Applied Peritoneal Dialysis: Improving Patient Outcomes

Foreword
Contents
Contributors
Chapter 1: History of Peritoneal Dialysis
	References
Chapter 2: Physiology of Peritoneal Dialysis
	Peritoneal Anatomy
	Peritoneal Membrane Histology
	Models of Peritoneal Transport
		The Three-Pore Model
		The Pore-Matrix Model
		The Distributed Model
	Physiology of Peritoneal Transport
		Solute Transport
		Ultrafiltration
		Sodium Sieving
		Fluid Absorption
		Kinetic of a Single Peritoneal Dialysis Dwell
	Peritoneal Equilibration Test
	Changes in the Peritoneal Membrane with Time on Peritoneal Dialysis
	References
Chapter 3: Peritoneal Dialysis Patient Selection
	References
Chapter 4: Epidemiology of Peritoneal Dialysis
	Introduction
	Incidence of Peritoneal Dialysis
	Prevalence of Peritoneal Dialysis
	Common Characteristics of Countries with High PD Prevalence Rates
	Epidemiological Factors Affecting Utilization of PD
		Patient Factors
			Age
			Comorbid Conditions: Diabetes Mellitus (DM)
			Physical Ability and Support System
			Patient Awareness of PD
			Financial Considerations
			Other Patient-Related Factors
		Facility Factors
			Clinician Attitude and/or Bias
			PD Catheter Placement
			Dialysis Organizational Priorities
			Clinical Governance/Registry Data
		Industry Factors
		Dialysis Factors
		Healthcare System Factors
			Universal Healthcare Coverage
			Financial Incentives and Clinical Reimbursement
			Healthcare Policies (PD-First and PD-Favored)
			Healthcare Disparities
	Epidemiology of Infection-Related Complications in PD Patients
	Epidemiology of Mortality in PD Compared to HD
	Proposed Solutions to Overcome Underutilization of PD
	References
Chapter 5: The Evolution of Peritoneal Dialysis Solutions
	Composition of PD Solutions
		Osmotic Agents
		Conclusion
	References
Chapter 6: Automated Cyclers for Peritoneal Dialysis
	Conclusion
	References
Chapter 7: Continuous Ambulatory Peritoneal Dialysis Versus Automated Peritoneal Dialysis – Are There Differences in Outcomes?
	Residual Kidney Function
	Peritonitis
	Volume Management
	Technique Survival
	Mortality
	Health-Related Quality of Life
	References
Chapter 8: Peritoneal Dialysis Access: Catheters and Placement
	Catheters
	Catheter Selection
	Catheter Insertion
	Percutaneous Needle-Guidewire Technique
	Open Surgical Dissection
	Peritoneoscopic Procedure
	Surgical Laparoscopy
	Extended Two-Piece Catheter Insertion
	Catheter Embedding
	Procedure Elements Common to All Approaches
	Choosing a Catheter Implantation Approach
	References
Chapter 9: Peritoneal Dialysis Catheter Insertion by the Nephrologist
	Introduction
	Patient Selection
	Patient Preparation
	Resources and Equipment
	Peritoneal Dialysis Catheter Insertion Technique
	Complications
	Early Peritoneal Dialysis Catheter Care
	Patient Outcomes
	Program Outcomes
	Financial Considerations
	Quality Improvement
		Operator Training
		Local Audit
		Program Collaboration
	Conclusions
	References
Chapter 10: Peritoneal Dialysis Adequacy
	The Importance of Time Compared to Small Solute Clearance
	A Solute Shift
	Putting Solute Clearance to the Test
	The Role of Residual Kidney Function
	Euvolemia as an Adequacy Measure
	Maintenance of Residual Kidney Function
	Practical Ways to Increase Adequacy
	Summary
	References
Chapter 11: Techniques in Peritoneal Dialysis
	Introduction
	PD Technique and Related Glossary
		PD Exchange
		PD Technique
	Continuous Flow Peritoneal Dialysis (CFPD)
		Regimen and Modes of Performing PD Exchanges [Fig. 11.4]
	Intermittent PD Regimens
		Automated Cycler-Assisted IPD Regimens (aIPD): (Nighttime or Daytime)
		Manual IPD Regimens (mIPD): (Daytime or Nighttime)
	Continuous Peritoneal Dialysis (CPD) Regimens
		Manual CPD, i.e. CAPD
		Machine-Assisted CPD, i.e., CCPD
	Aseptic Precautions
	References
Chapter 12: Peritoneal Dialysis in Acute Kidney Injury: Prescribing Acute PD
	Prescribing Acute PD
		Technical Aspects and Controversies
		Evidence and Guidelines
		Practical Aspects of Prescribing, Delivering, and Monitoring PD
	Conclusion
	References
Chapter 13: Prescribing Chronic Peritoneal Dialysis Therapy
	Introduction
	Peritoneal Dialysis Modalities
		Basics of the PD Prescription
		Initial Prescription
		Prescription Modification
	References
Chapter 14: Urgent-Start Peritoneal Dialysis
	Background
	Urgent-Start PD: Definition and Candidacy
	Urgent-Start PD: How Is It Accomplished?
	Establishing an Urgent-Start Program
	Studies to Support Early PD Initiation
	Contemporary Urgent-Start PD Studies
	Challenges of Urgent-Start PD
	Conclusion
	References
Chapter 15: Infectious Complications in Peritoneal Dialysis
	Introduction
	Exit-Site and Tunnel Infection
	Peritonitis
		Definition and Diagnosis
		Peritonitis Treatment
		Infection Prevention
	Infection Monitoring
	Summary
	References
Chapter 16: Noninfectious Complications of Peritoneal Dialysis
	PD Catheter Malfunction
	Inflow and Drain Pain
	Complications Related to Increased Intra-abdominal Pressure
		Hernias
		Abdominal Dialysate Leaks
		Hydrothorax
	Abnormal PD Effluent Appearance
		Hemoperitoneum
		Chyloperitoneum
		Other Abnormal PD Effluent Appearance
	Encapsulating Peritoneal Sclerosis
	References
Chapter 17: ESKD Complications: CKD-MBD
	Biomarkers: Calcium, Phosphate, and 1,25-Dihydroxyvitamin D
	Biomarkers: Parathyroid Hormone
	Biomarkers: FGF-23 and Klotho
	Secondary and Tertiary Hyperparathyroidism
	Renal Osteodystrophy
	Osteopenia/Osteoporosis
	Extraskeletal Calcifications
	Cardiovascular Disease
	Calcific Uremic Arteriolopathy
	Summary
	References
Chapter 18: Anemia Management in Peritoneal Dialysis
	Introduction
	Pathophysiology of Anemia in End-Stage Kidney Disease
	Rationale for Anemia Treatment
	Role of Iron in Anemia Therapy and Evidence for Use
	Erythropoiesis-Stimulating Agents and Evidence for Use
	Hypoxia-Inducible Factor Stabilizers and Evidence for Use
	Difference Between Anemia Therapy in Peritoneal and Hemodialysis Patients
	The Need for Further Workup
	References
Chapter 19: Peritoneal Dialysis in Diabetic Patients
	Introduction
	PD for Diabetic Patients
		Choice of PD as the Dialysis Modality
		Metabolic Consequence of PD
		Glucose-Sparing Strategies
	Management of Diabetic PD Patients
		Specific Problems
		Treatment of Diabetes
			Insulin Therapy in PD
			Oral Hypoglycemic Agents
			Target of Glycemic Control
			Hypoglycemia
			Glycemic Monitoring
		Treatment of Other Cardiovascular Risk Factors
			Blood Pressure
			Volume Control
			Lipid
			Antiplatelet and Antithrombotic Therapy
		Treatment of Other CKD Complications
			Anemia
			Mineral Bone Disease
	Conclusion
	References
Chapter 20: Peritoneal Dialysis in Special Situations
	Introduction
	Autosomal Dominant Polycystic Kidney Disease
	Chronic Heart Failure
	Liver Cirrhosis
	Abdominal Surgeries and Abdominal Complications
	Diverticular Disease of the Colon
	Abdominal Hernia
		Abdominal Surgery in PD
		Pregnancy
	Conclusion
	References
Chapter 21: Survival Outcomes with Peritoneal Dialysis
	Overview
	Survival Outcomes in ESKD Versus the General Population
	Survival Outcomes Between Dialysis Modalities
		Statistical Study Design
		Dialysis Modality Comparisons
	PD Survival Outcomes in Special Populations
		Diabetes
		Elderly Patients
		Obesity
		Failed Kidney Transplant
		Organ-/Disease-Specific Predictive Factors
			Cardiovascular Disease
			Coronary Artery Disease
			Arrhythmias
			Congestive Heart Failure
			Blood Pressure Abnormalities and Variability
			Hydration Levels: Over- or Underhydration
			Peritonitis
			Residual Kidney Function (RKF)
			Hypokalemia
			Frailty
			Peritoneal Membrane Transport Type
	Process/Infrastructure Factors
		Unplanned Starts and PD Patient Survival Outcomes
		Modality Transitions and PD Patient Survival Outcomes
	Discussing PD Survival Outcomes with ESKD Patients
	Conclusion
	References
Chapter 22: Quality of Life in Peritoneal Dialysis
	Introduction
	Measurement of Quality of Life
		Common Assessment Tools
	Quality of Life in Kidney Replacement Therapy
	Patient Priorities for Outcomes in PD
	Factors Associated with Quality of Life in PD
		Demographic Factors
			Sex
			Ethnicity
			Age
		Social Factors
			Socio-Economic Status
			Social Support Networks
			Burden on Caregivers
		Psychological Factors
			Depression
			Anxiety
			Body Image
		Physical Factors
			Sexual Dysfunction
			Nutrition
			Gastrointestinal (GI) Symptoms
			Sleep Disorders
		Disease-Related Factors
			Anaemia
			Infection
		Treatment-Related Factors
			Residual Kidney Function
			Small Solute Removal
			PD Modality (APD, CAPD)
			PD Solutions
	How Can We Optimise QOL in PD?
	Conclusions
	References
Chapter 23: Incremental Peritoneal Dialysis
	Introduction
	Adequacy and Residual Kidney Function
	Technique Survival in PD
	Quality of Life
	Prescription Design
	Incremental PD and Incremental HD
	References
Chapter 24: Pediatric Peritoneal Dialysis
	Introduction and Epidemiology
	Access
		Catheter Characteristics
		Surgical Considerations
		Chronic Catheter Care
	Technology
		Automated Cycler
		Peritoneal Dialysis Solutions
	Prescribing Peritoneal Dialysis to Children
	Infectious Complications
	Noninfectious Complications
	Outcome: Morbidity and Mortality
	Unique Population: Infants
	References
Chapter 25: The Principles of Drug Dosing in Peritoneal Dialysis
	Introduction
	Pharmacokinetic Alterations in Chronic Kidney Disease
		Absorption
		Volume of Distribution
		Metabolism
		Elimination
	Drug Adjustments in Patients on Peritoneal Dialysis
	Peritoneal Dialysis and Clearance
	Commonly Prescribed Medications
		Antimicrobial Agents
		Analgesics
		Anticoagulation Agents
		Diuretics and Antihypertensive Agents
		Hypoglycemia Agents
	Conclusion
	References
Chapter 26: Commonly Asked Questions About Peritoneal Dialysis
	Should Every Patient at the Start of Peritoneal Dialysis Have a Preemptive “Backup” Arteriovenous Access?
	Do I Have to Switch a Peritoneal Dialysis Patient to Hemodialysis After Hernia Repair?
	Is Peritoneal Dialysis Possible in Patients with Liver Disease and Ascites?
	Can We Continue Peritoneal Dialysis After Cardiac Surgery?
	Can Peritoneal Dialysis Patients Swim?
	Can We Do Peritoneal Dialysis in Patients with a G-Tube?
	Is There a BMI Cutoff for a Patient Who Wishes to Do Peritoneal Dialysis?
	References
Chapter 27: Building an Effective Peritoneal Dialysis Program
	Introduction
	Recruitment
		Patient Selection
	Education
		Modality Education for ESKD Patients
		Modality Education for CKD Patients
		Family Education
	Ongoing Patient and Family Education
		Staff Education
	PD Access Placement
	The Team!
	Interactions of the PD Program with the Health Ecosystem
		Support from Organizations
		Integrated Dialysis Program
	Transplantation
	Conclusion
	References
Chapter 28: The Peritoneal Dialysis Outcomes and Practice Patterns Study
	Introduction
	The Problem of Technique Failure
	PDOPPS: Design and Rationale
		Rationale
		Design
		Study Data and Collection Instruments
		Analysis
		Ancillary Studies
	Current Status of PDOPPS
	Early Findings from PDOPPS
		Infection Prevention and Management
		Patient Support
		PD Training and Education
		Dialysis Prescription and Fluid Management
	Conclusion
	References
Chapter 29: Peritoneal Dialysis in Developing Countries
	Introduction
	Advantages and Disadvantages of Peritoneal Dialysis
	Peritoneal Dialysis Models in Developing Countries
		PD for AKI (See Also Chap. 20)
			PD Fluids
			PD Catheters and Access
		PD in Chronic Kidney Disease
			Clean Surfaces
			Water for Washing
			Geography
			Lack of Electricity
	Conclusion
	References
Chapter 30: Advances in Peritoneal Dialysis
	Introduction
	Advances in Peritoneal Dialysis Solutions
		Biocompatible Solutions
		Glucose-Sparing Solutions
		Low-Sodium Solutions
		“Bimodal” Solutions
	Bimodal Dialysis and Hybrid Peritoneal Dialysis
	Remote Patient Monitoring for Peritoneal Dialysis Patients
	Assisted Peritoneal Dialysis
	Future Directions
	Conclusion
	References
Chapter 31: Nutritional Management of Adult Peritoneal Dialysis Patients Abstract
	Altered Metabolism and Nutrition Abnormalities
		Nutrient Losses During Peritoneal Dialysis
		Caloric Gain from Dextrose in Dialysate
		Gastrointestinal Disorders
		Peritoneal Solute Transport Rate
		Residual Kidney Function
		Peritonitis
		Protein Energy Wasting
	Goals for Nutritional Management
	Nutritional Requirements for Patients Undergoing Peritoneal Dialysis
		Energy
		Protein
		Sodium and Fluids
		Potassium
		Phosphorous
		Vitamins and Minerals
	Food-Based and Dietary Pattern Recommendations
	Effective Nutritional Management
		Protein Energy Wasting: Nutritional Status
		Sodium and Fluids
		Minerals
		Cardiovascular Health
		Gut Health
	Summary
	References
Chapter 32: The Role of Peritoneal Dialysis in Pandemics and Natural Disasters
	Introduction
	Earthquakes
	Tropical Cyclones and Flooding
	COVID-19 and Future Pandemics
	Conclusions
	References
Index