill adult patients.MethodsSwift programming language and common libraries were used for the development of an app, ColistinDose, on the iPhone operating system (iOS; Apple Inc). The compatibility among different iOS versions and mobile devices was validated. Dosing calculations were based on equations developed in our recent population pharmacokinetic study. Recommended doses generated by the app were validated by comparison against doses calculated manually using the appropriate equations.ResultsColistinDose provides 3 major functionalities, namely (1) calculation of a loading dose, (2) calculation of a daily dose based on the renal function of the patient (including differing types of renal replacement therapies), and (3) retrieval of historical calculation results. It is freely available at the Apple App Store for iOS (version 9 and above). Calculated doses accurately reflected doses recommended in patients with varying degrees of renal function based on the published equations. ColistinDose performs calculations on a local mobile device (iPhone or iPad) without the need for an internet connection.ConclusionsWith its user-friendly interface, ColistinDose provides an accurate and easy-to-use tool for clinicians to calculate dosage regimens of intravenous colistimethate in critically ill patients with varying degrees of renal function. It has significant potential to avoid the prescribing errors and patient safety issues that currently confound the clinical use of colistimethate, thereby optimizing patient treatment.

Comparison Of 2% Chlorhexidine And 70% Alcohol Swab Versus 10% Povidone- Iodine Solution In Preventing Peritoneal Dialysis Exit Site Infection

Peritoneal Dialysis (PD) utilization increases gradually due to increase of patient's awareness for different types of Renal Replacement Therapy (RRT). Hence, in order to be successful with PD program, we need to build strong strategies to improve patients’ quality of care. One of the risks associated with PD is the Exit-Site-Infection (ESI).

The activation of complement system in different types of renal replacement therapy.

The complement cascade is a part of innate immune system that responds rapidly to defend the host against invading microorganisms and complete the action of immune cells. The activation of the complement system leads to increased inflammatory response, fibrosis of tubulointestinal tissue and progression of chronic kidney disease (CKD). The purpose of this study was to determine whether the type of renal replacement therapy has an effect on activation of the complement system. The study included 79 patients with CKD stages 4 - 5 according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines on conservative treatment (CKD4-5) (n = 28), on peritoneal dialysis (PD) (n = 21) and undergoing chronic haemodialysis (HD) (n = 30). The concentrations of complement components C3a, C5a and C5b-9 were determined in plasma using the ELISA method. The highest concentration of C3a was found in PD group and differed significantly from HD group, both before and after haemodialysis treatment and CKD4-5 patients (P = 0.00001). The C5a concentration in HD patients was significantly higher than in PD patients and CKD4-5 group (P = 0.0001). The C5a and C5b-9 concentrations significantly increased during the haemodialysis session (P = 0.027 and P = 0.01, respectively). The values of C5b-9 observed in PD and CKD4-5 groups were significantly lower, than in HD patients (P = 0.0005). In HD patients the negative correlations were found between the time of haemodialysis treatment and C5b-9 concentration, both before and after haemodialysis session (Rs = -0.436, P = 0.016 and Rs = -0.365, P = 0.046, respectively). The type of renal replacement therapy influences the complement activation, which is the most intense during the haemodialysis treatment and correlates negatively with the haemodialysis vintage. The promising therapeutic intervention may be an improvement of HD biocompatibility.

Differences of connectivity between ESRD patients with PD and HD.

ObjectivesThe aim of this study was to investigate alterations in structural and functional brain connectivity between patients with end‐stage renal disease (ESRD) who were undergoing peritoneal dialysis (PD) and hemodialysis (HD).MethodsWe enrolled 40 patients with ESRD who were undergoing PD (20 patients) and HD (20 patients). We also enrolled healthy participants as a control group. All of the subjects underwent diffusion tensor imaging (DTI) and resting‐state functional magnetic resonance imaging (rs‐fMRI). Using data from the structural and functional connectivity matrix based on DTI and rs‐fMRI, we calculated several network measures using graph theoretical analysis.ResultsThe measures of global structural connectivity were significantly different between the patients with ESRD who were undergoing PD and healthy subjects. The global efficiency and local efficiency in the patients with PD were significantly decreased compared with those in healthy participants. However, all of the measures of global structural connectivity in the patients with HD were not different from those in healthy participants. Conversely, in the global functional connectivity, the characteristic path length was significantly increased and the small‐worldness index was decreased in patients with HD. However, the measures of the global functional connectivity in the patients with PD were not different from those in healthy subjects.ConclusionThis study revealed that alterations in structural and functional connectivity in patients who were undergoing PD and HD were different than those in healthy controls. These findings suggest that brain networks may be affected by different types of renal replacement therapy.

Usefulness of prolonged renal replacement therapy in patients with acute kidney injury requiring dialysis

Acute kidney injury (AKI) requiring dialysis is becoming more common. Several types of renal replacement therapies have been used, including continuous, intermittent, and prolonged intermittent renal replacement therapy (PIRRT). There is no clear difference between those therapies in terms of patient survival. The aim of this study was to describe a form of PIRRT (shift continuous veno-venous hemodialysis [CVVHD]) and the results of this technique in a population of patients with AKI requiring dialysis in a tertiary care center. We studied 302 patients with AKI requiring dialysis over a 3-year period. All patients were treated in the intensive care unit. There were 1709 treatments in the study. Shift CVVHD was done for 8 h daily using NxStage machines, with a bicarbonate base dialysate at a rate of 5 L/h. Demographics and laboratory data were obtained from the electronic medical record. Dialysis data were obtained from the dialysis run sheets. Patient mortality was 51.3%.The dialysis time was close to 8 h and the blood flow was 310 (± 43) mL/min. The mean arterial pressure was stable before and after the dialysis. The total ultrafiltration averaged 2934 mL per treatment; the ultrafiltration rate was 4.1 (± 3.1) mL/kg/h, and the ultrafiltration per hour was 359 (± 257.8) mL/h. The average dialysate potassium used was 2.9 mEq/L. The dose of dialysis was 57 (± 19) mL/kg/h. The urea reduction ratio was 48% (± 15%), the standardized KT/V (a measure of dialysis dose obtained by urea kinetic modeling) was 3.5 (± 0.9), and the equivalent renal urea clearance (EKR) was 9.8 (± 4.1) mL/min. The method produced a consistent reduction in the levels of blood urea nitrogen, creatinine, potassium, and phosphorous. The delivered dose of dialysis was stable during the observation period. In conclusion, shift CVVHD is effective in treating patients with AKI requiring dialysis and has a survival similar to that of continuous therapies with less intensive use of resources.

Direct medical costs of end-stage kidney disease and renal replacement therapy: a cohort study in Guangzhou City, southern China

BackgroundRenal replacement therapy was a lifesaving yet high-cost treatment for people with end-stage kidney disease (ESKD). This study aimed to estimate the direct medical costs per capita of ESKD by different treatment strategies: haemodialysis (HD); peritoneal dialysis (PD); kidney transplantation (KT) (in the first year); KT (in the second year), and by two urban health insurance schemes.MethodsThis was a retrospective observational cohort study. Data were obtained from outpatient and inpatient claims database of two urban health insurance from Guangzhou City, Southern China. Adult patients with HD (n = 3765; mean age 58 years), PD (n = 1237; 51 years), KT (first year) (n = 117; 37 years) and KT (second year) (n = 41; 39 years) were identified between 2010 and 2012. The primary outcome was the annual per patient medical costs in 2013 Chinese Yuan (CNY) incurred in the outpatient and inpatient sectors. Secondary outcomes were annual outpatient visits and inpatient admissions, length of stay per admission. Generalized linear regression and bootstrapping statistical methods were used for analysis.ResultsThe estimated average annual medical costs for patients on HD were CNY 94,760.5 (US$15,066.0), 95% Confidence Interval (CI): CNY85,166.6–106,972.2, which was higher than those for patients on PD [CNY80,762.9 (US$12,840.5), 95% CI: CNY 76,249.8-85,498.9]. The estimated annual cost ratio of HD versus PD was 1.17 (95% CI: 1.12–1.25). Among the transplanted patients, the estimated average annual medical costs in the first year were CNY132,253.0 (US$21,026.9), 95%CI: CNY114,009.9–153,858.6, and in the second year were CNY93,155.3 (US$14,810.8), 95%CI: CNY61,120.6–101,989.1. The mean annual medical costs for dialysis patients under Urban Employee-based Basic Medical Insurance scheme were significantly higher than those for patients under Urban Resident-based Basic Medical Insurance scheme (P < 0.001).ConclusionsThe direct medical costs of ESKD patients were high and different by types of renal replacement therapy and insurance. The findings can be used to conduct cost-effectiveness research on different types of RRT for ESKD patients that provides economic evidence for health policy design in China.

Drug Dosing Considerations in Critically Ill Patients Receiving Continuous Renal Replacement Therapy.

Acute kidney injury is very common in critically ill patients requiring renal replacement therapy. Despite the advancement in medicine, the mortality rate from septic shock can be as high as 60%. This manuscript describes drug-dosing considerations and challenges for clinicians. For instance, drugs’ pharmacokinetic changes (e.g., decreased protein binding and increased volume of distribution) and drug property changes in critical illness affecting solute or drug clearance during renal replacement therapy. Moreover, different types of renal replacement therapy (intermittent hemodialysis, prolonged intermittent renal replacement therapy or sustained low-efficiency dialysis, and continuous renal replacement therapy) are discussed to describe how to optimize the drug administration strategies. With updated literature, pharmacodynamic targets and empirical dosing recommendations for commonly used antibiotics in critically ill patients receiving continuous renal replacement therapy are outlined. It is vital to utilize local epidemiology and resistance patterns to select appropriate antibiotics to optimize clinical outcomes. Therapeutic drug monitoring should be used, when possible. This review should be used as a guide to develop a patient-specific antibiotic therapy plan.

Estado actual de la utilización de la hemodiálisis domiciliaria: revisión integrativa

Objetivo: Conocer la producción científica existente sobre el estado actual de la hemodiálisis domiciliaria. Material y Método: Se ha realizado una revisión integrativa mediante una búsqueda en las bases de datos Pubmed, Scopus y Google Académico. Se incluyeron artículos científicos originales y de revisión, en inglés y español, excluyendo aquellos artículos que no presentaban resultados o que no estuviesen en texto completo. Resultados: Se han incluido 23 artículos publicados entre el año 2012 y 2017. La hemodiálisis domiciliaria es poco utilizada en el mundo, a excepción de Australia y Nueva Zelanda. Las series publicadas encuentran mejor supervivencia en los pacientes en hemodiálisis domiciliaria diaria o intensiva, respecto a otras modalidades de terapia sustitutiva renal, así como mejores resultados clínicos. Como principales ventajas de la técnica, se destaca la flexibilidad en la vida diaria y la independencia del centro sanitario. Como principal inconveniente se ha encontrado un aumento de las infecciones relacionadas con el uso de catéteres venosos centrales o la técnica de punción en “ojal”. Conclusiones: La hemodiálisis domiciliaria presenta como principal ventaja la mayor libertad y flexibilidad para que el paciente dirija su propio tratamiento, siendo el principal inconveniente, una mayor probabilidad de padecer infecciones, relacionadas con el acceso vascular. Cuando se realiza hemodiálisis domiciliaria diaria o intensiva los resultados clínicos se muestran superiores a los otros procedimientos de diálisis, siendo comparables a los del trasplante renal. El papel de enfermería es fundamental en el desarrollo de esta técnica, especialmente en el proceso clave de la enseñanza al paciente y familiar.

Catheter Fixation Behind the Urachus: A Novel Laparoscopic Technique to Revise Malfunctioning Peritoneal Dialysis Catheters

Peritoneal dialysis is one of the types of renal replacement therapy which is commonly used in patients with the end-stage renal disease. The cost-effectiveness and easy usage are the advantages of peritoneal dialysis. However, peritoneal dialysis is not always free of a problem and among all of its complications, catheter tip migration and omental wrapping are more common as are considered as the causes of catheter malfunctioning. Different techniques are used to correct the malfunctioning catheters such as manipulator techniques, laparoscopic repositioning with tip suturing, omentectomy and omentopexy. In this article, we are proposing two cases, which had been referred by peritoneal catheter malfunctioning and then received a new method of surgery successfully and didn’t have any complications after 36 months follow up. This method could simplify the procedure of operation and urachus ligament and reduce time and cost of the process.