Strategies to Prevent Peritoneal Dialysis Failure
|
|
- Robyn Whitehead
- 6 years ago
- Views:
Transcription
1 Strategies to Prevent Peritoneal Dialysis Failure Constantinos J. Stefanidis, MD, PhD P & A Kyriakou Children s Hospital, Athens, Greece
2 Technique failure Drop-out Transfer to HD Technique failure rate is defined as the proportion of dialysis patients switching from one modality to another. Peritoneal dialysis (PD) Hemodialysis (HD)
3 Peritoneal dialysis (PD) in children: outcome 7,039 patients After three years of PD: Continue PD Death 10 % 5 % 25 % Transfer to hemodialysis (HD) 60 % Transplantation Νοrth American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2011
4 Peritoneal dialysis (PD) termination in children ~10% ~25% ~20% Benchmarking Νοrth American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2011
5 Peritoneal dialysis (PD) termination in children Νοrth American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2011
6 Peritoneal dialysis (PD) termination in children ~50% ~70% ~25% Νοrth American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2011
7 Peritoneal dialysis (PD) termination in children ~95% ~90% ~80% Benchmarking Νοrth American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2011
8 Peritoneal dialysis (PD) termination in children 1,697 patients started RRT between Probability of receiving a transplant within 4 years after initiating RRT: 77% for <5 year olds: 69% ESPN/ERA EDTA Registry database. Chesney N et al. Pediatr Nephrol 2014
9 Peritoneal dialysis (PD) in children ESPN/ERA EDTA Registry database. Chesney N et al. Pediatr Nephrol 2014
10 International Pediatric Peritoneal Dialysis Network Global registry active in 33 countries Information for 1900 children around the globe United States 10% Turkey 19% 12 European countries 31% Canada 59% Chile, Argentina, 80% - 90% China, Singapore, Nicaragua, Uruguay, 100% Schaefer F et al. Perit Dial Int. 2012
11 PD technique survival and GNI GNI: per-capita gross national income ~95% ~85% Schaefer F et al. Perit Dial Int. 2012
12 International Pediatric Peritoneal Dialysis Network D.Borzych-Duzalka et al Registered Network users: 222 centers in 53 countries Registry participants: 116 centers in 41 countries
13 Participants 2,453 PD patients (824 incident patients) from 105 pediatric nephrology centers enrolled in the IPPN registry between 2007 and % of patients had 452 PD access revisions over 3134 patient-years 23% of the incident patients had a PD access revision over 1066 patient-years 43% within the first 3 months D.Borzych-Duzalka et al. Clin J Am Soc Nephrol2016
14 D.Borzych-Duzalka et al. Clin J Am Soc Nephrol2016 PD access revisions The need for PD access revision was associated with a higher risk of PD failure or death (hazard ratio [HR], 1.35) The need for access revision due to mechanical dysfunction doubled the risk of technique failure compared with infectious causes (HR, 1.95)
15 PD access survival by time of revision D.Borzych-Duzalka et al. Clin J Am Soc Nephrol2016
16 PD access survival by age D.Borzych-Duzalka et al. Clin J Am Soc Nephrol2016
17 Risk Factors for Access Revision D.Borzych-Duzalka et al Odds ratio P Age at first observation 0.93 < GNI per capita Presence of any ostomy Swan neck tunnel with curled intaperitoneal portion Two cuff catheter 0.89 ns Exit site pointing upward vs. downward/lateral 0.97 ns Early (<7d) vs. delayed catheter use 0.88 ns
18 Reasons for Access Revision by Catheter Type D.Borzych-Duzalka et al Tenckhoff straight Tenckhoff curled/straight tunnel Tenckhoff curled/swan neck tunnel Other p N (%) 100 (24%) 47 (11%) 247 (58%) 30 (7%) Leak (n=29) 10 (35%) 3 (10%) 12 (41%) 4 (14%) Dysfunction (n=270) 59 (22%) 25 (9%) 172 (64%) 14 (5%) <0.001 Peritonitis (n=71) 15 (21%) 11 (15%) 39 (55%) 6 (9%) <0.001 Exit site infection (n=54) 16 (30%) 8 (15%) 24 (44%) 6 (11%) 0.018
19 Conclusions D.Borzych-Duzalka et al Access failure occurs in almost 15% of pediatric PD patients with the highest frequency in the first treatment year Early (< 3 mo) access failure is associated with poor technique survival Access failure risk factors include young age, coexisting stomies, presence of swan-neck tunel with curled intraperitoneal portion
20 Preventive strategies of PD technique failure Before starting PD During PD period
21 Establishing a Peritoneal Dialysis Program Location in a Pediatric Hospital with Hemodialysis and Intensive Care Units
22 Establishing a Peritoneal Dialysis Program One program per million child population
23 Establishing a Peritoneal Dialysis Program One program per million child population Age Group Total ~ years ~ (26%) 20 PD programs
24 Establishing a Peritoneal Dialysis Program Suitable Location in a Pediatric Hospital with Hemodialysis and Intensive Care Units Experienced staff with multidisciplinary team approach
25 Establishing a Peritoneal Dialysis Program Suitable Location in a Pediatric Hospital with Hemodialysis and Intensive Care Units Experienced staff with multidisciplinary team approach Teaching Plan, Training Manual, Continuing Education, Global Collaboration
26 Establishing a Peritoneal Dialysis Program Suitable Location in a Pediatric Hospital with Hemodialysis and Intensive Care Units Experienced staff with multidisciplinary team approach Teaching Plan, Training Manual, Continuing Education Reliable equipment suitable to all patients
27 Choice of therapy The patient and family should have been actively involved in the choice of therapy This choice has to take into account: the difficulties of vascular access in small children large distances from the tertiary-care center the psychosocial situation GUIDELINES BY AN AD HOC EUROPEAN COMMITTEE FOR ELECTIVE CHRONIC PD IN PEDIATRIC PATIENTS Watson AR et al.perit Dial Int 2001
28 Choice of therapy Automated peritoneal dialysis (APD) is generally advocated for children, as APD gives greater freedom during the day for school and social activities. GUIDELINES BY AN AD HOC EUROPEAN COMMITTEE FOR ELECTIVE CHRONIC PD IN PEDIATRIC PATIENTS Watson AR et al.perit Dial Int 2001
29 Preventive strategies of PD technique failure Before starting PD During PD period
30 Main reasons for technique failure Difficulties with peritoneal catheters Serious peritoneal infections Chronic peritoneal changes leading to: - ultrafiltration failure - encapsulating peritoneal sclerosis Declining residual renal function
31 Main reasons for technique failure Difficulties with peritoneal catheters Serious peritoneal infections Chronic peritoneal changes leading to: - ultrafiltration failure - encapsulating peritoneal sclerosis Declining residual renal function
32 PD catheter placement 6 tips for problems prevention 1. The placement of a PD catheter requires an experienced surgeon. GUIDELINES BY EPDWG FOR ELECTIVE CHRONIC PD IN PEDIATRIC PATIENTS Watson AR et al.perit Dial Int 2001
33 PD access surgeon The issue is not who places the access, but who does it right, every time, to everyone, and everywhere Davidson et al 2007
34 PD catheter placement 6 tips for problems prevention 1. The placement of a PD catheter requires an experienced surgeon. 2. All catheters in children are placed under general anesthetic. GUIDELINES BY EPDWG FOR ELECTIVE CHRONIC PD IN PEDIATRIC PATIENTS Watson AR et al.perit Dial Int 2001
35 PD catheter placement 3. Double-cuffed catheters are preferred: pediatric size in patients 3 10 kg adult catheter in patients > 10 kg GUIDELINES BY EPDWG FOR ELECTIVE CHRONIC PD IN PEDIATRIC PATIENTS Watson AR et al.perit Dial Int 2001
36 PD catheter placement 4. The exit site should avoid the belt line and be above the diaper line in infants. 5. A cephalosporin antibiotic should be given IV at the time of catheter implantation. GUIDELINES BY EPDWG FOR ELECTIVE CHRONIC PD IN PEDIATRIC PATIENTS Watson AR et al.perit Dial Int 2001
37 IRPCPD study: 503 PD catheters Rinaldi S et al Italian Registry of Pediatric Chronic Peritoneal Dialysis, Perit Dial Int 2004
38 IRPCPD study: 503 PD catheters 6. Paramedian insertion of a PD catheter should be the standard for pediatric PD Rinaldi S et al Italian Registry of Pediatric Chronic Peritoneal Dialysis, Perit Dial Int 2004
39 PD catheter External Segment Exit site > 4 cm 2 nd cuff subcutaneous tissue Tunneled Segment rectus muscle Intra-Peritoneal Segment Distance from umbilicus to the pubic symphysis + 2cm
40 PD catheter Exit site
41 PD catheters Straight catheter Coil catheter Cuffs mechanical anchors not microbiologic barriers
42 PD catheters Preformed intercuff bend (swan neck) coiled-tip catheter
43 IRPCPD study: 503 PD catheters Orientation of the exit site: upward 13% lateral 24% downward 46% arcuate configuration No difference in exit site or tunnel infections between the groups Rinaldi S et al Italian Registry of Pediatric Chronic Peritoneal Dialysis, Perit Dial Int 2004
44 Risk Factors for Access Revision D.Borzych-Duzalka et al Odds ratio P Swan neck tunnel with curled intaperitoneal portion Two cuff catheter 0.89 ns Exit site pointing upward vs. downward/lateral 0.97 ns Early (<7d) vs. delayed catheter use 0.88 ns
45 Main reasons for technique failure Difficulties with peritoneal catheters Serious peritoneal infections Declining residual renal function Chronic peritoneal changes leading to: - ultrafiltration failure - encapsulating peritoneal sclerosis
46 Νοrth American Pediatric Renal Transplant Cooperative Study
47 Peritonitis Incidence 1 episode per x months / only within study period
48 Peritonitis rate NAPRTCS Νοrth American Pediatric Renal Transplant Cooperative Study
49 Peritonitis rate Continuous monitoring of the rate of peritonitis and other complications Benchmarking
50 Prevention and management of peritonitis Peritoneal Dialysis International, Vol. 32, pp. S32-S86,
51 Main reasons for technique failure Difficulties with peritoneal catheters Serious peritoneal infections Chronic peritoneal changes leading to: - ultrafiltration failure - encapsulating peritoneal sclerosis Declining residual renal function
52 ISPD definition of EPS* - Symptoms suggestive of bowel obstruction mild complaints of abdominal pain and/or anorexia severe pain, vomiting and weight loss - Evidence of encapsulation of the bowel documented by: surgery or imaging (CT or ultrasound) *EPS: Encapsulating peritoneal sclerosis Kawaguchi Y et al Perit Dial Int. 2000
53 Surgical findings Honda K et al Perit Dial Int. 2005
54 Ascites Thickened peritoneum Calcifications Bowel loops are drawn into the centre of the abdominal cavity Vlijm A et al.ndt Plus 2011
55 Risk Factors - Peritonitis Etiology of peritonitis in EPS patients : 35% Staphylococcus aureus 11% Fungal infections 2% Pseudomonas Brown M et al Clin J Am Soc Nephrol, 2009
56 Risk Factors Peritonitis: EPDWG Study Annualized peritonitis rate EPS patients No EPS patients 1.9 ( ) 0.72 ( ) P = 0.02 European Pediatric Dialysis Working Ggroup study. Shroff R. et al. Nephrol Dial Transplant 2013
57 Advanced chronic kidney disease Prolonged exposure to PD solutions Mesothelial dysfunction Simple peritoneal sclerosis
58 Advanced chronic kidney disease Prolonged exposure to PD solutions Mesothelial dysfunction Alterations in the fibrinolytic cascade Simple peritoneal sclerosis Increased fibrin Severe peritonitis Peritoneal adhesions Discontinuation of PD Genetic predisposition Encapsulating peritoneal sclerosis
59 Staging of EPS Stages Asymptomatic Clinical symptoms Ultrafiltration failure Ascites Nakamoto H, et al. Perit Dial Int, 2005
60 Staging of EPS Stages Asymptomatic Inflammatory Clinical symptoms Ultrafiltration failure Ascites Loss of appetite Diarrhea Weight loss Fever Deterioration of anemia Blood-stained ascites Increased CRP Nakamoto H, et al. Perit Dial Int, 2005
61 Staging of EPS Stages Asymptomatic Clinical symptoms Ultrafiltration failure Ascites Inflammatory Progressive or encapsulating Loss of appetite Diarrhea Weight loss Fever Deterioration of anemia Blood-stained ascites Increased CRP Disappearance of the signs of inflammation Gastrointestinal obstruction Abdominal complaints Abdominal mass Ascites Nakamoto H, et al. Perit Dial Int, 2005
62 Staging of EPS Stages Asymptomatic Clinical symptoms Ultrafiltration failure Ascites Inflammatory Progressive or encapsulating Loss of appetite Diarrhea Weight loss Fever Deterioration of anemia Blood-stained ascites Increased CRP Disappearance of the signs of inflammation Gastrointestinal obstruction Abdominal complaints Abdominal mass Ascites Obstructive Anorexia Complete ileus Abdominal mass Nakamoto H, et al. Perit Dial Int, 2005
63 Possible fibrogenic effects of PD fluid Low ph and lactate buffer High concentration of glucose Glucose degradation products (GDPs) Advanced glycation end-products (AGEs)
64 Incidence of EPS in different registries Habib SM et al. Neth J Med, 2011
65 What patients are at risk for EPS? Patients on long-term (>5 years) PD, who develop ultrafiltration failure.
66 Should there be an expiration date for PD?
67 Incidence rates of EPS - duration of PD The Scottish Renal Registry has folllowed a cohort of adult PD patients from the start of PD for a total of 8 years Brown M et al Clin J Am Soc Nephrol, 2009
68 Prevention of EPS No evidence-based data supports a benefit of preemptively transferring long-term PD patients to HD PD may itself play a protective role against the development of EPS. Scotish EPS Registry: 74 % of EPS cases were diagnosed after PD had been stopped
69 Multidisciplinary approach 55 centres Study period: patients received PD for an average of 40 months 14 patients developed EPS Nakayama M et al. Perit Dial Int 2014
70 Next-PD study Nakayama M et al. Perit Dial Int 2014
71 Next-PD study 1338 patients Nakayama M et al. Perit Dial Int 2014
72 Number of EPS /all CPD patients Country Authors 3/35 (1 post-tx*) France Niaudet P et al /687 Japanese Registry Hoshii S et al /109 Japan Araki Y et al /104 Turkey Ekim M et al Germany von Schnakenburg et al Singapore Tan FL et al US Garces-Inigo et al US Marsenic et al (post-tx) Netherlands Tan R et al (post-tx) Portugal da Silva N et al /712 (3 post-tx) Italian Registry Vidal E et al /1472 (2 post-tx) EPDWG report Shroff R et al Total Nr: 60 Stefanidis CJ, Shroff R. Pediatr Nephrol 2013
73 EPS Data from the three studies 87 pediatric nephrology centres 2871 children received PD 47 children developed EPS Prevalence of 1.6% ~7 cases per 1000 patient-years on PD 11 patients died
74 Prevention of EPS Minimize the use of high-glucose PD solutions Use Biocompatible PD solutions Preserve residual renal function Children on long term PD, with ultrafiltration failure, should discontinue PD
75 Main reasons for technique failure Difficulties with peritoneal catheters Serious peritoneal infections Chronic peritoneal changes leading to: - ultrafiltration failure - encapsulating peritoneal sclerosis Declining residual renal function
76 Residual renal function
77 Residual renal function Urine output was monitored in 401 pediatric patients in the global IPPN registry who commenced PD with significant residual renal function. The risk factors of developing oligoanuria (under 100 ml/m 2 /day) were analyzed.
78 Residual renal function Dialysis prescription resulting in high ultrafiltration rate was a risk factors for rapid progression to oligoanuria. An increased duration of urine output associated with the use of biocompatible PD fluids was detected.
79 Take home messages Appropriate development of a PD center Adequate training in PD technique Prevention policies of technique failure Continuous surveillance and adherence to PD recommendations
80 Multiprofessional team
81 Benchmarking Continuous monitoring and comparing with the standards of the rate of technique failure, peritonitis and other complications Benchmarking
82 35 years of challenges Today Early 80 s
83
Encapsulating Peritoneal Sclerosis (EPS)
Encapsulating Peritoneal Sclerosis (EPS) Joni H. Hansson 1 Scott F. Cameron 1 Zenon Protopapas 1 Rajnish Mehrotra 2 1 Hospital of Saint Raphael/Yale University, New Haven, CT 2 Harbor-UCLA Medical Center,
More informationThe CARI Guidelines Caring for Australians with Renal Impairment. Guidelines
6. Type of peritoneal dialysis Date written: February 2003 Final submission: May 2004 Guidelines No peritoneal dialysis has proven to be superior to the two cuff standard Tenckhoff in the prevention of
More information6. Type of peritoneal dialysis catheter
Blackwell Science, LtdOxford, UKNEPNephrology1320-53582004 Asian Pacific Society of NephrologyOctober 20049S3S59S64MiscType of peritoneal dialysis The CARI Guidelines NEPHROLOGY 2004; 9, S59 S64 Date written:
More information2015 Children's Mercy Hospitals and Clinics. All Rights Reserved.
Growth van Stralen KJ, et al., Kidney Int, 2014 Blood Pressure Management van Stralen KJ, et al., Kidney Int, 2014 Sodium Losses on PD Infants might need higher UF rate per BSA as compared to adults to
More informationStrategies to Preserve the Peritoneal Membrane. Reusz GS Ist Dept of Pediatrics Semmelweis University, Budapest
Strategies to Preserve the Peritoneal Membrane Reusz GS Ist Dept of Pediatrics Semmelweis University, Budapest Outline 1. Structure of the peritoneal membrane 2. Mechanisms of peritoneal injury 3. Signs
More informationLong-term peritoneal dialysis and encapsulating peritoneal sclerosis in children
Pediatr Nephrol (2010) 25:75 81 DOI 10.1007/s00467-008-0982-z EDUCATIONAL REVIEW Long-term peritoneal dialysis and encapsulating peritoneal sclerosis in children Masataka Honda Bradley A. Warady Received:
More informationEpidemiology of kidney diseases in children
Epidemiology of kidney diseases in children Dr Lesley Rees Gt Ormond St Hospital for Children, London, UK September 2015 Definition of Epidemiology The patterns, causes, and effects of health and diseases
More informationInnovation in Technology II: Changed and Improved Design. PD Catheters- designs. Bharat Sachdeva MD LSU Shreveport
Innovation in Technology II: Changed and Improved Design PD Catheters- designs Bharat Sachdeva MD LSU Shreveport What s at risk? Why Is Material/Design Important? Reduce risk for transfer to HD Displacement
More informationPeritoneal Dialysis Catheter Placement. Peritoneal Dialysis Catheter Placement. Peritoneal Dialysis Catheter Placement
ASDIN Advanced Techniques Pre-course Feb. 24, 2012 New Orleans, La Randall L. Rasmussen, MD Special thank you to Drs. Rajeev Narayan, San Antonio, Tx and Hemant Dhingra, Fresno Ca for lending me slides
More informationII 12, 2017, 4:45-5:15 PM
Page 1 Choosing the Most Appropriate PD Catheter by Preoperative Mapping PD Nursing Fundamentals II Sunday, March 12, 2017, 4:45-5:15 PM by John H. Crabtree, MD Since patients come in all sizes and shapes
More informationMETABOLISM AND NUTRITION WITH PD OBESITY. Rajnish Mehrotra Harborview Medical Center University of Washington, Seattle
METABOLISM AND NUTRITION WITH PD OBESITY Rajnish Mehrotra Harborview Medical Center University of Washington, Seattle 1 Body Size in Patients New to Dialysis United States Body Mass Index, kg/m2 33 31
More informationObjectives. Peritoneal Dialysis vs. Hemodialysis 02/27/2018. Peritoneal Dialysis Prescription and Adequacy Monitoring
Peritoneal Dialysis Prescription and Adequacy Monitoring Christine B. Sethna, MD, EdM Division Director, Pediatric Nephrology Cohen Children s Medical Center Associate Professor Hofstra Northwell School
More information03/20/2019. Thank you for the invitation to speak. I have no conflicts of interest
Raj Munshi, MD Annual Dialysis Conference 2019 Thank you for the invitation to speak I have no conflicts of interest Expected remaining lifetime in years of prevalent patients by initial ESRD modality,
More information3/5/18. Background. Registry Reports. Dialysis Registry Update and Future Directions
Dialysis Registry Update and Future Directions Annabelle N. Chua, MD March 4, 2018 Background Founded in 1987 as a transplant registry Expanded registry to include dialysis (1992) and CKD (1994) Patient
More informationPD In Acute Kidney Injury. February 7 th -9 th, 2013
PD In Acute Kidney Injury February 7 th -9 th, 2013 Objectives PD as a viable initial therapy PD in AKI PD versus dhd PD versus CVVHD Why not PD first PD for AKI Early days (1970 s) PD was the option of
More informationOutcome of Immediate Use of the Permanent Peritoneal Dialysis Catheter in Children with Acute and Chronic Renal Failure
Original Article Iran J Pediatr Apr 2013; Vol 23 (No 2), Pp: 171-176 Outcome of Immediate Use of the Permanent Peritoneal Dialysis Catheter in Children with Acute and Chronic Renal Failure Ahmad-Ali Nikibakhsh,
More informationChapter 2 Peritoneal Equilibration Testing and Application
Chapter 2 Peritoneal Equilibration Testing and Application Francisco J. Cano Case Presentation FW, a recently diagnosed patient with CKD Stage 5, is a 6-year-old boy who has been recommended to initiate
More information02/27/2018. About half million people in the US with ESRD. HD is currently more prevalent than PD
Anil S. Paramesh, MD, FACS Professor of Surgery, Urology and Pediatrics Tulane University School of Medicine Transplant Advisor, ESRD Network 13 First described in the 1920s Chronic PD initiated in 1960s
More informationUltrasound (US) evaluation of peritoneal thickness in children and young patients on peritoneal dialysis (PD): A single centre experience
Ultrasound (US) evaluation of peritoneal thickness in children and young patients on peritoneal dialysis (PD): A single centre experience Poster No.: C-2812 Congress: ECR 2010 Type: Scientific Exhibit
More informationGeriatric Nutritional Risk Index, home hemodialysis outcomes 131
Subject Index Aksys PHD system 113 Anemia, home outcomes 111, 172, 173 Automated peritoneal dialysis dialysis comparison 17, 18 selection factors 18, 19 telemedicine system 19 21 Blood pressure -peritoneal
More informationA. Zurowska has documented that she has no relevant financial relationships to disclose or conflict of interest to resolve.
A. Zurowska has documented that she has no relevant financial relationships to disclose or conflict of interest to resolve. PERİTONEAL DİALYSİS İN İNFANTS BELOW 1 YEAR OF AGE Aleksandra Żurowska Department
More informationMoney or Patient well-being
John A. Navis President, Janin Group Inc john@janingroup.com TEL: 630-554-5533 CELL: 630-240-3710 Money or Patient well-being 2 3 4 Continual decisions by you and everyone involved focusing on the goal
More informationTHERAPEUTIC INTERVENTIONS TO PRESERVE RESIDUAL KIDNEY FUNCTION. Rajnish Mehrotra Harborview Medical Center University of Washington, Seattle
THERAPEUTIC INTERVENTIONS TO PRESERVE RESIDUAL KIDNEY FUNCTION Rajnish Mehrotra Harborview Medical Center University of Washington, Seattle 1 2 Outline of Presentation Refinements in our understanding
More informationRenal Association Clinical Practice Guideline on peritoneal dialysis in adults and children
Woodrow et al. BMC Nephrology (2017) 18:333 DOI 10.1186/s12882-017-0687-2 CORRESPONDENCE Renal Association Clinical Practice Guideline on peritoneal dialysis in adults and children Graham Woodrow 1*, Stanley
More informationNew Dimensions in Medical Technology
New Dimensions in Medical Technology MEDIONICS INTERNATIONAL INC. Table of Contents Adult Tenckhoff... pg. 1 Paediatric Tenckhoff... pg. 2 Neonatal Tenckhoff... pg. 2 Adult Coil... pg. 3 Paediatric Coil...
More informationUpdate in Peritoneal dialysis
Update in Peritoneal dialysis Matthew Jose MBBS, FRACP, PhD, FASN, AFRACMA Royal Hobart Hospital FACULTY OF HEALTH I pay my respects to the traditional owners of this land, the Larrakia people, and to
More informationAn Uncommon Use of High Dose Steroid in a CAPD patient. Hau Kai Ching, Kwan TzeHoi Tuen Mun Hospital
An Uncommon Use of High Dose Steroid in a CAPD patient Hau Kai Ching, Kwan TzeHoi Tuen Mun Hospital LKK, 63M HT, IHD, DM, ESRF on PD since 14, August, 2003 Bilateral inguinal hernia with repair done in
More informationAccidental Insertion of a Peritoneal Dialysis Catheter in the Urinary Bladder
Published online: April 26, 2018 2018 The Author(s) Published by S. Karger AG, Basel This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) (http://www.karger.com/services/openaccesslicense).
More informationAna Paula Bernardo. CHP Hospital de Santo António ICBAS/ Universidade do Porto
Ana Paula Bernardo CHP Hospital de Santo António ICBAS/ Universidade do Porto Clinical relevance of hyperphosphatemia Phosphate handling in dialysis patients Phosphate kinetics in PD peritoneal phosphate
More informationPERSISTENT SYMPTOMATIC INTRA-ABDOMINAL COLLECTION AFTER CATHETER REMOVAL FOR PD-RELATED PERITONITIS
Peritoneal Dialysis International, Vol. 31, pp. 34-38 doi:10.3747/pdi.2009.00185 0896-8608/11 $3.00 +.00 Copyright 2011 International Society for Peritoneal Dialysis PERSISTENT SYMPTOMATIC INTRA-ABDOMINAL
More informationFistula First? Vascular Symposium 4/28/18
Fistula First? Vascular Symposium 4/28/18 Disclosure I have no financial interest to disclose connected to any of the information presented in this discussion Objectives Scope of Problem Benefits of PD
More informationYou can sleep while I dialyze
You can sleep while I dialyze Nocturnal Peritoneal Dialysis Dr. Suneet Singh Medical Director, PD, VGH Division of Nephrology University of British Columbia Acknowledgements Melissa Etheridge You can sleep
More informationImad Ahmed MD. Renal Associates of West Michigan
Imad Ahmed MD Renal Associates of West Michigan ESRD Facts: - Medicare funded program - Cost - Significant mortality and morbidity - Reduced quality of life - Shrinking donor pool ESRD CAUSES - DM - Hypertension
More informationGambrosol Trio, clinical studies 91 Glitazone, malnutrition-inflammationatherosclerosis
Subject Index Acidosis, see Metabolic acidosis Activated carbon, sorbents 337 Adipokines adipose tissue and systemic inflammation 169 functions 167 169 prospects for study in renal patients 171 Adiponectin,
More informationPresternal Catheter Design An Opportunity to Capitalize on Catheter Immobilization
Advances in Peritoneal Dialysis, Vol. 26, 2010 Dale G. Zimmerman Presternal Catheter Design An Opportunity to Capitalize on Catheter Immobilization Effective immobilization of the peritoneal catheter has
More informationAdvances in Peritoneal Dialysis, Vol. 27, 2011
Advances in Peritoneal Dialysis, Vol. 27, 2011 Eriko Kojima, Tsutomu Inoue, Keita Sueyoshi, Takahiko Sato, Masahiro Tsuda, Tomohiro Kikuta, Yusuke Watanabe, Hiroshi Takane, Tsuneo Takenaka, Hiromichi Suzuki
More informationResumption of Peritoneal Dialysis by Externalization of the Embedded Catheter: A Case Report
15 Case Report J. St. Marianna Univ. Vol. 7, pp. 15 19, 2016 Resumption of Peritoneal Dialysis by Externalization of the Embedded Catheter: A Case Report Nagayuki Kaneshiro 1, Tsutomu Sakurada 2, Mikako
More informationCHAPTER 6 PERITONEAL DIALYSIS. Neil Boudville. Hannah Dent. Stephen McDonald. Kylie Hurst. Philip Clayton Annual Report - 36th Edition
CHAPTER 6 Neil Boudville Hannah Dent Stephen McDonald Kylie Hurst Philip Clayton 213 Annual Report - 36th Edition ANZDATA Registry 213 Report STOCK AND FLOW AUSTRALIA Peritoneal dialysis was used to treat
More informationEnrico Verrina has documented that he has no relevant financial relationships to disclose or conflict of interest to resolve.
Enrico Verrina has documented that he has no relevant financial relationships to disclose or conflict of interest to resolve. Should we always dialyze and transplant mentally disabled patients? Medical
More information5. Indications for the use of urokinase in peritoneal dialysis associated peritonitis
5. Indications for the use of urokinase in peritoneal dialysis associated peritonitis Date written: February 2003 Final submission: July 2004 Guidelines (Include recommendations based on level I or II
More information21th Budapest Nephrology School Ágnes Haris, Kálmán Polner
21th Budapest Nephrology School Ágnes Haris, Kálmán Polner 53 years old female, -worked as computer scientist, -lived with her husband and 2 children, -in excellent financial situation. Diagnosed with
More informationCARE FOR CHRONIC RENAL PATIENTS ROLE OF MULTIDISCIPLINARY APPROACH ÁGNES HARIS MD PHD, ST. MARGIT HOSPITAL, BUDAPEST BUDAPEST NEPHROLOGY SCHOOL, 2017
CARE FOR CHRONIC RENAL PATIENTS ROLE OF MULTIDISCIPLINARY APPROACH ÁGNES HARIS MD PHD, ST. MARGIT HOSPITAL, BUDAPEST BUDAPEST NEPHROLOGY SCHOOL, 2017 RENEGOTIATING LIFE WITH CHRONIC KIDNEY DISEASE CONSTANTINI
More informationLLL Session - Nutritional support in renal disease
ESPEN Congress Leipzig 2013 LLL Session - Nutritional support in renal disease Peritoneal dialysis D. Teta (CH) Nutrition Support in Patients undergoing Peritoneal Dialysis (PD) Congress ESPEN, Leipzig
More informationImaging Features of Encapsulating Peritoneal Sclerosis in Continuous Ambulatory Peritoneal Dialysis Patients
Genitourinary Imaging Pictorial Essay Ti et al. Encapsulating Peritoneal Sclerosis in CPD Patients Genitourinary Imaging Pictorial Essay Joanna P. Ti 1 li l-radi 2 Peter J. Conlon 2 Michael J. Lee 1 Martina
More information02/10/2017. Major Infectious Complications. Learning Objectives. Modalities. At the end of this session the listener will be able to:
Major Infectious Complications Alicia M Neu, MD Chief, Division of Pediatric Nephrology Medical Director, Pediatric Dialysis and Kidney Transplantation The Johns Hopkins University School of Medicine The
More informationASDIN 7th Annual Scientific Meeting
Strategies for Decreasing the Use of Hemodialysis Catheters ASDIN 7 th Annual Scientific Meeting Outline Late referral Primary failure Why Not PD? Summary Micah Chan MD MPH FACP Assistant Professor of
More informationFrom Peritoneal Dialysis to Hemodialysis How could we improve the transition? Th Lobbedez CHU de Caen Self Dialysis Meeting 22 May 2014
From Peritoneal Dialysis to Hemodialysis How could we improve the transition? Th Lobbedez CHU de Caen Self Dialysis Meeting 22 May 2014 Deux grands principes concernant la DP La dialyse péritonéale doit
More informationVolume Management 2/25/2017. Disclosures statement: Objectives. To discuss evaluation of hypervolemia in peritoneal dialysis patients
Volume Management Sagar Nigwekar MD, MMSc Massachusetts General Hospital E-mail: snigwekar@mgh.harvard.edu March 14, 2017 Disclosures statement: Consultant: Allena, Becker Professional Education Grant
More informationTraining for Fluoroscopic Peritoneal Dialysis Catheter Placement. Rajeev Narayan MD San Antonio Kidney Disease Center San Antonio, TX
Training for Fluoroscopic Peritoneal Dialysis Catheter Placement Rajeev Narayan MD San Antonio Kidney Disease Center San Antonio, TX Disclosures No financial conflicts of interest to disclose. My comments
More informationGuideline for chronic dialysis in children in South Africa
Guideline for chronic dialysis in children in South Africa This guideline was updated and adopted by the South African Renal Society in May 2015. Editor: Ida Van Biljon Contributors (in alphabetical order):
More informationOutcome of Patients Initiating Chronic Peritoneal Dialysis During the First Year of Life
Outcome of Patients Initiating Chronic Peritoneal Dialysis During the First Year of Life William A. Carey, MD a, Karen L. Martz, MS b, Bradley A. Warady, MD c BACKGROUND AND OBJECTIVE: Among children with
More informationIncreased peritoneal dialysis utilization and improved patient survival over a 20-year period: data from a Portuguese Peritoneal Dialysis Unit
ORIGINAL ARTICLE Port J Nephrol Hypert 2016; 30(2): 113-120 Advance Access publication 30 January 2016 Increased peritoneal dialysis utilization and improved patient survival over a 20-year period: data
More informationOutcomes of Peritonitis in Children on Peritoneal Dialysis: A 25-Year Experience at Severance Hospital
Original Article http://dx.doi.org/10.3349/ymj.2013.54.4.983 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 54(4):983-989, 2013 Outcomes of Peritonitis in Children on Peritoneal Dialysis: A 25-Year Experience
More informationAdhesive intestinal obstruction increases the risk of intestinal perforation in peritoneal dialysis patients: a case report
Fujii et al. BMC Nephrology (2018) 19:153 https://doi.org/10.1186/s12882-018-0954-x CASE REPORT Open Access Adhesive intestinal obstruction increases the risk of intestinal perforation in peritoneal dialysis
More informationThis is the published version of a paper published in Medicine (Baltimore, Md.). Citation for the original published paper (version of record):
http://www.diva-portal.org This is the published version of a paper published in Medicine (Baltimore, Md.). Citation for the original published paper (version of record): Stegmayr, B G., Sperker, W., Nilsson,
More informationConcern about the decreasing use of peritoneal dialysis
Page 1 of 8 Peritoneal Dialysis International Peritoneal Dialysis International, Vol. 30, pp. doi: 10.3747/pdi.2008.00277 0896-8608/10 $3.00 +.00 Copyright 2010 International Society for Peritoneal Dialysis
More information12c Release Notes Version: ( )
12c Release Notes Version: 3.2.02.47(10.22.0) 6 February 2017 1. NEW - PROMIS Password Expiry Update Location: PROMIS (Patient View, Classic View and PD View) Description: to comply with industry best
More informationCHAPTER 6 PERITONEAL DIALYSIS. Fiona Brown Aarti Gulyani Stephen McDonald Kylie Hurst Annual Report 35th Edition
CHAPTER 6 PERITONEAL DIALYSIS Fiona Brown Aarti Gulyani Stephen McDonald Kylie Hurst 212 Annual Report 35th Edition PERITONEAL DIALYSIS ANZDATA Registry 212 Report STOCK AND FLOW AUSTRALIA Peritoneal dialysis
More informationRenal replacement therapy in Pediatric Acute Kidney Injury
Renal replacement therapy in Pediatric Acute Kidney Injury ASCIM 2014 Dr Adrian Plunkett Consultant Paediatric Intensivist Birmingham Children s Hospital, UK Aims of the presentation Important topic: AKI
More informationWHEN (AND WHEN NOT) TO START DIALYSIS. Shahid Chandna, Ken Farrington
WHEN (AND WHEN NOT) TO START DIALYSIS Shahid Chandna, Ken Farrington Changing Perspectives Beta blockers 1980s Contraindicated in heart failure Now mainstay of therapy HRT 1990s must Now only if you have
More informationBAPN 2016 Audit of dialysis access and complications in UK children
BAPN 2016 Audit of dialysis access and complications in UK children Version 2, 8 th Dec 2015 Yincent Tse, BAPN audit committee member, yincenttse@nhs.net Introduction For children on dialysis, their access
More informationCHAPTER 6 PERITONEAL DIALYSIS
CHAPTER 6 PERITONEAL DIALYSIS Fiona Brown Aarti Gulyani Hannah Dent Kylie Hurst Stephen McDonald PERITONEAL DIALYSIS ANZDATA Registry 11 Report STOCK AND FLOW AUSTRALIA Peritoneal dialysis was used to
More informationDialysis-associated peritonitis in children
Pediatr Nephrol (2010) 25:425 440 DOI 10.1007/s00467-008-1113-6 EDUCATIONAL REVIEW Dialysis-associated peritonitis in children Vimal Chadha & Franz S. Schaefer & Bradley A. Warady Received: 15 August 2008
More informationA Case of Encapsulating Peritoneal Sclerosis Suspected to Result from the Use of Icodextrin Peritoneal Solution
Advances in Peritoneal Dialysis, Vol. 25, 2009 Hideki Kawanishi, Sadanori Shintaku, Masayuki Shishida, Misaki Morrishi, Shinichiro Tsuchiya, Kiyohiko Dohi A Case of Encapsulating Peritoneal Sclerosis Suspected
More informationSIMULTANEOUS CATHETER REPLACEMENT FOR INFECTIOUS AND MECHANICAL COMPLICATIONS WITHOUT INTERRUPTION OF PERITONEAL DIALYSIS
Peritoneal Dialysis International, Vol. 36, pp. 182 187 www.pdiconnect.com 0896-8608/16 $3.00 +.00 Copyright 2016 International Society for Peritoneal Dialysis SIMULTANEOUS CATHETER REPLACEMENT FOR INFECTIOUS
More informationIntroduction To The Peritoneal Dialysis Outcomes and Practice Pattern Study
Introduction To The Peritoneal Dialysis Outcomes and Practice Pattern Study Western Canada PD Days Friday February 8, 2013 Vancouver, British Columbia Jeffrey Perl MD SM FRCP(C) Division of Nephrology
More informationClinical and laboratory indices of severe renal lesions in children with febrile urinary tract infection
Clinical and laboratory indices of severe renal lesions in children with febrile urinary tract infection Constantinos J. Stefanidis Head of Pediatric Nephrology P. & A. Kyriakou Children s Hospital, Athens,
More informationPost-transplantation encapsulating peritoneal sclerosis without inflammation or radiological abnormalities
Habib et al. BMC Nephrology 2013, 14:203 CASE REPORT Open Access Post-transplantation encapsulating peritoneal sclerosis without inflammation or radiological abnormalities Sayed Meelad Habib 1, Frank Johan
More informationHemodiafiltration: principles and advantages over conventional HD. Rukshana Shroff Great Ormond Street Hospital for Children London, UK
Hemodiafiltration: principles and advantages over conventional HD Rukshana Shroff Great Ormond Street Hospital for Children London, UK Effectiveness of RRT modalities Mcfarlane, Seminars in dialysis, 2009
More informationACUTE KIDNEY INJURY AND RENAL REPLACEMENT THERAPY IN CHILDREN. Bashir Admani KPA Precongress 24/4/2018
ACUTE KIDNEY INJURY AND RENAL REPLACEMENT THERAPY IN CHILDREN Bashir Admani KPA Precongress 24/4/2018 Case presentation SP 11month old Presenting complaint: bloody diarrhea, lethargy On exam: dehydration,
More informationThe CARI Guidelines Caring for Australians with Renal Impairment. Monitoring patients on peritoneal dialysis GUIDELINES
Date written: August 2004 Final submission: July 2005 Monitoring patients on peritoneal dialysis GUIDELINES No recommendations possible based on Level I or II evidence SUGGESTIONS FOR CLINICAL CARE (Suggestions
More informationDisclaimer. PD Catheter Placement in Urgent and Emergent Peritoneal Dialysis. Catheter design and outcomes CATHETER DESIGN AND OUTCOME
ASDIN 2014 Scientific Meeting Disclaimer PD Catheter Placement in Urgent and Emergent Peritoneal Dialysis Bharat Sachdeva M.D. Associate Professor of Medicine/Nephrology Interventional Nephrology Division
More informationPERITONEAL EQUILIBRATION TEST. AR. Merrikhi. MD. Isfahan University of Medical Sciences
PERITONEAL EQUILIBRATION TEST AR. Merrikhi. MD. Isfahan University of Medical Sciences INTRODUCTION The peritoneal equilibration test (PET) is a semiquantitative assessment of peritoneal membrane transport
More informationUpdate on home dialysis
Update on home dialysis dr. Karlien François Nefrologie, UZ Brussel Let s start with the good news on PD! Tx All HD = PD ERA EDTA Annual Report 2014 ...despite we don t do it so often ERA EDTA Annual Report
More informationPeritoneal Fluid Analysis and Result Interpretation: Implications for Nursing Care
Annual Dialysis Conference Dallas, TX March 16-19, 2019 Peritoneal Fluid Analysis and Result Interpretation: Implications for Nursing Care Isaac Teitelbaum, MD Professor of Medicine Director, Home Dialysis
More informationOptions in Renal Replacement Therapy: When, whom, which? Prof Dr. Serhan Tuğlular Marmara University Medical School Division of Nephrology
Options in Renal Replacement Therapy: When, whom, which? Prof Dr. Serhan Tuğlular Marmara University Medical School Division of Nephrology CKD Classification Stage Description GFR (ml/min/1.73.m2) 1 Kidney
More informationPD catheter implantation (double-cuff straight Tenckhoff catheter) 基隆長庚一般外科卓世川
PD catheter implantation (double-cuff straight Tenckhoff catheter) 基隆長庚一般外科卓世川 Successful assess of PD Various techniques for various designs of peritoneal catheters. Access of catheter placement is the
More informationOUTCOME FOLLOWING CAPD-ASSOCIATED GRAM-NEGATIVE PERITONITIS
66 OUTCOME FOLLOWING CAPD-ASSOCIATED GRAM-NEGATIVE PERITONITIS CHIA-SHENG CHEN, SHYI-YU CHUNG, WEN-LIANG YU*, MING-TZUNG KAO Peritonitis remains the leading cause of patient dropout from peritoneal dialysis
More informationSelect the dialysis treatment option that is best for you and your family.
PEP CONNECT PEP Talk Outline P a t i e n t E d u c a t i o n P r o g r a m Your Treatment Options Part 1 Peritoneal Dialysis Select the dialysis treatment option that is best for you and your family. This
More informationKidney Decisions Aid
Kidney Decisions Aid A G U I D E F O R P E O P L E W H O H A V E, O R K N O W S O M E O N E, W I T H C H R O N I C K I D N E Y D I S E A S E, A N D T O A I D I N T H E D E C I S I O N A B O U T W H I C
More informationHemodiafiltration in Europe : Trends, Practices, Outcomes & Perspectives
Hemodiafiltration in Europe : Trends, Practices, Outcomes & Perspectives Prof. Bernard Canaud Nephrology, Dialysis and Intensive Care Lapeyronie Hospital CHRU Montpellier - France Opening remarks and special
More informationRenal Self Learning Package INTRODUCTION TO PERITONEAL DIALYSIS
Renal Self Learning Package INTRODUCTION TO PERITONEAL DIALYSIS St George Hospital Renal Department, reviewed 2017 St George Hospital Renal Department RENAL SELF LEARNING PACKAGE INTRODUCTION TO PERITONEAL
More informationPERITONEOSCOPIC PLACEMENT OF THE TENCKHOFF CATHETER: FURTHER CLINICAL EXPERIENCE
PERITONEOSCOPIC PLACEMENT OF THE TENCKHOFF CATHETER: FURTHER CLINICAL EXPERIENCE Stephen R. Ash*,*** Alan E. Handt** Richard Bloch*** SUMMARY In the past two and one-half years, 80 Tenckhoff peritoneal
More informationTroubleshooting the Dysfunctional PD Catheter
Troubleshooting the Dysfunctional PD Catheter ASDIN Annual Scientific Meeting Phoenix, Arizona February, 2014 Corporate Relationships in PD Area-Dr. Ash Developed Y-Tec System for placing PD catheters
More informationManagement of End Stage Renal Disease-Bangladesh Perspective
Send Orders for Reprints to reprints@benthamscience.net 108 The Open Urology & Nephrology Journal, 2014, 7, 108-112 Management of End Stage Renal Disease-Bangladesh Perspective Harun Ur Rashid * Open Access
More informationASDIN 9th Annual Scientific Meeting
Can Interventional Programs (IN) Help Popularize Home Dialysis Therapies? Gerald Beathard State of the Art Lecture ASDIN Washington, DC February 16, 2013 Stephen R. Ash, MD, FACP Indiana University Health
More informationAPD and its new frontier. Roberto Pecoits-Filho, MD, PhD, FACP, FASN
APD and its new frontier Roberto Pecoits-Filho, MD, PhD, FACP, FASN STARCH Study Phase IV Randomised (1:1) Parallel groups Multi-centre Nephrol Dial Transpl 2015 Nov;30(11):1905-11. Non-diabetic APD
More informationPeritoneal dialysis. Overview. Preparing for dialysis. Links to sections in topic Other topics available on website
Peritoneal dialysis This infokid topic is for parents and carers about children s kidney conditions. Visit www.infokid.org.uk to find more topics about conditions, tests & diagnosis, treatments and supporting
More informationAssisted Peritoneal Dialysis
Assisted Peritoneal Dialysis BC Kidney Days Vancouver, BC Matthew Oliver MD MHS Sunnybrook Health Sciences Centre University of Toronto Oct 18, 2012 Declaration 2 Co-inventor of the Dialysis Measurement
More informationStarting with Home Dialysis. Budapest Nephrology School 2016 Ágnes Haris MD, PhD, Kálmán Polner MD St. Margit Hospital, Budapest
Starting with Home Dialysis Budapest Nephrology School 2016 Ágnes Haris MD, PhD, Kálmán Polner MD St. Margit Hospital, Budapest Major concept of the RRT modality selection Hemodialysis Peritoneal dialysis
More informationDiane Watson, RN, MSc, C Neph (C) APN, Nephrology, UHN
Diane Watson, RN, MSc, C Neph (C) APN, Nephrology, UHN Welcome to Meet the Contestants Team Hemo Hemo In Centre Hemo Self Care Hemo Home Hemo Nocturnal Hemo CCC Meet the Contestants Team PD PD CAPD PD
More informationNew Zealand. Dialysis and Transplantation Audit
New Zealand Dialysis and Transplantation Audit Report for New Zealand Nephrology Services on behalf of the National Renal Advisory Board Grant Pidgeon Standards and Audit Subcommittee July 2012 Establishment
More informationad e quate adjective \ˈa-di-kwət\
PD Prescriptions and Adequacy Monitoring: The Basics Fundamentals of Dialysis in Children Seattle, Washington February 27th, 2016 Colin White Steve Alexander Brad Warady Alicia Neu Franz Schaefer Bruce
More informationKidney Patients with Chronic Kidney Disease
Cheshire and Merseyside Kidney Care Services Renal Replacement Therapy Options for Kidney Patients with Chronic Kidney Disease Stage 5 Renal Replacement Therapy Options for Kidney Patients with Chronic
More informationFIRST RENAL REPLACEMENT
FIRST RENAL REPLACEMENT THERAPY SELECTION IN DIABETIC PATIENTS Dr Cécile Couchoud (REIN registry, France) Davide Bolignano (ERBP, Italy) European Renal Best Practice Prof. Wim Van Biesen Chairman of ERBP
More informationAndrea Pizutti, LCSW Gayle Hall, BSN, RN, CNN Regional Operations Director Area Director Davita NxStage Kidney Care
Andrea Pizutti, LCSW Regional Operations Director Davita Gayle Hall, BSN, RN, CNN Area Director NxStage Kidney Care 1 Compare and contrast Home Dialysis Therapies Describe the End Stage Renal Disease patient
More informationEPS meeting. Post-transplant EPS. Naarden, The Netherlands February 4 th 2010
Naarden, The Netherlands February 4 th 2010 EPS meeting Post-transplant EPS Guido Garosi U.O.C. Nefrologia, Dialisi e Trapianto Azienda Ospedaliera Universitaria Senese Siena, Italy is post-transplant
More informationWhat Does Peritoneal Thickness in Peritoneal Dialysis Patients Tell Us?
Advances in Peritoneal Dialysis, Vol. 23, 2007 Soner Duman, 1 Suha Sureyya Ozbek, 2 Ebru Sevinc Gunay, 1 Devrim Bozkurt, 1 Gulay Asci, 1 Savas Sipahi, 1 Fatih Kirçelli, 1 Muhittin Ertilav, 1 Mehmet Özkahya,
More information