This paper summarizes our clinical studies on hydrostatic intraperitoneal pressure (IPP), showing the interest of this measurement in routine clinical practice. IPP can easily be measured routinely by a simple an d safe method: the measure of the column of dialysate in the peritoneal dialysis (PD) line before drainage, with point 0 located on the midaxillary line. The normal value is 12±2 cm of water (cm H2O) with an intraperitoneal volume (IPV) of 2 L, with linear increases of 2.2 cm H2O for each additional liter. IPP must be measured to estimate the tolerance of IPV: the maximal permissible IPV is reached for an IPP of 18 cm H2O, squaring with a decrease of 200/0 in vital capacity and sometimes arising before clinical symptomatology. However, IPP measured at rest could not predict PD mechanical complications (hernias, dialysis leakages, hemorrhoids, etc.), which are more dependent on parietal previous history or predisposition. IPP is significantly higher during the first three days after peritoneal catheter implantation (17±3 cm H2O) than during the 12 following days (10±4 cm H2O). It is recommended to postpone the start of PD until after catheter implantation, and patients should remain supine for the first three days. On the other hand, IPP strongly reduces the overall ultrafiltration (UF) volume: an increase of 1 cm H2O in IPP caused a decrease of 70 mL in global UF after two hours. Therefore, IPP should be measured in diagnosis of losses of UF. However, UF loss during peritonitis is not due to an increase of IPP.

This paper summarizes the basis of prescription for automated peritoneal dialysis (APD) established during a French national conference on APD. Clinical results and literature data show that peritoneal clearances are closely determined by peritoneal permeability and hourly dialysate flow rate, independently of dwell time or number of cycles. With APD, peritoneal creatinine clearance increases according to the hourly dialysate flow rate to a maximum (plateau), then decreases because of the multiplication of the drain-fill times. The hourly dialysate flow giving the maximum peritoneal creatinine clearance is defined as the “maximal effective dialysate flow” (MEDF). MEDF is higher for high peritoneal permeabilities: MEDF is 1.8 and 4.2 L/hr with nocturnal tidal peritoneal dialysis (TPD) for a 4-hr creatinine dialysate-to-plasma ratio (DIP) of 0.50 and 0.80, respectively. With nightly intermittent peritoneal dialysis (NIPD), MEDF is 1.6 and 2.3 Llhr for a DIP of 0.50 and 0.78, respectively. Under these conditions, tidal modalities can only be considered as a way to increase the MEDF. Using the MEDF concept for an identical APD session duration, the maximal weekly normalized peritoneal creatinine clearance can vary by 340% when 4hr DIP varies from 0.41 to 0.78. APD is not recommended when 4-hr creatinine DIP is lower than 0.50. However, the limits of this technique may be reached at higher peritoneal permeabilities in anurics because of the duration of sessions andlor the additional exchanges required by these patients.

HK was found to be highly prevalent and recurrent in this regional registry despite the widespread and dynamic prescription of low-K dialysis baths and K binders. More effective potassium mitigating strategies are eagerly warranted.

The use of telehomecare has the potential to facilitate access to healthcare services for vulnerable populations. However, evidence on the implications of telehomecare on various aspects related to patients, healthcare professionals, organizations, and healthcare systems is still limited. Assessing the various effects of telehomecare for these different groups of stakeholders is thus an essential step to ensure future integration of this technology into mainstream healthcare services. A synthesis of lessons learned from the evaluation of three telehomecare experimentations targeting specific vulnerable groups is proposed. This paper presents the various models that were implemented to assess telehomecare services for vulnerable populations, explores issues related to conducing telehomecare evaluations, and provides a reflection on key factors that might influence the success of telehomecare projects. Lessons learned from these three experimentations provide valuable insights to orient the development of telehomecare services for various vulnerable groups in the population.

BackgroundHome telemonitoring has developed considerably over recent years in chronic diseases in order to improve communication between healthcare professionals and patients and to promote early detection of deteriorating health status. In the nephrology setting, home telemonitoring has been evaluated in home dialysis patients but data are scarce concerning chronic kidney disease (CKD) patients before and after renal replacement therapy. The eNephro study is designed to assess the cost effectiveness, clinical/biological impact, and patient perception of a home telemonitoring for CKD patients. Our purpose is to present the rationale, design and organisational aspects of this study.MethodseNephro is a pragmatic randomised controlled trial, comparing home telemonitoring versus usual care in three populations of CKD patients: stage 3B/4 (n = 320); stage 5D CKD on dialysis (n = 260); stage 5 T CKD treated with transplantation (n= 260). Five hospitals and three not-for-profit providers managing self-care dialysis situated in three administrative regions in France are participating. The trial began in December 2015, with a scheduled 12-month inclusion period and 12 months follow-up. Outcomes include clinical and biological data (e.g. blood pressure, haemoglobin) collected from patient records, perceived health status (e.g. health related quality of life) collected from self-administered questionnaires, and health expenditure data retrieved from the French health insurance database (SNIIRAM) using a probabilistic matching procedure.DiscussionThe hypothesis is that home telemonitoring enables better control of clinical and biological parameters as well as improved perceived health status. This better control should limit emergency consultations and hospitalisations leading to decreased healthcare expenditure, compensating for the financial investment due to the telemedicine system.Trial registrationThis study has been registered at ClinicalTrials.gov under NCT02082093 (date of registration: February 14, 2014).