ABSTRACT
Despite the 40 years history, the comparable survival of Hemodialysis and Peritoneal Dialysis (PD), and the improved PD technique survival, the percentage of patients performing PD is low. After a short history review and data description, we analyze the many non-medical factors (“the vicious circle”) that contribute to the underutilization of PD: inadequate medical training, lack of infrastructures, small PD units, inadequate patient education for choice of dialysis modality, lack of multidisciplinary end-stage renal disease units, the proliferation of hemodialysis centers, or the trends in government reimbursement. Several of these factors are modifiable, and we propose future strategies to increase the use of PD.
Subject(s)
Peritoneal Dialysis/trends , Cost-Benefit Analysis , Forecasting , Health Personnel/education , Hospital Units/economics , Hospital Units/supply & distribution , Humans , Kidney Failure, Chronic/therapy , Nephrology/education , Patient Education as Topic , Peritoneal Dialysis/economics , Peritoneal Dialysis/statistics & numerical data , Peritoneal Dialysis, Continuous Ambulatory/economics , Peritoneal Dialysis, Continuous Ambulatory/statistics & numerical data , Peritoneal Dialysis, Continuous Ambulatory/trends , Renal Dialysis/economics , Renal Dialysis/statistics & numerical data , Spain , United States , WorkloadABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Diabetes Mellitus/physiopathology , Renal Insufficiency/etiology , Diabetic Nephropathies/epidemiology , Practice Patterns, Physicians'Subject(s)
Acute Kidney Injury/etiology , Diabetes Mellitus, Type 2/complications , Diabetic Nephropathies/diagnosis , Diagnostic Errors , Glomerulonephritis/diagnosis , Pyelonephritis/complications , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Biopsy , Diabetic Nephropathies/complications , Glomerular Basement Membrane/ultrastructure , Glomerulonephritis/etiology , Glomerulonephritis/pathology , Humans , Kidney/pathology , Male , Middle AgedSubject(s)
Abdominal Wall , Catheters, Indwelling/adverse effects , Peritoneal Dialysis , Peritoneum , Pressure Ulcer/etiology , Humans , Male , Middle AgedSubject(s)
Gardening , Gram-Negative Bacterial Infections/microbiology , Pantoea/isolation & purification , Peritonitis/microbiology , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/drug therapy , Humans , Male , Middle Aged , Peritonitis/diagnosis , Peritonitis/drug therapyABSTRACT
Central venous catheters are frequently used in leukapheresis to provide high flow rates. The most common locations are the subclavian or jugular vein, but insertion-related complications and inadequate flow are frequent problems. Experience using femoral venous access is limited, because this has been discouraged due to the high incidence of infectious or thromboembolic complications. We evaluated the safety and efficacy of 108 short-term femoral venous dialysis catheters used for the collection of peripheral blood stem cells (PBSCs). All catheters were placed by a member of the dialysis unit, and they remained in situ for the days needed to reach the target number of CD34+cells. No prophylactic antibiotic or antithrombotic therapy was used. A total of 232 apheresis sessions was performed. The longest duration a catheter remained in situ was 5 days. Most of the patients finished the collection in one or two apheresis sessions. There were no thrombotic or infectious complications, and insertion-related complications or mechanical problems were minimal. Apheresis results were similar to those reported using subclavian or jugular venous access. The short-term use of femoral venous dialysis catheters appears safe and effective for PBSC collection, simplifying the procedure, improving patient comfort, and reducing cost.
Subject(s)
Catheters, Indwelling/standards , Leukapheresis/methods , Adolescent , Adult , Aged , Catheters, Indwelling/adverse effects , Child , Female , Femoral Vein , Hematologic Neoplasms/therapy , Humans , Incidence , Infections , Leukapheresis/instrumentation , Male , Middle Aged , Peripheral Blood Stem Cell Transplantation , Retrospective Studies , ThrombosisABSTRACT
BACKGROUND: A significant number of complications and catheter failures in CAPD are due to mechanical problems. METHODS: We reviewed 105 consecutive peritoneal dialysis catheters, generally implanted by blind insertion technique, in 80 patients over an 11-year period. 137 mechanical problems were collected and classified according to their etiologies into the following: those related to the insertion procedure (n = 21; 15.3%), those related to the presence of dialysate in peritoneum (n = 33; 24%), catheter-related malfunction (n = 28; 20.4%), secondaries to abdominal events (n = 3; 0.2%), catheter accidents (n = 37; 26.2%) and others (n = 15; 11%). RESULTS: Removal of the catheter was performed in 86 of 105 catheters: mechanical complications accounted for 19 of them (21.8%) and 9 patients were definitively transferred to hemodialysis due to this problem. The most frequent complications were catheter accidents, although only a few of them required catheter removal. CONCLUSION: The majority of the catheter removals were due to catheter displacement (31.5%), this problem being more frequent in straight than in Swan Neck catheters.
Subject(s)
Catheters, Indwelling , Peritoneal Dialysis, Continuous Ambulatory/instrumentation , Accidents , Adolescent , Adult , Aged , Aged, 80 and over , Catheters, Indwelling/adverse effects , Child , Dialysis Solutions/adverse effects , Equipment Design , Equipment Failure , Equipment Failure Analysis , Fasciotomy , Female , Foreign-Body Migration/etiology , Humans , Male , Middle Aged , Peritoneal Cavity , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritoneal Dialysis, Continuous Ambulatory/methods , Peritoneum/surgery , Rectus Abdominis/surgery , Renal Dialysis , Surface PropertiesABSTRACT
Pancreatitis is a serious adverse effect of valproic acid (VPA). We report a case of VPA-induced pancreatitis in a dialysis patient. A brief review concerning VPA toxicity and acute pancreatitis in chronic renal patients is presented. We suggest that end-stage renal disease (ESRD) should be considered another risk factor for VPA-induced pancreatitis.
