Novel Colorimetric and Light Scatter Methods to Identify and Manage Peritoneal Dialysis-Associated Peritonitis at the Point-of-Care.

Introduction: Peritoneal dialysis (PD)-related peritonitis (PDRP) is a common cause of transfer to hemodialysis, patient morbidity, and is a risk factor for mortality. Associated patient anxiety can deter selection of PD for renal replacement therapy. Diagnosis relies on hospital laboratory tests; however, this might be achieved earlier if such information was available at the point-of-care (POC), thereby significantly improving outcomes.

International peritoneal dialysis training practices and the risk of peritonitis.

Background: The effects of training practices on outcomes of patients receiving peritoneal dialysis (PD) are poorly understood and there is a lack of evidence informing best training practices. This prospective cohort study aims to describe and compare international PD training practices and their association with peritonitis.

Methods: Adult patients on PD <3 months participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) were included.

Variation in Peritoneal Dialysis-Related Peritonitis Outcomes in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).

Rationale & Objective: Peritoneal dialysis (PD)-associated peritonitis is a significant PD-related complication. We describe the likelihood of cure after a peritonitis episode, exploring its association with various patient, peritonitis, and treatment characteristics.

Study Design: Observational prospective cohort study.

Peritoneal Dialysis-Related Infection Rates and Outcomes: Results From the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).

Rationale & Objective: Peritoneal dialysis (PD)-related peritonitis carries high morbidity for PD patients. Understanding the characteristics and risk factors for peritonitis can guide regional development of prevention strategies. We describe peritonitis rates and the associations of selected facility practices with peritonitis risk among countries participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).

Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis.

Background: There is little information about quality of life (QoL) for patients with end-stage kidney disease (ESKD) choosing conservative kidney management (CKM). The Frail and Elderly Patients on Dialysis (FEPOD) study demonstrated that frailty was associated with poorer QoL outcomes with little difference between dialysis modalities [assisted peritoneal dialysis (aPD) or haemodialysis (HD)]. We therefore extended the FEPOD study to include CKM patients with estimated glomerular filtration rate ≤10 mL/min/1.

Longitudinal Trends in Quality of Life and Physical Function in Frail Older Dialysis Patients: A Comparison of Assisted Peritoneal Dialysis and In-Center Hemodialysis.

Background: In-center hemodialysis (HD) has been the standard treatment for older dialysis patients, but reports suggest an associated decline in physical and cognitive function. Cross-sectional data suggest that assisted peritoneal dialysis (aPD), an alternative treatment, is associated with quality of life (QoL) outcomes that are comparable to in-center HD. We compared longitudinal changes in QoL between modalities.

Regional variation in the treatment and prevention of peritoneal dialysis-related infections in the Peritoneal Dialysis Outcomes and Practice Patterns Study.

Background: Peritoneal dialysis (PD)-related infections lead to significant morbidity. The International Society for Peritoneal Dialysis (ISPD) guidelines for the prevention and treatment of PD-related infections are based on variable evidence. We describe practice patterns across facilities participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).

Con: The role of diet for people with advanced Stage 5 CKD.

Restriction of dietary protein intake has been used in the management of chronic kidney disease (CKD) for many decades, yet remains controversial, with marked variations in its application in clinical practice. There is extensive literature on the subject, with some expert opinion advocating the use of protein restriction based on the balance of the available evidence. The largest randomized trial of low-protein diets is the Modification of Diet in Renal Disease study.

Changes in Body Composition in the Two Years after Initiation of Haemodialysis: A Retrospective Cohort Study.

Malnutrition is common in haemodialysis (HD) and is linked to poor outcomes. This study aimed to describe changes in body composition after the initiation of HD and investigate whether any routinely collected parameters were associated with these changes. The study cohort came from the HD population of a single centre between 2009 and 2014.

Longitudinal bioimpedance vector plots add little value to fluid management of peritoneal dialysis patients.

Bioimpedance (BI) has the potential to enable better management of fluid balance, which can worsen over time on peritoneal dialysis (PD) due to loss of residual kidney function and progressive muscle wasting. We undertook a prospective, randomized, open-label, blinded end-point controlled trial to determine whether availability of longitudinal BI measures as vector plots helped clinicians maintain stable fluid status over 12 months in 308 peritoneal dialysis patients from the United Kingdom and Shanghai, China. Patients were recruited into 4 groups nested within a single trial design according to country and residual kidney function.

Assessment of fluid status in peritoneal dialysis.

Fluid management is recognized as a basic component of management of patients on dialysis. Fluid overload is an important adverse factor in patient outcomes, and the negative effects of fluid depletion, including on residual renal function, are also increasingly being recognized. The complexities of fluid distribution in renal failure need to be understood to inform assessment of hydration.

Volume status in peritoneal dialysis.

Fluid homeostasis is one of the fundamental roles of the kidney and a crucial aspect in clinical management of patients on peritoneal dialysis (PD). Volume status has an important impact on the outcome of PD patients. Fluid excess leads to accelerated development of cardiovascular disease.

Body composition analysis techniques in the aged adult: indications and limitations.

Purpose Of Review: Body composition analysis allows division of the body into different compartments on the basis of differing physical properties. A variety of techniques are available for measuring body composition. This review describes the changes that occur with increasing age, their significance and also the limitations of available body composition analysis techniques when applied to the elderly.

Longitudinal relationships between fluid status, inflammation, urine volume and plasma metabolites of icodextrin in patients randomized to glucose or icodextrin for the long exchange.

Background: Randomized trials have shown that icodextrin reduces the volume of extra-cellular fluid (ECFv) with variable effects on residual renal function. To explore this fluid shift and its possible mechanisms in more detail, prospectively collected data from one such trial, including measures of inflammation (C-reactive protein, tumour necrosis factor-alpha, albumin and low and high molecular weight hyaluronan) ANP (atrial naturetic peptide), an indirect marker of intra-vascular volume, plasma concentrations of icodextrin metabolites and alpha-amylase activity were analysed.

Methods: 50 patients were randomized to either 2.

Body composition analysis techniques in adult and pediatric patients: how reliable are they? How useful are they clinically?

Complex abnormalities of body composition occur in peritoneal dialysis (PD). These abnormalities reflect changes in hydration, nutrition, and body fat, and they are of major clinical significance. Clinical assessment of these body compartments is insensitive and inaccurate.

Methodology of assessment of fluid status and ultrafiltration problems.

Loss of sodium and water excretion with disruption of volume homeostasis is a crucial abnormality of end-stage renal failure. Fluid management is a fundamental function of dialysis therapy, but studies show frequent occult fluid overload, hypertension, and cardiac dysfunction in peritoneal dialysis. A rigorous approach to fluid management in PD can achieve excellent fluid, hypertension, and cardiovascular results in clinical practice.

Successful treatment of fulminant encapsulating peritoneal sclerosis following fungal peritonitis with tamoxifen.

Encapsulating peritoneal sclerosis remains a serious complication of peritoneal dialysis. Prolonged duration on dialysis and severe episodes of peritonitis are the two most important risk factors for developing the condition. Here we describe a patient who developed a fulminant form of encapsulating peritoneal sclerosis soon after suffering from an episode of fungal peritonitis.