Continuous ambulatory peritoneal dialysis telemonitoring and education:A scoping review

The risk of peritonitis complications in continuous ambulatory peritoneal dialysis(CAPD)can be prevented or reduced by providing proper education and continuous monitoring.Telemedicine and telemonitoring are methods that enable remote monitoring and patient care.This study aimed to determine the success and factors affecting telemonitoring in CAPD patient care.This study is a scoping review(ScR)using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR method.Article searches were carried out on ProQuest,PubMed,and ScienceDirect with a time range of 2018-2023.Data extraction was performed regarding knowledge level,quality of life,clinical outcomes(peritonitis),and risk of hospitalization.Of the 12 articles and studies included,6 articles were related to the effect of telemonitoring on CAPD patient outcomes,and 6 articles were associated with the effect of education on CAPD patient outcomes.Education provided to patients can improve patient understanding of therapeutic modalities for renal disorders,reduce the potential for peritonitis and dialysis complications,and improve the quality of life of patients with CAPD.CAPD patients who received telemonitoring had a better quality of life,good clinical outcomes,and a lower risk of hospitalization than those who did not receive telemonitoring and had fewer health-care visits.In summary,the implementation of telemonitoring and education in chronic kidney disease patients with CAPD modality therapy has been proven effective in improving quality of life and reducing dialysis-related risks.

Spontaneous dislodgment of a peritoneal dialysis catheter inserted using the Seldinger technique:A case report

BACKGROUND Peritoneal dialysis(PD)is an important renal replacement therapy in patients with end-stage renal disease.PD catheters remain the lifeline for patients undergoing PD.The catheter technique survival rate is considered a core PD outcome domain.CASE SUMMARY The PD catheter spontaneously dislodged in a patient undergoing PD during regular fluid exchange without pain.Abdominal computed tomography showed a tunnel infection.A double-cuff straight Tenckhoff catheter had been inserted using the Seldinger technique.Before this incident,the patient had a history of tunnel infections.We speculate that recurrent tunnel infections and catheter insertion using the Seldinger technique may have led to catheter dislodgement.CONCLUSION The present case suggests that clinicians should more rigorously assess the persistence of catheter-related infections concerning the potential complications arising from catheter dislodgement associated with the Seldinger technique.

Hyperkalemia in Patients on Peritoneal Dialysis: Clinical Use Experience with New Potassium-Binders

Background: Patients with end-stage kidney disease (ESKD) on maintenance dialysis have a high risk of developing hyperkalemia. In addition to traditional approaches, a new option for the management of patients on dialysis includes the use of a potassium binder, sodium zirconium cyclosilicate (SZC). We evaluated the effect and safety of SZC in patients with chronic PD. Objective: To present a case series that illustrates the real-world use of new potassium-binders in hyperkalemic patients on peritoneal dialysis. Methods: This case series collected 9 patients on PD with baseline potassium values > 5.5 mmol/l and who were treated with SZC 5 g once a day. Data were collected at baseline and at 1, 2, and 3 months after initiation of treatment. Results: The median age of patients was 64.5 years and the median duration of observation was 90 ± 5 days. It was observed that median serum potassium decreased (5.8 mmol/l at baseline with a range of 5.8 mmol/L - 6.8 mmol/L versus 4.5 in the third month with a range of 3.6 mmol/L - 5.3 mmol/L) after SZC treatment. Adverse events were observed in 2 (22.2%). The unique adverse event was constipation and presented in 2 patients (22.2%). Constipation was mild and transient during the observation period. No adverse events of special interest were reported. Conclusion: Normokalemia was established and maintained in this series of patients treated with SZC. No episodes of hyper- or hypo-kalemia were observed. SCZ had a good safety profile and was well tolerated over 3 months.

Peritoneo-Vaginal Leaks in Peritoneal Dialysis: A Report of 3 Cases

Introduction: Peritoneal dialysis (PD) is an extra-renal purification technique indicated for patients with end-stage kidney disease (ESKD). Although it has many advantages, it also has a number of complications, such as peritoneo-vaginal leakage of dialysate. Cases Reports: Three male patients, aged 70, 50 and 77 respectively, with ESKD were placed on PD. All three patients presented with inadequate drainage and the progressive appearance of bilateral hydrocele, which occurred one year (late leakage), two and four days (early leakage) respectively after the initiation of exchanges. The etiological investigation led to the conclusion of a peritoneo-vaginal leak associated with an inguinal hernia in only one case. The two cases of early leakage were treated by temporary suspension of PD, with a good response in one case and failure in the second, leading to hisdefinitive transfer to hemodialysis (HD);however, the hernia repair enabled immediate resumption of PD in the third patient. Discussion and Conclusion: Peritoneo-vaginal leakage is a rare mechanical complication in PD. The clinical examination plays an essential role in confirming the diagnosis and in the therapeutic decision. If the diagnosis is uncertain, or if there is a clinical need to show the anatomy of the leak, an imaging approach becomes desirable. This complication should not prevent the progression of PD in the management of patients with ESKD.

Probiotic interventions in peritoneal dialysis:A review of underlying mechanisms and therapeutic potentials

Peritoneal dialysis(PD)is a commonly used modality for kidney replacement therapy for patients with end-stage kidney disease(ESKD).PD offers many benefits,including home-based care,greater flexibility,and preservation of residual kidney function compared to in-center hemodialysis.Nonetheless,patients undergoing PD often face significant challenges,including systemic inflammation,PD-related peritonitis,metabolic disorders,and cardiovascular issues that can negatively affect their quality of life and treatment outcomes.Recent studies have demonstrated the crucial role of the gut microbiome in overall health and treatment results,supporting the hypothesis that probiotics may bring potential benefits to the general population of ESKD patients.However,specific data on probiotic use in PD patients are limited.This opinion review aims to summarize the current knowledge on the relationship between PD and the gut microbiome and offers a novel perspective by specifically exploring how probiotic interventions could improve the outcomes of PD treatment.The review also outlines some clinical data supporting the effectiveness of probiotics in patients undergoing PD and considers the difficulties and restrictions in their application.Based on the current knowledge gaps,this study seeks to explore future research directions and their implications for clinical practice.

A Cross-Sectional Study on The Prevalence of Anemia in Maintenance Hemodialysis and Peritoneal Dialysis Patients and Its Related Factors

Objective:To study the prevalence of anemia,the proportion of hemoglobin(Hb)levels,the treatment methods,and the influencing factors of Hb levels in maintenance hemodialysis(MHD)and peritoneal dialysis patients.Methods:In this study,602 patients with maintenance hemodialysis and continuous ambulatory peritoneal dialysis were enrolled from December 2020 to December 2022 in our hospital,and their medical records were collected and summarized.The main contents included the patient’s gender,age,primary disease,dialysis duration,dialysis method,the use of erythropoietic stimulating agents(ESA),intravenous iron,and laboratory tests.A Hb index exceeding 110 g/L was set as the standard for the prevalence of anemia.Results:The rate of anemia in patients undergoing blood purification was 83%.The proportion of ESA use was 84.1%,and the proportion of iron use was 76.7%,of which the proportion of intravenous iron used was 17.0%,and the proportion of folic acid used was 28.3%.Conclusion:The incidence of anemia in MHD patients was relatively high,with a low proportion of patients reaching the standard Hb levels.Risk factors include albumin(ALB)levels,iron storage,white blood cells,C-reactive protein,cholesterol,etc.Nutritional support,iron supplementation,and prevention of micro-inflammatory reactions can effectively promote the improvement of Hb indicators in dialysis patients to prevent anemia.

Laparoscopic-assisted catheter insertion for continuous ambulatory peritoneal dialysis:A case report of simple technique for optimal placement

A 40-year-old male underwent tube placement surgery for continuous ambulatory peritoneal dialysis(CAPD).A2-cm skin incision was made,and the peritoneum was reflected enough to perform secure fixation.A swannecked,double-felted silicone CAPD catheter was inserted,and the felt cuff was sutured to the peritoneum to avoid postoperative leakage.An adequate gradient for tube fixation to the abdominal wall was confirmed.The CAPD tube was passed through a subcutaneous tunnel.Aeroperitoneum was induced to confirm that there was no air leakage from the sites of CAPD insertion.Two trocars were placed,and we confirmed that the CAPD tube led to the rectovesical pouch.Tip position was reliably observed laparoscopically.Optimal patency of the CAPD tube was confirmed during surgery.Placement of CAPD catheters by laparoscopic-assisted surgery has clear advantages in simplicity,safety,flexibility,and certainty.Laparoscopic technique should be considered the first choice for CAPD tube insertion.

REDUCTION IN PERITONITIS INCIDENCE IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS WITH A NEW CATHETER AND IMPLANTATION TECHNIQUE

Recurrent episodes of peritonitis with the same organism cultured at thecatheter exit site suggest that early tunnel colonization is associated with a transferof these organisms through the catheter tunnel directly from the skin into the peri-toneal cavity.In this circumstance the catheter has failed in its fundamental designto establish and maintain a bacteriological barrier.A three part study was conductedusing the Moncrief-Popovich Catheter and Implantation Technique.The first part

Effect of Continuous Nursing Model on Nursing Effect of Continuous Peritoneal Dialysis

Objective:To analyze and study the effect of continuous nursing mode for continuous peritoneal dialysis nursing.Methods:40 patients with continuous peritoneal dialysis received in our hospital were randomly selected as the research object.The research time was from June 2018 to June 2020.The patients were divided into two groups by random number table method.The patients with routine nursing mode were named as the control group and the patients with continuous nursing mode were named as the observation group(20 cases in each group).The clinical nursing effects of different nursing modes are compared.Results:After nursing,the nursing compliance of the observation group was 95%,which was higher than 70% of the control group.There was significant difference between the two groups(P<0.05).Comparing the blood routine related indexes of the two groups,the blood potassium,hemoglobin,serum creatinine and carbon dioxide binding force of the observation group were better than those of the control group(P<0.05).The incidence of peritonitis and rehospitalization rate in half a year in the observation group were lower than those in the control group(P<0.05).Conclusion:The continuous nursing model for patients undergoing continuous peritoneal dialysis can improve the treatment effect of patients,significantly improve the compliance of patients,significantly improve the serological indexes,promote the health of patients,reduce the incidence of peritonitis,and significantly reduce the rehospitalization rate in half a year.It has a broad prospect of clinical promotion.

Peritonitis due to <i>Geotrichum candidum</i>in Continuous Ambulatory Peritoneal Dialysis

This paper is a report of a 34-year-old man with chronic renal failure undergoing Continuous Ambulatory Peritoneal Dialysis which developed peritonitis due to Geotricum candidum. The diagnosis was established by culture of dialysis fluid. The purpose of this report is to provide data on a fungal peritonitis due to a non-common agent.

RESEARCH ON A REAL-TIME CONTROL SYSTEM OF LOW POWER DISSIPATION FOR CONTINUOUS CYCLIC PERITONEAL DIALYSIS(CCPD) CYCLER

A low power dissipation control system for continuous cyclic peritoneal dialysis (CCPD) cycler and its characteristics are reported. Combined withhemodialysis and renal transplantation, peritoneal dialysis is used mainly for thetreatment of renal failure. CCPD has been developed during 1980＇s. It provided automatic dialysis procedures during the night to avoid interruptions in patients＇dailyroutine. Furthermore,there is a remarkable decrease in peritonitis occurance usingCCPD. The control system is a critical part for CCPD cycler. The system is approvedto be reliable and flexible in practical experiments. When AC power failure,the system can still ensure the completion of dialysis.

Effect of different nursing interventions on the incidence of peritonitis in peritoneal dialysis patients at home: a network meta-analysis

Objective:Bayesian network meta-analysis was used to evaluate the effect of different nursing interventions on the incidence of peritonitis in peritoneal dialysis patients at home.Methods:Cochrane Library,PubMed,Embase,Web of Science,China Biology Medicine disc,CNKI and Wanfang data were searched to identify randomized controlled trials(RCTs)investigating the effects of different nursing interventions or health education on peritonitis in home peritoneal dialysis patients from the establishment of each database to March 2022.After literature screening,the Cochrane 5.1 evaluation tool was used to assess quality,Review Manager 5.4 software was used to generate a literature quality evaluation chart and R4.1.2 software,JAGS package,and GEMTC package were used for statistical analysis.Results:A total of 9 RCTs involving 8 different nursing interventions and a total of 1011 patients were included in the meta-analysis.The incidence of peritonitis for the eight nursing interventions,ranked from highest to lowest,were:systematic nursing,Omaha system case management intervention,routine care+health promotion mode,PD specialist nurse-led multi-disciplinary network platform management mode,5E rehabilitation nursing mode,routine care+Omaha extended nursing service,one-on-one coordinated family support intervention,and routine care.Conclusions:Systematic nursing was found to be the most effective intervention in reducing the incidence of peritonitis in peritoneal dialysis patients at home.However,this conclusion needs to be further verified by more high-quality,multicenter and large sample RCTs.

Effect of Shenmai injection combined with irbesartan on the microinflammatory state and nutritional status of patients with peritoneal dialysis

Objective: To study the effect of Shenmai injection combined with irbesartan on the microinflammatory state and nutritional status of patients with peritoneal dialysis. Methods:A total of 108 patients with end-stage renal disease who received peritoneal dialysis in Guangyuan First People's Hospital between May 2014 and November 2016 were selected and randomly divided into two groups, the combined group received Shenmai injection combined with irbesartan therapy, and the ARB group received irbesartan therapy. The renal function indicators, inflammatory response indicators and nutritional status indicators of the two groups were detected before treatment as well as 3 months and 6 months after treatment. Results: Scr, BUN and RRF of both groups 3 months and 6 months after treatment were not significantly different from those before treatment;serum SAA, CRP, PAPP-A, CHE, TNF-α, IL-6 and IL-8 contents of both groups 3 months and 6 months after treatment were significantly lower than those before treatment, and serum SAA, CRP, PAPP-A, CHE, TNF-α, IL-6 and IL-8 contents of combined group 3 months and 6 months after treatment were significantly lower than those of ARB group;serum Alb, PA and Tf contents as well as mid-arm muscle circumference and mid-arm circumference of combined group 3 months and 6 months after treatment were not significantly different from those before treatment while serum Alb, PA and Tf contents as well as mid-arm muscle circumference and mid-arm circumference of control group 3 months and 6 months after treatment were significantly lower than those before treatment. Conclusion: Shenmai injection combined with irbesartan for peritoneal dialysis can reduce the microinflammatory state and improve the nutritional status.

THE RESEARCH OF FLOW CONTROLLED SYSTEM FOR CONTINUOUS CYCLIC PERITONEAL DIALYSIS (CCPD)

Peritoneal dialysis is widely used in clinical practices.The flow controlled sys-tem we have developed is completely under computer control.In order to be as simpleas possible,we use only one valve to control the three stages of peritoneal dialysis,that is the infusion,dwell,and drainage of dialysate.In clinical application the wholetime during which the pipeline is shut is about 8-10 hours for every treatment.In or-der to avoid the phenomenon that the pipeline can’t open after it was closed for

Effect of peritoneal dialysis on inflammatory factors, nutritional index and renal function in patients with chronic renal failure

Objective:To explore the effect of peritoneal dialysis on inflammatory factors, nutritional index and renal function indexes in patients with chronic renal failure, and to provide help for clinical treatment of patients with chronic renal failure. Methods:80 cases of chronic renal failure patients in our hospital were selected as the study group, given peritoneal dialysis treatment;80 healthy people during the same period in our hospital selected as the normal group. The inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α) and IL-8], renal function indices [BUN (Urea nitrogen) and SCR (serum creatinine)] and nutritional index [PA (prealbumin), Hb (hemoglobin), ALB (albumin) and TF (Transferrin)] levels were detected in healthy population and patients with chronic renal failure patients before and after treatment of 1 and 30 d, and the relative significance was analyzed. Results:Compared with the normal group, the inflammatory factors (CRP, IL-6, TNF-αand IL-8) and renal function indices (BUN and SCR) of patients with chronic renal failure in study group increased significantly and nutritional indexes (TF, PA and ALB) decreased significantly (P<0.05). The inflammatory factors (CRP, IL-6, TNF-αand IL-8), nutritional index (TF, PA and ALB) and renal function indices (BUN and SCR) of patients with chronic renal failure by peritoneal dialysis in the treatment of 1 d in research group were significantly lower than the level before treatment, and Hb was significantly higher than that before treatment (P<0.05). After 30 d of dialysis, inflammatory factors (CRP, IL-6, TNF-αand IL-8), nutritional index (TF, PA and ALB) and renal function indices (BUN and SCR) decreased further and Hb increased further (P<0.05). Conclusions:Peritoneal dialysis can improve the inflammatory factors levels of patients with chronic renal failure, reduce the renal function index, and can affect the nutritional index of patients, and has important significance in clinical treatment of patients with chronic renal failure.

Gastrointestinal symptoms in patients undergoing peritoneal dialysis: Multivariate analysis of correlated factors

AIM: To investigate gastrointestinal (GI) symptoms in peritoneal dialysis (PD) patients and to explore related factors contributing to GI symptoms. METHODS: One hundred and twelve patients undergoing PD participated in the study. The gastrointestinal symptom rating scale was used for measuring GI symptoms. Information on age, height, weight, body mass index, disease leading to chronic renal failure, history of corticosteroid therapy, presence of predialytic GI symptoms, daily dosage of pills, and duration, type and daily dialysate volume of PD was obtained by interviewing patients and/or reviewing the medical records. Hemoglobin, albumin and Kt/V data were obtained from follow-up database. We used multiple regression analysis with stepwise backward variable selection to test for factors predicting GSRS scores with significance level of selection entry at 0.05 and selection of stay at 0.10. RESULTS: The prevalence of eating dysfunction, reflux and indigestion in the PD patients was 44.2%, 32.7%,32.7%, respectively. A history of corticosteroid therapy (b = 8.93, P < 0.001) and all pills daily intake (b = 0.16, P = 0.007) were positively correlated to GI symptoms, while residual renal Kt/V (b =-3.47, P = 0.009) was negatively correlated to GI symptoms. Other factors were proven to be not associated with GI symptoms, with P > 0.05. CONCLUSION: Eating dysfunction, reflux and indigestion were common in PD patients. Daily dosage of pills and corticosteroid history predicted GI symptoms, while residual renal function prevented them.

Gastrointestinal symptoms: A comparison between patients undergoing peritoneal dialysis and hemodialysis

AIM: To compare the prevalence and diversity of gastrointestinal (GI) symptoms in patients undergoing peritoneal dialysis (PD) and hemodialysis (HD).

Comparison of clinical features and outcomes in peritoneal dialysisassociated peritonitis patients with and without diabetes:A multicenter retrospective cohort study

BACKGROUND The number of end-stage renal disease patients with diabetes mellitus(DM)who are undergoing peritoneal dialysis is increasing.Peritoneal dialysis-associated peritonitis(PDAP)is a serious complication of peritoneal dialysis leading to technical failure and increased mortality in patients undergoing peritoneal dialysis.The profile of clinical symptoms,distribution of pathogenic organisms,and response of PDAP to medical management in the subset of end-stage renal disease patients with DM have not been reported previously.Discrepant results have been found in long-term prognostic outcomes of PDAP in patients with DM.We inferred that DM is associated with bad outcomes in PDAP patients.AIM To compare the clinical features and outcomes of PDAP between patients with DM and those without.METHODS In this multicenter retrospective cohort study,we enrolled patients who had at least one episode of PDAP during the study period.The patients were followed for a median of 31.1 mo.They were divided into a DM group and a non-DM group.Clinical features,therapeutic outcomes,and long-term prognostic outcomes were compared between the two groups.Risk factors associated with therapeutic outcomes of PDAP were analyzed using multivariable logistic regression.A Cox proportional hazards model was constructed to examine the influence of DM on patient survival and incidence of technical failure.RESULTS Overall,373 episodes occurred in the DM group(n=214)and 692 episodes occurred in the non-DM group(n=395).The rates of abdominal pain and fever were similar in the two groups(P>0.05).The DM group had more infections with coagulase-negative Staphylococcus and less infections with Escherichia coli(E.coli)as compared to the non-DM group(P<0.05).Multivariate logistic regression analysis revealed no association between the presence of diabetes and rates of complete cure,catheter removal,PDAP-related death,or relapse of PDAP(P>0.05).Patients in the DM group were older and had a higher burden of cardiovascular disease,with lower level of serum albumin,but a higher estimated glomerular filtration rate(P<0.05).Cox proportional hazards model confirmed that the presence of diabetes was a significant predictor of all-cause mortality(hazard ratio=1.531,95%confidence interval:1.091-2.148,P<0.05),but did not predict the occurrence of technical failure(P>0.05).CONCLUSION PDAP patients with diabetes have similar symptomology and are predisposed to coagulase-negative Staphylococcus but not E.coli infection compared those without.Diabetes is associated with higher all-cause mortality but not therapeutic outcomes of PDAP.

Peritoneal dialysis for chronic cardiorenal syndrome:Lessons learned from ultrafiltration trials

The current models of cardiorenal syndrome(CRS) are mainly based on a cardiocentric approach; they assume that worsening renal function is an adverse consequence of the decline in cardiac function rather than a separate and independent pathologic phenomenon. If this assumption were true,then mechanical extraction of fluid(i.e.,ultrafiltration therapy) would be expected to portend positive impact on renal hemodynamics and function through improvement in cardio-circulatory physiology and reduction in neurohormonal activation. However,currently available ultrafiltration trials,whether in acute heart failure(AHF) or in CRS,have so far failed to show any improvement in renal function; they have reported no impact or even observed adverse renal outcomes in this setting. Moreover,the presence or absence of renal dysfunction seems to affect the overall safety and efficacy of ultrafiltration therapy in AHF. This manuscript briefly reviews cardiorenal physiology in AHF and concludes that therapeutic options for CRS should not only target cardio-circulatory status of the patients,but they need to also have the ability of addressing the adverse homeostatic consequences of the associated decline in renal function. Peritoneal dialysis(PD) can be such an option for the chronic cases of CRS as it has been shown to provide efficient intracorporeal ultrafiltration and sodium extraction in volume overloaded patients while concurrently correcting the metabolic consequences of diminished renal function. Currently available trials on PD in heart failure have shown the safety and efficacy of this therapeutic modality for patients with chronic CRS and suggest that it could represent a pathophysiologically and conceptually relevant option in this setting.

TREATMENT OF COMPLICATIONS DUE TO PERITONEAL DIALYSIS FOR CHRONIC RENAL FAILURE WITH TRADITIONAL CHINESE MEDICINE

In this paper,the experience in the treatment of complications due to continuousambulatory peritoneal dialysis for chronic renal failure with traditional Chinese medicine(TCM)is reported.Modified Renshen Yangrong Tang(Ginseng Nutrition Decoction)wasused for anorexia and hypoproteinemia;modified Xiangsha Liujunzi Tang(Decoction ofCyperus and Amomum with Six Noble Ingredients)for abdominal pain and distension;modified Da Chaihu Tang(Major Bupleurum Decoction)for peritonitis;modifiedShenling Baizhu San(Powder of Ginseng,Poria and Atractylodes)for diarrhea due toinsufficiency of the spleen with abundance of dampness;Lizhong Tang(Decoction forRegulating the Function of Middle-jiao)and modified Sishen Wan(Pills of FourMiraculous Drugs)for insufficiency of both the spleen and the kidney;Siwu Tang(Decoction of Four Ingredients)added with other drugs for cutaneous pruritus,andGuishao Sijunzi Tang(Decoction of Four Noble Drugs added with Chinese Angelica Rootand white Peony Root)for renal anemia.The therapeutic principles of invigorating theliver and kidney,strengthening the bones and muscles,and promoting blood circulation toeliminate blood stasis were adopted in the treatment of renal osteopathy,and thetherapeutic principles of invigorating the liver and kidney,expelling phlegm and resolvingdampness,and promoting blood circulation to eliminate blood stasis in the treatment ofhyperlipemia.Shen Tekang capsules(capsules for improving the renal function)wasadministered to patients for strengthening the viability and improving the nutrition state,and the recipe for treating renal function failure(both formulated by the authors)forimproving the renal function so as to decrease the frequency and duration of dialysis.