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![Prof. MacLeod:
4
“Patients whose kidney fail require life-saving treatment with
dialysis or with a kidney transplant.
Although dialysis is now very advanced, allowing more
patients to be treated successfully, it is also very expensive.
It is essential, therefore, to ensure that resources are used as
effectively as possible.”[1]
[1] Khan I., MacLeod A. Towards cost-effective dialysis therapy in Europe: the need for a multidisciplinary
approach. Nephrol Dial Transplant 1997; 12: p. 2483](https://image.slidesharecdn.com/pd-170120000609/85/peritoneal-dialysis-4-320.jpg)
Uploaded bydarsh 1980
peritoneal dialysis
Peritoneal dialysis (PD) has several potential advantages over hemodialysis (HD), though patient and clinical factors must be considered when determining the optimal renal replacement therapy (RRT). PD is associated with better preservation of residual renal function, higher quality of life due to greater flexibility, and lower risk of infection. However, HD requires more nursing staff per patient. The "right modality at the right time" depends on individual patient characteristics and preferences as well as resource availability. Overall, PD can be a cost-effective first-line RRT option when integrated with HD.
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- 1. Peritoneal Dialysis Indicationsand Limitations By Mostafa Abd_Elsalam, MD
- 2. Stage GFR Description 1>90 Kidney damage with normal or increased GFR 2 60-89 Kidney damage with mild GFR fall 3 30-59 Moderate fall in GFR 4 15-29 Severe fall in GFR 5 <15 or RRT Established renal failure Classification of CKD according to GFR
- 3. . Managing New Patientwith ESRD
- 4. Prof. MacLeod: 4 “Patients whosekidney fail require life-saving treatment with dialysis or with a kidney transplant. Although dialysis is now very advanced, allowing more patients to be treated successfully, it is also very expensive. It is essential, therefore, to ensure that resources are used as effectively as possible.”[1] [1] Khan I., MacLeod A. Towards cost-effective dialysis therapy in Europe: the need for a multidisciplinary approach. Nephrol Dial Transplant 1997; 12: p. 2483
- 5. The word preitoneum refersto the Greek word “peritononion” and means to stretch. Ancient Egypt were probably the first people to get a look at the peritoneum 1st steps towards peritoneal dialysis.
- 6. Preservation of RRF HigherHb concentration Less risk of acquiring blood borne infections e.g. HCV Better quality of life Why to start with PD ?
- 7. Travel , employment Itallows expansion with limited resources Lower staff / patient ratio
- 8.
- 9. Things to Remember ESRDis life-long ordeal • Access problems • Higher morbidity and mortality Survival lines • One PD membrane • 4 sites for permanent vascular access • Two iliac for transplantation
- 10. “The right modalityat the right time.” Peter Blake, MD, John Burkart, MD “Complementary Not Competitive” Coles 1998
- 11. PD versus HD Whichis best? • PD may best be seen as a therapy for early years of dialysis with HD being used as a back up if or when PD fails • This approach which has recently been called “integrated dialysis care” has economic as well as medical advantages
- 12. CAPD Advantages • Medical •Lifestyle • Economic
- 13. Economic • Paradoxically, howeverthe difference is greater in poorer developing countries and least in wealthier countries .
- 14. LIFESTYLE • Given freechoice , because it involves less daytime procedures and so less disruptive . • Exceptions are people who are nervous about machines or who have difficulty staying in bed .
- 15. • Patient Preference. • Availability And Convenience. • Underlying Medical Problems and Comorbid Conditions. • Socioeconomic and Dialysis Center Factors. • The Patient's Home Situation • Medical staff Training. Selecting RRT modalities is influenced by a number of considerations such as Patient selection
- 16. • Those wantinga lifestyle with more freedom and flexibility • Those with diabetes, cardiovascular disease, or hypertension • Patients who live a long way from their dialysis unit and /or who have had problems with hemodialysis • Individuals whose peritoneal membrane can handle the daily needs of this option
- 17. 11% of alldialysis patients are treated with PD PD distribution differs significantly between countries Global dialysis patients HD – PD patient distribution 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2013 2,522,000 11% 89% 100%0% 80%40% 60%20% USA China Japan Thailand Egypt Korea France Italy Turkey Malaysia Brazil Germany Mexico Taiwan India PDHD (countries ordered according to dialysis patient population)PDHD ESRD, end-stage renal disease; HD, haemodialysis; PD, peritoneal dialysis. Fresenius Medical Care annual report 2013, available at: http://www.fresenius.com/191.htm, accessed September 2014
- 20. Perl J, WaldR, McFarlane P, et al. Hemodialysis vascular access modifies the associated between dialysis modality and survival. J Am Soc Nephrol 2011;22:1113-1121
- 22. PD Patients Havean Initital Survival Advantage Relative to HD. Danish Registry 2001 0 5 10 15 20 25 30 35 0.5 1 1.5 2 2.5 3 3.5 4 HD PD Time (years) J Heaf, NDT 2002 4921 patients
- 23. J. Kevin Tucker,MD, is Medical Director of the Peritoneal Dialysis Program at Brigham and Women’s Hospital Nephrology Times May 2009
- 24. better maintenance of residualrenal function Better maintenance of residual renal function
- 25. What Are theBenefits of Preserving RRF? Reduces Mortality Contributes to total solute clearance (1 ml/min CrCl = 10 liter CrCl/week) Facilitates volume control Allows for more liberal diet and fluid intake Provides endocrine functions Improves 2-microglobulin and middle molecule clearance Improves nutritional status Improves QOL Increases total Na removal Davies, S. 2000
- 27. Most Patients AreMedically Eligible for PD Netherlands 83% and U.S.A 76% The prevalence of medical contraindications to PD (23% to 24%) is similar to the 17% to 21% reported … from other parts of the world Jager KJ, Korevaar JC, Dekker FW et al. The effect of contraindications and patient preference on dialysis modality selection in ESRD patients in the Netherlands. Am J Kidney Dis. 2004;43:891-899. Mehrotra R, Marsh D, Vonesh E, et al. Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis.. Kidney Int. 2005;68:378-390
- 28. 7% 13% 16% 19% 23% 31% 44% 47% 50% 35% 25% 5% 2%2% 0% 17% 8% 12% 34% 5% 15% 20% 0% 20% 40% 60% M cIntyre Brugnano C han Jonas C antu D ussol Barril N eto Selgas H uang Yoshida HD PD Pereira KI1997;51:981-999 Prevalence of anti-HCV Among Patients on Dialysis by Modality
- 29. 40 Nurses per100 HD- patients. 4 Nurses in the Out- patient Clinic per 100 PD-patients. Logistics of PD versus HD Logistics of PD versus HD
- 30. Transports Hospitalisation Pharmaceuticals (e.g. EPO) Equipment costs (Lease,depreciation, maintenance) Disposables Labor Water Treatment Infrastructure Transports Hospitalisation Pharmaceuticals (e.g. EPO) Equipment costs Disposables Labor Infrastructure Schematic RRT Cost Comparison Available Modalities
- 31. Modality Cost Comparisonin KSA