Low-volume supine peritoneal dialysis in a chronic obstructive airway disease patient.

Continuous ambulatory peritoneal dialysis (CAPD) may not be tolerated by patients with chronic obstructive pulmonary disease (COPD) because of increased abdominal pressure in the standing position after instillation of peritoneal fluid. We report, here, a patient with COPD who had marked distress while on CAPD but was more comfortable with supine intermittent peritoneal dialysis. It is probable that the continuous high intraperitoneal pressure during CAPD caused diaphragmatic fatigue. During intermittent peritoneal dialysis, the supine position induces the least increase in intraperitoneal pressure; it may be the preferred mode of peritoneal dialysis for patients with COPD.

Home visit effectiveness for peritoneal dialysis patients.

Medicare regulations require follow-up home visits to home dialysis patients, yet routine home visits require a lot of personnel time. The effectiveness of home visits was evaluated by a nurse, dietitian and social worker using a questionnaire. Thirty-six patients were evaluated during an 18-month period. Collectively the team documented an average of 10 pertinent observations per visit and made an average of 4 recommendations for change. Staff members gained new information about the patient as indicated by the fact that they changed their rankings on 5 of 15 parameters following the home visit. The home visit policy that recommended an annual home visit was revised to recommend a single home visit for each new peritoneal dialysis patient. Further visits are performed only if significant problems are identified.

Chronic nightly tidal peritoneal dialysis.

Nightly tidal peritoneal dialysis (NTPD) is a technique in which, after an initial fill of the peritoneal cavity, only a portion of dialysate is rapidly cycled. Five anuric, stable, PD patients entered a 4 month study to determine the NTPD session length necessary for clinically adequate dialysis and creatinine clearance similar to those on four daily 2 L CAPD exchanges. NTPD was performed using a modified PAC-X-2 cycler, with the drain phase regulated by a target volume. One patient completed 3.5 months of study, one 4 months, three 6 months, and one patient each continued on NTPD for 13, 14, and 32 months. The mean NTPD session time was 9 hr 24 min (range 8 hr 35 min to 9 hr 55 min) at the end of 4 months. All patients had clinically adequate dialysis. Three patients preferred NTPD over CAPD, particularly because of an empty abdomen during the daytime. One patient required an increase in NTPD time, and an addition of one daytime exchange, because of low creatinine clearance. In conclusion, NTPD provides weekly creatinine clearances comparable to CAPD, with an acceptable duration of nightly dialysis sessions in most anuric patients. A new PD machine providing inexpensive dialysis solution in large quantities, as well as safe and false alarm free dialysis sessions, is needed for practical NTPD implementation.

Effectiveness of a phosphorous educational program for dialysis patients.

Fifty-four percent of all dialysis patients followed by a single center had elevated serum phosphorus levels on more than 25% of all measurements. A phosphorus patient education program was developed and implemented and knowledge was measured with a pretest and posttest. The continuous ambulatory peritoneal dialysis group had a significant increase in knowledge and a minor, but statistically significant, decrease in serum phosphorus after participating in the education program. In contrast, center hemodialysis patients did not demonstrate a significant increase in knowledge or decrease in serum phosphorus. These different outcomes could not be attributed to specific differences between the two groups. Serum phosphorus control is a complex process, and this education program did not result in a clinically significant improvement in serum phosphorus levels.