Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis最新文献

{"title":"Impact of assistance on peritonitis due to breach in aseptic procedure in diabetic patients: A cohort study with the RDPLF data.","authors":"Clémence Béchade,&nbsp;Antoine Lanot,&nbsp;Sonia Guillouët,&nbsp;Maxence Ficheux,&nbsp;Annabel Boyer,&nbsp;Thierry Lobbedez","doi":"10.1177/08968608211039669","DOIUrl":"https://doi.org/10.1177/08968608211039669","url":null,"abstract":"<p><strong>Background: </strong>Diabetic patients often have physical impairment that could lead to manipulation errors in peritoneal dialysis (PD) and touch contamination. Nurse assistance in diabetic PD patients is known to help prevent peritonitis. We made the hypothesis that this lower risk of peritonitis was observed thanks to prevention of breach in aseptic procedure. We evaluated the impact of nurse-assisted PD on specific causes of peritonitis, especially on peritonitis due to a breach in aseptic procedure.</p><p><strong>Methods: </strong>This was a retrospective observational study of the data from the French Language Peritoneal Dialysis Registry. All diabetic patients older than age 18 years starting PD in France between 1 January 2012 and 31 December 2015 were included in the study. The event of interest was the first peritonitis event due to a breach in aseptic procedure. Death, kidney transplantation and peritonitis due to another mechanism were considered as competing events. We examined the association of the covariates with all the possible outcomes using a subdistribution hazard model developed for survival analysis in the presence of competing risks.</p><p><strong>Results: </strong>Four thousand one hundred one diabetic patients incident in PD were included in the study. At least one peritonitis event occurred in 1611 patients over the study period. A breach in aseptic procedure was reported in 441/1611 cases (27.3%): 209/575 (36.3%) in the self-care PD group, 56/217 (25.8%) in the family-assisted PD group and 176/819 (21.5%) in the nurse-assisted PD group. Both nurse and family assistance were associated with a lower risk of peritonitis due to breach in aseptic procedure in bivariate analysis. After adjustment on age, modified Charlson index, sex and diabetic nephropathy, patients treated by nurse-assisted PD (subdistribution hazard ratio (sd-HR) 0.52, 95% confidence interval (CI) 0.40-0.67) and those treated by family-assisted PD (sd-HR 0.70, 95% CI 0.51-0.95) had a lower likelihood of peritonitis due to a connection error compared to self-care PD in multivariate analysis. The modality of assistance was not associated with other causes of peritonitis in the multivariate analysis.</p><p><strong>Conclusion: </strong>While both nurse-assisted PD and family-assisted PD were associated with lower risk of peritonitis due to a breach in aseptic procedure compared to self-care PD in our study, the protective effect was greater with nurse assistance.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"185-193"},"PeriodicalIF":2.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39413501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes of antibiotic resistance over time among <i>Escherichia coli</i> peritonitis in Southern China.","authors":"Haishan Wu,&nbsp;Chunyan Yi,&nbsp;Dihua Zhang,&nbsp;Qunying Guo,&nbsp;Jianxiong Lin,&nbsp;Haiping Mao,&nbsp;Fengxian Huang,&nbsp;Xueqing Yu,&nbsp;Xiao Yang","doi":"10.1177/08968608211045272","DOIUrl":"https://doi.org/10.1177/08968608211045272","url":null,"abstract":"<p><p><i>Escherichia coli</i> (<i>E. coli</i>) is the main cause of Gram-negative bacterial peritonitis among peritoneal dialysis patients. According to the 2016 update of the International Society for Peritoneal Dialysis Peritonitis Recommendations, drug susceptibilities of specific organisms should be regularly monitored. The aim of this study was to examine the evolution of antimicrobial resistance of <i>E. coli</i> peritonitis from 2006 to 2018. Two hundred and fifty-three episodes of <i>E. coli</i> peritonitis were enrolled in our study, corresponding to a rate of 0.024 episodes per patient-year. According to drug sensitivity test results, isolates were most sensitive to carbapenems, followed by cefmetazole, piperacillin/tazobactam, cefotetan and amikacin, with an overall rate of more than 90% in both cohorts. Cefazolin and ciprofloxacin resistance increased significantly from 2006-2011 to 2012-2018. Conversely, cefepime and ceftazidime resistance decreased significantly. The extended-spectrum β-lactamase (ESBL) rate fluctuated from 34.7% in 2006-2011 to 46.8% in 2012-2018. Compared with the ESBL-negative strains, ESBL-producing <i>E. coli</i> were more likely be resistant to ampicillin, ampicillin/sulbactam, cephalosporins, quinolones, aminoglycosides, furadantin and sulfamethoxazole and accounted for over 50% of the drug resistance. In the correlation analysis, <i>E. coli</i> displayed significantly increased resistance to cefazolin and ciprofloxacin, a finding correlated with ESBL production (<i>r</i> = 0.883 and 0.276 respectively, <i>p</i> < 0.001 and <i>p</i> = 0.003). In conclusion, the rate of <i>E. coli</i> peritonitis declined stably in recent years, but the resistance to antimicrobial was high.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"218-222"},"PeriodicalIF":2.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39488036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of peritonitis after gastroscopy in peritoneal dialysis patients.","authors":"Gordon Chun-Kau Chan,&nbsp;Sunny Hei Wong,&nbsp;Jack Kit-Chung Ng,&nbsp;Philip Kam-Tao Li,&nbsp;Cheuk-Chun Szeto,&nbsp;Kai-Ming Chow","doi":"10.1177/08968608211018608","DOIUrl":"https://doi.org/10.1177/08968608211018608","url":null,"abstract":"<p><strong>Background: </strong>Peritonitis is a common and serious complication of peritoneal dialysis (PD). Translocation of gut bacteria to peritoneum is an important mechanism, which may be enhanced by gastrointestinal endoscopy.</p><p><strong>Methods: </strong>In this retrospective observational cohort study, we identified 450 gastroscopies performed in PD patients within a single centre between 2014 and 2019. Gastroscopy-related peritonitis was defined by peritonitis within 1 week after endoscopy.</p><p><strong>Results: </strong>A total of 408 endoscopic episodes in 216 patients were analysed after excluding 42 cases with either pre-existing peritonitis before endoscopy, or concomitant biliary, small bowel or large bowel endoscopy. There were 16 episodes of peritonitis within 1 week of endoscopy (3.9%). One-quarter of cases were polymicrobial (four episodes, 25.0%). Logistic regression model showed that patient's age, number of endoscopic biopsies, and histamine-2 receptor blocker use were independently associated with peritonitis, while prior antibiotics exposure was associated with lower risk of peritonitis, odds ratio 0.23 (95% confidence interval 0.06-0.95; <i>p</i> = 0.04).</p><p><strong>Conclusion: </strong>Peritonitis can complicate gastroscopy in PD patients and occurs more often in elderly or after repeated biopsy procedures.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"162-170"},"PeriodicalIF":2.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08968608211018608","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38946289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the use of exchange devices for peritoneal dialysis fluids and peritonitis incidence: A nationwide cohort study.","authors":"Takeshi Hasegawa,&nbsp;Hisashi Noma,&nbsp;Takayuki Hamano,&nbsp;Masanori Abe,&nbsp;Atsushi Wada,&nbsp;Hirokazu Honda,&nbsp;Yasuhiko Ito,&nbsp;Ikuto Masakane,&nbsp;Kosaku Nitta","doi":"10.1177/08968608211051591","DOIUrl":"https://doi.org/10.1177/08968608211051591","url":null,"abstract":"<p><strong>Background: </strong>The use of exchange devices for peritoneal dialysis (PD) fluids is a common practice in Japan. Evidence on the effectiveness of exchange devices in preventing PD-related peritonitis is scarce. We evaluated the association between the use of exchange devices for PD fluids and peritonitis incidence.</p><p><strong>Methods: </strong>We retrospectively enrolled 3845 patients, aged ≥20 years, receiving PD for ≥3 months, with available data on the exchange procedure for PD fluids and peritonitis incidence that was obtained from the Japan Renal Data Registry, a nationwide annual survey. The patients were grouped according to whether the manual or device PD fluid exchange method was used. The onset of peritonitis was defined as a leukocyte count of >100/µL (neutrophils ≥50%) in PD effluents. We applied quasi-Poisson regression analyses to estimate the incidence rate ratio (IRR). Age, sex, PD vintage, body mass index, automated PD use, residual kidney function, comorbidities, haemoglobin and serum albumin were adjusted as potential confounders.</p><p><strong>Results: </strong>Older age, automated PD use, diabetes as comorbidity and lower haemoglobin levels were associated with the use of exchange devices for PD fluids. Patients using devices for PD fluid exchange (69.2%) had an increased risk of peritonitis of 37% (IRR: 1.37, 95% confidence interval (CI): 1.07-1.75) and 28% (IRR: 1.28, 95% CI: 1.00-1.63) in the crude and multivariate adjustment models, respectively.</p><p><strong>Conclusions: </strong>The use of exchange devices for PD fluids and peritonitis incidence showed no favourable association. There may remain possible residual confounding by indication.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"177-184"},"PeriodicalIF":2.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39554697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of radiological imaging on treatment delay and hospitalisation in patients with peritoneal dialysis-related peritonitis: A secondary analysis of the PROMPT study.","authors":"K Muthucumarana,&nbsp;P Howson,&nbsp;S Burrows,&nbsp;S Swaminathan,&nbsp;A Irish","doi":"10.1177/08968608211065871","DOIUrl":"https://doi.org/10.1177/08968608211065871","url":null,"abstract":"<p><strong>Background: </strong>In peritoneal dialysis-related peritonitis (peritonitis), delayed antibiotic therapy is associated with adverse outcomes. Identifying barriers to timely treatment may improve outcomes.</p><p><strong>Aim: </strong>To determine the impact of radiological investigations on treatment delay and predictors of hospitalisation and length of stay (LOS).</p><p><strong>Methods: </strong>Retrospective review of patients with presumed peritonitis in Western Australia.</p><p><strong>Results: </strong>In 153 episodes of peritonitis, 79 (51.6%) resulted in admission with a median LOS of 3 days (Q1, Q3: 1, 6). In a multivariable model, significant predictors of admission were abnormal exit-site (odds ration (OR) 5.7; 95% confidence interval (CI): 1.4, 23.6; <i>p</i> = 0.02), failure to detect a cloudy bag (OR 11.9; 95%CI: 3.2, 44.7; <i>p</i> < 0.001), female sex (OR 3.3; 95% CI: 1.4, 9.7; <i>p</i> = 0.027), radiological imaging within 24 h (OR 8.8; 95% CI: 2.2, 34.8; <i>p</i> = 0.002) and contact with ambulant care facility (OR 0.32, 95% CI: 0.11, 0.98; <i>p</i> = 0.04). Imaging within 24 h of presentation occurred in 41 (27%) episodes of peritonitis, mostly plain X-rays (91%), of which 83% were clinically irrelevant. Imaging performed within 24 h of presentation increased the median time to antibiotic treatment (2.9 h (Q1, Q3: 1.6, 6.4) vs 2.0 h (Q1, Q3: 1, 3.8; <i>p</i> = 0.046)). Imaging performed prior to administering antibiotics significantly increased the median time to treatment (4.7 h (Q1, Q3: 2.9, 25) vs 1.5 h (Q1, Q3: 0.75, 2.5; <i>p</i> < 0.001)) in those where imaging followed antibiotic treatment.</p><p><strong>Conclusions: </strong>Half of all presentations with peritonitis result in hospital admission. Radiological imaging was associated with an increased risk of hospitalisation, potentially contributes to treatment delay, and was mostly clinically unnecessary. When required, imaging should follow antibiotic therapy.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"154-161"},"PeriodicalIF":2.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39744197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical course of peritoneal dialysis-related peritonitis due to non-tuberculosis mycobacterium - A single centre experience spanning 20 years.","authors":"Winston Wing-Shing Fung,&nbsp;Kai-Ming Chow,&nbsp;Philip Kam-Tao Li,&nbsp;Cheuk-Chun Szeto","doi":"10.1177/08968608211042434","DOIUrl":"https://doi.org/10.1177/08968608211042434","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis (PD)-related peritonitis caused by non-tuberculous mycobacteria (NTM) are difficult to diagnose, is associated with significant morbidity and mortality, and clinical course remains unclear. We determined the prevalence and clinical course of peritonitis caused by these organisms through our kidney registry over 20-year period.</p><p><strong>Method: </strong>We reviewed all patients with NTM peritonitis identified in our tertiary centre between July 2000 and July 2020. The demographic characteristics, microbiological and clinical outcomes were examined.</p><p><strong>Result: </strong>Among 27 patients identified, 20 patients presented with abdominal pain and all had cloudy peritoneal fluid. Twenty-one cases had concomitant exit site infection and 14 cases had prior antibiotic use. The majority of the cases are caused by <i>Mycobacterium chelonae</i> (37%) and <i>Mycobacterium fortuitum</i> (29.7%), with most being resistant to fluoroquinolones (59.3%) and cefoxitin (73.1%). They are all sensitive to amikacin otherwise. None of the cases achieve primary response at day 10 and 20 cases resulted in Tenckhoff catheter removal. Only two of them were able to resume PD. Eight patients died in our cohort. The presence of exit site infection, the use of prior antibiotics and topical disinfectants did not associate with a poorer outcome.</p><p><strong>Conclusion: </strong>NTM peritonitis remains difficult to treat and often with a delay in diagnosis. Refractory peritonitis with negative culture and a poor response to standard antibiotics should raise a possibility of NTM infection and prompt catheter removal and an expert with experience treating NTM infections should be consulted.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"204-211"},"PeriodicalIF":2.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39397134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of cyanoacrylate glue to seal an early pericatheter leak.","authors":"Vishal Pooniya,&nbsp;S Namrata Rao,&nbsp;Abhilash Chandra,&nbsp;Sanjeet Singh","doi":"10.1177/08968608211014645","DOIUrl":"https://doi.org/10.1177/08968608211014645","url":null,"abstract":"Dialysate leaks early after peritoneal dialysis (PD) initiation constitute a common mechanical complication, with incidence varying between 5% and 10%, more so in patients with chronic liver disease with pre-existing ascites. We describe the successful use of cyanoacrylate glue in the management of early and persistent pericatheter PD leak in a patient with liver cirrhosis and end-stage renal disease. The index case is a 61-year-old male patient, with diabetic end-stage renal disease and decompensated liver disease with ascites. The patient underwent percutaneous straight Tenckhoff catheter insertion via median infraumbilical incision, with complete drainage of peritoneal fluid post-insertion and thrice in the first 2 weeks. Upon initiating PD on day 15, the patient developed a pericatheter dialysate leak at the catheter insertion site, which persisted despite PD discontinuation and fluid drainage over next 2 weeks. Thereafter, under ultrasound guidance, the catheter cuff was located in the pre-peritoneal plane, surrounded by a hypoechoic collection, up to 1 cm in thickness (Figure 1). Using a 24G needle, up to 8–10 ml of clear straw-coloured fluid was drained from around the cuff. With the needle in the same location, 1 ml of 1-butyl N-cyanoacrylate (Endocryl; Samarth Life Sciences, Mumbai, Maharashtra, India) was injected in the peri-cuff area. Two days later, PD was re-initiated successfully and continuing without leaks as on the last follow-up on day 102. Temporary discontinuation of PD, surgical repair and transfer to automated peritoneal dialysis using a cycler are the most commonly practised approaches for handling leaks. In adults, Joffe and Herbrig described two cases of percutaneous fibrin glue use, in an external and a subcutaneous leak, respectively. However, the cost of fibrin glue is quite high and, in the Indian scenario, matches the cost of a straight Tenckhoff catheter. Cyanoacrylate glue, on the other hand, costs up to 20 times lesser, has demonstrated excellent tissue adhesive properties and we have used this glue safely earlier to seal post paracentesis site leaks in patients with cirrhosis. There are theoretical concerns with regard to degradation of silicone material upon prolonged contact to cyanoacrylates; however, clinical experience with cyanoacrylate used in closure of urinary fistulas in adults on silicone urinary catheters did not report any damage to the catheter. Also, utilising a paramedian catheter insertion site and prophylactic glue injection might have prevented the development of the leak. To the best of our knowledge, this is the first case to describe the successful use of cyanoacrylate glue in the management of external dialysate leak in a patient on PD. With further experience, cyanoacrylate glue could be considered as an alternate to fibrin glue for sealing post-insertion leaks when fibrin glue is not available or where the cost is prohibitive.","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"513-514"},"PeriodicalIF":2.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08968608211014645","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38971836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growing home dialysis: The Ontario Renal Network Home Dialysis Initiative 2012-2019.","authors":"Peter G Blake,&nbsp;Brendan B McCormick,&nbsp;Leena Taji,&nbsp;James Kh Jung,&nbsp;Jane Ip,&nbsp;Joanie Gingras,&nbsp;Phil Boll,&nbsp;Phil McFarlane,&nbsp;Andreas Pierratos,&nbsp;Anas Aziz,&nbsp;Angie Yeung,&nbsp;Monisha Patel,&nbsp;Rebecca Cooper","doi":"10.1177/08968608211012805","DOIUrl":"https://doi.org/10.1177/08968608211012805","url":null,"abstract":"<p><p>The Ontario Renal Network (ORN), a provincial government agency in Ontario, Canada, launched an initiative in 2012 to increase home dialysis use province-wide. The initiative included a new modality-based funding formula, a standard mandatory informatics system, targets for prevalent home dialysis rates, the development of a 'network' of renal programmes with commitment to home dialysis and a culture of accountability with frequent meetings between ORN and each renal programme leadership to review their results. It also included funding of home dialysis coordinators, encouragement and funding of assisted peritoneal dialysis (PD), and support for catheter insertion and urgent start PD. Between 2012 and 2017, home dialysis use rose from 21.9% to 26.5% and then between 2017 and 2019 stabilised at 26% to 26.5%. Over 7 years, the absolute number of people on home dialysis increased 40% from 2222 to 3105, while the number on facility haemodialysis grew 11% from 7935 to 8767. PD prevalence rose from 16.6% to 20.9%, a relative increase of 25%. The initiative showed that a sustained multifaceted approach can increase home dialysis utilisation.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"441-452"},"PeriodicalIF":2.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08968608211012805","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38977093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ecological momentary assessment to explore fatigue, mood and physical activity levels in people receiving peritoneal dialysis: A study protocol.","authors":"Brett Tarca,&nbsp;Shilpanjali Jesudason,&nbsp;Richard Le Leu,&nbsp;Michelle Ovenden,&nbsp;Monique Borlace,&nbsp;Anthony Meade,&nbsp;Paul N Bennett,&nbsp;Thomas P Wycherley,&nbsp;Terry Boyle,&nbsp;Katia E Ferrar","doi":"10.1177/0896860821992243","DOIUrl":"https://doi.org/10.1177/0896860821992243","url":null,"abstract":"<p><strong>Introduction: </strong>Fatigue is a frequent and debilitating symptom for people with end-stage kidney disease (ESKD) receiving dialysis. Ecological momentary assessment (EMA) allows real-time data capture of day-to-day and diurnal variations. EMA has been used to study haemodialysis-related fatigue but not in people receiving peritoneal dialysis who are unique in their physical, environmental and logistical characteristics. The aim of this study is to explore the real-time associations between fatigue and mood (EMA mobile application) and objective physical activity levels (accelerometry) in people with EKSD receiving peritoneal dialysis.</p><p><strong>Method: </strong>A 7-day intensive longitudinal study will be conducted. People receiving peritoneal dialysis within South Australia will be invited to participate. Five times throughout the day, participants will be prompted to answer 18 questions relating to fatigue (Visual Analogue Scale to Evaluate Fatigue Severity) and a single question for mood (Visual Analogue Mood Scale). Participants will continuously wear a GENEActiv accelerometer to capture physical activity levels during the 7-day period. At the completion of the data collection, participants will answer questions to evaluate the feasibility and acceptability of using EMA.</p><p><strong>Discussion: </strong>This study will be the first to explore the real-time relationships between fatigue, mood and physical activity in people with ESKD receiving peritoneal dialysis. Understanding the fluctuations people experience and the relationships between mood and physical activity and fatigue will inform clinical management and well-being intervention development.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"502-508"},"PeriodicalIF":2.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0896860821992243","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25357211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulling the goalie: What the United States and the world can learn from Canada about growing home dialysis.","authors":"Graham Abra,&nbsp;Eric D Weinhandl","doi":"10.1177/08968608211034696","DOIUrl":"https://doi.org/10.1177/08968608211034696","url":null,"abstract":"Both peritoneal dialysis (PD) and home haemodialysis (HHD) offer well-documented advantages and are typically associated with lower total costs in high-income countries. In the United States (US), the last decade has seen growth in these modalities, at least partially driven by payment changes, and continuing during the COVID-19 global pandemic (Figure 1). Despite this growth, prevalent utilisation of home dialysis in the US still lags utilisation in other high-income countries, including Australia (25%), Canada (25%), New Zealand (44%) and the United Kingdom (17%). The Presidential Executive Order on Advancing American Kidney Health (AAKH), promulgated in July 2019, set a 2025 target of 80% of patients with newly diagnosed endstage kidney disease (ESKD) initiating kidney replacement therapy with either home dialysis or a pre-emptive kidney transplant. Although this goal is not compulsory, both mandatoryand voluntary-participation payment models have been developed to drive progress towards this goal. These models include financial bonuses (up to 8%) and penalties (up to 10%) for dialysis provider organisations and nephrologists to increase utilisation of home dialysis and kidney transplantation. Of course, there are many barriers to home dialysis. Whether a predominantly financial approach will be effective is uncertain, considering a mixed track record of financial incentives successfully expanding home dialysis use outside the US.","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"437-440"},"PeriodicalIF":2.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08968608211034696","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39262069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}