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Transitioning the Nutritional Support Patient to Homecare
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
A few interesting exceptions to the hospital model existed. The polio epidemic of the early 20th century had left some patients dependent on negative pressure ventilators. Many of these patients were treated in respiratory care facilities. But some did transition to a homecare environment. Similarly, the early use of hemodialysis included home hemodialysis machines for patients that could not find a suitable, nearby dialysis unit. In contrast, peritoneal dialysis was typically done at home, utilizing an overnight cycle of infusions.
Diabetic Nephropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Treatment of GBM diabetic neuropathy avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors. Their use may cause poor BP control, and reduce effects of antihypertensive drugs. Medications and dosing of oral hypoglycemics are critical. The patient at high risk for progressive renal deterioration should be referred to a nephrologist for consultation to manage renal failure. Other options include hemodialysis, peritoneal dialysis, and renal transplantation. Most of the patients prefer hemodialysis over peritoneal dialysis.
Renal and Electrolytes
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Dialysis describes the use of a semipermeable membrane that acts as a filter with a solution to regulate the fluid and electrolytes in the blood. There are three main forms: Haemodialysis: Uses an AV fistula (between radial artery and cephalic vein) with blood flowing from one side of a semipermeable membrane with dialysis solution flowing in the opposite direction. Requires multiple treatments per week. Complications include hypotension, infection, thrombosis (from AV fistula) and dialysis disequilibrium syndrome (cerebral oedema).Haemofiltration: Blood flows through a machine through a semipermeable membrane but no dialysis solution is used. Positive hydrostatic pressure pushes fluid across. Complications are similar to haemodialysis but haemofiltration causes less hypotension.Peritoneal dialysis: Uses the peritoneum as the semipermeable membrane with access gained via a Tenchkoff catheter through the anterior abdominal wall. Cheaper than haemodialysis/haemofiltration and more flexible for patients. Complications include peritonitis (most commonly due to Staphylococcus epidermidis). Contraindications include peritoneal adhesions, abdominal hernias and colostomy.
Clinical outcomes, quality of life, and costs evaluation of peritoneal dialysis management models in Shanghai Songjiang District: a multi-center and prospective cohort study
Published in Renal Failure, 2021
Xiaoyan Ma, Min Tao, Yan Hu, Lunxian Tang, Jiasun Lu, Yingfeng Shi, Hui Chen, Si Chen, Yi Wang, Binbin Cui, Lin Du, Weiwei Liang, Guansen Huang, Xun Zhou, Andong Qiu, Shougang Zhuang, Xiujuan Zang, Na Liu
This was a prospective cohort study that included 190 ESRD patients who underwent peritoneal dialysis at Shanghai Songjiang District, including Songjiang District Central Hospital and 8 Songjiang community PD units. The PD patients were recruited from 1 January 2016 to 31 August 2019 and followed up until 31 August 2020. The exclusion criteria were as follows: PD patients with an age younger than 18 years, who were undergoing hemodialysis once a week for dialysis adequacy, who previously accepted hemodialysis or kidney transplantation, and who occasionally underwent PD in other districts. According to the Chinese Peritoneal Dialysis Guideline, we adopted standardized surgical catheterization technique 2016 [17]. Exit-site care, catheter management, and peritonitis prevention referred to International Society for Peritoneal Dialysis (ISPD) Guidelines 2016 and 2017 update [18,19]. Peritonitis was defined according to the ISPD guidelines by 2 of the 3 indices: (1) abdominal pain, (2) dialysate leukocyte count >100 cells/μl with at least 50% neutrophils, (3) positive dialysate microbiological culture [18]. The treatment type of peritoneal dialysis was continuous ambulatory peritoneal dialysis (CAPD), with dextrose dialysate (Baxter Healthcare, Guangzhou, China). According to residual renal function (RRF), body surface area (BSA), and peritoneal equilibrium test (PET) of each patient, dialysis prescription adjusted timely, including dialysate concentration (1.5–2.5%) and dosages (6000–10 000 ml).
miR-15a-5p suppresses peritoneal fibrosis induced by peritoneal dialysis via targeting VEGF in rats
Published in Renal Failure, 2020
Qianxin He, Lu Wen, Luyao Wang, Ya Zhang, Wei Yu, Fanliang Zhang, Weifeng Zhang, Jing Xiao, Xuejun Wen, Zhanzheng Zhao
The number of end-stage renal disease (ESRD) patients caused by chronic kidney diseases (CKD), such as glomerular disease, diabetic nephropathy, hypertension and obesity, is rapidly increasing [1]. ESRD patients must rely on kidney transplant, hemodialysis (HD) and peritoneal dialysis (PD) as renal replacement therapy (RRT). PD has become an important method of RRT because of its weak influence on hemodynamics and protection of residual renal function [2,3]. Biological incompatibility of peritoneal dialysate, oxidative stress, activation of the renin-angiotensin-aldosterone system (RAAS), and recurrent peritonitis can result in changes in peritoneal morphology and function in patients undergoing long-term PD. Patients have to withdraw from PD when peritoneal fibrosis (PF) causes ultrafiltration failure (UFF) [4–8]. Peritoneal angiogenesis, epithelial-to-mesenchymal transition (EMT), and inflammatory cell infiltration are the pathophysiological causes of PF in patients with PD. EMT and angiogenesis are the major causes of UFF [9–11].
Early-start and conventional-start peritoneal dialysis: a Chinese cohort study on outcome
Published in Renal Failure, 2020
Ying Wang, Yang Li, Haiyun Wang, Ying Ma, Danna Ma, Dongli Tian, Bingyan Liu, Zijuan Zhou, Wei Yang, Xuemei Li, Jie Cui, Limeng Chen
Patients were divided into three groups according to the duration of break-in period: 3 days or less (BI ≤3), 4-13 days (BI 4-13) and more than 14 days (BI ≥14). Early-start PD was defined as initiation of PD within 2 weeks after catheter insertion. All Tenckhoff catheter insertions were performed by experienced urologists or nephrologists using open surgery under local anesthesia. The time from placement-to-PD was determined by the nephrologists based on the clinical condition of each patient. An infused volume of 0.8–1.0L in the supine position was used to avoid leakage, which was gradually increased to 2 L per exchange within 3 weeks after catheter insertion if the patients did not present with leakage or abdominal distension. Otherwise, the infused volume would remain at a tolerable level until patients could adapt to a higher volume and gradually titrated to the maximum tolerable volume (less than 2 L). Manual intermittent peritoneal dialysis (IPD) or cycler-assisted dialysis (automated peritoneal dialysis, APD) was used during the first 2 weeks, and continued with continuous ambulatory peritoneal dialysis (CAPD) or APD depending on the clinical situation and preference of patients. All patients were dialyzed using a glucose-based PD solution.