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Background: The standard rate of sodium removal in adult anuric patients on continuous ambulatory peritoneal dialysis (CAPD) is 7.5 g/L of ultrafiltration volume (UFV). Although automated PD (APD) is widely used in pediatric patients, no attempt has yet been made to estimate sodium removal in APD. Methods: The present, retrospective cohort study included pediatric patients with APD who were managed at Tokyo Metropolitan Children's Medical Center between July 2010 and November 2017. The patients underwent a peritoneal equilibrium test (PET) at our hospital. Sodium removal per UFV was calculated by peritoneal function and dwell time using samples from patients on APD with 1- and 2-h dwell effluent within three months of PET and 4- and 10-h dwell effluent at PET. Results: In total, 217 samples from 18 patients were included, with 63, 81, and 73 of the samples corresponding to the High [H], High-average [HA], and Low-average [LA] PET category, respectively. Sodium removal per UFV (g/L in salt equivalent) for dwell times of one, two, four, and ten hours was 5.2, 8.8, 8.0, and 11.5 for PET [H], 5.3, 5.8, 5.6, and 8.1 for PET [HA], and 4.6, 5.1, 5.1, and 7.1 for PET [LA], respectively. Conclusions: Sodium removal per UFV in pediatric APD was less than the standard adult CAPD and tended to be lower with shorter dwell times, leading to sodium accumulation. Therefore, salt intake should be restricted in combination with one or more long daytime dwells, especially in anuric patients. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore in depth the lived experience and quality of life outcomes in patients receiving automated peritoneal dialysis (APD) treatment. Methods: The study adhered to the standards of the Consolidated Criteria for Reporting Qualitative Research. A total of 19 APD patients were recruited and assessed using in‐depth semi‐structured interviews on various aspects of life with respect to APD modality. The interviews were transcribed verbatim and analyzed using Interpretive Phenomenological Analysis. Results: Study findings generated five superordinate themes: (a) treatment–free daily routine, (b) sleep disturbances, (c) remote care, (d) limitations of peritoneal dialysis, and (e) the dimension of chronic disease. Further analysis of the material revealed the relationship of these themes with individual patient characteristics. Conclusions: Overall, our findings suggest that APD characteristics contribute to the perceptions of quality of life in patients under dialysis considerably. [ABSTRACT FROM AUTHOR]

The management of end-stage kidney disease (ESKD) has been constantly evolving over the last decade with the development of targeted approaches. In this field, telemedicine and remote monitoring are based on the availability of new cyclers that allow for bidirectional communication (between patient and physician) and for the application of the Sharesource cloud-based platform. These technologies allow patients with ESKD to undergo automated peritoneal dialysis (APD) at home. However, these approaches are not well standardized and largely applied yet. Therefore, this study aimed to elaborate a protocol for the utilization of the Sharesource platform to facilitate the practical management of patients treated with APD. A series of expert meetings were held between September 2022 and January 2023 in Italy. The participants (ten nephrologists and five nurses) from nine Italian public dialysis centers shared their opinions, examined the current scientific literature in the field, and reviewed the key characteristics of the Sharesource system to achieve a common position on this topic. A detailed and practical document containing experts' opinions and suggestions on the use of the Sharesource platform for the management of patients treated with APD was produced. This expert opinion might represent a new useful instrument in clinical practice for managing patients undergoing home-based peritoneal dialysis (PD) through the Sharesource platform, which is valid not only for Italy. These recommendations pave the way to novel patient-centered and personalized therapeutic approaches for ESKD and highlight the advantages of telemedicine and remote monitoring in the management of patients with ESKD undergoing PD and its positive impact on their quality of life. [ABSTRACT FROM AUTHOR]

In recent years, the incidence of end-stage kidney disease (ESKD) in China has been increasing annually. Dialysis patients often experience various complications, and they are also a high-risk population for psychological disorders such as anxiety and depression. The choice of dialysis method and the dialysis process are closely related to the daily lives of the patients and their families. All these patients require a patient-centric treatment strategy. Before entering end-stage renal disease (ESRD) and preparing for renal replacement therapy, it is crucial for patients and their families to understand the characteristics of each renal replacement therapy. Considering clinical treatment needs, as well as the patient's living environment, work and study requirements, social reintegration, psychological needs, and personalized preferences, a collaborative decision-making approach is essential to choose an appropriate renal replacement therapy. With the growing preference for shared decision-making, more patients wish to undergo home dialysis treatment. Currently, due to limitations in equipment technology, economic costs, and human resources, home hemodialysis is challenging to widely adopt. Peritoneal dialysis, as a primary form of home dialysis, faces issues such as improper patient operation, poor treatment compliance, delayed prescription adjustments, and intervention for complications due to problems related to training and follow-up management. This article focuses on elucidating the shared decision-making process for ESRD patients,the prescription settings and remote patient follow-up management of automated peritoneal dialysis,which may help to collectively improve the treatment quality and social reintegration of home peritoneal dialysis patients. [ABSTRACT FROM AUTHOR]

Background and aims Dwell time is a critical component of automated peritoneal dialysis (APD) prescription, the stage at which transmembrane mass and fluid transfer occur. Loss of prescribed dwell time (LDT) can negatively influence the efficiency of APD. We investigated the incidence of LDT and related causes using APD in the acute care setting at a tertiary care center.Methods Retrospective analysis was conducted of all inpatients receiving APD treatments from 1 December 2021 to 1 June 2023. Patient demographics, comorbidities, laboratory, and treatment data were extracted from electronic medical records and a propriety database.Results N = 235 cycler treatments completed by 32 patients were included for analysis. The total LDT per treatment exceeding 30 minutes and 60 minutes occurred in 27% and 20% of all treatments. LDT of more than 10 minutes per each cycle exchange occurred in 26%. Session disruptions were caused by slow out-flow (55%), inadequate drain volumes (32%), patient line occlusions (20%), and priming errors (23%). The slow flow alarm requiring user intervention was reported to occur in about one-third of all treatments (31%).Conclusion There was significant LDT and inadequate drain volume seen in about one-quarter and one-third of all inpatient APD treatments respectively. This can impact solute clearance and ultrafiltration. Slow flow alarms were the most prevalent and the leading cause of LDT followed by inadequate drain volume. Future studies are required to investigate measures to reduce slow drain and improve drain volume in the hospital setting.

Background: Dialytic phosphate removal is a cornerstone of the management of hyperphosphatemia in peritoneal dialysis (PD) patients, but the influencing factors on peritoneal phosphate clearance (PPC) are incompletely understood. Our objective was to explore clinically relevant factors associated with PPC in patients with different PD modality and peritoneal transport status and the association of PPC with mortality. Methods: This is a cross-sectional and prospective observational study. Four hundred eighty-five PD patients were enrolled and divided into 2 groups according to PPC. All-cause mortality was evaluated after followed-up for at least 3 months. Results: High PPC group showed lower mortality compared with Low PPC group by Kaplan–Meier analysis and log-rank test. Both multivariate linear regression and multivariate logistic regression revealed that high transport status, total effluent dialysate volume per day, continuous ambulatory PD (CAPD), and protein in total effluent dialysate volume appeared to be positively correlated with PPC; body mass index (BMI) and the normalized protein equivalent of total nitrogen appearance (nPNA) were negatively correlated with PPC. Besides PD modality and membrane transport status, total effluent dialysate volume showed a strong relationship with PPC, but the correlation differed among PD modalities. Conclusions: Higher PPC was associated with lower all-cause mortality risk in PD patients. Higher PPC correlated with CAPD modality, fast transport status, higher effluent dialysate volume and protein content, and with lower BMI and nPNA. [ABSTRACT FROM AUTHOR]

Remote patient monitoring (RPM) of patients treated with automated peritoneal dialysis (APD) at home allows clinicians to supervise and adjust the dialysis process remotely. This study aimed to review recent scientific studies on the use of RPM in patients treated with APD and based on extracted relevant data assess possible clinical implications and potential economic value of introducing such a system into practice in Poland. A systematic literature review was performed in the MEDLINE, EMBASE, and Cochrane databases. The model of clinical effects and costs associated with APD was built as a cost-effectiveness analysis with a 10-year time horizon from the Polish National Health Fund perspective. Cost-effectiveness analysis compared 2 strategies: APD with RPM versus APD without RPM. Thirteen publications assessing the clinical value of RPM among patients with APD were found. The statistical significance of APD with RPM compared with APD without RPM was identified for the main clinical outcomes: frequency and length of hospitalizations, APD technique failure, and death. An incremental cost-effectiveness ratio was equal to €27 387 per quality-adjusted life-year. The obtained incremental cost-effectiveness ratio is below the willingness-to-pay threshold for the use of medical technologies in Poland (€36 510 per quality-adjusted life-year), which means that APD with RPM was a cost-effective technology. RPM in patients starting APD is a clinical option that is worth considering in Polish practice because it has the potential to decrease the frequency of APD technique failure and shorten the length of hospitalization. • To the best of our knowledge, our work is the first cost-effectiveness analysis of using the newest remote patient monitoring (RPM) in automated peritoneal dialysis in Poland. • It presents an assessment of the clinical effects of the latest research for RPM and an estimate of the costs and resource utilization of the currently used technologies and the new RPM in dialysis from the perspective of the Polish National Health Fund. • Our results show cost-effectiveness of the new RPM, and policymakers take this aspect into account. • Poland is one of the leaders in introducing new policies into practice in healthcare in Central and Eastern Europe; therefore, our research can give valuable information to any other local policymakers, in Europe and other countries. [ABSTRACT FROM AUTHOR]

Introduction: In-center automated peritoneal dialysis (APD) has been more frequently adopted in clinical practice for maintenance PD patients in China. For a better understanding of its clinical uptake, this retrospective study reviewed incident PD patients for a period of 6 years, investigating the practice pattern of in-center APD, factors associated with the use of in-center APD, and report on the patient survival compared to the nonusers of APD among hospitalized PD patients. Methods: This was a cohort study of all incident PD patients who met the inclusion criteria from January 1, 2013 to September 30, 2018, and were followed until death, cessation of PD, loss to follow-up, or December 31, 2018. Clinical characteristics, patient outcomes, and detailed data on APD sessions were recorded. We used time-dependent Cox model to estimate the variables associated with the initiation of in-center APD, and marginal structural model through inverse probability weighting to adjust for time-varying APD use on the causal pathway to all-cause mortality. Results: A total of 651 subjects over 17,501 patient-months were enrolled. Of these, 633 (97.2%) PD patients were hospitalized at least once during follow-up, and 369 (56.7%) received in-center APD at a certain point, and the timing of APD use during the first 3 months, first year, and first 2 years since PD inception were 14.8%, 45.4%, and 74.8%, respectively. A total of 12,553 in-center APD sessions were recorded, where 85.9% used 4 bags of 5L-exchanges per prescription. Time-dependent Cox model showed that diabetes (hazard ratio (HR), 1.39, 95% confidence interval (CI), 1.09−1.76), urine output (HR 0.80, 95% CI: 0.70–0.92), serum albumin (HR 0.84, 95% CI: 0.72–0.99), hemoglobin (HR 0.88, 95% CI: 0.77–0.99), and Ca × P (HR 1.19, 95% CI: 1.06–1.35) were significantly associated with in-center APD use. Among all hospitalized PD patients, the estimated HR corresponding to the marginal causal effect of in-center APD use on all-cause mortality was 0.13 (95% CI: 0.05–0.31, p < 0.001). Starting APD after the first PD year was associated with a significantly lower risk of all-cause mortality (adjusted-HR 0.56, 95% CI: 0.33–0.95). Conclusions: In-center APD is used intensively during the first 2 years of PD and is associated with certain clinical features. Overall, in-center APD use was associated with a lower risk of all-cause death when compared with non-use. [ABSTRACT FROM AUTHOR]

During urgent-start peritoneal dialysis (USPD) in end-stage renal disease (ESRD) patients, both adequate dialysis and skill training for fluid exchange are essential. However, automated peritoneal dialysis (APD) alone or manual fluid exchange peritoneal dialysis (MPD) alone could meet the above demands. Therefore, our study combined APD with MPD (A-MPD), and compared A-MPD with MPD, aiming to find the most appropriate treatment mode. This was a single-center, prospective, randomized controlled study. All eligible patients were randomized into the MPD and A-MPD groups. All patients underwent a five-day USPD treatment 48 h after catheter implantation, and they were followed up for six months after discharge. Overall, 74 patients were enrolled in this study. Among these, 14 and 60 patients quit due to complications during USPD and completed the study (A-MPD = 31, MPD = 29), respectively. Compared with MPD, the A-MPD treatment mode had a better effect on removing serum creatinine, blood urea nitrogen, and potassium and improving serum carbon dioxide combining power levels; it had less time expenditure on the fluid exchange by nurses (p < 0.05). In addition, patients in the A-MPD group had higher scores on the skill tests than those in the MPD group (p = 0.002). However, no significant differences in short-term peritoneal dialysis (PD) complications, PD technical survival rate, or mortality were found between the two groups. Therefore, the A-MPD mode could be recommended as an adoptable and suitable PD modality for USPD in the future. [ABSTRACT FROM AUTHOR]

Background: Due to the health emergency of COVID-19, telemedicine has become more relevant. Remote monitoring conspicuous as a valuable tool for the clinical follow-up of kidney patients, in this case, who are treated with automated peritoneal dialysis. This study aims to describe the use of remote monitoring as a surveillance method in a cohort of patients on automated peritoneal dialysis prevent complications and COVID-19 contagion. Methods: Study of a cohort of patients who initially participated in a randomized block clinical trial in which the use of Automated Peritoneal Dialysis with Remote Monitoring (APD-RM) was compared with conventional treatment. A descriptive analysis was performed of the rates of infection by COVID-19, the time of incidence until this, mortality, and rates of transfer to hemodialysis. In addition, survival was measured by survival curves. Results: Of the 509 patients, 19 were positive for COVID-19 (incidence rate of 7.0 episodes/100 patient-year), and only six patients recovered from the infection; the death rate was 2.6 % compared to all-cause death of 9.8 %. The most affected group of patients were those over 50 years old, with 71.4 % mortality, in contrast to younger patients infected, with a mortality of 60 %. During the follow-up period, 21 patients were transferred to HD: six due to peritonitis, five due to UF failure, seven due to catheter dysfunction, one due to uremic syndrome, one due to COVID-19, and one by surgical intervention. Conclusion: APD-RM patients have a significant advantage over other dialysis therapies because the use of telemedicine not only provides continuity in the patient's clinical treatment but also favors the prevention of COVID-19 infection, the management and prevention of complications inherent to therapy and the preservation of the life of Peritoneal Dialysis patients.

AbstractDuring urgent-start peritoneal dialysis (USPD) in end-stage renal disease (ESRD) patients, both adequate dialysis and skill training for fluid exchange are essential. However, automated peritoneal dialysis (APD) alone or manual fluid exchange peritoneal dialysis (MPD) alone could meet the above demands. Therefore, our study combined APD with MPD (A-MPD), and compared A-MPD with MPD, aiming to find the most appropriate treatment mode. This was a single-center, prospective, randomized controlled study. All eligible patients were randomized into the MPD and A-MPD groups. All patients underwent a five-day USPD treatment 48 h after catheter implantation, and they were followed up for six months after discharge. Overall, 74 patients were enrolled in this study. Among these, 14 and 60 patients quit due to complications during USPD and completed the study (A-MPD = 31, MPD = 29), respectively. Compared with MPD, the A-MPD treatment mode had a better effect on removing serum creatinine, blood urea nitrogen, and potassium and improving serum carbon dioxide combining power levels; it had less time expenditure on the fluid exchange by nurses (p

Due to the health emergency of COVID-19, telemedicine has become more relevant. Remote monitoring conspicuous as a valuable tool for the clinical follow-up of kidney patients, in this case, who are treated with automated peritoneal dialysis. This study aims to describe the use of remote monitoring as a surveillance method in a cohort of patients on automated peritoneal dialysis prevent complications and COVID-19 contagion. Study of a cohort of patients who initially participated in a randomized block clinical trial in which the use of Automated Peritoneal Dialysis with Remote Monitoring (APD-RM) was compared with conventional treatment. A descriptive analysis was performed of the rates of infection by COVID-19, the time of incidence until this, mortality, and rates of transfer to hemodialysis. In addition, survival was measured by survival curves. Of the 509 patients, 19 were positive for COVID-19 (incidence rate of 7.0 episodes/100 patient-year), and only six patients recovered from the infection; the death rate was 2.6 % compared to all-cause death of 9.8 %. The most affected group of patients were those over 50 years old, with 71.4 % mortality, in contrast to younger patients infected, with a mortality of 60 %. During the follow-up period, 21 patients were transferred to HD: six due to peritonitis, five due to UF failure, seven due to catheter dysfunction, one due to uremic syndrome, one due to COVID-19 , and one by surgical intervention. APD-RM patients have a significant advantage over other dialysis therapies because the use of telemedicine not only provides continuity in the patient's clinical treatment but also favors the prevention of COVID-19 infection, the management and prevention of complications inherent to therapy and the preservation of the life of Peritoneal Dialysis patients. [ABSTRACT FROM AUTHOR]

Background Choosing a dialysis modality is an important decision for people to make as their kidney failure progresses. In doing so, their options should be informed by any absolute or relative indications that may favour one modality over another. Methods In creating this update, we reviewed literature using a framework that considered first, high-level outcomes (survival and modality transition) from large registry data and cohort studies when considering optimal patient pathways; second, factors at a dialysis provider level that might affect relative indications; and third, specific patient-level factors. Both main types of dialysis modality, peritoneal (PD) and haemodialysis (HD), and their subtypes were considered. Results For most people starting dialysis, survival is independent of modality, including those with diabetes. Better survival is seen in those with less comorbidity starting with PD or home HD, reflecting continued improvements over recent decades that have been greater than improvements seen for centre HD. There are provider-level differences in the perceived relative indications for home dialysis that appear to reflect variability in experience, prejudice, enthusiasm, and support for patients and carers. Absolute contraindications are uncommon and, in most cases, where modality prejudice exists, e.g. obesity, Adult Polycystic Kidney Disease, and social factors, this is not supported by reported outcomes. Conclusion Absolute contraindications to a particular dialysis modality are rare. Relative indications for or against particular modalities should be considered but are rarely more important than patient preferences. [ABSTRACT FROM AUTHOR]

Introduction: Automated peritoneal dialysis (APD) employs cyclers to control inflow and outflow of the dialysis fluid to the patient's abdomen. To allow more patients to use this modality, cyclers should support the achievement of an adequate dialysis dose and be easy to use, cost-effective, and silent. The new SILENCIA cycler (Fresenius Medical Care, Bad Homburg, Germany), designed to improve these characteristics in comparison to its predecessor device, was evaluated in this respect in a prospective study. Methods: This cross-over study comprised two 2-week study periods, separated by a 3-week training phase. First, patients underwent APD with their current cycler (PD-NIGHT [Fresenius Medical Care, Bad Homburg, Germany] or HomeChoice Pro [Baxter, Deerfield, IL, USA] as control), followed by training on the SILENCIA cycler. Then, patients were switched to the SILENCIA cycler. During each treatment period, we collected data on total Kt/Vurea, ultrafiltration (UF) volume, patient-reported outcomes (sleep quality, among others), and device handling. Results: Sixteen patients were enrolled; 2 patients terminated the study prematurely before study intervention, 1 patient due to a protocol violation. In 13 patients, total Kt/Vurea and UF could be evaluated. Neither Kt/Vurea nor UF differed significantly between control and SILENCIA cyclers. Out of 10 patients answering the questionnaire on sleep quality after the 2-week phase with the SILENCIA cycler, sleep quality improved in 5 patients; in the other patients, sleep quality was rated unchanged compared to the previously used cycler. The average reported sleep time was 5.9 ± 1.8 h with the PD-NIGHT, 7.2 ± 2.1 h with HomeChoice Pro, and 8.0 ± 1.6 h with the SILENCIA cycler. All patients were much or very much satisfied with the new cycler. Conclusion: The SILENCIA cycler delivers adequate urea clearance and UF. Importantly, sleep quality improved, possibly related to less caution messages and alarms. [ABSTRACT FROM AUTHOR]

Background: Recent evidence suggests that automated peritoneal dialysis (APD) might be a feasible alternative to hemodialysis (HD) in urgent‐start peritoneal dialysis. Methods: This prospective study enrolled end‐stage renal disease (ESRD) patients who had started APD as an urgent‐start dialysis modality at a single center. Dialysis‐related complications were recorded. Dialysis adequacy and electrolytes imbalance were compared between baseline, 14 and 42 days after catheter insertion. Technique survival and patient survival were also recorded. Results: A total of 36 patients were included in the study. Mean follow‐up duration was 22 months. During the follow‐up, 11 PD patients (30.6%) developed dialysis‐related complications. Only two patients (5.6%) required re‐insertion and one patients (2.8%) transfer to HD. The 2‐year technique survival rate and patient survival rate were 94.4% and 97.2%, respectively. Conclusion: In considering safety and dialysis adequacy, APD could be a feasible dialysis modality for urgent‐start dialysis in ESRD patients, using a standard procedure. [ABSTRACT FROM AUTHOR]

Abstract Background Pulmonary arterial hypertension (PAH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PAH among patients with ESRD treated with automated peritoneal dialysis (APD), investigated the effect of different variables and compared pulmonary artery pressure and cardiac function at the beginning and end of the study. Methods This is a 5-year study in which 31 ESRD patients on APD were recruited after fulfilling inclusion criteria. Blood samples were collected from all patients for the biochemical and hematological data at the beginning of the study and every month and at the study termination. Total body water (TBW) and extracellular water (ECW) were calculated using Watson’s and Bird’s calculation methods. All patients were followed-up at 3-month interval for cardiac evaluation. Logistic regression analysis was used to assess the relation between different variables and PAH. Results The mean age of the study population (n = 31) was 51.23 ± 15.24 years. PAH was found in 24.2% of the patients. Mean systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) were significantly higher in the APD patients at study initiation than at the end of the study (40.75 + 10.61 vs 23.55 + 9.20 and 29.66 + 11.35 vs 18.24 + 6.75 mmHg respectively, p = 0.001). The median ejection fraction was significantly lower in patients with PAH at zero point than at study termination [31% (27-34) vs 50% (46-52), p = 0.002]. Hypervolemia decreased significantly at the end of study (p 1 years) seemed to decrease pulmonary arterial pressure, right atrial pressure and improve left ventricular ejection fraction (LVEF). Risk factors for PAH in ESRD were hypervolemia, abnormal ECHO findings and low hemoglobin levels. Clinical and echocardiographic abnormalities and complications are not uncommon among ESRD patients with PAH. Identification of those patients on transthoracic echocardiography may warrant further attention to treatment with APD.

Objectives: End-stage renal disease (ESRD) may result in different degrees of physical and psychological pain. Automated peritoneal dialysis (APD), continuous ambulatory peritoneal dialysis (CAPD), and hemodialysis (HD) as the main treatment methods lead to a heavy burden on social economic and family financial. However, there are few studies on the economic evaluation of the three dialysis methods in China. Methods: Cost-effectiveness analyses were performed using Markov models based on longitudinal data for 15 years of different modalities in Kunshan City, China. Direct cost derived from medical insurance information system, and indirect cost referred to as loss of productivity. Sensitivity analyses were conducted to study uncertainty. Results: The per capita total cost of CAPD was 664,027.00 yuan, the per capita utility is 5.9105. The per capita total cost of APD was 858,800.65 yuan, the per capita utility is 6.4548. The per capita total cost of HD was 1,281,213.64 yuan, the per capita utility is 6.1356. When CAPD was compared with HD, Incremental Cost-Effectiveness Ratio (ICER) was 1,323,389.53 yuan per QALY, compared with APD, ICER was 357,848.13 yuan per QALY. ICER value suggests that APD was cost-effective compared with CAPD and HD at a willingness-to-pay threshold of 538,200 yuan. Conclusion: Our research showed that APD is the most appropriate and HD is the worst in terms of cost-effectiveness. However, in fact, HD accounts for a high proportion in China, so some relevant policy suggestions need to be implemented to change the current situation. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to study the prevalence, risk factors, management, and outcome of hernias in end‐stage renal disease (ESRD) patients on peritoneal dialysis (PD) from India. Methods: This was a retrospective study of ESRD‐PD patients who developed hernias over 11 years. Results: Of 470 PD patients, 21 developed hernias (4.2%). Mean age of patients was 49.9 ± 15.36 years; 15 (66.66%) were males; 18 (85.71%) patients had umbilical hernia, 3 (14.28%) had inguinal hernia. Continuous ambulatory PD (CAPD) versus automated PD (APD) (OR: 11.623, 95% CI: 2.060–65.581, p = 0.005) was the independent risk factor identified. Incarcerated umbilical/inguinal hernia was managed surgically (6 [28.57%]); uncomplicated umbilical hernia (15 [71.42%]) managed conservatively (shift to (APD) [33.33%]; switch to low‐volume APD [20%], switch to low‐volume CAPD [46.66%]). None had postoperative hernia recurrences; 4 (19%) had PD technique failure; median PD survival was 36 (IQR 17–55) months. Conclusion: Although complicated hernias in PD require surgical repair, uncomplicated umbilical hernias can be managed conservatively by switching to APD/low‐volume CAPD, with good long‐term PD technique survival. [ABSTRACT FROM AUTHOR]

Background: Pulmonary arterial hypertension (PAH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PAH among patients with ESRD treated with automated peritoneal dialysis (APD), investigated the effect of different variables and compared pulmonary artery pressure and cardiac function at the beginning and end of the study.Methods: This is a 5-year study in which 31 ESRD patients on APD were recruited after fulfilling inclusion criteria. Blood samples were collected from all patients for the biochemical and hematological data at the beginning of the study and every month and at the study termination. Total body water (TBW) and extracellular water (ECW) were calculated using Watson's and Bird's calculation methods. All patients were followed-up at 3-month interval for cardiac evaluation. Logistic regression analysis was used to assess the relation between different variables and PAH.Results: The mean age of the study population (n = 31) was 51.23 ± 15.24 years. PAH was found in 24.2% of the patients. Mean systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) were significantly higher in the APD patients at study initiation than at the end of the study (40.75 + 10.61 vs 23.55 + 9.20 and 29.66 + 11.35 vs 18.24 + 6.75 mmHg respectively, p = 0.001). The median ejection fraction was significantly lower in patients with PAH at zero point than at study termination [31% (27-34) vs 50% (46-52), p = 0.002]. Hypervolemia decreased significantly at the end of study (p <  0.001) and correlated positively with the PAP (r = 0.371 and r = 0.369), p = 0.002). sPAP correlated with left ventricular mass index, hemoglobin level, and duration on APD.Conclusions: Long term APD (> 1 years) seemed to decrease pulmonary arterial pressure, right atrial pressure and improve left ventricular ejection fraction (LVEF). Risk factors for PAH in ESRD were hypervolemia, abnormal ECHO findings and low hemoglobin levels. Clinical and echocardiographic abnormalities and complications are not uncommon among ESRD patients with PAH. Identification of those patients on transthoracic echocardiography may warrant further attention to treatment with APD. [ABSTRACT FROM AUTHOR]

Introduction: It is still controversial whether automated peritoneal dialysis (APD) or hemodialysis (HD) is a more favorable choice for the rapid initiation of peritoneal dialysis (PD). Methods: A pilot randomized prospective controlled trial was carried out in Shanghai Ruijin Hospital. Sixty-seven patients who chose long-term PD treatment and needed unplanned dialysis were enrolled and randomized into HD-CAPD group (33 cases) or APD-CAPD group (34 cases) based on the dialysis modality during the transition period (within 14 days from the day PD catheter was implanted). Continuous ambulatory PD started after the transition period. The primary outcome was the decline rates of residual glomerular filtration rate (GFR). Secondary outcomes included the rates of mechanical complications, the rates of infectious complications, and complications of end-stage renal disease. Results: We found residual GFR decline was faster in HD-CAPD group than in APD-CAPD group (0.06 mL/min/w vs. 0.03 mL/min/w, p < 0.01). The incidences of mechanical complications were similar in APD-CAPD group comparing with HD-CAPD group, including hernia (2.9% vs. 3.0%, p = 1.00), catheter malposition (0.02 episodes/patient-months vs. 0.02 episodes/patient-months, p = 0.70), leakage (5.9% vs. 6.1%, p = 1.00), and omental wrap (0 episode vs. 3 episodes, p = 0.368). Though the 1-year overall infection rates were similar (0.03 episodes/patient-months vs. 0.05 episodes/patient-months, p = 0.10), APD-CAPD group had lower rate of bacteremia compared to HD-CAPD group (0 episodes/patient-months vs. 0.02 episodes/patient-months, p < 0.01). Conclusions: Both APD and HD could be used for patients who need to start dialysis in an unplanned manner. APD may have the advantage in protecting residual renal functions among these patients.

Background: Intraperitoneal (IP) aminoglycosides (AGs) continue to be the cornerstone of empiric management of peritonitis. AG dosing during automated peritoneal dialysis (APD), however, has not been well studied in patients with peritonitis. We sought to identify differences in AG exposure in the peritoneum and plasma for two different dosing regimens with little supporting evidence in patients on APD with peritonitis., Methods: A retrospective design that utilised the peritoneal and plasma concentration-time data from a prior study of 18 continuous ambulatory peritoneal dialysis (CAPD) patients with peritonitis to generate an in silico peritoneal and plasma PK model. This model was then used to compare via simulation using Phoenix© WinNonlin Software with IP AG dosing for a loading-dose regimen (1.5 mg/kg first dose) versus a fixed-dose regimen (0.6 mg/kg/d) in patients on APD with peritonitis., Results: Outcome measures were (1) percentage of time where peritoneal peak concentrations/minimal inhibitory concentration (MIC) ratio >10, (2) AUC/MIC > 74 and (3) plasma Cmin concentrations. Both regimens resulted in > 90% optimal peak/MIC ratio and AUC/MIC ratios on days 1 and 5 of the dose protocol. The loading-dose regimen resulted in IP exposures that were 2.5 times greater in the peritoneal compartment on day 1. By day 5, both protocols resulted in similar accumulation of AG plasma Cmin concentrations of 2.5-3.4 mg/L versus 2.4-3.3 mg/L, respectively, for the loading-dose regimen versus fixed-dose regimen., Conclusions: The current international guidelines for the treatment of peritoneal dialysis-associated peritonitis can continue to recommend the fixed-dose regimen for those on APD with the addition of plasma Cmin monitoring after 3 days to assess for drug accumulation., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract Introduction: Chronic kidney disease, more prevalent in the elderly, is considered a public health issue worldwide. Objective: To evaluate the impact of automated, peritoneal dialysis modalities, intermittent and continuous, on the inflammatory profile of elderly people with chronic kidney disease. Methods: Prospective, cross-sectional and analytical study carried out in a dialysis clinic in Brasília - Brazil, with 74 elderly people aged 60 years or older. The patients underwent rapid Peritoneal Equilibration Test, clinical assessment, blood collection for biochemical and cytokine assessments, interleukin 6 and transforming growth factor beta 1, and answered a quality-of-life questionnaire (KDQOL-SF36). We used a 5% significance level for data analysis, associations and correlations. Results: Patients in the continuous modality had higher serum values of transforming growth factor beta 1 than those in the intermittent modality, which had higher peritoneal transforming growth factor beta 1, age and residual renal function than those in continuous mode. Interleukin 6 dosage in the peritoneum was associated with age, while serum IL-6 was associated with IL-6 in the peritoneum, time on dialysis and age. There was no association between the modality and the presence of diabetes, blood volume or nutritional status. Both modalities enable good adaptation to the dialysis treatment. Conclusion: Inflammation in automated peritoneal dialysis is mainly associated with low residual renal function, advanced age and longer time on therapy, and not to the type of dialysis performed.

Abstract Background In the development of medical devices usability is an important aspect standing alongside performance and safety. Peritoneal dialysis (PD) can be provided by use of automated PD (APD), assisted by a cycler performing the solution exchanges. The present study has been executed to simulate training on APD cyclers to evaluate learnability and usability through established questionnaires. Methods Usability of two APD cyclers (sleep•safe harmony, Fresenius Medical Care, Bad Homburg, Germany and HomeChoice Pro, Baxter International Inc., Deerfield (IL), USA) were evaluated with the User Experience Questionnaire (UEQ), the NASA TLX Questionnaire, and the System Usability Scale (SUS), both after training and after experience sessions. Results Lay persons (n = 10) and health care personnel (HCPs, n = 11) participated in the study. The respondents consistently gave positive ratings in the UEQ after training and experience session. The ratings from the NASA TLX Questionnaire were mostly below 50 points indicating a low workload. Lay users and HCPs gave high ratings in the SUS evaluation both after the training and experience sessions confirming a good learnability and usability of the devices. Conclusions The usability study to assess learnability and use-related safety revealed consistent results with all applied instruments, which demonstrated good learnability and ease-of-use of the studied APD cyclers.

A breakthrough in peritoneal dialysis (PD) therapy occurred in 1977 with the development of continuous ambulatory peritoneal dialysis (CAPD). Its simplicity, low cost, and ease with which CAPD could be performed on patients at home contributed to the popularity of this procedure. However, there is a need for continuous improvement in building optimal systems for incident chronic kidney disease (CKD) patients. This research showed the design and construction of a simplified prototype of low-cost automated peritoneal dialysis (APD) equipment that meets international standards to automatically regulate infusion and fluid drainage in and out of a patient with low margins of error. Experimental tests allowed the adjustment of the RPM values concerning the flow rate provided. In addition, thanks to the pressure sensor, it was possible to observe a fluctuation ranging from 9 to 13 kPa, which is within the permissible average specified in the catalogs of medical instruments and equipment. Furthermore, a turbidity sensor was added to decrease the possibility of presenting peritonitis. The results showed absolute values of flow, angular velocity, and pressure that it could deliver for use in APD therapies. Finally, the construction of the APD equipment is presented generally, showing the electronic and mechanical components that constitute it. [ABSTRACT FROM AUTHOR]

Background and Aims: Dwell time is a critical component of automated peritoneal dialysis (APD) prescription, the stage at which transmembrane mass and fluid transfer occur. Loss of prescribed dwell time (LDT) can negatively influence the efficiency of APD. We investigated the incidence of LDT and related causes using APD in the acute care setting at a tertiary care center., Methods: Retrospective analysis was conducted of all inpatients receiving APD treatments from 1 December 2021 to 1 June 2023. Patient demographics, comorbidities, laboratory, and treatment data were extracted from electronic medical records and a propriety database., Results: N  = 235 cycler treatments completed by 32 patients were included for analysis. The total LDT per treatment exceeding 30 minutes and 60 minutes occurred in 27% and 20% of all treatments. LDT of more than 10 minutes per each cycle exchange occurred in 26%. Session disruptions were caused by slow out-flow (55%), inadequate drain volumes (32%), patient line occlusions (20%), and priming errors (23%). The slow flow alarm requiring user intervention was reported to occur in about one-third of all treatments (31%)., Conclusion: There was significant LDT and inadequate drain volume seen in about one-quarter and one-third of all inpatient APD treatments respectively. This can impact solute clearance and ultrafiltration.  Slow flow alarms were the most prevalent and the leading cause of LDT followed by inadequate drain volume. Future studies are required to investigate measures to reduce slow drain and improve drain volume in the hospital setting.   .

Background. To analyze the health-related quality of life associated with the conversion of dialysis modality among end-stage renal disease patients in China. Methods. Patients were recruited from hospitals and a dialysis center in Kunshan, China. Patients converting from continuous ambulatory peritoneal dialysis to auto- mated peritoneal dialysis were recruited as the observation group (nD64), and patients continuing with continuous ambulatory peritoneal dialysis treatment were included in the control group (n D 64) after matching in this retrospective cohort study. Their health-related quality of life was measured using the kidney disease quality of life instrument in 2019 and 2020, respectively. Baseline socio-demographic characteristics and clinical data were collected in 2019. The before-and-after cross-group comparisons of subscale scores of two groups were conducted using a Student's t-test. Multiple linear regression models were fitted to identify the factors associated with the change of each scale. Results. The health-related quality of life scores of the two groups was comparable in baseline, while the observation group had higher scores in Physical Component Summary (51.92 ± 7.50), Kidney Disease Component Summary (81.21 ± 8.41), Symptoms (90.76 ± 6.30), Effects (82.86 ± 11.42), and Burden (69.04 ± 15.69) subscales after one year. In multivariate regression analysis, the change of Physical Component Summary was significantly associated with conversion to APD (β = 11:54, 95% CI [7.26 ± 15.82]); the change of Mental Component Summary with higher education (β = to automated peritoneal dialysis generally had improved health-related quality of life scores. to automated peritoneal dialysis generally had improved health-related quality of life scores. [ABSTRACT FROM AUTHOR]

Abstract Background It has been estimated that automated peritoneal dialysis (APD) is currently the fastest growing renal replacement therapy in the world. However, in light of the growing number of diabetic patients on peritoneal dialysis (PD), the unwanted glucose absorption during APD remains problematic. Recent results, using an extended 3-pore model of APD, indicated that large reductions in glucose absorption are possible by using optimized bi-modal treatment regimens, having “UF cycles” using a higher glucose concentration, and “Clearance cycles” using a low concentration or, preferentially, no glucose. The present study is designed to test the theoretical prediction of a lower glucose absorption using these novel regimes. Methods This study is a randomized single-center, open-label, prospective study. Prevalent PD patients between 18 and 75 years old without known catheter problems or recent peritonitis are eligible for inclusion. Patients are allocated to a first treatment session of either standard APD (6 × 2 L 1.36% over 9 h) or optimized APD (7 × 2 L 2.27% + 5 × 2 L 0.1% over 8 h). A second treatment session using the other treatment will be performed in a crossover fashion. Samples of the dialysis fluid will be taken before and after the treatment, and the volume of the dialysate before and after the treatment will be carefully assessed. The primary endpoint is difference in glucose absorption between the optimized and standard treatment. Secondary endpoints are ultrafiltration, sodium removal, Kt/V urea, and Kt/V Creatinine. The study will be closed when a total of 20 patients have successfully completed the interventions or terminated according to interim analysis. A Monte Carlo power analysis shows that the study has 80% power to detect a difference of 10 g (in line with that of theoretical results) in glucose absorption between the two treatments in 10 patients. Discussion The present study is the first clinical investigation of optimized bi-modal treatments proposed by recent theoretical studies. Trial registration ClinicalTrials.gov identifier: NCT04017572 . Registration date: July 12, 2019, retrospectively registered.

Antecedentes: La calidad de vida relacionada con la salud (CVRS) se encuentra disminuida en la enfermedad renal en etapa avanzada (EREA) pero se conoce poco acerca del impacto de los trastornos del sueño, la modalidad de diálisis y los factores demográficos sobre la CVRS de pacientes mexicanos con EREA. Métodos: Se incluyeron 121 adultos con EREA pertenecientes a 4 unidades de diálisis del estado de Guanajuato, México, estratificados por unidad y modalidad de diálisis (Hemodiálisis [HD], diálisis peritoneal continua ambulatoria [DPCA] y diálisis peritoneal automatizada [DPA]). Se realizó un análisis de la información clínica y los datos obtenidos del Sleep Hart Health Study Sleep Habits Questionnaire, del cuestionario corto del Medical Outcomes Study (MOS; SF-36) y de la Escala de Somnolencia Epworth. Resultados: En general, los síntomas y los trastornos del sueño fueron frecuentes (ej. insomnio 37.2%). Los puntajes de SF-36 resultaron más bajos comparados con las normas de México y Estados Unidos. En la subescala de Vitalidad, los pacientes de HD reportaron mejor CVRS y los pacientes de DPCA la peor CVRS. En el modelo de análisis multivariado, la modalidad de diálisis y los trastornos del sueño en grupo y el ingreso bajo, resultaron asociados significativamente con una pobre calidad de vida total (SF-36) y una pobre salud mental (CVRS). Los modelos de calidad de vida total y del componente mental mostraron una CVRS significativamente mejor tanto para DPA como para la HD con tamaños del efecto de pequeño a moderado. El análisis de costo-efectividad mostró ventaja para la DPA. Conclusiones: Los pacientes mexicanos de EREA tienen una CVRS reducida, y los trastornos del sueño pueden ser importantes para conducir a este hallazgo. La DPA debe ser la modalidad de diálisis de preferencia en México.

Background and Hypothesis: Remote monitoring (RM) of patients on automated peritoneal dialysis (APD) prevent complications and improve treatment quality. We analyzed the effect of RM-APD on mortality and complications related to cardiovascular disease (VD), fluid overload and insufficient dialysis efficiency., Methods: In a cluster-randomized, open-label, controlled trial, 21 hospitals with APD programs were assigned to use either RM-APD (10 hospitals; 403 patients) or conventional APD (11 hospitals; 398 patients) for the treatment of adult patients starting PD. Primary outcomes were time to first event of: 1) Composite Index-1 comprising all-cause mortality, first adverse events and hospitalizations of any cause, and 2) Composite Index-2 comprising cardiovascular mortality, first adverse event and hospitalizations related to CVD, fluid overload and insufficient dialysis efficiency. Secondary outcomes were time to first event of individual components of the two composite indices, and rates of adverse events, hospitalizations, unplanned visits, and transfer to hemodialysis. Patients were followed for a median of 9.5 months. Primary outcomes were evaluated by competing-risk analysis and restricted mean survival time (RMST) analysis., Results: While time to reach Composite Index-1 did not differ between the groups, Composite Index-2 was reached earlier (ΔRMST: -0.85 months; p=0.02), and all-cause mortality (55 vs. 33 deaths, p=0.01; sHR 1.69 (95%CI 1.39-2.05), p<0.001) and hospitalizations of any cause were higher in APD group than in RM-APD as were cardiovascular deaths (24 vs. 13 deaths, p=0.05; sHR 2.44 (95%CI 1.72 - 3.45), p<0.001) and rates of adverse events and hospitalizations related to CVD, fluid overload or insufficient dialysis efficiency. Dropouts were more common in the APD group (131 vs. 110, p=0.048)., Conclusions: This randomized controlled trial shows that remote monitoring may add significant advantages to APD, including improved survival and reduced rate of adverse events and hospitalizations, which can favorably impact the acceptance and adoption of the therapy., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

Pregnant women with end-stage kidney disease who undergo peritoneal dialysis have lower pregnancy rates and higher obstetric risk than their peers undergoing hemodialysis. Although there has been some improvement in pregnancy rates and outcomes due to the intensification of dialysis prescriptions, there is currently a lack of guidelines for optimizing peritoneal dialysis regimens for pregnant women with end-stage kidney disease. Besides, there is limited data available regarding pregnancy outcomes in women with end-stage kidney disease undergoing peritoneal dialysis. We report the case of a 23-year-old Hispanic woman with end-stage kidney disease caused by focal and segmental glomerulosclerosis. She became pregnant while undergoing successful treatment with an intensified automated peritoneal dialysis regimen. The patient gave birth to a live female preterm infant weighing 938 g during the 28th week of her pregnancy. The baby required neonatal intensive care due to prematurity, extremely low birth weight, and respiratory distress syndrome., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Bacillus licheniformis ( B. licheniformis ) is an aerobic, gram-positive, spore-forming rod typically found in soil, decaying organic matter, vegetables, and water, and occasionally part of normal gut flora. This report highlights a case of unusual repeated peritonitis caused by  B. licheniformis , with three episodes occurring over six months, all of which were sensitive to vancomycin yet presented an unclear cause for recurrence. Peritonitis represents a significant cause of mortality, hospitalization, and failure of peritoneal dialysis catheters, leading to forced transitions to hemodialysis. The rarity of  B. licheniformis  as a pathogen in human infections emphasizes the critical need for precise microbial identification and customized therapeutic strategies., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ali et al.)

Peritoneal dialysis utilisation in Indonesia decreased yearly from 6.6% in 2014 to 1.6% in 2018. Various efforts have been made by the government and the Indonesian Nephrologist Organization (PERNEFRI) through education and regulation to optimise the use of peritoneal dialysis, but have yet to succeed. The simplicity of automated peritoneal dialysis (APD) made it worth considering as another solution to optimise peritoneal dialysis in Indonesia. Several advantages are offered by using APD, such as providing more time for activities compared to continuous ambulatory peritoneal dialysis, cheaper cost than haemodialysis and allowing remote monitoring. The advantages of APD make it a promising kidney replacement therapy (KRT) modality for developing countries like Indonesia, but the application is scarce. Some of the challenges in implementing APD in Indonesia include APD machines and fluids that are not available in the Indonesian market; the price of machines and fluids is still high; health workers are not familiar with APD; patients and their families not knowing APD as one of KRT; and APD machines distribution in archipelagic country is challenging., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Peritoneal dialysis (PD) shows promise for urgent-start dialysis in end-stage renal disease (ESRD), with automated PD (APD) having advantages. However, there is limited multicenter randomized controlled trial (RCT) evidence comparing APD with temporary hemodialysis (HD) for this indication in China., Methods: This multicenter RCT enrolled 116 patients with ESRD requiring urgent dialysis from 11 hospitals, randomized to APD or HD. Patients underwent a 2-week treatment with APD or HD via a temporary central venous catheter (CVC), followed by a maintenance PD. Outcomes were assessed over 12 months during 8 visits. The primary outcome was dialysis-related complications., Results: The 1-year incidence of dialysis-related complications was significantly lower in the APD group than in the HD group (25.9% vs. 56.9%, P  = 0.001). No significant differences were found between the groups in terms of PD catheter survival rates ( P  = 0.388), peritonitis-free survival rates ( P  = 0.335), and patient survival rates ( P  = 0.329). In terms of health economics, the total direct medical cost of the initial hospitalization for patients with ESRD was significantly lower in the APD group (27,008.39 CNY) than in the HD group (42,597.54 CNY) ( P  = 0.001), whereas the duration of the first hospital stay showed no significant difference ( P  = 0.424)., Conclusion: For patients with ESRD needing urgent initiation of dialysis, APD was associated with a lower incidence of dialysis-related complications and lower initial hospitalization costs compared with HD, with no significant differences in PD catheter survival rate, peritonitis-free survival rates, or patient survival rates. These findings can guide clinical decision-making for the optimal dialysis modality for patients requiring urgent dialysis initiation., (© 2024 International Society of Nephrology. Published by Elsevier Inc.)

Background Cognitive deterioration decreases quality of life, self-care and adherence to treatment, increasing mortality risk. There is scarce information of cognitive impairment in peritoneal dialysis (PD) and data are controversial. Our aim was to determine the frequency and associated factors of cognitive impairment in patients on automated PD (APD). Methods In this cross-sectional study, 71 patients on APD underwent clinical, biochemical and cognitive function evaluation by means of the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Cognitive function was also evaluated in healthy controls. Results Participants mean age was 42 ± 16 years, 79% were men and dialysis vintage was 17 months (interquartile range 7–32). In APD patients, cognitive impairment was present in 7% (mild deterioration) and 68% according to the MMSE and MoCA, respectively, and 4 and 37% in the healthy controls. Patients with cognitive impairment (according to MoCA) were older, with less education, had diabetes more frequently and higher serum glucose as well as lower serum creatinine, phosphorus and sodium concentrations than patients with normal cognitive function. In multiple linear regression analysis, predictors for the MoCA score (R 2 = 0.63, P   =   0.002) were education { B  = 0.54 [95% confidence interval (CI) 0.20–0.89]; P   =   0.003}, age [ B = −0.11 (95% CI −0.21 to −0.01); P   =   0.04], serum sodium [ B  = 0.58 (95% CI 0.05–1.11); P   =   0.03] and creatinine concentration [ B  = 3.9 (95% CI 0.03–0.83); P   =   0.03]. Conclusions In this sample of APD patients, the prevalence of cognitive impairment by the MoCA was 65% and was associated with older age, lower education level and lower serum concentrations of sodium and creatinine. [ABSTRACT FROM AUTHOR]

Sodium removal in peritoneal dialysis (PD) depends on convective clearance, typically generated by a glucose gradient, but this can result in glucose absorption. We wished to determine which factors determine peritoneal sodium losses to glucose absorption (PD Na/Gluc). Peritoneal sodium losses and glucose absorption were calculated from measured 24‐h collections of PD effluent, in patients attending for assessment of peritoneal membrane function. Five hundred and fifty eight patients; 317 (56.8%) males, mean age 56.1 ± 16.0 years, were studied, 281 treated by automated peritoneal dialysis (APD) with a daytime exchange (50.4%); 179 (32.1%) by APD and 98 (17.6%) by continuous ambulatory peritoneal dialysis (CAPD). All patients used glucose containing dialysates, with 352 (63.1%) using icodextrin and 210 (37.6%) hypertonic (22.7 g/L glucose) dialysates. The ratio of PD Na/Gluc was 0.14 (0.02–0.29). Patients using icodextrin had a higher ratio (0.16 (0.03–0.32) versus 0.11 (−0.02–0.26), P <.001), as did those using 22.7 g/L glucose versus 13.6 g/L (0.16 (0.06–0.32) versus 0.13 (−0.01–0.19), P <.01), and CAPD versus APD (0.18 (0.05–0.36) versus 0.11 (0.0–0.27), P <.05), respectively. A multivariable model showed that 24‐h ultrafiltration (odds ratio [OR] 7.6 (95% confidence interval [3.9–14.8]), P <.001 was associated with increased PD Na/Gluc, whereas APD (OR 0.19 (0.06–0.62), P <.01 and increased extracellular water to total body water (OR 0.001 [0–0.08], P =.03) were associated with lower ratios. Twenty four‐hour peritoneal ultrafiltration was strongly associated with PD Na/Gluc, whereas patients treated with APD cyclers without a daytime icodextrin exchange and those with an increased extracellular water to total body water had lower peritoneal sodium losses but with greater peritoneal glucose absorption. [ABSTRACT FROM AUTHOR]

Purpose: Follow-up of automated peritoneal dialysis (APD) has been improved by data transmission by cellular modem and internet cloud. With the new remote patient monitoring (RPM) technology, clinical control and prescription of dialysis are performed by software (Baxter Claria-Sharesource), which allows the center to access home operational data. The objective of this pilot study was to determine the impact of RPM compared to traditional technology, in clinical, organizational, social, and economic terms in a single center. Methods: We studied 21 prevalent APD patients aged 69 ± 13 years, on dialysis for a median of 9 months, for a period of 6 months with the traditional technology and 6 months with the new technology. A relevant portion of patients lived in mountainous or hilly areas. Results: Our study shows more proactive calls from the center to patients after the consultation of RPM software, reduction of calls from patients and caregivers, early detection of clinical problems, a significant reduction of unscheduled visits, and a not significant reduction of hospitalizations. The analysis also highlighted how the RPM system lead to relevant economic savings, which for the health system have been calculated € 335 (mean per patient-month). With the social costs represented by the waste of time of the patient and the caregiver, we calculated € 685 (mean per patient-month). Conclusion: In our pilot report, the RPM system allowed the accurate assessment of daily APD sessions to suggest significative organizational and economic advantages, and both patients and healthcare providers reported good subjective experiences in terms of safety and quality of follow-up. [ABSTRACT FROM AUTHOR]

Tomoyuki Takura,1 Makoto Hiramatsu,2 Hidetomo Nakamoto,3 Takahiro Kuragano,4 Jun Minakuchi,5 Hironori Ishida,6 Masaaki Nakayama,7 Susumu Takahashi,8 Hideki Kawanishi9 1Department of Health Economy and Society Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 2Outpatient Center Hospital, Okayama Saiseikai General Hospital, Okayama City, Okayama, Japan; 3General Intrarenal Medicine, Saitama Medical University, Saitama, Japan; 4Internal Medicine (Nephrology and Dialysis), Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan; 5Nephrology (Endocrinology), Kawashima Hospital, Tokushima City, Tokushima, Japan; 6Urology, Kitasaito Hospital, Asahikawa City, Hokaido, Japan; 7Kidney Center, St. Luke’s International Hospital, Tokyo, Japan; 8Head Office, International Kidney Evaluation Association Japan, Tokyo, Japan; 9Artificial Organs and Surgery, Tsuchiya General Hospital, Hiroshima City, Hiroshima, JapanCorrespondence: Tomoyuki TakuraDepartment of Health Economy and Society Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanTel +81 35 800 9523Fax +81 35 800 9156Email ttakura@m.u-tokyo.ac.jpBackground: In Japan, the medical expenditures associated with dialysis have garnered considerable interest; however, a cost-effectiveness evaluation of peritoneal dialysis (PD) is yet to be evaluated. In particular, the health economics of the “PD first” concept, which can be advantageous for clinical practice and healthcare systems, must be evaluated.Methods: This multicenter study investigated the cost-effectiveness of PD. The major effectiveness indicator was quality-adjusted life year (QALY), with a preference-based utility value based on renal function, and the cost indicator was the amount billed for a medical service at each medical institution for qualifying illnesses. In comparison with hemodialysis (HD), a baseline analysis of PD therapy was conducted using a cost-utility analysis (CUA). Continuous ambulatory PD (CAPD) and automated PD (APD) were compared based on the incremental cost-utility ratio (ICUR) and propensity score (PS) with a limited number of cases.Results: The mean duration since the start of PD was 35.0±14.4 months. The overall CUA for PD (179 patients) was USD 55,019/QALY, which was more cost effective (USD/monthly utility) compared with that for HD for 12–24 months (4,367 vs. 4,852; p

Yi Zhang,* Sheng Feng,* Ying Lu, Zhoubing Zhan, Huaying ShenDepartment of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China*These authors contributed equally to this workObjectives: Whether automated peritoneal dialysis (APD) is a feasible strategy in perioperative period of uremic patients undergoing nonabdominal surgery remains unclear. This study was conducted to research the perioperative management and the best choice of dialysis modalities for peritoneal dialysis patients.Materials and methods: A retrospective analysis was made on the clinical data of 58 ESRD patients who had received peritoneal dialysis for more than three months were treated with APD during perioperative period from July 2015 to March 2018 in the Second Affiliated Hospital of Soochow University. The differences of clinical parameters, such as urine volume, ultrafiltration volume, hemoglobin, renal function and electrolytes were collected and analyzed before and after APD.Results: The vital signs of 58 patients were stable after APD treatment, and there were no significant differences in 24-hour urine volume, hemoglobin and electrolytes (calcium, phosphorus, potassium, sodium) before and after surgery (P>0.05). Compared with those before treatment, the amount of ultrafiltration increased significantly (P

Background: Health-related quality of life (HR-QOL) is reduced with end-stage renal disease (ESRD) but little is known about the impact of sleep disorders, dialysis modality and demographic factors on HR-QOL of Mexican patients with ESRD. Methods: 121 adults with ESRD were enrolled from 4 dialysis units in the state of Guanajuato, Mexico, stratified by unit and dialysis modality (hemodialysis [HD], continuous ambulatory peritoneal dialysis [CAPD] and automated peritoneal dialysis [APD]). Analysis included clinical information and data from the Sleep Heart Health Study Sleep Habits Questionnaire, the Medical Outcomes Study (MOS) short form (SF-36) HR-QOL measure and Epworth Sleepiness Scale. Results: Overall, sleep symptoms and disorders were common (e.g., 37.2% insomnia). SF-36 scores were worse versus US and Mexican norms. HD patients reported better, while CAPD patients poorer HR-QOL for Vitality. With multivariate modelling dialysis modality, sleep disorders as a group and lower income were significantly associated with poorer overall SF-36 and mental health HR-QOL. Overall and Mental Composite Summary models showed HR-QOL was significantly better for both APD and HD with small to moderate effect sizes. Cost-effectiveness analysis demonstrated an advantage for APD. Conclusions: Mexican ESRD patients have reduced HR-QOL, and sleep disorders may be an important driver of this finding. APD should be the preferred mode of dialysis in Mexico.

The COVID-19 pandemic has highlighted the growing role of telemedicine in home dialysis treatments. Since the appearance of a connected automated peritoneal dialysis (APD) machine (Claria Sharesource Baxter® machine), we have systematically offered this solution to our patients treated with APD. Over the past two years, we have treated 35 patients with connected APD, of which 20 are still under the technique (aged 50 to 87) and represent 54% of the patients on peritoneal dialysis. A questionnaire on five subjects (perception of switching to the connected machine, stress, safety, everyday life, and vacations) was also given to them and showed that 80% of the patients had no stress related to the telemonitoring, while 18 out of 20 patients (90%) felt safe. In 2020, we received 74 phone calls during on-call phone duty, including 42 calls for the 20 patients on connected APD, one all for a patient on normal APD, and 32 calls for 16 patients on continuous ambulatory peritoneal dialysis (CAPD). Handling errors concerned 42.85% of the calls, system errors concerned 4.76%, program validation concerned 7.14%, and connection problems concerned 9.52%. We were thus able to correct several problems remotely, such as drainage problems, weight gain, blood pressure imbalance, poor compliance, and connection problems. Thanks to the platform, we are notified daily of a possible problem. This saves the nurses time and allows them to deal with other issues. The way we educate patients and assist private nurses has not changed. Indeed, only the connection to the network as well as the entry of the weight and arterial pressure were added, and the disposables remained the same. Night or day, or in times of a health crisis, we can provide a rapid and targeted response to the patients’ questions, thanks to the platform.

Keywords: Automated peritoneal dialysis; Coronavirus disease 19; Telehealth; Remote monitoring program; Pandemic EN Automated peritoneal dialysis Coronavirus disease 19 Telehealth Remote monitoring program Pandemic 279 282 4 06/26/21 20210501 NES 210501 Coronavirus disease 19 (COVID-19) is a pandemic that has generated a global public health crisis with significant clinical, social, and economic repercussions. In this context, home therapy with peritoneal dialysis, particularly automated peritoneal dialysis with remote patient management programs (APD-RPM), emerges as an enabling technology to reduce and prevent risks of infection, as recommended by the International Society of Peritoneal Dialysis (ISPD) and others [[5]]. [Extracted from the article]

Automated peritoneal dialysis (APD) treatment for end-stage kidney disease affords patients a degree of autonomy in everyday life. Clinical investigations of their energy expenditure (EE) are usually based on resting EE, which could mask day and night variations in EE. The aim of this study, therefore, was to compare the components of EE in APD patients and healthy control (C) subjects. Patients treated with APD for more than 3 months were compared with C volunteers matched for age and lean body mass (LBM). Biochemical analyses were performed and body composition was determined by DEXA to adjust EE to LBM. Total EE, its different components and respiratory quotients (RQ) were measured by a gas exchange method in calorimetric chambers. Spontaneous total and activity-related EE (AEE) were also measured in free-living conditions over 4 days by a calibrated accelerometer and a heart rate monitor. APD (n = 7) and C (n = 7) patients did not differ in age and body composition. REE did not differ between the two groups. However, prandial increase in EE adjusted for dietary energy intake was higher in APD patients (+57.5 ± 12.71 kcal/h) than in C subjects (+33.8 ± 10.5 kcal/h, p = 0.003) and nocturnal decrease in EE tended to be lower in APD patients undergoing dialysis sessions (- 4.53 ± 8.37 kcal/h) than in subjects (- 11.8 ± 7.69 kcal/h, p = 0.059). Resting RQ (0.91 ± 0.09 vs 0.81 ± 0.04, p = 0.032) and nocturnal RQ (0.91 ± 0.09 vs 0.81 ± 0.04, p = 0.032) were significantly higher in APD patients, indicating a preferential use of glucose substrate potentially absorbed across the peritoneum. AEE was lower in APD patients (595.9 ± 383.2 kcal/d) than in C subjects (1205.2 ± 370.5 kcal/d, p = 0.011). In contrast, energy intakes were not significantly different (1986 ± 465 vs 2083 ± 377 kcal/d, p = 0.677). Although the two groups had identical resting EE, APD patients had a higher prandial increase in EE, a lower activity-related EE and higher resting and nocturnal RQ than healthy subjects. [ABSTRACT FROM AUTHOR]

Bacillus licheniformis is a rare pathogen causing peritonitis in peritoneal dialysis (PD) patients, and it is usually recognized among immunosuppressed or traumatized patients. A 24-year-old lady was treated for peritonitis as an outpatient with empirical therapy. PD culture grew Bacillus licheniformis after 48 hours, and she continued receiving intraperitoneal (IP) vancomycin for a total of three weeks. The patient was clinically stable throughout the course of therapy and showed complete resolution of her symptoms. This was the first case of reported Bacillus peritonitis in an automated peritoneal dialysis (APD) patient with rapid clinical and biochemical improvement without evidence of relapse or recurrence. [ABSTRACT FROM AUTHOR]

Background Failure to control volume is the second most common cause of peritoneal dialysis (PD) technique failure. Sodium is primarily removed by convection, but according to the three-pore model, water and sodium movements are not necessarily concordant. We wished to determine factors increasing sodium to water clearance in clinical practice. Methods We reviewed 24-h peritoneal dialytic sodium removal (DSR) and ultrafiltration (UF) volume in consecutive PD patients attending for routine assessment of peritoneal membrane function and adequacy testing. We used a regression model with the DSR/UF ratio as the dependent variable. A second model with DSR as the dependent variable and interaction testing for UF was used as sensitivity analysis. Results We included 718 adult PD patients. Mean values were 51.8 ± 64.6 mmol/day and 512 ± 517 mL/day for DSR and UF, respectively. In multivariable analysis, DSR/UF ratio was positively associated with transport type (fast versus slow, P < 0.001), serum sodium (P < 0.001) and diabetes (P = 0.026), and negatively associated with PD mode [automated PD versus continuous ambulatory PD (CAPD), P < 0.001] and the use of 2.27% glucose dialysate (P < 0.001). Sensitivity analysis showed positive interaction with UF for transport type (P < 0.001) and serum sodium (P = 0.032) and negative interaction for PD mode (P < 0.001) and cycles number (P < 0.001). Conclusions CAPD, fast transport and high serum sodium allow relatively more sodium to be removed compared with water. Icodextrin has no effect on sodium removal once confounders have been accounted for. Although widely used in the assessment of PD patients, UF should not be considered as a surrogate for DSR in clinical practice. [ABSTRACT FROM AUTHOR]

A breakthrough in peritoneal dialysis (PD) therapy occurred in 1977 with the development of continuous ambulatory peritoneal dialysis (CAPD). Its simplicity, low cost, and ease with which CAPD could be performed on patients at home contributed to the popularity of this procedure. However, there is a need for continuous improvement in building optimal systems for incident chronic kidney disease (CKD) patients. This research showed the design and construction of a simplified prototype of low-cost automated peritoneal dialysis (APD) equipment that meets international standards to automatically regulate infusion and fluid drainage in and out of a patient with low margins of error. Experimental tests allowed the adjustment of the RPM values concerning the flow rate provided. In addition, thanks to the pressure sensor, it was possible to observe a fluctuation ranging from 9 to 13 kPa, which is within the permissible average specified in the catalogs of medical instruments and equipment. Furthermore, a turbidity sensor was added to decrease the possibility of presenting peritonitis. The results showed absolute values of flow, angular velocity, and pressure that it could deliver for use in APD therapies. Finally, the construction of the APD equipment is presented generally, showing the electronic and mechanical components that constitute it.

Background: Dialytic phosphate removal is a cornerstone of the management of hyperphosphatemia in peritoneal dialysis (PD) patients, but the influencing factors on peritoneal phosphate clearance (PPC) are incompletely understood. Our objective was to explore clinically relevant factors associated with PPC in patients with different PD modality and peritoneal transport status and the association of PPC with mortality., Methods: This is a cross-sectional and prospective observational study. Four hundred eighty-five PD patients were enrolled and divided into 2 groups according to PPC. All-cause mortality was evaluated after followed-up for at least 3 months., Results: High PPC group showed lower mortality compared with Low PPC group by Kaplan-Meier analysis and log-rank test. Both multivariate linear regression and multivariate logistic regression revealed that high transport status, total effluent dialysate volume per day, continuous ambulatory PD (CAPD), and protein in total effluent dialysate volume appeared to be positively correlated with PPC; body mass index (BMI) and the normalized protein equivalent of total nitrogen appearance (nPNA) were negatively correlated with PPC. Besides PD modality and membrane transport status, total effluent dialysate volume showed a strong relationship with PPC, but the correlation differed among PD modalities., Conclusions: Higher PPC was associated with lower all-cause mortality risk in PD patients. Higher PPC correlated with CAPD modality, fast transport status, higher effluent dialysate volume and protein content, and with lower BMI and nPNA., (© 2024 Wiley Periodicals LLC.)

Introduction: Most patients on peritoneal dialysis (PD) in the United States are on automated PD (APD) utilizing several liters of PD solution daily for their treatment. The ordering, delivery, and storage of PD solutions can be challenging and is an important factor that can dissuade patients from doing PD. The generation of PD solutions at home is a strategy that could potentially be used to overcome this problem. The APD Solution Generation System (SGS) allowed for PD solution generation using tap water in patients' homes., Methods: In this study, we set out to evaluate the performance of the SGS in prevalent, adult patients with end-stage kidney disease, who are on maintenance PD. We evaluated the primary safety (microbiological testing) and efficacy (chemical composition) of the product water generated by the SGS device., Results: Twenty-two patients from 12 different United States centers were enrolled, of which 14 patients completed the study. The results of the primary safety and efficacy end point analyses of the product water showed that all 64 samples met the International Organization for Standardization (ISO) specifications. Secondary safety analysis found a total of 34 adverse events (AEs) in 12 patients. Of these AEs, 3, namely, culture negative peritonitis, bacterial peritonitis, and atrial fibrillation were deemed serious treatment-emergent AEs., Conclusion: This study demonstrated that the SGS can successfully generate PD solution in patients' homes, while meeting chemical composition and ISO microbiological standards. Lessons learned from this clinical trial will be useful in optimizing product development and future clinical trials., (© 2024 International Society of Nephrology. Published by Elsevier Inc.)

Abstract Background This study aimed to evaluate the longitudinal changes in cardiac structure and function in incident-automated peritoneal dialysis (APD) patients. Methods We conducted a 2-year prospective, randomized, open-label, parallel-group study to compare the efficacy of icodextrin solution versus glucose-based solution. Echocardiography was performed at baseline, 1 and 2 years. Echocardiographic parameters over 2 years were evaluated for each group, using the Friedman test. Generalized linear regression analysis was used to test the associations between baseline clinical variables and echocardiographic changes, and a multivariate model was used to analyze cardiac function between the two groups. Results A total of 43 APD patients were enrolled in the beginning of this study. Twenty patients in the icodextrin group (ICO) and 18 patients in the glucose group (GLU) completed the study. In left ventricular (LV) systolic function measurements, ejection fraction (EF) increased significantly in the GLU group. Measurements of LV diastolic function and septal early mitral annulus velocity (EMV) increased significantly from baseline to 24-months in the ICO group (5.43–5.51 ms). The GLU group showed a significant decrease in peak early diastolic velocity (EDV) (70.67–68.25 cm/s), but a significant increase in septal EMV (5.94–7.57 ms) from baseline to 24-months. No significant association was found between the baseline clinical variables and echocardiographic changes within 24 months in the generalized linear regression analysis. Multivariate models were used to investigate changes in the four primary endpoints, namely, myocardial performance index (MPI), left ventricular ejection fraction (LVEF), deceleration time (DT), and E/e′ ratio. These primary endpoints show no significant association with the baseline values in both the ICO and GLU groups. Conclusion The present study demonstrates that long-dwell icodextrin solution can maintain reasonable cardiac structure and function in incident-APD patients. Trial registration ISRCTN14931270 (retrospectively registered on 23/03/2018).

Background: Automated peritoneal dialysis (APD) can cater to individual needs, provide treatment while asleep, take into account the adequacy of dialysis, and improve the quality of life. Currently, independent research and development of APD machines made in China are more conducive to patients. A randomized, multicenter, crossover study was conducted by comparing an APD machine made in China with an imported machine. The safety, effectiveness, and manipulability of the two machines were compared. Methods: Two hundred and sixty patients who underwent peritoneal dialysis (PD) on a regular basis in 18 centers between August 2015 and February 2016 were included. The inclusion criteria include age ≥18 years and PD ≥30 days. The exclusion criteria were as follows: hemodialysis; exit site or tunnel infection; and peritonitis ≤30 days. The patients were randomly divided into Group A, who were first treated with a FM machine made in China, then changed to an imported machine; and Group B, who were treated using the reverse sequence. APD treatment was performed with 10 L/10 h and 5 cycles of exchange. After 72 h, the daily peritoneal Kt/V, the accuracy of the injection rate, accuracy of the injection temperature, safety, and manipulability of the machine were assessed. Noninferiority test was conducted between the two groups. Results: The daily peritoneal Kt/V in the APD machine made in China and the imported APD machine were 0.17 (0.14, 0.25) and 0.16 (0.13, 0.23), respectively. There was no significant difference between the groups (Z = 0.15, P = 0.703). The lower limit of the daily Kt/V difference between the two groups was 0.0069, which was greater than the noninferiority value of −0.07 in this study. The accuracy of the injection rate and injection temperature was 89.7% and 91.5%, respectively, in the domestic APD machine, which were both slightly better than the accuracy rates of 84.0% and 86.8% in the imported APD machine (89.7% vs. 84.0%, P = 0.2466; 91.5% vs. 86.8%, P = 0.0954). Therefore, the APD machine made in China was not inferior to the imported APD machine. The fuselage of the imported APD machine was space-saving, while the APD machine made in China was superior with respect to body mobility, man-machine dialog operation, alarm control, and patient information recognition. Conclusions: The FM machine made in China was not inferior to the imported APD machine. In addition, the FM machine made in China had better operability. Trial Registration: Clinicaltrials.gov, NCT02525497;.