We Use Bioincompatible Peritoneal Dialysis Solutions.

Despite advances in peritoneal dialysis (PD) technique and therapy over the last 40 years, PD therapy for end-stage renal disease (ESRD) in the United States remains underutilized. One of the major factors contributing to this underutilization involves concerns about technique failure. More physiologic PD solutions, with a lower concentration of glucose degradation products and a neutral pH, exist and are readily available in Europe, Asia, and Australia.

The chronic kidney disease patient in the acute hospital environment.

CKD is common, affecting more than 10% of the adult US population. Hospital admissions are common among these patients and present challenges for their caregivers. In the acute hospital setting, there is often a lack of awareness of the CKD patient and the best practices developed to help this population.

Patient-specific phosphorus mobilization clearance during nocturnal and short daily hemodialysis.

The kinetics of plasma phosphorus during different hemodialysis (HD) modalities are incompletely understood. We recently demonstrated that a pseudo one-compartment kinetic model including phosphorus mobilization from various body compartments into extracellular fluids can describe intradialytic and postdialytic rebound kinetics of plasma phosphorus during conventional and short 2-hour HD treatments. In this model, individual patient differences in phosphorus kinetics were characterized by a single parameter, the phosphorus mobilization clearance (K(M)).

Factors influencing dialysis modality for end-stage renal disease in developing countries: a survey of Filipino nephrologists.

Background: In the Philippines, 86% of incident dialysis patients are started on hemodialysis (HD) and 14% are treated with peritoneal dialysis (PD), representing a decline over a 2-year period. One important factor which affects patients' choice of dialysis modality is the input of their physicians. Our objective was to identify the factors affecting attitudes and recommendations of Filipino nephrologists regarding HD and PD.

Trends in chronic peritoneal dialysis utilization in New England.

Utilization of chronic peritoneal dialysis (CPD) continues to decline in the United States. Technique failure remains a key factor in this decline. Center size has been associated with technique failure.

Enhanced solute removal with intermittent, in-center, 8-hour nocturnal hemodialysis.

Advances in the dialysis technique and increasing urea Kt/V have not improved outcomes for end-stage renal disease patients maintained on hemodialysis (HD) therapy. Attention has, thus, focused on enhancing solute removal via prolonged HD sessions. A reduction in the serum levels of phosphorus and beta-2-microglobulin (B2M) with longer HD treatments has been linked to improved patient outcomes.

Technique failure and center size in a large cohort of peritoneal dialysis patients in a defined geographic area.

Background: Hemodialysis (HD) and peritoneal dialysis (PD) are both viable options for renal replacement therapy. Technique failure has been shown to be a major problem in PD therapy.

Objective: To examine the relationship between center size and PD technique failure.

Taking home dialysis--in-center. Part 1. Managing a successful in-center nocturnal program.

We received an enthusiastic response from patients interested in the nocturnal program at our clinic, and staff willing to work at night. It is a good idea to offer in-center nocturnal dialysis to prevalent patients versus incident patients, because they are used to the therapy. While that may help your program succeed, some patients may still decide that the long hours on dialysis are not comfortable, and may return to standard HD therapy.

Depression and end-stage renal disease: a therapeutic challenge.

Hedayati et al. document a 26.5% incidence of clinical depression and a strong association between depression and hospitalizations and mortality in hemodialysis patients.

A thrice weekly in-center nocturnal hemodialysis program.

The mortality associated with hemodialysis (HD) remains high. Recent studies have found that a session time of 4 to 4.5 hours and an ultrafiltration rate of less than 10 cc/h/kg were each independently associated with a decreased mortality among HD patients.

Effects of home hemodialysis on health-related quality of life measures.

In recent years, there has been an increased interest in performing hemodialysis (HD) more frequently than thrice weekly, particularly in the home setting. This interest has been stimulated by some studies that have indicated significant benefits to performing more frequent HD on various medical and quality of life outcome measures. However, only a few studies using varying quality of life instruments have critically examined the impact of frequent HD on the quality of life of patients.

Complications associated with the development of bacteremia with Staphylococcus aureus.

Access-related infections are a leading cause of morbidity and mortality among hemodialysis patients. Staphylococcus aureus bacteremia accounts for 25% of these episodes. Nissenson et al.

Barriers to utilization of chronic peritoneal dialysis in network #1, New England.

Objective: The percentage of prevalent end-stage renal disease (ESRD) patients maintained on chronic peritoneal dialysis (CPD) therapy in the United States declined from 15% in 1991 to 8.1% in 2002. Previous studies indicate that nephrologists in the United States feel 32.

The role of chronic peritoneal dialysis in the management of the patient with chronic kidney disease.

The role of chronic peritoneal dialysis (CPD) in the management of patient with chronic kidney disease is being reexamined. There has been a decline in CPD utilization in the United States, which has been attributed to a variety of factors. It is important that these factors be understood and addressed, since nephrologists feel that about 30% of end-stage renal disease patients should be maintained on CPD and patients are more satisfied with CPD and feel that CPD has a less negative impact on their lives than hemodialysis.

Outcome of patients on chronic peritoneal dialysis undergoing peritoneal catheter removal because of peritonitis.

Peritoneal catheter removal may be clinically indicated in the management of peritonitis. The data on the course of patients undergoing peritoneal catheter reinsertion after removal for peritonitis are limited. The present study was designed to examine what happens to patients on chronic peritoneal dialysis (CPD) after peritoneal catheter removal for peritonitis.

Treatment and outcome of CPD-associated peritonitis.

CPD-associated peritonitis is a leading cause of morbidity and mortality for ESRD patients maintained on CPD therapy. The percentage of ESRD patients maintained on CPD therapy is declining. The reasons are unclear, but may be due to concerns about CPD-associated peritonitis.

Course of C-reactive protein during continuous peritoneal dialysis-associated peritonitis.

Objective: C-reactive protein (CRP) levels increase during peritonitis. Little is known about the extent and duration of CRP elevation.

Patients And Methods: Patients on continuous peritoneal dialysis (CPD) therapy had a baseline CRP value at the start of the study.

The BDI and the SF36: which tool to use to screen for depression?

Recent studies have suggested a relationship between depression--as assessed by the Beck Depression Inventory (BDI)--and mortality in end-stage renal disease (ESRD) patients. A recent study from the Dialysis Outcomes and Practice Patterns Study (DOPPS) indicated an association between mortality in a large cohort of hemodialysis patients and the patients' responses in the preceding 4 weeks to two questions on the Kidney Disease Quality of Life, Short Form (KDQOL-SF36): "Have you felt downhearted and blue?" and "Have you felt so down in the dumps that nothing could cheer you?" A BDI score > or = 11 and a score < or = 3 for the two questions on the SF36 were considered to suggest the presence of depressive symptoms; both scores have been associated with increased mortality in hemodialysis patients. We aimed to examine the relationship of the two SF36 questions with depressive symptoms as assessed by the BDI.

Continuous peritoneal dialysis-associated peritonitis: a review and current concepts.

The percentage of end-stage renal disease (ESRD) patients in the United States maintained on continuous peritoneal dialysis (CPD) therapy is decreasing. Complications from CPD therapy, including peritonitis, may be the reason for the decline. Improvements in CPD technology and a better understanding of the risk factors that predispose patients to the development of peritonitis have been responsible for a decline in the rate of peritonitis.

Depression and its association with peritonitis in long-term peritoneal dialysis patients.

Background: Depression is the most common psychological disorder among patients with end-stage renal disease and has been associated with mortality in patients maintained on hemodialysis therapy. Peritonitis is the leading cause of technique failure among long-term peritoneal dialysis (PD) patients. This prospective study is designed to examine the relationship between depression and peritonitis.