Background: Hyperphosphatemia is almost universal in well-nourished patients with end stage kidney disease treated with dialysis due to an imbalance between dietary intake and phosphate removal via residual kidney function and dialysis. Although food phosphate content can vary dramatically between meals, the current standard is to prescribe a fixed dose of phosphate binder that may not match meal phosphate intake. The primary objective of our study was to determine if the use of an APP that matches phosphate binder dose with food phosphate content would be associated with an improvement in serum phosphate and a reduction in calcium carbonate intake compared to the multidisciplinary renal team. Methods: Eighty patients with end stage renal disease treated with peritoneal dialysis at a tertiary care hospital in Canada were randomized to the standard of care for serum phosphate management (multidisciplinary renal team) versus the OkKidney APP. Serum phosphate was measured at baseline and then monthly for 3 months with adjustments to phosphate management as deemed necessary by the multidisciplinary team (control) or the phosphate binder multiplier in the OkKidney APP (intervention) based on the laboratory values. The primary analysis was an un-paired t-test of the serum phosphate at study completion. Results: The participants were 56 (±14) years old, 54% were male; the most common cause of ESRD was diabetes mellitus. The serum phosphate was 1.96 (0.41) mmol/L and 1.85 (0.44) mmol/L in the control and intervention groups at the end of 3 months (p=0.30). The median elemental daily dose of calcium carbonate did not differ between the groups at study completion [587mg (309-928) versus 799mg (567-1183), p=0.29]. Conclusion: The OkKidney APP was associated with similar but not superior serum phosphate control to the standard of care which included renal dietician support.

Background:Patients treated with peritoneal dialysis (PD) are at increased risk of developing mechanical complications such as dialysate leaks and hernias thought to be partially related to an increase in intra-abdominal pressure (IAP) secondary to dialysate in the abdomen. However, measurement of IAP requires specialized equipment that is not readily available in the home dialysis unit.Objectives:To develop a reliable method of measuring IAP in PD patients that could be easily used in the home dialysis unit. We hypothesized that the handheld Stryker pressure monitor would be suitable for this purpose via connection to the PD catheter.Design:Cross-sectional.Setting:Tertiary Care Hospital, Ottawa, Ontario, Canada.Patients:Patients who were having a PD catheter inserted via laparoscopic surgery at The Ottawa Hospital were recruited for the study.Measurements:With the patients at end-expiration, the IAP measured with the Stryker monitor connected to the PD catheter was compared with the insufflator pressures of 15, 10, and 5 mm Hg.Methods:Bland-Altman plots were constructed and intraclass correlation coefficients were calculated for each pressure.Results:Twelve patients participated in the study: 9 men and 3 women. They were on average 53 ± 15 years old and 81 ± 13.4 kg. Two patients had to be excluded from the analysis due to difficulties zeroing the Stryker pressure monitor at the time of surgery. There were also rapid fluctuations in the insufflator pressure recording, creating additional challenges in comparing the 2 measurements at end-expiration. The 95% limits of agreement for the Bland-Altman plots ranged from 7.9 (@15 mm Hg) to 12.2 (@10 mm Hg). The intraclass correlation coefficients for reliability of the individual measurements ranged from 0.015 (10 mm Hg) to 0.634 (15 mm Hg).Limitations:Small sample size and lack of a gold standard comparator may have affected our results.Conclusions:In our study, we used the operating room insufflator as the gold standard for measuring IAP. By Bland-Altman plots and intraclass correlation coefficients, the pressure values obtained with the Stryker pressure monitor were not a reliable estimate of insufflator IAP especially at lower pressures. Further studies are needed to identify an ideal tool for measurement of IAP to guide PD management.