I spent most of last week at the ADC, which was in Seattle for the 50th anniversary of the first chronic dialysis treatments. Here are some interesting things I learned about PD:
– Dr. Salim Mujais reported that PD technique failure goes up as: patients are older, (except in Australia), programs are smaller (less than 40 patients), more people have diabetes, more people are transfers from HD. The first 6 months of PD is the biggest challenge. There were NO differences between regular and “biocompatible” PD solutions in PD success or survival.
– Dr. JoAnn Bargman noted that even one episode of peritonitis can permanently reduce the filtering ability of the peritoneum. Chronic inflammation could be behind both the loss of remaining kidney function AND long-term damage to the peritoneum (not glucose exposure from PD fluid, as was thought). Low urine output and lymphatic absorption can be confused with true ultrafiltration (fluid removal) failure. (Read about the “Rule of 4s” for diagnosing true UF failure here: http://renalfellow.blogspot.com/2009/08/rule-of-4s-for-diagnosing.html.
– Dr. Peter Blake suggested improving PD success by:
1). Having a peritonitis protocol that everyone follows
2). Keep it simple: ONE cycler and ONE CAPD system
3). Use a standard exit site care plan
4). Standardize patient teaching so everyone gets the same message. Have further home visits and retraining for folks who are running into problems
5). Track and report data on peritonitis