The Current State of Peritoneal Dialysis

Abstract

Technical innovations in peritoneal dialysis (PD), now used widely for the long-term treatment of ESRD, have significantly reduced therapy-related complications, allowing patients to be maintained on PD for longer periods. Indeed, the survival rate for patients treated with PD is now equivalent to that with in-center hemodialysis. In parallel, changes in public policy have spurred an unprecedented expansion in the use of PD in many parts of the world. Meanwhile, our improved understanding of the molecular mechanisms involved in solute and water transport across the peritoneum and of the pathobiology of structural and functional changes in the peritoneum with long-term PD has provided new targets for improving efficiency and for intervention. As with hemodialysis, almost half of all deaths on PD occur because of cardiovascular events, and there is great interest in identifying modality-specific factors contributing to these events. Notably, tremendous progress has been made in developing interventions that substantially reduce the risk of PD-related peritonitis. Yet the gains have been unequal among individual centers, primarily because of unequal clinical application of knowledge gained from research. The work to date has further highlighted the areas in need of innovation as we continue to strive to improve the health and outcomes of patients treated with PD.

Manifestaciones gastrointestinales de la enfermedad renal crónica

“…Las complicaciones relacionadas con la técnica de diálisis peritoneal incluyen la esofagitis por reflujo, las hernias, la erosión del asa intestinal por presión del catéter, la peritonitis esclerosante y la pancreatitis. Las complicaciones relacionadas con la hemodiálisis incluyen náuseas, vómito, ansiedad, hambre, isquemia intestinal por hipotensión, sangrado digestivo por la heparina y pancreatitis inducida por hemólisis accidental 11,47,48 .…”

Glükózterhelés a peritonealis dialízisben. Újabb elméleti megfontolások

“…A gyakorló klinikus szempontjából a jelenleg kezünkben lévő eszközök birtokában definiál-ható követendő irányelv, ha a legkisebb szükséges peritonealis dialízis mennyiséget biztosító, individualizált glü-kóztakarékos PD-rezsimet írjuk elő [40].…”

Towards A Successful Peritoneal Dialysis Program

“…Likewise, allowing reimbursement of PD, but not HD, has permitted to increase the use of PD over HD in many Asian countries like Hong Kong, Vietnam, Taiwan, Thailand, as well as in New Zealand and Australia over recent years [42,43]. The major reasons of under utilization of PD modality include (1) lack or inadequate pre-dialysis education [44] and patient's awareness of RRT options [7,44,45], and in particular the suitability and advantages of PD modality, (2) insufficient or lack of focus on patients' training and encouragement and support, especially for anxious and unwell patients who might be nervous about participating in their own treatment [46][47][48], (3) lack or inadequate training of nursing staff and nephrologists in PD therapy [45,49], (4) insufficient encouragement and support of medical and nursing staff to guide patients to chose or implement PD modality as a possible first choice therapy [45,50], (5) lack or insufficient appreciation of the concept of "integrated renal replacement therapy (RRT) program" [1], and (6) inadequate preparation or lack of a proper set up of an independent PD unit [51,52].…”

“…More recent studies have shown that PD and in center HD provide similar short and long term survival [7]. PD has the benefits of preserving residual renal function [8], delaying the need for vascular access and helping patients with multiple vascular access failure, and constitutes a better option for older age groups especially those with cardiovascular disease [8,10].…”

“…In fact, PD has become an attractive modality of renal replacement therapy following the recent availability of new PD solutions such as icodextrin and amino-acid-based [13,14] and biocompatible PD fluids [15]. The better understanding of the molecular mechanisms involved in solute and water transport across the peritoneum, the advances in PD technology, and in particular catheter placement [16], better connecting systems with significant reduction in peritonitis rate, and the improved technology of new generation of automated compact easy to use cyclers with many advantages (table 2) have enhanced PD utilization [7]. Studies from the United Kingdom [17] and studies from Netherlands, Belgium and New Haven study [18][19][20] have documented that if patients are given informed choice of dialysis treatment, 40-60% will choose PD modality.…”