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Characteristics, complications and outcome of patients treated with automated peritoneal dialysis at the peritoneal dialysis unit, University Hospital of the West Indies. Retrospective data were collected from peritoneal dialysis patients’ case files retrieved from the medical records department of UHWI.
Demographic data age, gender, address, marital statusyear of dialysis commencement, cause of end stage renal disease ESRDhaemoglobin, serum electrolytes, serology, blood pressure readings, medications used, blood transfusion and erythropoietin use were collated.
There were patients receiving peritoneal dialysis between September, and December, Dialiss on were analysed. The case files of 12 patients were not included because of incom plete data.
The ages of the studied PD patients ranged between 33 and 65 years. The mean haemoglobin was 7. Most patients were from Kingston and St Andrew Forty-one per cent ofpatients were transferred to haemodialysis mainly on account ofinadequate dialysis clearance. Of those who died of sepsis, Infection and cardiovascular disease were common complications observed in this study.
Therefore intensive management of risk factors hypertension, diabetes and dyslipidaemia and prompt recognition ofinfection is hereby recommended. Early recognition and appropriate management of sepsis in peritoneal dialysis patients should be initially based on standard protocol.
The use of erythropoietin in peritoneal dialysis patients will enhance better management ofanaemia and improve quality of life. Complications, outcome, peritoneal dialysis. Los datos de pacientes fueron analizados. La hemoglobina media fue 7. De los fallecidos por sepsis, Peritoneal dialysis PD first became a practical and widespread modality of renal replacement therapy in the s.
Renal replacement therapy RRT in the Caribbean mainly comes in the form of haemodialysis and to a less extent, transplantation 1. There are no data available from the Caribbean evaluating patients on PD. Peritoneal dialysis is one of the available renal replacement therapy for patients with end stage renal disease ESRD. It involves the transport of solutes and water across a “membrane” that separates two fluid containing compartments.
Blood in the peritoneal capillaries in renal failure contains excess of urea, creatinine and potassium etc on one side and the dialysis solution in the peritoneal cavity, which typically contains sodium, chlorine and lactate rendered hyperosmolar by inclusion of glucose is on the other side.
The peritoneal membrane acts as the dialyzer.
Knowledge of the transport properties of the peritoneal membrane is important to guide therapy, evaluate changes in the peritoneal membrane over time and also prognosticate. Peritoneal equlibration test is used to characterize the peri dlalisis membrane function and to select the most appropriate technique for the patient. This will ultimately guide clinical decision and prescription management. Chronic long-term PD is associated with progressive loss of ultrafiltration capacity and integrity of the peritoneal membrane.
In PD therapy, the quality of life for patients with ESRD is improved with preservation and prolongation of residual renal function which is associated with improved survival. Despite this, technique failure rate and complica tion remain high.
Factors contributing to this include peri tonitis, catheter-related difficulties, viability of the peritoneal membrane and various automatizara problems. A retrospective review of all data collected from peritoneal dialysis case files of patients dialyzed at the Peritoneal Dialysis Unit UHWI was performed.
The study period was between Automatizda and December Patient’s case files were all retrieved from the medical records department, UHWI. Parameters peritoneao for study included demographic data age, gender, address, marital statusyear of dialysis commencement, cause of ESRD, haemoglobin, serum ureaserum creatinineserum calcium, serum phosphate, HIV and hepatitis serology.
Blood pressure readings, number and types of daily medications used, blood transfusion, erythropoietin use, complications, outcome and cause of death were also collected. Of these, Most patients were from Kingston St Catherine and Clarendon accounted for The unmarried accounted for There was no data available for those who were in commonlaw union. Females dialidis for The major causes of Aautomatizada found in this population were hypertension, diabetes mellitus and chronic glomerulonephritis Fig.
Sickle cell disease and persistent pos terior urethral valves were also found as significant causes of ESRD. Of those who died due to sepsis Fig. However, death could not be ascribed to peritonitis in these four patients.
Pill burden in this study showed that the majority of patients were taking between five to ten pills per day, with some taking up to 16 pills for the day Fig. Peritoneal dialysis is one of the effective means of renal replacement therapy and can be home-based or centre-based but this study was based at an in-hospital centre. The long term use of intermittent peri toneal dialysis in ESRD was well documented as far back as and peritoneal dialysis was popularized in by Popovich and co-worker and it has been shown to offer better quality of life with better mortality profile 10, Despite advancements, peritoneal dialysis is plagued by different types of complications as revealed by this study.
The average age of 49 range of 33 to 65 years from this study is similar to many other reviewed studies 8, 12 and is also similar to the age seen in patients on haemodialysis 1. The geographic location of the patients on PD reflects a higher proportion in the Kingston as well St Catherine environs and this could simply be due to location bias as the PDU is located in this area.
En marcha un novedoso sistema de diálisis domiciliaria con monitorización remota de los pacientes
The causes of ESRD were no different from other studies as hypertension, diabetes mellitus and chronic glomerulonephritis were the leading causes 1, 3, 8, Persis tent posterior urethral valves are found to be quite a significant cause of ESRD compared to the causes found in patients on chronic haemodialysis 1. Perhaps this reflects the fact that PD is a better choice in paediatric and adolescent population combined with the fact that patients with persistent posterior urethral valves will present earlier in life with CKD.
However, when compared to data on HD, the mean age was similar. Therefore, the reason for this is still unclear. Sickle cell disease was also seen in a significant proportion of these cases and this will have implications especially on the mean haemoglobin concentration seen in the studies.
A sub-analysis of the mean haemoglobin among the different cause of ESRD would reflect this and possibly shed some light on the observed trend. Anaemia is a common complication of ESRD 1, 6, 7, 8.
The mean haemoglobin from this study was 7. However, this can be attributed to the general low usage of erythropoietin as demonstrated in this study. Patients had to purchase erythropoietin out of their own resources. A peritonela majority of the patients rely on packed red cell transfusion to maintain their haemoglobin as well as to relieve symptoms of anaemia. The repeated use of blood transfusion also has impli cations matching, selection and graft survival for patients being considered for renal transplantation.
Other causes of anaemia in CKD includes poor dietary intake of iron and the presence of high levels of circulating inflammatory cytokines promoting destruction of immature erythroblast and hepatic release of hepcidin a peptide hormone reducing iron ab sorption from the gut.
Of these deaths, Cardiac-related causes accounted for The cause is multifactorial as the ESRD patient is in a pro-inflammatory state with multiple risk factors for CVD including diabetes mellitus, hypertension and uncontrolled dyslipidaemia.
There is new evidence 15, 16 which suggests that the constant high load of glucose in PD patients may predispose to impaired glucose tolerance, diabetes mellitus and even metabolic syndrome. Although further breakdown showed that pneumonia Prompt recognition of sepsis in peritoneal dialysis patients is highly recommended to reduce this preventable cause of mortality. Also, the use of vaccination as primary prevention in this population which is also likely to have congestive cardiac failure is recommended.
It is worthwhile to note that only 9. Also it would have been useful to know how many peritonitis episodes were there per patient. It therefore is not automatiaada that they also xialisis for the higher mortality seen in the study. Identification and risk stratification should be en couraged in the patients both on PD as well as HD, and should be extended to other stages of CKD.
Dialisis peritoneal automatizada Pisa
Management of blood pressure and lipid according to international guidelines should be followed. The PD first concept as practised in Hong Kong should be examined in this region. The hospital authority in Hong Kong reimburses only patients for PD. Peritoneal dialysis offers significant advantage of better residual renal function RRF when compared with haemodialysis. High RRF trans late to less mortality in dialysis patients. Peritoneal dialysis has been documented in various studies to be a cheaper modality of renal replacement therapy when compared with haemodialysis.
In fact, the Asian Round Table on dialysis economics has agreed to look into ways to increase the utilization of PD in order to improve the clinical and financial management of patients with ESRD. Peritoneal dialysis for patients with ESRD offers many advantages, including better quality of life, preservation of residual renal function, and patients and care-giver flexibility and satisfaction.
Therefore, careful attention should be paid to patient selection, timing and dose of PD, patients’ and family quality of life, maintenance of adequate volume status, maintaining serum biochemical parameters at recommended values, control of calcium-phosphate product and long term viability of therapy.
Calaméo – Napoleón Serrano
It is recommended that more peritoneal dialysis centres be set up, both home and centre-based, as first line modality of renal replacement therapy.
Report from the Caribbean Renal Registry, West Indian Med J ; Anemia Management in ;eritoneal Dialysis Patients: Treatment and outcome of CPD-absorbed peritonitis. Ann of clin mic Iron therapy for renal anemia: Aufomatizada Nephrol ; Impact of CPD on treatment of renal failure in patients aged over 60 years. BMJ7 January; Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: