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INTRODUCTION: Peritoneal dialysis (PD), as a home treatment, ensures better patient autonomy and lower intrusiveness compared to hemodialysis. However, choosing PD comes with an increased burden of responsibility that the patient may not always be able to bear, due to advanced age and deteriorating health condition. Various approaches have been explored to address this issue and mitigate its primary complications. In this study, we aim to present the ongoing PD training at-home program implemented by the Vicenza PD Center, and evaluate its impact on patients' prognoses. MATERIAL AND METHODS: We enrolled 210 patients who underwent PD at Vicenza Hospital between 1 January 2019 and 1 January 2022 for a minimum of 90 days. Each patient was observed retrospectively for one year. We categorized the patients into three groups based on their level of autonomy regarding their PD management: completely independent patients; patients able to perform some parts of the PD method on their own, while the remaining aspects were carried out by a caregiver; and patients who required complete assistance from a caregiver, like in the assisted PD program (asPD). RESULTS: A total of 70% of the PD population were autonomous regarding their PD therapy, 14% had an intermediate degree of autonomy, and 16% were entirely dependent on caregivers. The PD nurses performed a median of four home visits per patient per year, with a tendency to make more visits to patients with a lower degree of autonomy. All the groups achieved similar clinical outcomes. At the end of the year of observation, only 6% of the patients witnessed a decline in their autonomy level, whereas 7% demonstrated an enhancement in their level of autonomy, and 87% remained stable. CONCLUSIONS: A home care assistance program ensures clinical support to a household with the purpose of improving the empowerment of the PD population and reducing the prevalence of assisted PD. Ongoing PD training at home helps patients to maintain a stable degree of autonomy and stay in their home setting, even though they present with relative attitudinal or social barriers.
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Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited human renal disorder. Progressive enlargement of the kidneys is due to aberrant proliferation of the cyst epithelial cells, together with accumulation of fluid within the cyst cavities due to transepithelial fluid secretion. Multiple studies have suggested that fluid secretion across ADPKD cyst-lining cells is driven by the transepithelial secretion of chloride, mediated by the apical cystic fibrosis transmembrane conductance regulator chloride channel (CFTR) and specific basolateral transporters. Increased levels of cAMP, probably reflecting modifications in intracellular calcium homeostasis and abnormal stimulation of the vasopressin V2 receptor, in mutant renal epithelia, play an important role in the pathogenesis of ADPKD and contribute to both transepithelial secretion of fluid and proliferation of cyst epithelia. For example, cAMP activates the CFTR leading to the stimulation of Cl- secretion into the cyst lumen. This review focuses on the pathophysiology and molecular mechanism of fluid secretion in ADPKD cysts examined during pre-clinical trials of potentially useful drugs for the treatment of this condition.
