Overcoming barriers and building a strong peritoneal dialysis programme - Experience from three South Asian countries.

The development of peritoneal dialysis (PD) programmes in lower-resource countries is challenging. This article describes the learning points of establishing PD programmes in three countries in South Asia (Nepal, Sri Lanka and Pakistan). The key barriers identified were government support (financial), maintaining stable supply of PD fluids, lack of nephrologist and nurse expertise, nephrology community bias against PD, lack of nephrology trainee awareness and exposure to this modality.

Is overhydration in peritoneal dialysis patients associated with cardiac mortality that might be reversible?

Aim: To study the relationship between overhydration (OH) in peritoneal dialysis (PD) patients and cardiac mortality.

Methods: OH, as measured by body composition monitor (BCM), is associated with increased mortality in dialysis patients. BCM has been used to guide treatment on the assumption that correcting OH will improve cardiac morbidity and mortality although data demonstrating causality that is reversible is limited.

Can Bioimpedance Measurements of Lean and Fat Tissue Mass Replace Subjective Global Assessments in Peritoneal Dialysis Patients?

Objective: Malnutrition and protein energy wasting (PEW) determined by Subjective Global Assessment (SGA) is associated with increased mortality. There is an inverse relationship between body mass and overhydration in dialysis patients. Is the predictive accuracy of SGA (for death) independent of hydration status? Can bioimpedance spectroscopy analysis of lean tissue index (LTI) and fat tissue index (FTI) accurately identify dialysis patients with protein energy wasting and increased mortality?

Methods: We report an observational study of 455 peritoneal dialysis (PD) patients.

Increasing the use of biocompatible, glucose-free peritoneal dialysis solutions.

A major concern inhibiting some clinicians from embracing peritoneal dialysis (PD) as the preferred first modality of dialysis is the effects of PD solutions on the peritoneal membrane. These anatomical and functional changes predispose to complications like peritonitis, encapsulating peritoneal sclerosis and ultrafiltration failure. In recent years, "biocompatible" and glucose-sparing PD regimens have been developed to minimize damage to the peritoneal membrane.

Lack of motivation: a new modifiable risk factor for peritonitis in patients undergoing peritoneal dialysis?

Aim: Can we identify modifiable risk factors for peritonitis in patients undergoing peritoneal dialysis (PD)? We aimed to determine whether housing standard, PD exchange technique or patient motivation might be modifiable risks for peritonitis. We also explored the relationship between lack of motivation and depression.

Methods: Nurse home visits assessed PD exchange technique, environment and patient motivation.

Comparing lung ultrasound with bioimpedance spectroscopy for evaluating hydration in peritoneal dialysis patients.

Background: Bioimpedance spectroscopy (BIS), ultrasound lung comets (ULC) and serum biomarkers (N-terminal pro-brain natriuretic peptide, NT-proBNP) have all been used to assist clinicians to determine hydration status in dialysis patients.

Methods: We performed simultaneous BIS, ULC and NT-proBNP measurements in 27 peritoneal dialysis patients to determine the concordance of the three methods.

Results: Patients with evidence of increasing lung congestion (as determined by ultrasound) were more likely to be diabetic, have systolic hypertension and have higher NT-proBNP (r = 0.

Prevalence and clinical characteristics of hypothyroidism in a population undergoing maintenance hemodialysis.

Background: The prevalence of hypothyroidism in persons with chronic kidney disease is documented to be higher, compared to the normal population. However, no data is available about the prevalence rate of hypothyroidism among hemodialysis patients in Nepal.

Methods: A cross-sectional analysis was done on consecutive patients enrolled for maintenance hemodialysis in the Hemodialysis Unit of Gandaki Medical College Teaching Hospital, Pokhara, Nepal, during the period of one year (1(st) January 2011 to 31(st) December 2011).

Reactions of nepali adults to warning labels on cigarette packages: a survey with employee and medical students of a tertiary care medical college of Western region of Nepal.

Background: For the past 30 years, there have been no changes in the text-only cigarette warning labels in Nepal. During this same time period, other countries placed large graphic warning labels on cigarette packages. The purpose of the current study was primarily to compare the differences in reactions to different types of warning labels on cigarette packages, with a specific focus on whether the new warning label adopted by WHO FCTC was better than the text only label used by Nepal.

The diagnostic significance of the holter monitoring in the evaluation of palpitation.

Purpose: To determine the diagnostic yield of the 24-hour Holter monitoring in the patients who were evaluated for palpitations.

Methods: A prospective, single-centre study was performed to evaluate the diagnostic yield of the Holter monitoring. The inclusion criteria was age greater then 18 years with the symptom of unexplained recurrent palpitations.