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Published byLiliana Ryan Modified over 9 years ago
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James Heaf Herlev Hospital University of Copenhagen
Peritoneal Dialysis James Heaf Herlev Hospital University of Copenhagen
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Choice of dialysis modality Herlev 2012
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Peritonitis-free Survival Denmark 2000-2014
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PD as a viable long term dialysis option
James Heaf University of Copenhagen Herlev Hospital
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The Poor and the Smart Home Dialysis World Leaders 2011
GDP/capita USD 36,667 38,222 10,247 7,855 67,723 56,202 55,158 46,098 5,678 52,232 46,142 38,589 99,622 3,113 38,589 USRDS 2013
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Countries with High Home HD Prevalence
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Corruption Index Transparency International 2011
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Dialysis Costs Danish National Health Service Medical Technology Assessment Report 2006
Aim: 45% on Home Dialysis within 10 years 1 € = 85p
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Two basic types Automatic PD, APD CAPD
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PD Variations Night Cycler APD CAPD Night (9 hours) Day (15 hours)
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CAPD Variations Possibly Night cycler CAPD x 5 Gentle start PD
Night (9 hours) Day (15 hours)
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APD: Wet and Dry Days APD with wet day APD with Dry day
Night (9 hours) Day (15 hours)
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Osmotic Pressure and Ultrafiltration
Icodextrin Extraneal® 4,25% 2,5% 1,5% KI 62;S81,
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Peritoneal Equilibration Test (PET) Twardowski Perit Dial Bull 7:138 1987
82 68 52
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2 year Survival in CAPD CANUSA Studiet. Churchill et al
2 year Survival in CAPD CANUSA Studiet. Churchill et al. J Am Soc Nephrol. 1998; 9: Technique Patient Combined Survival Survival Survival Slow Slow average Fast average Fast
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PET og Ultrafiltration
2000 ml medium strength ( %) for 4 hours Transport Type UF Slow >650 ml Slow average ml Fast Average ml Fast <85 ml
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Ultrafiltration og transportstatus
Neg UF CAPD Night This slide shows the results of computer modeling that characterizes the ultrafiltration (UF) potential of 1.5% dextrose by peritoneal membrane transport pattern—low, low-average, high-average, and high—using actual peritoneal transport data from patients on continuous ambulatory peritoneal dialysis.1 As expected, patients with high transport patterns exhibited the greatest decline in UF potential over time, while those with low transport patterns exhibited the most gradual declines. Nevertheless, during long dwell exchanges of about hours, the majority of patients would likely experience negative net UF, regardless of transport status. This is explained by the relatively low concentration of glucose and its rapid diffusion across the peritoneal membrane, resulting in progressive loss of osmotic driving forces.1 APD Day Mujais S, Vonesh E. Kidney Int. 2002;62(suppl 81):S17-S22. 1.5% Glucose 1Mujais S, Vonesh E. Profiling peritoneal ultrafiltration. Kidney Int. 2002;62(suppl 81):S17-S22.
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Outcome in high transporters is improved during recent years
Commencing Commencing Davies SJ, Kidney Int 70: S76-S83, 2006
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ADP vs CAPD: Transport Status
Multivariate analysis Johnson NDT 25,
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PD Prevalance Denmark 1990-2010
Mortality
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HD vs. PD: Status 2014
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PD vs. HD: Effect of Cohort Denmark 1990-2010
Adjusted for age, sex, renal diagnosis Comorbidity, & referral pattern Heaf PlosOne 2014
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Effect of Cohort & Diabetes
Heaf PlosOne 2014
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Effect of Cohort & Age Heaf PlosOne2014
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Effect of Cohort & Referral
Early Referral Planned, out-patient Dialysis initiation Heaf PlosOne2014
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Risk Factors for Residual Renal Function Loss Moist JASN 11:556-565, 2000
** *** *** * * ** *** *** * *:p<0.05 **:p<0.01 ***:p<0.001 1843 patients 50% PD 50% HD Odds Ratio Multivariate Analyse
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Peritoneal and Renal Clearance: Different Effects on Mortality
Creatinine Clearance: Change per 1 ml/min Kt/V: Change per 0.1/week
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Wu: QOL after 1 Year Wu JASN 15,743 2004
** * ** ** * * * p<0.05 **p<0.01
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CAPD på en tømmerflåde With thanks to Johan Povlsen
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Conclusions Economical compared to Center HD Popular in Scandinavia
Better patient survival the first two years, possibly due to better preservation of renal function Not a longterm therapy CAPD and APD choice based on transport characteristics and patient wishes A sensible choice for patients who want freedom from hospital and freedom to travel
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