This book offers a comprehensive guide to peritoneal dialysis (PD). Home dialysis, and more specifically PD, is growing in popularity in the US. By conservative estimates, experts suggest that 45 percent of dialysis patients in the US can be on home dialysis. However, the current penetration rate is only 10 percent. This is changing with an expected major increase in the next 5 years. One of the reasons for the low uptake is that many nephrologists lack comfort and confidence in using PD as a dialysis modality.
This book addresses those concerns by covering all aspects of PD. Chapters include its history, patient selection, implementation options, comorbidities, quality of life concerns, and developing approaches to treatment. This comprehensive resource fills the unmet need for a practical, hands-on book that is both detailed and can work as a quick reference.
This is an ideal guide for academic nephrologists, private practice nephrologists, NPs, PAs, nurses, fellows, and residents.
Author(s): Anjay Rastogi, Edgar V. Lerma, Joanne M. Bargman
Publisher: Springer
Year: 2021
Language: English
Pages: 489
City: Cham
Foreword
Contents
Contributors
Chapter 1: History of Peritoneal Dialysis
References
Chapter 2: Physiology of Peritoneal Dialysis
Peritoneal Anatomy
Peritoneal Membrane Histology
Models of Peritoneal Transport
The Three-Pore Model
The Pore-Matrix Model
The Distributed Model
Physiology of Peritoneal Transport
Solute Transport
Ultrafiltration
Sodium Sieving
Fluid Absorption
Kinetic of a Single Peritoneal Dialysis Dwell
Peritoneal Equilibration Test
Changes in the Peritoneal Membrane with Time on Peritoneal Dialysis
References
Chapter 3: Peritoneal Dialysis Patient Selection
References
Chapter 4: Epidemiology of Peritoneal Dialysis
Introduction
Incidence of Peritoneal Dialysis
Prevalence of Peritoneal Dialysis
Common Characteristics of Countries with High PD Prevalence Rates
Epidemiological Factors Affecting Utilization of PD
Patient Factors
Age
Comorbid Conditions: Diabetes Mellitus (DM)
Physical Ability and Support System
Patient Awareness of PD
Financial Considerations
Other Patient-Related Factors
Facility Factors
Clinician Attitude and/or Bias
PD Catheter Placement
Dialysis Organizational Priorities
Clinical Governance/Registry Data
Industry Factors
Dialysis Factors
Healthcare System Factors
Universal Healthcare Coverage
Financial Incentives and Clinical Reimbursement
Healthcare Policies (PD-First and PD-Favored)
Healthcare Disparities
Epidemiology of Infection-Related Complications in PD Patients
Epidemiology of Mortality in PD Compared to HD
Proposed Solutions to Overcome Underutilization of PD
References
Chapter 5: The Evolution of Peritoneal Dialysis Solutions
Composition of PD Solutions
Osmotic Agents
Conclusion
References
Chapter 6: Automated Cyclers for Peritoneal Dialysis
Conclusion
References
Chapter 7: Continuous Ambulatory Peritoneal Dialysis Versus Automated Peritoneal Dialysis – Are There Differences in Outcomes?
Residual Kidney Function
Peritonitis
Volume Management
Technique Survival
Mortality
Health-Related Quality of Life
References
Chapter 8: Peritoneal Dialysis Access: Catheters and Placement
Catheters
Catheter Selection
Catheter Insertion
Percutaneous Needle-Guidewire Technique
Open Surgical Dissection
Peritoneoscopic Procedure
Surgical Laparoscopy
Extended Two-Piece Catheter Insertion
Catheter Embedding
Procedure Elements Common to All Approaches
Choosing a Catheter Implantation Approach
References
Chapter 9: Peritoneal Dialysis Catheter Insertion by the Nephrologist
Introduction
Patient Selection
Patient Preparation
Resources and Equipment
Peritoneal Dialysis Catheter Insertion Technique
Complications
Early Peritoneal Dialysis Catheter Care
Patient Outcomes
Program Outcomes
Financial Considerations
Quality Improvement
Operator Training
Local Audit
Program Collaboration
Conclusions
References
Chapter 10: Peritoneal Dialysis Adequacy
The Importance of Time Compared to Small Solute Clearance
A Solute Shift
Putting Solute Clearance to the Test
The Role of Residual Kidney Function
Euvolemia as an Adequacy Measure
Maintenance of Residual Kidney Function
Practical Ways to Increase Adequacy
Summary
References
Chapter 11: Techniques in Peritoneal Dialysis
Introduction
PD Technique and Related Glossary
PD Exchange
PD Technique
Continuous Flow Peritoneal Dialysis (CFPD)
Regimen and Modes of Performing PD Exchanges [Fig. 11.4]
Intermittent PD Regimens
Automated Cycler-Assisted IPD Regimens (aIPD): (Nighttime or Daytime)
Manual IPD Regimens (mIPD): (Daytime or Nighttime)
Continuous Peritoneal Dialysis (CPD) Regimens
Manual CPD, i.e. CAPD
Machine-Assisted CPD, i.e., CCPD
Aseptic Precautions
References
Chapter 12: Peritoneal Dialysis in Acute Kidney Injury: Prescribing Acute PD
Prescribing Acute PD
Technical Aspects and Controversies
Evidence and Guidelines
Practical Aspects of Prescribing, Delivering, and Monitoring PD
Conclusion
References
Chapter 13: Prescribing Chronic Peritoneal Dialysis Therapy
Introduction
Peritoneal Dialysis Modalities
Basics of the PD Prescription
Initial Prescription
Prescription Modification
References
Chapter 14: Urgent-Start Peritoneal Dialysis
Background
Urgent-Start PD: Definition and Candidacy
Urgent-Start PD: How Is It Accomplished?
Establishing an Urgent-Start Program
Studies to Support Early PD Initiation
Contemporary Urgent-Start PD Studies
Challenges of Urgent-Start PD
Conclusion
References
Chapter 15: Infectious Complications in Peritoneal Dialysis
Introduction
Exit-Site and Tunnel Infection
Peritonitis
Definition and Diagnosis
Peritonitis Treatment
Infection Prevention
Infection Monitoring
Summary
References
Chapter 16: Noninfectious Complications of Peritoneal Dialysis
PD Catheter Malfunction
Inflow and Drain Pain
Complications Related to Increased Intra-abdominal Pressure
Hernias
Abdominal Dialysate Leaks
Hydrothorax
Abnormal PD Effluent Appearance
Hemoperitoneum
Chyloperitoneum
Other Abnormal PD Effluent Appearance
Encapsulating Peritoneal Sclerosis
References
Chapter 17: ESKD Complications: CKD-MBD
Biomarkers: Calcium, Phosphate, and 1,25-Dihydroxyvitamin D
Biomarkers: Parathyroid Hormone
Biomarkers: FGF-23 and Klotho
Secondary and Tertiary Hyperparathyroidism
Renal Osteodystrophy
Osteopenia/Osteoporosis
Extraskeletal Calcifications
Cardiovascular Disease
Calcific Uremic Arteriolopathy
Summary
References
Chapter 18: Anemia Management in Peritoneal Dialysis
Introduction
Pathophysiology of Anemia in End-Stage Kidney Disease
Rationale for Anemia Treatment
Role of Iron in Anemia Therapy and Evidence for Use
Erythropoiesis-Stimulating Agents and Evidence for Use
Hypoxia-Inducible Factor Stabilizers and Evidence for Use
Difference Between Anemia Therapy in Peritoneal and Hemodialysis Patients
The Need for Further Workup
References
Chapter 19: Peritoneal Dialysis in Diabetic Patients
Introduction
PD for Diabetic Patients
Choice of PD as the Dialysis Modality
Metabolic Consequence of PD
Glucose-Sparing Strategies
Management of Diabetic PD Patients
Specific Problems
Treatment of Diabetes
Insulin Therapy in PD
Oral Hypoglycemic Agents
Target of Glycemic Control
Hypoglycemia
Glycemic Monitoring
Treatment of Other Cardiovascular Risk Factors
Blood Pressure
Volume Control
Lipid
Antiplatelet and Antithrombotic Therapy
Treatment of Other CKD Complications
Anemia
Mineral Bone Disease
Conclusion
References
Chapter 20: Peritoneal Dialysis in Special Situations
Introduction
Autosomal Dominant Polycystic Kidney Disease
Chronic Heart Failure
Liver Cirrhosis
Abdominal Surgeries and Abdominal Complications
Diverticular Disease of the Colon
Abdominal Hernia
Abdominal Surgery in PD
Pregnancy
Conclusion
References
Chapter 21: Survival Outcomes with Peritoneal Dialysis
Overview
Survival Outcomes in ESKD Versus the General Population
Survival Outcomes Between Dialysis Modalities
Statistical Study Design
Dialysis Modality Comparisons
PD Survival Outcomes in Special Populations
Diabetes
Elderly Patients
Obesity
Failed Kidney Transplant
Organ-/Disease-Specific Predictive Factors
Cardiovascular Disease
Coronary Artery Disease
Arrhythmias
Congestive Heart Failure
Blood Pressure Abnormalities and Variability
Hydration Levels: Over- or Underhydration
Peritonitis
Residual Kidney Function (RKF)
Hypokalemia
Frailty
Peritoneal Membrane Transport Type
Process/Infrastructure Factors
Unplanned Starts and PD Patient Survival Outcomes
Modality Transitions and PD Patient Survival Outcomes
Discussing PD Survival Outcomes with ESKD Patients
Conclusion
References
Chapter 22: Quality of Life in Peritoneal Dialysis
Introduction
Measurement of Quality of Life
Common Assessment Tools
Quality of Life in Kidney Replacement Therapy
Patient Priorities for Outcomes in PD
Factors Associated with Quality of Life in PD
Demographic Factors
Sex
Ethnicity
Age
Social Factors
Socio-Economic Status
Social Support Networks
Burden on Caregivers
Psychological Factors
Depression
Anxiety
Body Image
Physical Factors
Sexual Dysfunction
Nutrition
Gastrointestinal (GI) Symptoms
Sleep Disorders
Disease-Related Factors
Anaemia
Infection
Treatment-Related Factors
Residual Kidney Function
Small Solute Removal
PD Modality (APD, CAPD)
PD Solutions
How Can We Optimise QOL in PD?
Conclusions
References
Chapter 23: Incremental Peritoneal Dialysis
Introduction
Adequacy and Residual Kidney Function
Technique Survival in PD
Quality of Life
Prescription Design
Incremental PD and Incremental HD
References
Chapter 24: Pediatric Peritoneal Dialysis
Introduction and Epidemiology
Access
Catheter Characteristics
Surgical Considerations
Chronic Catheter Care
Technology
Automated Cycler
Peritoneal Dialysis Solutions
Prescribing Peritoneal Dialysis to Children
Infectious Complications
Noninfectious Complications
Outcome: Morbidity and Mortality
Unique Population: Infants
References
Chapter 25: The Principles of Drug Dosing in Peritoneal Dialysis
Introduction
Pharmacokinetic Alterations in Chronic Kidney Disease
Absorption
Volume of Distribution
Metabolism
Elimination
Drug Adjustments in Patients on Peritoneal Dialysis
Peritoneal Dialysis and Clearance
Commonly Prescribed Medications
Antimicrobial Agents
Analgesics
Anticoagulation Agents
Diuretics and Antihypertensive Agents
Hypoglycemia Agents
Conclusion
References
Chapter 26: Commonly Asked Questions About Peritoneal Dialysis
Should Every Patient at the Start of Peritoneal Dialysis Have a Preemptive “Backup” Arteriovenous Access?
Do I Have to Switch a Peritoneal Dialysis Patient to Hemodialysis After Hernia Repair?
Is Peritoneal Dialysis Possible in Patients with Liver Disease and Ascites?
Can We Continue Peritoneal Dialysis After Cardiac Surgery?
Can Peritoneal Dialysis Patients Swim?
Can We Do Peritoneal Dialysis in Patients with a G-Tube?
Is There a BMI Cutoff for a Patient Who Wishes to Do Peritoneal Dialysis?
References
Chapter 27: Building an Effective Peritoneal Dialysis Program
Introduction
Recruitment
Patient Selection
Education
Modality Education for ESKD Patients
Modality Education for CKD Patients
Family Education
Ongoing Patient and Family Education
Staff Education
PD Access Placement
The Team!
Interactions of the PD Program with the Health Ecosystem
Support from Organizations
Integrated Dialysis Program
Transplantation
Conclusion
References
Chapter 28: The Peritoneal Dialysis Outcomes and Practice Patterns Study
Introduction
The Problem of Technique Failure
PDOPPS: Design and Rationale
Rationale
Design
Study Data and Collection Instruments
Analysis
Ancillary Studies
Current Status of PDOPPS
Early Findings from PDOPPS
Infection Prevention and Management
Patient Support
PD Training and Education
Dialysis Prescription and Fluid Management
Conclusion
References
Chapter 29: Peritoneal Dialysis in Developing Countries
Introduction
Advantages and Disadvantages of Peritoneal Dialysis
Peritoneal Dialysis Models in Developing Countries
PD for AKI (See Also Chap. 20)
PD Fluids
PD Catheters and Access
PD in Chronic Kidney Disease
Clean Surfaces
Water for Washing
Geography
Lack of Electricity
Conclusion
References
Chapter 30: Advances in Peritoneal Dialysis
Introduction
Advances in Peritoneal Dialysis Solutions
Biocompatible Solutions
Glucose-Sparing Solutions
Low-Sodium Solutions
“Bimodal” Solutions
Bimodal Dialysis and Hybrid Peritoneal Dialysis
Remote Patient Monitoring for Peritoneal Dialysis Patients
Assisted Peritoneal Dialysis
Future Directions
Conclusion
References
Chapter 31: Nutritional Management of Adult Peritoneal Dialysis Patients Abstract
Altered Metabolism and Nutrition Abnormalities
Nutrient Losses During Peritoneal Dialysis
Caloric Gain from Dextrose in Dialysate
Gastrointestinal Disorders
Peritoneal Solute Transport Rate
Residual Kidney Function
Peritonitis
Protein Energy Wasting
Goals for Nutritional Management
Nutritional Requirements for Patients Undergoing Peritoneal Dialysis
Energy
Protein
Sodium and Fluids
Potassium
Phosphorous
Vitamins and Minerals
Food-Based and Dietary Pattern Recommendations
Effective Nutritional Management
Protein Energy Wasting: Nutritional Status
Sodium and Fluids
Minerals
Cardiovascular Health
Gut Health
Summary
References
Chapter 32: The Role of Peritoneal Dialysis in Pandemics and Natural Disasters
Introduction
Earthquakes
Tropical Cyclones and Flooding
COVID-19 and Future Pandemics
Conclusions
References
Index
