Use Of Continuous Ambulatory Peritoneal Dialysis Research Articles

MO1051: Standardized Simulation Education Program with Summative Assessment on Exchange Procedure of Ultrabag System for Peritoneal Dialysis: Innovations in Practical Recommendations

Abstract BACKGROUND AND AIMS Inexperience in practicing peritoneal dialysis (PD) and lack of standard education program under the instruction of qualified renal nurses are known causes of peritonitis in patients with chronic renal failure [1]. Thus far, the standardized and validated curriculum for Continuous Ambulatory Peritoneal Dialysis (CAPD) training has not been well-established under simulation-based education model [2]. We aimed i) to develop a well-structured and standardized educational training program on exchange procedure of Ultrabag system and ii) to evaluate the degree of acquisition in domains of cognitive (knowledge) and psychomotor (skills) by summative assessment using valid and reliable knowledge evaluation index and performance checklist. METHOD Following an invention of 3D-printed CAPD device, ‘Helping Hands’ in closed system operation, the Renal Unit in the Department of Medicine and Multi-Disciplinary Simulation and Skills Centre (MDSSC) in Queen Elizabeth Hospital (QEH) formulated a standard 5-day CAPD training to equip PD patients with knowledge and skills for safe Ultrabag exchange. In order to optimize training effectiveness and assessment standards, the program was designed with ‘6 (+2 additional) guiding questions’ from the International Society for Peritoneal Dialysis (ISPD) document [3]. Scoring Checklist with specific and relevant items, such as fixation of the connecting catheter, parallel point-to-point connection and procedures in placing disinfection cap, could strengthen internal validity. RESULTS In 2021, 17 CAPD patients with partial impairment in vision (12, 71%) or eye-hand coordination (13, 77%) attended this education program. Post-training assessment showed that participants had improved cognitive knowledge (M = 71%; A Grade (>80 marks) = 5, 29% B Grade (60–80 marks) = 9, 53%; C Grade (<60 marks) = 3, 18%) and psychomotor skills (100% achievement in simulation task). Except for 1 participant who required additional training session and re-assessment, 94% of them passed the simulation examination by completing all procedures without any assistance in one-take. A validated educator-guided scheme of psychomotor skills in proper use of CAPD is recommended with six operational phases: CONCLUSION Repetitive performance in task-specific procedure of bag exchange, coupled with constructive feedback from experienced renal nurse educators and well-validated assessment (with a standardized scoring sheet and checklist), resulted in improved skill performance. The training program, correspondent with traditional concept of Miller's pyramid (1990), demonstrated how CAPD novice turns skillful user by developing competence in cognition with factual knowledge of dialysis (‘Knows’) and verbalization of rationale and flows of PD (‘Knows How’); and competence in behavior with simulation practice with CAPD device (‘Shows’) and summative assessment demonstrating mastery of safe bag exchange skills to be integrated into everyday practice (‘Does’). Further studies may be warranted to investigate whether knowledge and skills acquired before use of CAPD could be carried over time and on how education program accounts for risk minimization of CAPD-related peritonitis and survival rate.

Use of continuous ambulatory peritoneal dialysis (CAPD) in the treatment of children with END-stage renal disease

Continuous ambulatory peritoneal dialysis is a form of treatment for end-stage renal disease. This mini-review discusses the use of CAPD as a treatment for ESRD in children. It also discusses the knowledge of the complications of this technique on the effectiveness of the treatment as well as the knowledge of its therapeutic effects. Studies have been collected from electronic rulers (Google scholar /PubMed...) where 30 studies have been studied and analyzed so that these studies included experimenting with CAPD on many children of different age groups. Results of these studies have shown that CAPD is considered an advanced technique for the treatment of ESRD in children, despite many complications such as peritonitis and catheter problems, which are among the most important, but several studies have indicated that the position of the catheter in a surgically controlled manner by specialized physicians mitigates its problems. However, this treatment has many advantages over dialysis. Especially in children, they are freer, more energetic, and more easily able to carry out their activities, especially children who live in remote areas and far from health centers. But we need to think about how to relieve the complications of peritonitis that were common in all the studies that have been done analyzed in this mini-review.

Risk Predictors and Causes of Technique Failure Within the First Year of Peritoneal Dialysis: An Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) Study

Concern regarding technique failure is a major barrier to increased uptake of peritoneal dialysis (PD), and the first year of therapy is a particularly vulnerable time. A cohort study using competing-risk regression analyses to identify the key risk factors and risk periods for early transfer to hemodialysis therapy or death in incident PD patients. All adult patients who initiated PD therapy in Australia and New Zealand in 2000 through2014. Patient demographics and comorbid conditions, duration of prior renal replacement therapy, timing of referral, PD modality, dialysis era, and center size. Technique failure within the first year, defined as transfer to hemodialysis therapy for more than 30 days or death. Of 16,748 patients included in the study, 4,389 developed early technique failure. Factors associated with increased risk included age older than 70 years, diabetes or vascular disease, prior renal replacement therapy, late referral to a nephrology service, or management in a smaller center. Asian or other race and use of continuous ambulatory PD were associated with reduced risk, as was initiation of PD therapy in 2010 through 2014. Although the risk for technique failure due to death or infection was constant during the first year, mechanical and other causes accounted for a greater number of cases within the initial 9 months of treatment. Potential for residual confounding due to limited data for residual kidney function, dialysis prescription, and socioeconomic factors. Several modifiable and nonmodifiable factors are associated with early technique failure in PD. Targeted interventions should be considered in high-risk patients to avoid theconsequences of an unplanned transfer to hemodialysis therapy or death.

Current state of continuous ambulatory peritoneal dialysis in Egypt.

Patients with end-stage renal disease (ESRD) continue to increase in number worldwide, especially in developing countries. Although continuous ambulatory peritoneal dialysis (CAPD) has comparable survival advantages as hemodialysis (HD), it is greatly underutilized in many regions worldwide. The prevalence of use of CAPD in Egypt is 0.29/million population in 2017. The aim of this study is to describe the current state and practice of CAPD in Egypt and included 22 adult patients who were treated by CAPD. All the study patients were switched to CAPD after treatment with HD failed due to vascular access problems. Patients were mainly female (68.2 %) with the mean age of 49.77 ± 11.41 years. The average duration on CAPD was 1.76 ± 1.30 years. Hypertension was the main cause of end-stage renal disease (ESRD) constituting 36.4%, followed by diabetes (27.3 %), and toxic nephropathy (4.5%). Of importance is that about 31.8% of patients had ESRD of unknown etiology. The mean weekly Kt/V urea of patients on PD was 1.92 ± 0.18. The mean hemoglobin, serum calcium, phosphorus, parathormone, and albumin levels were 10.27 ± 1.98 g/dL, 8.36 ± 1.19 mg/dL, 5.70 ± 1.35 mg/dL, 541.18 ± 230.12 pg/mL, and 2.98 ± 0.73 g/dL, respectively. There was no significant difference between diabetic and nondiabetic CAPD patients regarding demographic and laboratory data. Our data indicate that there is continuing underutilization of CAPD in Egypt which may be related to nonavailability of CAPD fluid, patient factors (education and motivation), gradual decline of the efficiency of health-care professionals, and lack of a national program to start PD as the first modality for renal replacement therapy. It is advised to start an organized program to make CAPD widespread and encourage local production of PD fluids to reduce the cost of CAPD.

A novel method for salvage of malfunctioning peritoneal dialysis catheter.

Context:Continuous ambulatory peritoneal dialysis (CAPD) has been widely used as an effective therapy in the management of patients with end-stage renal disease. Long-term use of CAPD needs methods with low incidence of catheter-related complications. Moreover, some complications may cause failure of fluid drainage and treatment interruption.Aims:We have innovated and studied a new minimal-invasive method of malfunctioning peritoneal catheter repair.Materials and Methods:Thirty-five patients agreed to undergo catheter rescue operation by this new method during 2004 and 2012. Under local anesthesia and light sedation, access to the abdominal cavity was made, the catheter and wrapped omentum grasped and the tip of catheter was released, debris were removed and the catheter was directed toward the pelvic floor with a finger guide. The patients were followed after catheter salvage up to the end of study (April 2012). PD catheter function restored to the normal level in 28 (80%) of patients, and PD was started 1-2 days after the procedure.Results:All patients had an uneventful recovery. PD catheter function was restored to the normal level in 28 (80%) patients, and PD was started 1-2 days after the procedure. Of these patients, 10 (35%) died of reasons unrelated to catheter or catheter complications; 7 (25%) were ultimately referred for kidney transplant; 8 (29%) continued PD up to the end of this study with no problem, and only 3 (11%) due to catheter complications. Catheter function did not restore to the normal level in seven patients (20%); however, six patients continued PD for 1-18 months with the catheter.Conclusions:Comparing the advantages and disadvantages of this method to the previous laparoscopically repaired catheter, we concluded that this new method is efficient, and is a suitable way for malfunctioning PD catheter salvage.

Predictors of Peritonitis in Patients on Peritoneal Dialysis

Despite the decreasing incidence of peritonitis among peritoneal dialysis (PD) patients over time, its occurrence is still associated with significant morbidity and mortality. Determining factors that are associated with PD peritonitis may facilitate the identification of patients who are at risk. Using data collected in the multicenter Baxter POET database between 1996 and 2005, the study population included incident Canadian PD patients. Potential predictors of peritonitis were sought using a negative binomial model and an Andersen-Gill model. Study variables included age, gender, race, cause of renal disease, diabetes status, transfer from hemodialysis (HD), previous renal transplant, and continuous ambulatory PD (CAPD) versus automated PD (APD). Data were available for 4247 incident PD patients, including 1605 patients with a total of 2555 peritonitis episodes. Using the negative binomial regression model, factors that were independently associated with a higher peritonitis rate included age, Black race, and having transferred from HD. There was an interaction between gender and diabetes, with an increased risk for peritonitis among female patients with diabetes. The use of CAPD versus APD did not affect the peritonitis rate. The Andersen-Gill model for recurrent events yielded similar results. Predictors of PD peritonitis included Black race, transferring from HD to PD, and diabetes among women. In contrast to previous findings, CAPD and APD were similar with regard to peritonitis risk.

Kontinuierliche ambulante Peritonealdialyse: Patienten- und Methodenüberlebensrate, Peritonitishäufigkeit und Dialysewirksamkeit über 10 Jahre

From 1979 to 1989, continuous ambulatory peritoneal dialysis (CAPD) was undertaken for terminal renal failure in 104 patients (56 women and 48 men; average age 54 +/- 15.3 years at the onset of dialysis), for a total observation period of 175 patients years. Survival rate for patients and methods and dialysis effectiveness were analysed retrospectively, the incidence of peritonitis prospectively, 40 patients were aged 60 years and over. Diabetic nephropathy was the most common cause of terminal renal failure (44%). Cumulative patient survival rate was 80% in the first year of treatment; 57% of patients were still alive after two years. The cause of death in 45 of the 54 patients who had died was unrelated to CAPD, cardiac disease and cerebrovascular accident being the most frequent causes (n = 26). During the first treatment year 47% of patients contracted bacterial peritonitis, 59% during the first two years. In 9% of patients CAPD had to be discontinued within the first two treatment years because of CAPD-related complications. There was no case of sclerosing peritonitis or of ultrafiltration loss forcing CAPD termination. These data indicate that there is no plausible explanation from a medical viewpoint for the highly restrictive use of CAPD in the Federal Republic of Germany.

Lactate-Buffered and Bicarbonate-Buffered Solutions with Less Glucose Degradation Products in a Two-Chamber System

During past years, industry has realized several improvements in techniques and materials—for example, with respect to catheter and connection systems—with the goal of reducing the incidence of peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). Still, peritonitis represents a major problem in peritoneal dialysis (PD) treatment (1). As a contributor to the patient’s therapy, industry is also always searching for alternative, more biocompatible solutions. The restricted biocompatibility of present CAPD solutions—acidic pH; high glucose concentrations, whether directly or indirectly via formation of glucose degradation products (GDPs); hyperosmolality; and nonphysiological high lactate concentrations—may play a role in the limited use of CAPD as renal replacement therapy. Today, about 50% of PD patients are estimated to drop out over a period of five years for various reasons, including peritonitis and loss of ultrafiltration capacity by the peritoneal membrane (2). This statistic strongly suggests a direct relationship between the repeated and long-term exposure of the peritoneal membrane to conventional PD solutions and the potential functional impairment of peritoneal cell populations. Therefore, to ensure membrane longevity, the protection of the peritoneal membrane is a matter of concern.

Current Status of Peritoneal Dialysis in Korea: Efforts to Achieve Optimal Outcome

Since its introduction in 1981, peritoneal dialysis (PD) has become firmly established as an effective mode of renal replacement therapy and serves an increasing patient population in Korea. The latest registry data indicate that about 3700 end-stage renal disease patients are maintained on chronic PD, representing 24.1% of the country's dialysis population. The majority (93.3%) of these patients are on continuous ambulatory peritoneal dialysis (CAPD) using the two-bag disconnect system, while only 3.3% are on automated PD. Under current renal reimbursement policies, most dialysis patients have to pay 20% of dialysis fees. Thus CAPD patients on 4 x 2-L daily exchanges pay about US$200 per month, not including medication and travel costs. Traditionally, most PD centers in Korea have used the "standard" prescription of 4 exchanges of 2 L of solution for most of their patients. A recent survey of 1467 patients who commenced CAPD in 1997 revealed that 84% of these patients were initially prescribed 4 x 2-L exchanges, while 12% were given a daily volume of 6 L. With this standard prescription, the percentages of Korean CAPD patients initially achieving the adequacy target of Kt/V urea > or = 2.0 and standardized creatinine clearance (SCCr) > or = 60 L/week/1.73 m2, were 74.4% and 82.1%, respectively. It is likely that, among current Korean CAPD patients, a much lower percentage will achieve the clearance targets compared to this initial outcome, but the precise data are not available. However, it is not clear whether the levels of small-solute clearance recommended for optimal PD outcomes, and proposed by the NKF-DOQI guidelines, will bring the expected benefits to Korean patients. Overall survival of Korean PD patients appears to be as good as, or even better than, that in most other countries. Recently, a single large PD center reported patient survival of 92.1%, 85.6%, 81.4%, and 67.6% at 1, 2, 3, and 5 years respectively. Other centers also reported similar outcomes. As in other countries, cardiovascular deaths predominate among Korean patients: death was due to cardiac causes in 29%, to vascular causes in 21%, and to infectious causes in 24%. Peritonitis is the most important barrier to prolonged use of CAPD in Korea, and more PD patients transfer to hemodialysis because of peritonitis than in other countries. To further reduce the morbidity and mortality of Korean PD patients, various control measures need to be implemented that can reduce or prevent peritonitis and other infectious complications. Also, to further improve long-term patient outcome, Korean nephrologists need to establish and practice optimal clearance targets in the chronic care of these patients.

Clinical significance not statistical significance: a simple Bayesian alternative to p values.

OBJECTIVES: To take the common "Bayesian" interpretation of conventional confidence intervals to its logical conclusion, and hence to derive a simple, intuitive way to interpret the results of public health...

Continuous ambulatory peritoneal dialysis in the elderly: a seven-year experience.

This is a retrospective comparison of the status among the elderly (> or = 60 years, 23 patients) and younger patients (< 60 years, 31 cases) who initiated continuous ambulatory peritoneal dialysis (CAPD) between January 1986 and December 1992 at the National Taiwan University Hospital. The distribution of underlying renal diseases differed in the two groups with diabetes (56%) as the most common disease in the elderly, in contrast to glomerulonephritis (60%) in the younger patients. Haemodialysis intolerance and patient preference were the main reasons leading to the use of CAPD in both groups. Social rehabilitation status was poorer in the elderly group. The difference in cumulative risk of the first peritonitis episode and the technique failure rate were not statistically significant. The major causes of mortality were of vascular origin in both groups. In conclusion, similarities in the technique failure rate and the cumulative risk of peritonitis imply that CAPD is an acceptable alternative long-term dialysis therapy for geriatric patients.

Pseudomonal and candidal peritonitis as a complication of continuous ambulatory peritoneal dialysis in human immunodeficiency virus-infected patients

purpose: To our knowledge, there has been no report documenting the spectrum of peritonitis in human immunodeficiency virus (HIV)-infected persons. We therefore analyzed our records to confirm our previous observation of a higher incidence of pseudomonal and fungal peritonitis in a group of HIV antibody-positive (HIV+) patients undergoing continuous ambulatory peritoneal dialysis (CAPD). patients and methods: During a 22-month period, we retrospectively studied 71 patients with endstage renal disease undergoing CAPD. Of these seven were HIV+, five were at high risk for HIV infection but antibody-negative, and 59 were at low risk for HIV infection. Organisms isolated in episodes of peritonitis were classified microbiologically as one of the following: gram-positive, non-pseudomonal gram-negative, pseudomonal, fungal, or culture-negative. results: The total peritonitis rate was higher in both the high-risk (p ≤0.01) and the HIV+ (p ≤0.02) groups when compared with that in the low-risk population. These differences were attributable to the following: (1) the high-risk group's two-fold increase in gram-positive infections (p ≤0.01), and (2) a 24-fold increase in pseudomonal (p <0.001) infections and seven-fold increase in fungal (p <0.005) infections in the HIV+ group. These infections were invariably associated with catheter loss and frequently resulted in conversion to hemodialysis. conclusion: We believe that the use of CAPD in HIV+ patients may be limited by this increased occurrence of pseudomonal and fungal peritonitis.

Peritoneal morphology on maintenance dialysis.

Thirty-eight peritoneal biopsies from 37 patients with normal renal function or with end-stage renal failure without replacement therapy or utilizing continuous ambulatory peritoneal dialysis (CAPD), haemodialysis (HD) or a functioning transplant were examined histologically. No abnormality in peritoneal membrane morphology was observed in uraemia in the absence of dialysis. Significant abnormalities of peritoneal membrane morphology were observed in association with CAPD, the predominant finding being the development of peritoneal fibrosis which had a deleterious effect on membrane function. Abnormal peritoneal morphology was less commonly observed in patients on maintenance HD and with functioning transplants but may have implications regarding the future use of CAPD in these patients.

CAPD Fluid Examination using the Bactec 460

In the microbiological laboratory CAPD fluid analysis is an unstandardized and sometimes a labor intensive procedure. This pilot study was set up to demonstrate the value of in-place technology -the Bactec 460 blood culture system, in reducing the work-load. Our results indicate that it is at least as effective as other, more tedious conventional methods. Since its introduction, continuous ambulatory peritoneal dialysis (CAPD) has proved to be a major advance in the management of end-stage renal disease (I). Despite refinements in technique over the years leading to more widespread use of CAPD, the major hazard remains peritonitis and other infections (2). Also peritonitis is a major cause of failure of CAPD (3,4). Because CAPD allows more freedom of movement, several laboratories receive the postdialysis effluents from the same patient; furthermore there is no widely recognized, single method for the examination of these fluids (2, 5). Some centers recommend daily sampling for microbiological studies and while this is ideal for patient management, it imposes a significant workload on the microbiology laboratory, particularly in a larger centre (2). Currently it appears that the number of patients on CAPD will continue to increase for the foreseeable future and so will the numbers of specimens to be examined. To facilitate these examinations, we carried out a five-month pilot study using the Bactec 460 blood-culture system to examine CAPD fluids. We compared these results with a conventional method used previously in our laboratory.

Continuous ambulatory peritoneal dialysis (CAPD): an established treatment for endstage renal failure.

This paper is a study of 117 patients with endstage renal failure, treated by continuous ambulatory peritoneal dialysis (CAPD) over periods of 1-56 months. The study has shown CAPD to be an effective form of dialysis with a number of advantages over intermittent peritoneal dialysis and hemodialysis (better control of salt and water status, hypertension and anemia, steady state biochemistry and greater ease of self-dialysis). Peritoneal clearance and ultrafiltration have remained adequate in all but a few patients. Hypoproteinemia, poor nutrition, obesity and abdominal herniae have been problems in a small percentage of patients. Hyperlipidemia has developed in half the patients but improved with diet. Peritonitis remains the major barrier to the more widespread use of CAPD, although its incidence can be considerably reduced by use of better connectors, bacterial filters and choice of patients.

Continuous ambulatory peritoneal dialysis.

ONE of the most significant developments in the treatment of end-stage renal disease during the last 10 yr has been the emergence of continuous ambulatory peritoneal dialysis (CAPD) as a treatment modality. Intermittent peritoneal dialysis (IPD) has been available for many years but because of problems with infection and with the equipment has never been used widely. Currently, IPD is used by only 1610 patients (2.7%) of all dialysis patients in the United States. Since its introduction by Popovich and Moncrief in 1976,1 after a slow start, CAPD has shown a meteoric increase in the number of patients treated both in the United States and Europe. As of December 31, 1981, there were 4330 patients on CAPD in the United States (45.8% of all home dialysis and 7.4% of all dialysis patients), 2 and by March, 1982, the number was unofficially reported as having risen to 5397 patients. 3 There were an additional 6000 patients elsewhere in the world on CAPD, and CAPD was reported as being the treatment for 3035% of patients in New Zealand, 24% of patients in Australia and Canada, and 20% in the United Kingdom, while at the other extreme it is only used by 1 % or less of patients in Israel, Germany, and Japan. 3 Why was there this rapid increase in use of an unfamiliar and new therapy? Was this solely the result of publicity and pressure by the manufacturer? How much does the use of CAPD result from pressure by patients who wish to do home dialysis? Is CAPD as simple and safe as has been claimed? Has CAPD been endorsed too enthusiastically and too quickly? Is CAPD really as costsaving a modality of treatment as has been claimed? These and other questions have not been adequately answered. The accompanying articles. one from Toronto where enthusiasm for CAPD is extremely high. and one from Minneapolis from a very experienced dialysis and transplant center where results with CAPD have been disappoint-