Peritoneal Dialysis for AKI in Cameroon: Commercial Vs Locally-Made Solutions

Palmer, Dennis; Lawton, William J.; Barrier, C.; Fine, B.D.; Hemphill, Hayden; Nyah, Norah; Kinne, Virginie; Ringnwi, Njaprim Ivor; Yong, Genevive; Neufeldt, Amy L.; Mitterand, Yves; Finkelstein, Fredric O.; Krahn, Thomas A.

doi:10.3747/pdi.2017.00190

Cited by 28 publications

(20 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…43,44 More recent publications from Africa have demonstrated good outcomes using bedside preparation of PD fluids made from commercially available IV fluid. 12,45,46 Palmer et al performed a retrospective review of all acute PD patients and showed no difference in peritonitis rates between those treated with commercial solutions and those using locally mixed solutions. 45 A retrospective review of 49 children from Cape Town, using bedside prepared PD solutions, made from IV fluids showed a low peritonitis rate and no complications.…”

Section: Guideline 32 -Commercial Versus Locally Mixed Solutionsmentioning

confidence: 99%

ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 update (adults)

et al. 2020

View full text Add to dashboard Cite

Summary statements (1) Peritoneal dialysis (PD) should be considered a suitable modality for treatment of acute kidney injury (AKI) in all settings (1B). Guideline 2: Access and fluid delivery for acute PD in adults (2.1) Flexible peritoneal catheters should be used where resources and expertise exist (1B) (optimal). (2.2) Rigid catheters and improvised catheters using nasogastric tubes and other cavity drainage catheters may be used in resource-poor environments where they may still be life-saving (1C) (minimum standard). (2.3) We recommend catheters should be tunnelled to reduce peritonitis and peri-catheter leak (practice point). (2.4) We recommend that the method of catheter implantation should be based on patient factors and locally available skills (1C). (2.5) PD catheter implantation by appropriately trained nephrologists in patients without contraindications is safe and functional results equate to those inserted surgically (1B). (2.6) Nephrologists should receive training and be permitted to insert PD catheters to ensure timely dialysis in the emergency setting (practice point). (2.7) We recommend, when available, percutaneous catheter insertion by a nephrologist should include assessment with ultrasonography (2C). (2.8) Insertion of PD catheter should take place under complete aseptic conditions using sterile technique (practice point). (2.9) We recommend the use of prophylactic antibiotics prior to PD catheter implantation (1B). (2.10) A closed delivery system with a Y connection should be used (1A) (optimal). In resource poor areas, spiking of bags and makeshift connections may be necessary and can be considered (minimum standard). (2.11) The use of automated or manual PD exchanges are acceptable and this will be dependent on local availability and practices (practice point). Guideline 3: Peritoneal dialysis solutions for acute PD (3.1) In patients who are critically ill, especially those with significant liver dysfunction and marked elevation of lactate levels, bicarbonate containing solutions should be used (1B) (optimal). Where these solutions are not available, the use of lactate containing solutions is an alternative (practice point) (minimum standard). (3.2) Commercially prepared solutions should be used (optimal). However, where resources do not permit this, then locally prepared fluids may be life-saving and with careful observation of sterile preparation procedure, peritonitis rates are not increased (1C) (minimum standard). (3.3) Once potassium levels in the serum fall below 4 mmol/L, potassium should be added to dialysate (using strict sterile technique to prevent infection) or alternatively oral or intravenous potassium should be given to maintain potassium levels at 4 mmol/L or above (1C). (3.4) Potassium levels should be measured daily (optimal). Where these facilities do not exist, we recommend that after 24 h of successful dialysis, one consider adding potassium chloride to achieve a concentration of 4 mmol/L in the dialysate (minimum standard) (practice point). Guideline 4: Prescribing and achieving adequate clearance in acute PD (4.1) Targeting a weekly K t/ V urea of 3.5 provides outcomes comparable to that of daily HD in critically ill patients; targeting higher doses does not improve outcomes (1B). This dose may not be necessary for most patients with AKI and targeting a weekly K t/ V of 2.2 has been shown to be equivalent to higher doses (1B). Tidal automated PD (APD) using 25 L with 70% tidal volume per 24 h shows equivalent survival to continuous venovenous haemodiafiltration with an effluent dose of 23 mL/kg/h (1C). (4.2) Cycle times should be dictated by the clinical circumstances. Short cycle times (1–2 h) are likely to more rapidly correct uraemia, hyperkalaemia, fluid overload and/or metabolic acidosis; however, they may be increased to 4–6 hourly once the above are controlled to reduce costs and facilitate clearance of larger sized solutes (2C). (4.3) The concentration of dextrose should be increased and cycle time reduced to 2 hourly when fluid overload is evident. Once the patient is euvolemic, the dextrose concentration and cycle time should be adjusted to ensure a neutral fluid balance (1C). (4.4) Where resources permit, creatinine, urea, potassium and bicarbonate levels should be measured daily; 24 h K t/ V urea and creatinine clearance measurement is recommended to assess adequacy when clinically indicated (practice point). (4.5) Interruption of dialysis should be considered once the patient is passing >1 L of urine/24 h and there is a spontaneous reduction in creatinine (practice point). The use of peritoneal dialysis (PD) to treat patients with acute kidney injury (AKI) has become more popular among clinicians following evidence of similar outcomes when compared with other extracorporeal therapies. Although it has been extensively used in low-resource environments for many years, there is now a renewed interest in the use of PD to manage patients with AKI (including patients in intensive care units) in higher income countries. Here we present the update of the International Society for Peritoneal Dialysis guidelines for PD in AKI. These guidelines extensively review the available literature and present updated recommendations regarding peritoneal access, dialysis solutions and prescription of dialysis with revised targets of solute clearance.

show abstract

Section: Guideline 32 -Commercial Versus Locally Mixed Solutionsmentioning

confidence: 99%

ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 update (adults)

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Likewise in Cameroon, Palmer et al found that there was no difference in the rate of peritonitis and mortality between patients who have been dialyzed by commercial versus locally made solutions. 8 The infection was a big challenge when we were establishing this first PD program, given the unfortunate experience of using locally produced fluids attempted long before by the adult nephrology in the University Hospital of Kinshasa. To meet this challenge, strict aseptic measures have been followed during the implementation of the current pediatric PD program: newly refurbished and constantly maintained infrastructure, clear protocol of asepsis starting from the insertion of the PD catheter to PD sessions has to be respected by all medical and paramedical staff.…”

Section: Discussionmentioning

confidence: 99%

A promising pediatric peritoneal dialysis experience in a resource-limited setting with the support of saving young lives program

et al. 2020

View full text Add to dashboard Cite

In the Democratic Republic of Congo (DRC), acute kidney injury (AKI) contributes to the high rate of child mortality owing to the conjunction of poverty, deficiency of qualified health-care providers in pediatric nephrology, and the lack of pediatric dialysis programs. We aimed to describe the recent experience of the first pediatric acute peritoneal dialysis (PD) program in DRC. This is a retrospective cohort study on epidemiology, clinical features and outcomes of children admitted from January 2018 to January 2019 at the University Hospital of Kinshasa for AKI and treated with PD. This pediatric PD program started by a team of one physician and one nurse who were trained in the local production of PD fluids and bedside catheter insertion technique in Benin Republic. The training was jointly supported by the Flemish Inter-University Council (VLIR) TEAM project and Saving Young Lives (SYL) program of ISN, ISPD, EuroPD, and IPNA. From January 2018 to January 2019, 49 children (aged 4 months–15 years) were admitted for AKI mainly due to severe malaria and sepsis. Dialysis was indicated in 35 of 49 (71.4%), 32 of 35 (91.4%) were treated with PD, two with hemodialysis (HD) in adult ward and one died at admission. Data of the two patients transferred for HD were not available for follow-up. The main indications were uremia and prolonged anuria. Of 32 dialyzed patients, 24 (75%) recovered normal renal function 3 months after discharge. Peritonitis was observed in 2 of 32 (6.2%) patients and the mortality was 18.7%. This promising experience proves that with simple means including use of locally produced dialysis fluids and low peritonitis rates, we can effectively save lives of children suffering from AKI.

show abstract

“…Furthermore, the costs of distribution of supplies has limited the availability of PD in many LMICs. 24,129 It is important to note that provision of PD involves not only the provision of dialysis solutions but also the availability of satisfactory connection ports between PD solutions and the catheter and appropriate support systems. In addition, it needs to be appreciated that 10% to 15% of PD patients transfer to HD each year because of various complications; thus, having an HD facility available to help manage these patients is essential.…”

Section: And the Deliberations Of Isn's 2ndmentioning

confidence: 99%

Increasing access to integrated ESKD care as part of universal health coverage

Harris

Davies

Finkelstein

et al. 2019

Kidney International

Self Cite

145

132

View full text Add to dashboard Cite

show abstract

Peritoneal Dialysis for AKI in Cameroon: Commercial Vs Locally-Made Solutions

Abstract: Locally produced PD solutions, used with locally available tubing, were used to treat AKI with PD. The mortality and peritonitis rates were similar whether locally produced or commercial supplies were used.

Cited by 28 publications

References 13 publications

ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 update (adults)

ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 update (adults)

A promising pediatric peritoneal dialysis experience in a resource-limited setting with the support of saving young lives program

Increasing access to integrated ESKD care as part of universal health coverage

Contact Info

Product

Resources

About