Nolph and Gokal's Textbook of Peritoneal Dialysis

Preface to the Fourth Edition
Preface to the Second Edition
Preface to the First Edition
Acknowledgments
Contents
About the Editors
Contributors
1 History of Peritoneal Dialysis
The Discovery of Principles of Dialysis: Diffusion and Ultrafiltration. Thomas Graham and Henri Dutrochet
The Peritoneal Cavity and the Peritoneal Membrane
The Birth of Clinical Dialysis
First Attempts at Peritoneal Dialysis: Georg Ganter (1923)
Early Experience in Peritoneal Dialysis (1923-1950)
The Modern Era of Peritoneal Dialysis
First Step in Long-Term Peritoneal Dialysis: Intermittent Peritoneal Dialysis
The Tenckhoff Catheter
The Growth of and Disappointment with Intermittent/Periodic Peritoneal Dialysis
Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD with Plastic Bags
The Y-Set and ``Flush Before Fill´´ Technique
Automated Peritoneal Dialysis (APD)
Peritoneal Dialysis Catheters
Peritoneal Dialysis Solutions
Current State of Peritoneal Dialysis
Conclusion
References
2 Current Status and Growth of Peritoneal Dialysis
Introduction
Trends in the PD Technique
Trends in Catheter Design
Trends in Connectology
Trends in PD Solutions
Trends in Types of PD
Automated PD (APD)
Assisted PD
Epidemiology
Number of Patients on PD
Growth of Automated PD
Factors Affecting the Choice of PD
Medical Factors
Patient Education
Physician Bias
Economic Factors
Outcomes of PD
Hemodialysis and Peritoneal Dialysis: Survival Comparison
Residual Renal Function
Technique Failure
Adequacy of Small Molecule Clearance
Nutritional Status
The Malnutrition-Inflammation-Atherosclerosis (MIA) Syndrome
Protein Loss in the Dialysate
Strategies to Improve Protein-Energy Wasting in PD Patients
Obesity
Cardiovascular Effects of PD
Anemia in Patients on PD
Infectious Complications of PD
Encapsulating Peritoneal Sclerosis (EPS)
Psychosocial Benefits of PD
Financial Benefits of PD
Future Directions
References
3 Patient Survival Comparisons Between Peritoneal Dialysis and Hemodialysis
Introduction
Points to Consider When Interpreting Survival Analyses in Dialysis Therapy
The Use of Prevalent Versus Incident Patients
As-Treated (AT) Versus Intent-to-Treat Analysis (ITT)
When to Enter Patients in Comparative Studies
Adjustment for Baseline Confounders
Statistical Methods for Comparison of Patient Survival
Clinical Factors
The Studies
Randomized Trials
Registry-Based Studies
Prospective Cohort Studies
What Conclusions Can be Made Regarding Patient Survival in PD Compared with HD?
References
4 Peritoneal Structure and Changes as a Dialysis Membrane After Peritoneal Dialysis
Introduction
Peritoneal Microanatomy and Histology
Normal Mesothelium Cell Biology
The Submesothelial Basement Membrane
Ultrastructure of Peritoneal Fluid Mesothelial Cells
Interstitium
Blood Vascular System
Terminology of the Peritoneal Blood Vessel System
Types of Capillary Endothelial Cell in the Peritoneum
Continuous Capillary
Fenestrated Capillary: Endothelial Fenestration and Fenestral Diaphragm
Endothelial Transcellular Transport: Pinocytosis and Endocytosis
Junctional Apparatus of the Endothelium: TJ, AJ, and GJ
Basement Membrane of the Endothelium
Glycocalyx of the Endothelium
Water Transport Across the Endothelium
Lymphatic Vascular System
Peritoneal Membrane at Baseline Conditions
Anatomy Studies
Functional Studies
Cytology of the Peritoneal Fluid Cells
The Pore Concept in Anatomy of Peritoneum
Peritoneal Membrane After Peritoneal Dialysis: Anatomy Studies at Short Term
Mesothelial Cell, Submesothelial Basement Membrane, and Interstitium: The Concept of MMT and Senescence of Mesothelium - Two F...
The Mesothelium and Submesothelial Basal Membrane
The Interstitium: Simple Peritoneal Sclerosis
Anatomical Basis of Ultrafiltration Failure
Angiogenesis
Hyalinizing Vasculopathy
Peritoneal Membrane After Long-Term Dialysis: EPS
Macroscopic Alterations of Peritoneal Findings in Patients on PD (Laparoscopic Findings)
Characteristic Macroscopic Findings in Patients on PD
Points of Macroscopic Finding in Patients on PD
Final Remarks
References
5 The Physiology and Pathophysiology of Peritoneal Transport
The Surface Area of the Peritoneum
Pathways and Barriers
Mechanisms of Solute Transport
Size-Selectivity
Electric Charge
Peritoneal Blood Flow
The Regulation of Surface Area and Permeability
Models and Parameters of Solute Transport
Physiology of High/Fast Transporters
Fast Transport Status and Prognosis
Types of Fast Transport Status
Inherent Fast Transporters
Acquired Fast Transporters
Treatment of Patients with a Fast Transport Status
Transport of Electrolytes
Transport of Macromolecules
Transport from the Peritoneal Cavity
Low Molecular Weight Solutes
Effects of Bidirectional Anion Transport on Acid-Base Status
Macromolecules
Fluid Transport
Transcapillary Ultrafiltration
Lymphatic Absorption
Peritoneal Pathophysiology During Infectious Peritonitis
References
6 Peritoneal Dialysis Program Organization and Management
Introduction
Structure and Function of a PD Program
Physical Structure and Program Operation
Patient Safety
Infection Control for Peritoneal Dialysis
Hand Hygiene
Immunizations
Dialysate Disposal
Standard Operating Procedure, Policy, and Procedure Development
The Interdisciplinary Healthcare Team
Patient Intake
Education of the Patient with Chronic Kidney Disease
Transitional Dialysis Care
Urgent-Start Peritoneal Dialysis
Assisted Peritoneal Dialysis
PD Patient Education and Training for Home Dialysis
Prevention of Infection
Exit Site
Peritonitis
Swimming
Warming Dialysis Solutions
Follow-Up Post Home Training
Home Visits
Clinic Visits
Communication Between Visits
Long-Term Management
Retraining
Providing On-Call Coverage
The Hospitalized PD Patient
PD in Long-Term Care Facilities
Modality Transfers
Quality Improvement Program
Financial Considerations
Risk Management
Special Considerations
Employment
Exercise
Travel
Disaster Preparation
Roles of the PD Nurse
Conclusion
References
7 Peritoneal Dialysis Access and Exit-Site Care Including Surgical Aspects
Glossary
Historical Perspective
Currently Used Chronic Peritoneal Catheters
Straight and Coiled Tenckhoff Catheters
Swan-Neck Catheters
Swan-Neck Tenckhoff Straight and Coiled Catheters
Swan-Neck Missouri Straight Catheter
Swan-Neck Missouri Coiled Catheter
Swan-Neck Presternal Catheter
Moncrief-Popovich Catheter
Radiopaque Stripe
Other Catheters
Accessories for Implantation of Catheters
Stencils
Stiffening Stylet
Tunneling Devices
Tenckhoff Trochar
Scanlan Tunneler/Bard Tunneler
Exit Trochar
Peritoneoscopic Equipment
Seldinger (Guidewire) with Peel-Away Sheath Equipment
Titanium Connectors, Tyton Ties, and a Tension Tool
Insertion of Rigid Catheters
Rigid Catheters for Acute Dialysis
Preinsertion Patient Assessment and Preparation
Insertion Technique
Complications
Insertion of Soft Catheters
Patient Preparation
Acute Dialysis
Chronic Dialysis
Abdominal Exit
Presternal Exit
Catheter Preparation
Implantation Method
Blind (Tenckhoff Trochar)
Peritoneoscopic
Seldinger (Guidewire) and Peel-Away Sheath
Surgical (by Dissection)
Swan-Neck Abdominal Missouri
Swan-Neck Presternal
Tenckhoff
Swan-Neck Tenckhoff
Moncrief-Popovich Technique
Laparoscopic Technique
Immediate and Early Postoperative Care
Factors Influencing Catheter Complications
Tissue Reaction to a Foreign Body Penetrating Skin
Tunnel Morphology after Healing Process Is Completed
Factors Influencing Healing and Early Infection
Tissue Perfusion
Mechanical Factors
Microorganisms
Epithelialization
Cleansing Agents
Exit Direction
Systemic Factors
Factors Influencing Infection of Healed Catheter Tunnel
Bacterial Colonization of the Sinus
Nasal Carriage of S. aureus
Catheter Skin-Exit Direction
Swan-Neck Catheters
Sinus Tract Length
Number and Location of Cuffs
Material for the External Cuff and Tubing in the Sinus
Exit Sites: Classification and Care
Exit-Site Appearance Post Implantation
Classification of Exit-Site Appearance
Acute Catheter Exit-Site Infection
Chronic Catheter Exit-Site Infection
Equivocally Infected Catheter Exit Site
Good Catheter Exit
Perfect Catheter Exit
External Cuff Infection Without Exit Infection
Traumatized Exit
Alternative Exit-Site Classification Systems
Exit-Site Care
Early Care
Chronic Exit-Site Care
Local Care
Antibiotic Prophylaxis
Early Complications Related to Peritoneal Access
Late Complications Related to Peritoneal Access
Exit-Site Infections
Acute Exit-Site Infection
Chronically Infected Exit Site
Equivocal Exit
Good and Perfect Exit
Traumatized Exit
External Cuff Infection with or Without Exit Infection
Peritonitis
Infusion or Pressure Pain
External Cuff Extrusion
Catheter Obstruction
Catheter-Tip Migration
Pericatheter Leak
Unusual Complications
Organ Erosion
Mechanical Accidents
Material Breakdown and Catheter Fracture
Allergic Reactions
Radiologic Imaging in Diagnosis of Complications
Catheter Removal
Indications
Catheter Malfunction
Functioning Catheter with a Complication
Functioning Catheter That Is No Longer Needed
Removal Methods
Uncuffed Catheter
Cuffed Catheters
Swan-Neck Presternal Catheter
Operations in Peritoneal Dialysis Patients
Extra-Abdominal
Abdominal
Concluding Remarks
References
8 Automated Peritoneal Dialysis
History of APD
Peritoneal Dialysis Solutions
Peritoneal Dialysis Cyclers
Physiology of Solute and Fluid Transport
Solute Transport
Solute Transport by Diffusion
Solute Transport by Convection
Fluid Transport
Ultrafiltration
Lymphatic Absorption
Relationship Between Intraperitoneal Volume and IPP
Dialysate Fill and Drain Profiles
Factors Influencing Selection of APD
Different Regimens of APD
Classical Intermittent Peritoneal Dialysis
Nocturnal Intermittent Peritoneal Dialysis
Continuous Cyclic Peritoneal Dialysis
Tidal Peritoneal Dialysis
Breakpoint APD
Continuous Flow Peritoneal Dialysis
Nighttime Exchange Device
Adequacy of Automated Peritoneal Dialysis
Background
Adequacy Recommendations
Guidelines from Kidney Disease Outcomes Quality Initiative (K/DOQI)
Other Guidelines
The Automated Peritoneal Dialysis Prescription
Management of Ultrafiltration
Incremental Peritoneal Dialysis
Monitoring of Treatment
Complications of APD
Peritonitis
Catheter Infections (Exit Site and Tunnel)
Complications of Increased IPP
Hernias and Dialysate Leaks
Respiratory Function
Hydrothorax
Back Pain
Residual Kidney Function
Technique and Patient Survival in APD
References
9 Incremental Peritoneal and Hemodialysis
Introduction
Rationale
RKF and Dialysis Equivalency
Incremental PD
Patient Survival in Incremental PD
Incremental HD
Patient Survival in Incremental HD
Lifestyle
Cost
Psychology
Strategies
Timing and Initiation
Prescription
Residual Kidney Function
Nutrition
Advancing to Full Dialysis
Transitioning Dialysis Modalities
Transitional Care Units
Other Transition Points
Respite Care and Incremental Dialysis
Glossary
References
10 Urgent-Start Peritoneal Dialysis
Background
Definition of Urgent-Start PD
Establishing an Urgent-Start Program
Urgent-Start Pathways
Urgent-Start PD Studies
Uncontrolled Studies
Controlled Studies: Urgent-Start PD Versus Urgent-Start HD
Urgent-Start PD Versus Planned PD
Emergent-Start PD
Urgent-Start PD in Specific Populations
Urgent-Start PD in the Elderly
Urgent-Start PD as a Bridge to Vascular Access Maturation
Long-Term Abdominal Wall and Mechanical Complications
Economics of Urgent-Start PD
Conclusion
References
11 Monitoring the Functional Status of the Peritoneum
Introduction
Mesothelial Cell Markers
The Mesothelium
Cancer Antigen 125 (CA125) as a Marker of Mesothelial Cell Mass
CA125 in Serum During Various Conditions and Renal Replacement Therapy
CA125 in Ascites
Release of CA125 by Cultured Human Peritoneal Mesothelial Cells
CA125 in Peritoneal Dialysate in Stable Peritoneal Dialysis Patients
CA125 and Peritoneal Transport
Dialysate CA125 and Duration of Peritoneal Dialysis
Dialysate CA125 and Peritonitis
Dialysate CA125 as Marker of Biocompatibility of Dialysis Solutions
Conclusions
Other Mesothelial Cell Markers
Phospholipids
Glycosaminoglycans
Cytokines, Prostanoids, Chemokines, and Growth Factors
Coagulation and Fibrinolytic Factors
Markers of Other Peritoneal Structures
Markers of the Interstitial Tissue
Markers for Epithelial to Mesenchymal Transition (EMT)
Markers During Peritonitis
Markers During Long-Term Peritoneal Dialysis
Markers During Peritoneal Sclerosis
Dialysate Markers of Biocompatibility of Dialysis Solutions
Monitoring the Peritoneal Membrane Using Solute and Water Transport
Interpretation of Solute Transport in Relation to the Structures of the Peritoneal Membrane
Interpretation of Fluid Transport in Relation to the Structures of the Peritoneal Membrane
Tests for the Measurement of Solute and Fluid Transport
The Peritoneal Equilibrium Test (PET)
Test Procedure
Calculated Parameters
Interpretation of the Test
Drawbacks
Fast PET
Test Procedure
Calculated Parameters
Interpretation of the Test
Drawbacks
Mini-PET
Test Procedure
Calculated Parameters
Interpretation of the Test
Drawbacks
Accelerated Peritoneal Examination (APEX)
Double-Mini PET
Test Procedure
Calculated Parameters
Interpretation of the Test
Drawbacks
Standard Peritoneal Permeability Analysis (SPA)
Test Procedure
Calculated Parameters
Interpretation of the Test
Drawbacks
Dialysis Adequacy and Transport Test (DATT)
Test Procedure
Calculated Parameters
Interpretation of the Test
Drawbacks
Computer Software Available for Measuring the Properties of the Peritoneal Membrane
PD Adequest 2.0
Test Procedure
Calculated Parameters
Interpretation of the Test
Drawbacks
Peritoneal Dialysis Capacity Test (PDC)
Test Procedure
Calculated Parameters
Interpretation of the Test
Drawbacks
Patient On Line (POL)
Test Procedure
Calculated Parameters
Interpretation of the Test
Drawbacks
Conclusions
References
12 New Peritoneal Dialysis Solutions and Solutions on the Horizon
Effects of Alterations in Electrolytes
Magnesium
Calcium
Low Sodium
Amino Acids
Osmotic Efficacy
Nutritional Efficacy
Icodextrin
History
Pathophysiology
Biocompatibility of Icodextrin
Randomized Controlled Trials with Icodextrin
General Effects and Side Effect of Icodextrin
The Place of Icodextrin in Modern Peritoneal Dialysis
Neutral pH, Low/Ultralow Glucose Degradation Product (``Biocompatible´´) PD Solutions
Residual Renal Function
Peritoneal Ultrafiltration
Fluid Status
Peritoneal Solute Transport Rate
Peritonitis
Inflow Pain
Other Clinical Outcomes
Conclusions
Bicarbonate and/or Lactate Solutions
References
13 Blood Pressure Control in Peritoneal Dialysis
Epidemiology
Diagnosis
Non-pharmacological Management of Hypertension
Definition and Assessment of Dry-Weight
Dietary Sodium Restriction
Loop Diuretics
Peritoneal Transport Characteristics
Icodextrin
Low-Sodium Solutions
Biocompatible Solutions
Pharmacotherapy of Hypertension
Conclusion
Disclosures
Definition of Key Terms
References
14 Peritoneal Infections in Peritoneal Dialysis (PD Peritonitis)
Introduction
Epidemiology
Pathogenesis
Clinical Manifestations and Diagnosis
Treatment
Targeted Antimicrobial Therapy
Gram-Positive Organisms
Gram-Negative Organisms
Follow-Up and Outcomes
Primary Prevention
Conclusions and Future Perspectives
References
15 Noninfectious Complications of Peritoneal Dialysis
Introduction
Complications Related to Increased Intra-abdominal Pressure
Hernia
Genital and Abdominal Wall Edema
Hydrothorax
Gastroesophageal Reflux Disease
Respiratory Complications
Altered Mechanics of Breathing
Obstructive Sleep Apnea and Other Sleep Disorders
Metabolic Complications
Sodium and Water Balance
Potassium Balance
Acid-Base Balance
Cardiovascular Complications
Cardiac Function
Vascular Disease
Diabetes Mellitus
Body Composition
Gastrointestinal Complications
Pancreatitis
Hepatic Complications
Peritoneal Sclerosis and Encapsulating Peritoneal Sclerosis
Calcifying Peritonitis
Other Gastrointestinal Complications
Dermatological Complications
Pruritis
Calciphylaxis
Musculoskeletal Complications
Tendinitis, Tendon Rupture, and Calcific Periarthritis
Back Pain
Dialysis-Related Amyloidosis
Peritoneal Fluid Complications
Hemoperitoneum
Chyloperitoneum
Colored Peritoneal Dialysis Effluent
Renal Complications
Oxalate Metabolism
Acquired Cystic Kidney Disease
Transplantation
Cancer
References
16 Protein-Energy Wasting During Peritoneal Dialysis
Introduction
PEW in Patients on PD; Why Does it Appear?
Undernutrition and Loss of Appetite
Systemic Inflammation
Gastrointestinal Complications
Metabolic Acidosis
Reduced Anabolic Drive
Physical Inactivity
Residual Kidney Function
Peritoneal Dialysis Technique as a Cause of PEW
Peritoneal Transport Rate, Volume Overload
Loss of Nutrients into Dialysate
Peritonitis
Clinical Consequences of PEW in Patients on PD
Nutritional Considerations of Peritoneal Dialysis Solutions
Conventional Glucose-Based PD Solutions
Icodextrin-Based PD Solutions
Amino Acid-Based PD Solutions
PD Solutions with Low Content of Glucose Degradation Products
Criteria for Screening and Diagnosing PEW
Dietary Requirements of Patients on PD
Treatment Strategies for PEW
Strategies to Correct the Undernutrition Component of PEW
Strategies to Correct the Wasting Component of PEW
Conclusions
References
17 Calcium, Phosphate, and Renal Osteodystrophy
Classification of Renal Osteodystrophy
High-Turnover Bone Lesions
Low-Turnover Bone Lesions
Mixed Bone Lesions
Osteoporosis
Pathogenesis of Renal Osteodystrophy
Parathyroid Hormone, FGF23, Klotho, and Calcium Metabolism
Vitamin D Metabolism
Phosphate Metabolism
Magnesium Metabolism
Aluminum and Osteodystrophy
Acid-Base Balance
Calcitonin
Clinical and Radiological Features of Renal Osteodystrophy
Extraskeletal Manifestations
Skeletal Manifestations
Radiological Features
Renal Osteodystrophy and PD
Calcium and Phosphate Balance in PD
Gastrointestinal Absorption
The Role of Calcium Salts in Renal Osteodystrophy
Noncalcemic Phosphate Binders
Peritoneal Flux and Reduced Calcium Dialysis Fluid
Serum Magnesium in PD
Acid-Base Balance and 40 mmol/L Lactate PD Fluid
Parathyroid Hormone in PD
Vitamin D in PD
The Role of Vitamin D Analogue Therapy in PD
Oral Pulse Calcitriol Therapy
Intraperitoneal Vitamin D Therapy
Calcitriol Analogues
Calcimimetics
Renal Osteodystrophy in Diabetic PD Patients
The Idiopathic Adynamic Bone Lesion in PD
Recommendations for Management of CKD Mineral and Bone Disease/Osteodystrophy in PD
Biochemical Monitoring
Radiological Monitoring
Transiliac Bone Biopsy
Phosphate Restriction
Phosphate Binders
Dialysis Removal of Phosphates
Summary
References
18 Cardiovascular Disease and Inflammation
Epidemiology of Cardiovascular Disease in Chronic Kidney Disease
Reverse Epidemiology
Risk Factors for Cardiovascular Disease
Traditional (Framingham) Risk Factors
Age, Gender, and Smoking
Diabetes Mellitus
Hypertension
Dyslipidemia
Insulin Resistance
Nontraditional and/or Uremia-Specific Risk Factors
Oxidative Stress
Endothelial Dysfunction
Anemia
Cardiovascular Calcification
Autonomic Dysfunction and Sleep Apnea
Advanced Glycation End Products (AGEs)
Hyperhomocysteinemia
Genetic/Epigenetic Factors
Inflammation in Chronic Kidney Disease
Inflammation Is a Common Feature in Chronic Kidney Disease that Predicts Outcome
Multiple Causes of Inflammation in Chronic Kidney Disease
Do Inflammatory Biomarkers Promote Vascular Disease?
Inflammation in CKD: Can It Be Treated?
Conclusion
References
19 Vascular Calcification and Calciphylaxis in Peritoneal Dialysis Patients
Introduction
Epidemiology and Risk Factors
History
Pathophysiology
Calcification Inhibitors
Matrix Gla Protein (MGP) and the Role of Vitamin K
Fetuin-A
Pyrophosphate
Other Calcification Inhibitors (Osteoprotegerin, Osteopontin, Bone Morphogenic Protein 7, Klotho, and Magnesium)
Calcification Promoters
Hyperphosphatemia
Calcium
Vitamin D
Uremia
Warfarin
Glucose
Alkaline Environment
Trans Differentiation of Vascular Smooth Muscle Cells
Genetic Factors in Vascular Calcification
Pathogenesis of Calciphylaxis
Clinical Manifestations
Intimal Calcifications
Medial Arterial Calcification
Bone Disease
The Calcification Paradox
Calciphylaxis
Diagnosis
Clinical Tools
Histopathology
Computed Tomography
Plain Radiography
Dexa Scan
Ultrasound
PET Scan
Serum Biomarkers
Treatment
Cardiovascular Risk Reduction
PTH and Mineral Balance
Treatment of Hyperphosphatemia
PTH Directed Therapies
Magnesium
Renal Replacement Therapies
Anticoagulation Strategies
Medication Review
Treatment Considerations Specifically for Calciphylaxis
Wound Management
Pain Control and Palliative Care
Sodium Thiosulfate
Dialysis Modalities
Other Therapies
Conclusions
References
20 Electrolyte Management in Peritoneal Dialysis
Introduction
Peritoneum
Three-Pore Model of Peritoneal Transport
Mechanisms of Solute Transport
Electrolytes and Small Solutes
Diffusion
Convection
Sodium
Sodium Sieving
Dialysis Modality and Sodium Removal
Low-Sodium Dialysate Solutions
Effect of Icodextrin
Effect of Losing Residual Urine Production on Serum Sodium
Potassium
Hypokalemia in PD Patients
Calcium
Magnesium
Bicarbonate
Buffer Transport in Peritoneal Dialysis
References
21 Management of Anemia in Peritoneal Dialysis Patients
Introduction
Pathophysiology
Erythropoietin Deficiency
Iron Metabolism
Hypoxia Sensing
Implications of Anemia
Diagnosis of Anemia
Iron Indices in Peritoneal Dialysis
Iron Treatment
Intravenous Iron Administration
Potential Concerns About IV Iron
Infection Risk
Oxidative Risk
Erythropoiesis Stimulating Agents
Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitors
Roxadustat
Vadadustat
Daprodustat
Molidustat
Novel Therapies in Development
Hepcidin Modulation
Conclusion
References
22 Peritoneal Dialysis in Diabetic End-Stage Kidney Disease
The Proposed Benefits of CAPD/CCPD
Drawbacks of CAPD
When Is the Ideal Time to Initiate Dialysis in Diabetics?
Peritoneal Access
Dialysis Schedules
Intermittent Peritoneal Dialysis
Automated Peritoneal Dialysis (APD)
Continuous Cyclic Peritoneal Dialysis (CCPD)
Continuous Ambulatory Peritoneal Dialysis (CAPD)
Glucose as an Osmotic Agent
Blood Sugar Control During Peritoneal Dialysis
Intraperitoneal Insulin (Kinetics and Putative Benefits)
Problems with Intraperitoneal Insulin Therapy
Blood Sugar Control During APD
Clinical Results
Blood Pressure Control
Benefits of Slow and Continuous Ultrafiltration During CAPD
Residual Kidney Function (RKF)
Visual Problems
Cardiac and Vascular Diseases
Metabolic and Nutritional Problems
Peritonitis
Patient and Technique Survival on CAPD
Technique-Related Complications
Hospitalization Rates
Protecting the Peritoneal Membrane in Diabetes: Role of Newer PD Solutions
Can Peritoneal Dialysis Be a Long-Term Therapy for ESKD Patients?
Can CAPD/CCPD Be Recommended Over Hemodialysis for Diabetic Patients?
Summary
References
23 Peritoneal Dialysis in Children
Notes on the History of PD Use in Children
Demographic Issues
Incidence of ESKD in Children
Prevalence of ESKD in Children
Causes of ESKD in Children
Principles of Peritoneal Membrane Solute and Fluid Transport in Children
Effective Membrane Surface Area and Solute Permeability: Diffusive Transport
Convective Mass Transfer and Ultrafiltration
Peritoneal Lymphatic Absorption
Peritoneal Dialysis for Acute Kidney Injury
Indications and Contraindications
Technical Considerations
Catheters
Acute Catheters: Temporary Versus Permanent
Temporary Catheters for Infants
Permanent Catheters for AKI
Prophylactic Antibiotics
Prophylactic IP Heparin
Acute Peritoneal Dialysis Solutions
The Acute PD Prescription
Special Equipment
PD for ESKD in Children
Indications and Contraindications for CPD
Choice of Dialysis Modality
PD Catheters
Catheter Design
Number of Cuffs
Exit-Site Orientation
Catheter Implantation and Postoperative Care
Specialized Equipment for Children
Pediatric Catheters
Dialysate Bag Size
Pediatric Cyclers
PD Solutions
Conventional Dialysis Solution
Alternate Osmotic Agents
Biocompatible Solutions
Calcium
Magnesium
Chronic PD Prescription
Principles of the PET and Its Role in Prescription Management
PD Adequacy
Nutritional Management of Children on CPD
Nutritional Goals
Monitoring of Nutritional and Hydration Status
Controlled Enteral Nutrition
Management of the Very Young Infant: Special Considerations
Growth Failure
Neurocognitive Development
Nutrition
Hyponatremia
Hypophosphatemia
Hypothyroidism
Infectious Complications
Hypogammaglobulinemia
Mortality
Transplantation
When to Recommend and When to Consider Withholding/Withdrawing CPD in the Infant with ESKD
Renal Anemia and Its Treatment in Children on CPD
Treatment
ESA Resistance
Immune Status and Vaccine Responsiveness
Growth
CKD-Associated Mineral and Bone Disorder
Complications
Peritonitis and Exit-Site Infection
Hernias, Leaks, and Hydrothorax
Hernias
Leaks
Hydrothorax
Encapsulating Peritoneal Sclerosis
Other Major Disorders of the Gastrointestinal Tract
Miscellaneous Complications
Hypogammaglobulinemia
Prune-Belly Syndrome
Ventriculoperitoneal Shunt
Genitourinary Surgery
Bloody Dialysate
Quality of Life and Other Psychosocial Issues
Transplantation
Peritoneal Dialysis Catheter Removal
Complications Post-Transplant Related to PD
Congenital Hyperammonemia and Other Inborn Errors of Metabolism
References
24 PD in the Older Person
Introduction
Distinguishing Between ``Elderly´´ and ``Frail´´
Assessing Frailty
Goals of Treatment
Survival and Prognosis
Goal-Oriented Therapy
Modality Choice
Clinical Studies Comparing Dialysis Modalities
Advantages and Disadvantages of PD in the Elderly
Complications of PD in the Elderly
Peritonitis
Constipation
Hernias and Incontinence
Encapsulating Peritoneal Sclerosis
Individualizing the Dialysis Prescription for the Older Patient
Dialysis Dose and the Elderly Patient
Commencing Incremental PD or Palliative PD
Assisted Peritoneal Dialysis
Models of Assisted PD
Outcomes Associated with Assisted PD
Conclusion
References
25 Ultrafiltration Failure
Fluid Transport During Peritoneal Dialysis
Definition of Ultrafiltration Failure
Classification
Diagnosis of Fluid Overload
Causes of Volume Homeostasis Failure
Input-Dependent Causes
Output-Dependent Causes
Uncompensated Loss of Residual Renal Function
Inadequate Provision of Optimal Ultrafiltration Conditions
Long Dwells
Inappropriate Tonicity
Exaggerated Contrary Mechanisms
Failure of Peritoneal Response: Ultrafiltration Failure
Other Causes of a Low Dialysate Output
Loss of Functional Peritoneum
Catheter Malfunctions
Leaks
Therapy
General Guidelines
Routine Standardized Monitoring
Dietary Counseling
Protection of Residual Renal Function and the Use of Diuretics
Education and Enhanced Compliance
Preservation of Peritoneal Membrane Function
Future Prospects
References
26 Long-Term Peritoneal Dialysis
Introduction
Genetic Factors
Peritoneal Biomarkers in Effluent
Cancer Antigen 125
Interleukin-6
Plasminogen Activator Inhibitor-1
Peritoneal Fluid and Solute Transport
Fluid Transport
Solute Transport
References
27 Encapsulating Peritoneal Sclerosis
Risk Factors
Epidemiology of EPS
Pathology Description
Pathogenesis of EPS
Clinical Manifestations
Investigations
Treatment
Prevention
References
28 Role of Peritoneal Dialysis in Acute Kidney Injury
Introduction
Acute PD Compared with Extracorporeal Dialysis Modalities for Patients with AKI
Advantages of Acute PD
Cost-Effectiveness
Patients with Difficult Vascular Access
Use of Acute PD in with Intracranial Hypertension
Acute PD Is Associated with Earlier Recovery of Renal Function
Acute PD in Patients with Heart Failure
Acute PD in Patients with Liver Cirrhosis
Delivery of Nutrients
Acute PD in Patients with Hemorrhagic Pancreatitis
Management of Hypothermia or Hyperthermia
Antibiotic Delivery
No Systemic Anticoagulation Required
Acute PD Access, Techniques, and Fluids
Types of Catheters
Flexible Catheters
Coiled Versus Straight Tenckhoff Catheters
Advantages of Flexible Tenckhoff Catheters
Method Insertion of These Catheters for Acute PD
Percutaneously by the Seldinger Technique
Rigid Trocath Catheters
Use of Prophylactic Antibiotics
Acute PD Techniques
Acute Intermittent Peritoneal Dialysis
Acute Continuous Peritoneal Dialysis
Tidal Peritoneal Dialysis (TPD)
High-Volume Peritoneal Dialysis
Acute PD: Manual Exchanges Versus Use of the Automated Device
Peritoneal Dialysis Solutions for Acute PD
Standard Glucose Concentration PD Solutions (Table 3)
Lactate Versus Bicarbonate-Buffered Solutions
Dialysis Solution Additives (Table 4)
Prescription of Acute PD
Dose and Efficacy of PD
Acute PD for Hyperkalemia
Acute PD for Heart Failure and Pulmonary Edema
Components of Acute PD Prescription
Fluid Delivery
Complications of Acute PD (Table 5)
Infectious Complications
Mechanical Complications
Metabolic Complications
Pulmonary Complications
Cardiovascular Complications
Contraindications of Acute PD/Controversies (Table 6)
Acute PD in Critical Care Units
Acute PD in Children
Advantages of Acute PD in Pediatric Population
Acute PD Prescription in Pediatric Patients
Disadvantages of Acute PD in Children
Evidence of Use of Acute PD in Pediatric Patients
Conclusion
References
29 Kidney Transplant and Peritoneal Dialysis
Background
Who Should Be Evaluated for Renal Transplantation?
Pre-Transplant Differences Between Peritoneal (PD) and Hemodialysis (HD) Patients
Transplantation Rates for PD/HD
Post-Transplant Outcomes
DGF
Graft Thrombosis
Allograft Failure
Post-Transplant Mortality
New Onset Diabetes After Transplant
Other Aspects: Timing of PD Catheter Removal
Dialysis as Bridge for Non-renal Transplant
Conclusion
References
30 Basic Science and Translational Research in Peritoneal Dialysis
Basic and Applied Clinical Science
Structure of the Peritoneal Barrier and Transport Principles
Distributed Nature of the Barrier
Effects of the Interstitial Matrix on Transport
Nature of the Endothelial Barrier
Effects of Lymphatic Absorption from the Tissue on Transport
Linking Basic Research with the Clinical Studies
Translational Research: Overview
Translational Research: Preservation of the Barrier
Peritonitis: New Treatments and Methods of Prevention
Methods of Mitigating Peritonitis
Catheter and Biofilm: Methods of Mitigation
Technical Use of PD
Solute and Water Transfer
PD Technique Optimization
Glossary of Terms
References
31 Animal Models for Peritoneal Dialysis Research
Acute Peritoneal Dialysis Models
Model for Assessment of Peritoneal Transport Properties
Anatomic/Physiologic Observations from Acute Models of Peritoneal Dialysis
Peritoneal Inflammation/Peritonitis
Models Utilized
Measurements of Outcome
Interventions
Other Models of Peritoneal Injury
Chronic Peritoneal Exposure Models
Chemical Irritants
Chlorhexidine
Acidic Dialysis Solution
Other
Effects of Systemic Diseases on the Peritoneum
Uremia
Diabetes
Genetic/Cellular Manipulation
Transgenic Mice
Gene Transfer
Cell Transplantation/Depletion
Measurements Tools in Animal Models for Peritoneal Dialysis Research
Angiogenesis
Fibrosis
Inflammation/Immune Response
Summary
References
32 Intraperitoneal Chemotherapy
Pharmacokinetic Advantage
Multicompartmental Concept
Blood Flow: Does It Limit Solute Transfer?
Simplified Compartmental Model
The Problem of Surface Contact Area
Simplified Model Concept
Variation of MTAC with Body Size
Calculation of the Pharmacokinetic Advantage
Application of Model to the Pharmacokinetic Advantage
Antibiotics: Vancomycin
Intraperitoneal Insulin
Antineoplastic Agents
Cisplatin
5-Fluorouracil (5-FU)
Approaches to Enhance Contact Area and Residence Time Intraperitoneally Administered Drugs
Intraperitoneally Administered Drug Penetration in Neoplasms
Normal Versus Neoplastic Barriers in the Peritoneal Cavity
Anatomic Peritoneum
Interstitium or Tumor Microenvironment
Microcirculation
Summary of Normal Versus Neoplastic Peritoneal Barrier
Penetration of Small Molecules: Distributed Model Theory
Concentration Profiles in Normal and Neoplastic Tissue
Intraperitoneal Antibody Therapy and the Pharmacokinetic Advantage
Summary
References
Index