A team approach needs to be taken to achieve successful self-management in patients having peritoneal dialysis, as with other chronic disease treatments. Nurses should use multiple strategies based on self-efficacy theory to improve patients' self-efficacy levels and self-management capacities.

Background: Volume overload is a common problem in peritoneal dialysis patients and may contribute to the high cardiac mortality in this patient population. Controlling volume status is difficult due to the lack of appropriate and accurate assessment of dry weight. This randomized, controlled study was conducted to test if the recent use of overhydration value (OH) provided by bioimpedance spectroscopy and patients’ education would help to control overhydration. Methods: 160 continuous ambulatory peritoneal patients were included in this study. All the patients were randomly allocated to 2 groups: in Group 1 the patients and their primary nurses were informed of the OH values provided by bioimpedance spectroscopy whereas in Group 2 the values were not revealed and patients’ volume was measured by the standard methods. Fluid status was evaluated by means of repeated bioimpedance analysis and clinical assessment. Urine volume, blood pressure and use of antihypertensive medications were recorded. Results: There were no differences in gender, age, diabetes, height, weight and clinical hydration status between the 2 groups at the baseline. In Group 1, OH (p < 0.05), extracellular volume and the extracellular volume to intracellular volume ratio decreased steadily during the 3-month follow-up. On the contrary, all 3 parameters increased significantly in Group 2. SBP decreased significantly in Group 1 but increased significantly in Group 2. Conclusion: Our study shows that the use of OH as determined by bioimpedance spectroscopy may facilitate volume control in peritoneal dialysis patients.

Detection of malnutrition in dialysis patients is important since this is a predictor of morbidity and mortality. Lean body mass (LBM) reflects the somatic protein store and this was measured by creatinine kinetics, anthropometry, and biometric impedance in 210 incident Chinese patients on continuous ambulatory peritoneal dialysis. The study was started in the third month of dialysis and the patients were followed for an average of 29 months. We devised three models of survival by combining the three different LBM measures with several nutritional markers and recognized outcome predictors. Follow-up was censored for transplantation or transfer to hemodialysis with an end point of death while on peritoneal dialysis. Statistical correlations were observed among the LBM values determined by all the three methods and these correlated significantly with both left and right hand grip strength but not with nutritional markers. LBM by creatinine kinetics, mean arterial pressure, and the calcium-phosphorus product were significant, independent predictors of death in one survival model. Anthropometry and bioelectric impedance were not significant predictors of death in the other two models. Our study suggests that LBM measured by creatinine kinetics, anthropometry, and bioelectrical impedance correlates well with the somatic protein store but not with the general nutritional status.

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