Growing home dialysis: The Ontario Renal Network Home Dialysis Initiative 2012-2019.

The Ontario Renal Network (ORN), a provincial government agency in Ontario, Canada, launched an initiative in 2012 to increase home dialysis use province-wide. The initiative included a new modality-based funding formula, a standard mandatory informatics system, targets for prevalent home dialysis rates, the development of a 'network' of renal programmes with commitment to home dialysis and a culture of accountability with frequent meetings between ORN and each renal programme leadership to review their results. It also included funding of home dialysis coordinators, encouragement and funding of assisted peritoneal dialysis (PD), and support for catheter insertion and urgent start PD.

Retrospective study of patients on hybrid dialysis: Single-center data from North America.

Hybrid dialysis involves combining peritoneal and hemodialysis (HD) in patients with end-stage renal disease. Its reported use is quite limited outside of Japan. We present a retrospective review of 18 patients at our center that received this therapy and describe their ultimate disposition.

Successful Initiation of Dialysis with a 20-Year-Old Buried Peritoneal Dialysis Catheter: Case Report and Literature Review.

Buried peritoneal dialysis (PD) catheters are typically inserted several weeks or months before the anticipated need for dialysis. Occasionally, renal function unexpectedly stabilizes after the surgery, and a patient may go years before the catheter is needed. We report a case of successful initiation of PD with a twenty-year-old buried catheter.

Characteristics and Outcomes of Exit Sites of Buried Peritoneal Dialysis Catheters: A Cohort Study.

Buried peritoneal dialysis (PD) catheters are placed months before dialysis is needed and the exit site is created when the catheter is dissected out at the initiation of dialysis. In contrast, the exit site of an unburied catheter is created by the surgeon at the time of insertion. We reviewed all patients who initiated PD at our center over a 2-year period.

Abdominal visceral perforation by buried peritoneal dialysis catheters: Cause or coincidence?

Delayed visceral organ perforations after PD catheter insertions are extremely rare. We report two patients who presented with asymptomatic visceral perforation from their buried PD catheters. Five months after a laparoscopic buried PD catheter insertion in a 92-year-old man PD was initiated; bile and bowel contents were noted in the PD effluent.

Spironolactone is effective in treating hypokalemia among peritoneal dialysis patients.

Background: Hypokalemia is common in peritoneal dialysis (PD) patients and is associated with increased cardiovascular and all-cause mortality. The management approach for such patients routinely includes spironolactone at our centre. We undertook this study to assess the efficacy of spironolactone for the treatment of hypokalemia in PD patients.

Microparticle Formation in Peritoneal Dialysis: A Proof of Concept Study.

Background: Injury to the mesothelial layer of the peritoneal membrane during peritoneal dialysis (PD) is implicated in loss of ultrafiltration capacity, but there are no validated biomarkers for mesothelial cell injury. Microparticles (MPs) are 0.1 to 1.

Diabetes Mellitus and Younger Age Are Risk Factors for Hyperphosphatemia in Peritoneal Dialysis Patients.

Hyperphosphatemia has been associated with adverse outcomes in patients with end stage kidney disease (ESKD). The purpose of this study was to determine risk factors for hyperphosphatemia in ESKD patients treated with peritoneal dialysis (PD). This information will be used to develop a patient specific phosphate binder application to facilitate patient self-management of serum phosphate.

Systemic Toxicity of Intraperitoneal Vancomycin.

Intraperitoneal vancomycin is used for empiric treatment of peritoneal dialysis peritonitis. It is dosed intermittently and a high systemic concentration is often achieved. Despite this, there are very few reports of systemic toxicity from intraperitoneal vancomycin.

Diastolic Hypotension in a Tertiary Care Hypertension Clinic: Have We Gone Too Far?

Background: Treatment-induced diastolic hypotension has been associated with an increased risk of adverse cardiovascular events in post hoc analyses of major blood pressure (BP)-lowering trials. We undertook this retrospective study to assess the prevalence and risk factors for diastolic hypotension among patients referred to a tertiary care hypertension clinic.

Methods: Charts of all active patients were reviewed, and BP at the initial visit was compared with BP at the first visit at which the systolic BP target was achieved or the last visit if the target was not achieved.

Peritoneal dialysis catheter implantation by nephrologists is associated with higher rates of peritoneal dialysis utilization: a population-based study.

Background: The likelihood of peritoneal dialysis (PD) utilization following a PD catheter insertion attempt is poorly described. We explored the risk factors for PD nonuse, focusing on the method of PD catheter implantation.

Methods: This population-based retrospective cohort study employed Ontario administrative health data to identify 3886 predialysis adults who had an incident PD catheter implantation between 2002 and 2010.

Emphysematous polycystic infection in a patient on peritoneal dialysis.

Emphysematous infection of the cysts in patients with polycystic kidney disease is very rare and seldom reported. We herein report a case of emphysematous polycystic infection in a 61-year-old male patient who was on peritoneal dialysis for end-stage renal disease caused by adult polycystic kidney disease.

Patients' quality of life after stopping plasma exchange: a pilot study.

Background: Plasma exchange is being widely used to treat various serious medical conditions. There has been very little follow-up data to describe the quality of life (QOL) of plasma exchange-recipients after active plasma exchange has stopped.

Objective: To assess the QOL of plasma exchange recipients after stopping plasma exchange.

BpTRUth: do automated blood pressure monitors outperform mercury?

Manual measurement of blood pressure (BP) in the office (MOBP) is inferior in accuracy when compared with ambulatory BP measurements (ABPM) since it misses white coat and masked effects on BP. BpTRU, an automated office BP device (AOBP), has been reported to reduce white coat effect. We performed a retrospective review of the diagnostic accuracy of MOBP (taken by a trained nurse in clinical hypertension) and AOBP using the Bland-Altman method in hypertensive patients referred to a Renal Hypertension Clinic.

Clinical hypotension with co-prescription of macrolide antibiotics and calcium-channel blockers in haemodialysis patients: a retrospective chart review.

Background: Macrolide antibiotics inhibit the cytochrome p450 enzyme system, which metabolizes calcium-channel blockers. This may result in a clinically significant interaction, causing hypotension in patients co-prescribed these two drugs. Since these drugs are frequently used in the haemodialysis population, we studied the effect of their co-prescription on actual blood pressure.

Pharmacologic treatment of hypertension in patients with chronic kidney disease.

Hypertension remains an important cause of morbidity and mortality in patients with chronic kidney disease. It both contributes to and is a consequence of chronic renal dysfunction. There is a high prevalence of hypertension in chronic kidney disease, and rates of control remain sub-optimal.

Severe hypocalcemia following denosumab injection in a hemodialysis patient.

Denosumab is a human monoclonal antibody directed against RANKL (receptor activator of NF-κB ligand) and is a novel treatment for postmenopausal osteoporosis, although its safety and efficacy in end-stage renal disease is unclear. We report the case of a 61-year-old female hemodialysis patient who developed severe hypocalcemia (total serum calcium, 5.37 mg/dL [1.

Peritoneal dialysis catheter insertion strategies and maintenance of catheter function.

It has been more than 40 years since permanent peritoneal dialysis (PD) access with the Tenckhoff catheter was first described, and despite much experimentation with catheter design and insertion techniques, access to timely and skilled PD catheter insertion remains a barrier to more widespread PD use in many centers. This article reviews different insertion techniques with a focus on both mechanical outcomes as well as logistic advantages associated with the embedded catheter and percutaneous techniques. Maintenance of catheter function is discussed with a focus on an organized and evidence-based approach to preventing and treating mechanical catheter problems.