Pd selection

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Pd selection

  1. 1. Dr Mohamed Alameen
  2. 2. PD: Patient selection Dr M Alamin
  3. 3. : Strong need for independence and control of own care.  to set up a safe area in their home for treatment PD: Patient selection Dr M Alamin
  4. 4. : Ability to learn and apply theory, principles, and practical procedures —employed or desire to travel PD: Patient selection Dr M Alamin
  5. 5. especially if they have a motivated caregiver to assist PD: Patient selection Dr M Alamin
  6. 6. : Any new ESRD patient with severe cardiovascular disease.  ‡ Reduction in dialysis-associated symptoms A patient whose blood pressure is not well controlled with medications. PD: Patient selection Dr M Alamin
  7. 7. : Patients with hemodialysis access failure or fear of needles.  ‡ No vascular access required  ‡ Blood sugar can be well-controlled even though sugar is the base of PD solution PD: Patient selection Dr M Alamin
  8. 8. Inclusion Criteria for PD Choose the modality. CVD, CHF. Want “control.” Geriatric. Prefer home for Pediatric. dialysis. Have residual renal function. PD: Patient selection Social support system. Dr M Alamin
  9. 9. PD: Patient selection Dr M Alamin
  10. 10.  No/unreliable electricity  †Homeless  †Poor personal hygiene  †Dementia, poor short-term memory, brain injury without a helper  † Uncontrolled seizure disorder PD: Patient selection Dr M Alamin
  11. 11. PD: Patient selection Dr M Alamin
  12. 12.  Step 1: Promote Pre-Dialysis Care.  Step 2: Identify all patients who start dialysis without pre- dialysis care.  Step 3: Identify all patients who are eligible for PD.  Step 4: Overcome barriers to PD by offering support (Home Care).  Step 5: Educate patients about PD in the home and support them. PD: Patient selection Dr M Alamin
  13. 13. PD: Patient selection Dr M Alamin
  14. 14.  Continuous ambulatory peritoneal dialysis (CAPD)  Continuous cycling peritoneal dialysis (CCPD)  Conventional in-center HD (4 hoursX3 times/weekthree times     per week for three to four hours per treatment) Nocturnal in-center HD (6-8 hours X 3-4 times/week) Nocturnal HHD (three to six times per week for eight to 10 hours per treatment) Short daily HHD ( five to seven times per week for two to three hours per treatment) Transplant PD: Patient selection Dr M Alamin
  15. 15. :  Assuages concerns and misconceptions.  Provides objective information.  Promotes self-care  Helps patients make an informed modality decision.  Dramatically increase patient choice of home dialysis. PD: Patient selection Dr M Alamin
  16. 16.  Who are the pre dialysis patients ??????  Proved CKD patient.  SCr > 250 umol/l or GFR < 30 ml/min.  How to reach to those patients ????  Informing the referring physicians about the importance of early referral: Family Physicians, ER Physicians, Specialists (General Internal Medicine, Urology, Cardiology, Emergency; Hypertension specialists; Endocrine Clinics), Walk-In Clinics. PD: Patient selection Dr M Alamin
  17. 17.  Who will give predialysis care ????  Nephrologist  Nurses  Social workers  Dietitians  Social workers  Often include: a surgeon, a cardiologist, a psychologist, a psychiatrist, a physiotherapist etc. PD: Patient selection Dr M Alamin
  18. 18.  What is the predialysis care topics ???? 1. 2. 3. 4. 5. 6. What is CKD? Anemia of CKD. Blood pressure. CKD nutrition. Conservative therapy RRT: Transplantation, PD and HD PD: Patient selection Dr M Alamin
  19. 19.  Most patients with ESRD are anxious and unwell and will be nervous about participating in their own treatment  Getting them to do PD requires encouragement and support and is best done in advance before they become very uremic PD: Patient selection Dr M Alamin
  20. 20. PD: Patient selection Dr M Alamin
  21. 21. PD: Patient selection Dr M Alamin
  22. 22. PD: Patient selection Dr M Alamin
  23. 23.  All patients, including acute HD starts, should be offered the various options of RRT that they are suitable for.  Once patients are medically stable, they are to be rapidly assessed to determine what components of pre-dialysis care they have received.  Education about home dialysis to be completed prior to discharge. PD: Patient selection Dr M Alamin
  24. 24.  Absolute contraindications for PD 1. Documented loss of peritoneal membrane function or extensive abdominal adhesions that limit dialysate flow. 2. Uncorrectable mechanical defects that prevent effective PD or increase the risk of infection (eg, surgically irreparable hernia, omphalocele, gastroschisis, diaphragmatic hernia, and bladder extrophy) PD: Patient selection Dr M Alamin
  25. 25. Absolute contraindications for PD PD: Patient selection Dr M Alamin
  26. 26. Absolute contraindications for PD PD: Patient selection Dr M Alamin
  27. 27. Absolute contraindications for PD PD: Patient selection Dr M Alamin
  28. 28. Absolute contraindications for PD PD: Patient selection Dr M Alamin
  29. 29. Relative contraindications for PD Fresh intra-abdominal foreign bodies (eg, 4-month wait after abdominal vascular prostheses, recent ventricularperitoneal shunt) 2. Body size limitations i.e. Morbid obesity (in short individuals) 3. Intolerance to PD volumes necessary to achieve adequate PD dose 1. PD: Patient selection Dr M Alamin
  30. 30. Relative contraindications for PD 4. Inflammatory or ischemic bowel disease 5. Abdominal wall or skin infection 6. Severe malnutrition 7. Frequent episodes of diverticulitis. PD: Patient selection Dr M Alamin
  31. 31. Social Contraindications to PD A patient lives in a residence that does not permit PD. A patient requires rehabilitation in a centre that does not permit PD. 3. A patient’s residence has insufficient storage space for PD supplies and equipment. 4. A patient’s family is not supportive of PD in the home. 1. 2. PD: Patient selection Dr M Alamin
  32. 32. Recommendations  Assess all patients starting chronic dialysis to determine if they are eligible for PD in the home (no contraindication).  Modality options for patients are determined by conducting multidisciplinary assessments in partnership with the patient and their families. PD: Patient selection Dr M Alamin
  33. 33. Recommendations  Communication between pre-dialysis and home dialysis health care teams to be conducted on an ongoing basis to assist in the assessment process.  Involvement of home dialysis nurses in the pre-dialysis clinic to be part of the strategy. PD: Patient selection Dr M Alamin
  34. 34. PD: Patient selection Dr M Alamin
  35. 35. The following conditions should not be considered as contraindications to PD  Physical or mental inability to     perform PD Older age Poor adherence/noncompliance to therapy Obesity Congestive heart failure PD: Patient selection  Polycystic kidney disease  Diverticulosis  Abdominal hernias  Portal hypertension  Liver transplantation Dr M Alamin
  36. 36.  Theoretical:     CKD Acceptance of chronic disease Conservative therapy RRT options  Practical:   Conducted by experienced PD nurse Using educational materials PD: Patient selection Dr M Alamin
  37. 37. Factors in Favour of PD        Young child Full time work Desire for autonomy Mother with young children Good family support Good motivation Early transplant likely PD: Patient selection Dr M Alamin
  38. 38. ‘ PD FIRST ‘ Advances of PD as Initial Modality 1. 2. 3. 4. 5. 6. 7. Preserves residual renal function better May allow better blood pressure and volume control with cardiovascular benefits May give better quality of life Has less anemia and lower EPO doses Lower risk of Hepatitis C Equal or better survival in early years Cost advantages - in many countries
  39. 39. Conclusion  Several factors must be in place in order to maximize patient compliance.  First, the health care professionals and treatment setting have to be positive and inspire hope and trust.  Patients should be seen as colleagues in the design and implementation of their treatment plan.  Treatment plans should be realistic based on what the patient should and will do. PD: Patient selection Dr M Alamin
  40. 40. PD: Patient selection Dr M Alamin

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