[Show abstract][Hide abstract]ABSTRACT: GFR BEFORE, AT START AND 1ST VISIT AFTER STARTING PD
Yan Dorneich, Filitsa Bender, Heena Sheth, Beth Piraino
University of Pittsburgh School of Medicine, Pittsburgh PA, USA.
A number of studies have examined the loss of residual kidney function (RKF) on PD over years but there are few data on whether starting PD has an immediate impact on RKF. We studied incident PD patients to examine this question.
Chart reviews were done on 10 CKD patients started on PD between 12/14 to 10/15. All signed consent to participate in an IRB approved PD registry. Those who started on HD and transferred to PD were excluded. Paired t test examined changes in eGFR (MDRD) and 24 hr urine GFR (24 U, average urea N and cr cl) done at start and at 1st visit on PD)and regression to compare eGFR with 24 U. All trained on APD.
Mean age of the patients was 55 y, 40% were women, 20% were African American and 20% were diabetic. Results by patients:
Patient eGFR eGFR 24 U 24 U tKt/V
referral start start 1st visit 1st visit
1 16 16 16.5 16.1 3.27
2 9.6 10.0 8.1 8.0 1.72
3 9 15 19.5 21.4 4.46
4 7.0 8.0 5.5 6.7 2.57
5 6.0 5.0 9.1 9.2 2.55
6 6.0 5.0 12.1 10.8 3.09
7 6 5 5.4 5.3 3.42
8 5 4 5.6 6.0 1.72
9 5 5 4.4 2.6 1.79
10 4 3 5.0 4.4 1.86
eGFR referral for PD catheter (~ 1-8 wk before start PD) vs eGFR start p = 0.4; 24 U start vs 24 U 1st visit p=0.6; eGFR and 24U at start, r=0.8, p=0.002, R2=0.7, p=0.002. At PD start eGFR and 24 U GFR were different by >4 ml/min in 3 patients (30%) but overall there was a good correlation. Mean 24 U clearance did not change from start (9.1) to first visit at one month (9.1).
To summarize, eGFR gives a reasonable approximation of measured GFR by 24 U in the majority of patients. The initiation of APD did not have an immediate negative impact RKF in this small sample but larger numbers should be studied.
[Show abstract][Hide abstract]ABSTRACT: Background: Daily gentamicin cream exit-site prophylaxis reduces peritoneal dialysis (PD)-related gram-negative infections. However, there is a concern about the potential for increasing gentamicin resistance with the long-term use of prophylactic gentamicin. This study evaluated the incidence of gentamicin-resistant PD-related infections over more than 2 decades. ♦ Methods: Study data on prevalent PD patients were retrieved from a prospectively maintained institutional review board (IRB)-approved PD registry at a single center from January 1, 1991, to December 31, 2000, and January 1, 2004, to December 31, 2013. The rates of gram-negative infections, fungal infections and those infections with organisms resistant to gentamicin were examined for the 2 periods. Period 1 from 1991 to 2000 when S. aureus prophylaxis consisted initially of oral rifampin to treat nasal carriage with S. aureus, and was then daily exit-site mupirocin ointment for all PD patients, was compared to the period from 2004 to 2013 when daily exit-site gentamicin cream was prescribed as prophylaxis (Period 2). ♦ Results: The study included a total of 444 PD patients (265 and 179 in Period 1 and Period 2, respectively). No significant difference was noted in demographics between the 2 periods except race. The gram-negative exit-site infection rates for Period 1 and Period 2 were 0.109 versus 0.027 (p < 0.0001). Gram-negative peritonitis rates were similar. There were 3 episodes of gentamicin-resistant infections in each period. Fungal infections remained consistently low. ♦ Conclusion: Despite a decade of exit-site gentamicin prophylaxis, gentamicin-resistant PD-related infections and fungal infections remained very low and similar to the prior period.
Full-text Article · Dec 2015 · Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis
[Show abstract][Hide abstract]ABSTRACT: Studies have shown that a single-item question might be useful in identifying patients with limited health literacy. However, the utility of the approach has not been studied in patients receiving maintenance peritoneal dialysis (PD). We assessed health literacy in a cohort of 31 PD patients by administering the Rapid Estimate of Adult Literacy in Medicine (REALM) and a single-item health literacy (SHL) screening question "How confident are you filling out medical forms by yourself?" (Extremely, Quite a bit, Somewhat, A little bit, or Not at all). To determine the accuracy of the single-item question for detecting limited health literacy, we performed sensitivity and specificity analyses of the SHL and plotted the area under the receiver operating characteristic (AUROC) curve using the REALM as a reference standard. Using a cut-off of "Somewhat" or less confident, the sensitivity of the SHL for detecting limited health literacy was 80%, and the specificity was 88%. The positive likelihood ratio was 6.9. The SHL had an AUROC of 0.79 (95% confidence interval: 0.52 to 1.00). Our results show that the SHL could be effective in detecting limited health literacy in PD patients.
Article · Oct 2014 · Advances in peritoneal dialysis. Conference on Peritoneal Dialysis
[Show abstract][Hide abstract]ABSTRACT: This review is focused on minimizing complications and avoiding harm in peritoneal dialysis (PD) patients. Issues related to planning for PD are covered first, with emphasis on PD versus hemodialysis outcomes. Catheter types and insertion techniques are described next, including relevant recommendations by the International Society for Peritoneal Dialysis. A brief review of both noninfectious and infectious complications follows, with emphasis on cardiovascular and metabolic complications. Finally, recommendations for preventing PD-related infections are provided. In conclusion, with proper catheter insertion technique, good training, and attention to detail during the tenure in PD, excellent outcomes can be obtained in a well-informed motivated patient.
Article · May 2012 · Advances in chronic kidney disease
[Show abstract][Hide abstract]ABSTRACT: Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of peritoneal dialysis. Few data are available from the United States about the incidence of EPS over time. To examine that question, we retrospectively examined our PD registry, in existence for 30 years, to identify patients with EPS. All other data were collected prospectively. We asked a radiologist to review all computed tomography (CT) scans taken at the time of EPS diagnosis. Incidence of EPS in our 676 patients was 1.2%, but rose to 15% after 6 years, and 38% after 9 years on PD. Peritonitis rates were not high in patients that developed EPS. Scoring of CT scans confirmed the diagnosis of EPS in all patients. Treatment was variable, but in recent years, steroids and tamoxifen were generally used when EPS was recognized. Mortality related to EPS was 38%. Several years after diagnosis, 3 patients are still alive; none is on total parenteral nutrition. In summary, the risk of EPS is low early in the course of PD, but increases progressively at 6 years and beyond. Imaging by CT is useful for diagnosing EPS. Our preliminary results suggest that steroids and tamoxifen are beneficial. Multicenter studies on this serious problem are needed.
Full-text Article · Jan 2010 · Advances in peritoneal dialysis. Conference on Peritoneal Dialysis
[Show abstract][Hide abstract]ABSTRACT: Home dialysis in the United States, both home hemodialysis and peritoneal dialysis, peaked in the early 1990s. Since then, there has been a striking increase in the numbers and proportion of patients on in-center home hemodialysis (HD). As of 2008, there were approximately 27,000 patients on peritoneal dialysis (PD) and 2,455 on home HD with over 300,000 on in-center HD. There are multiple barriers to home dialysis in the United States, including lack of adequate patient education on modalities prior to starting dialysis, physician competence with home dialysis, lack of infrastructure in many programs for home dialysis, and a misinterpretation of literature and research with selection bias that suggests higher mortality on PD versus in-center HD. These barriers to home dialysis can be overcome.
Full-text Article · Jun 2009 · Advances in chronic kidney disease