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Urgent start PD

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18 papers 0 to 25 followers Expedited starts on PD to avoid HD with a CVC
By Daniel Schwartz Passionate about knowledge translation
Daniel Dean, Dinna N Cruz
The rising tide of severe acute kidney injury requiring dialysis (AKI-D) and unplanned dialysis initiation for advanced CKD patients remains a major problem for the nephrology community worldwide. Hemodialysis (HD) through a central venous catheter remains the most common practice for both. Peritoneal dialysis (PD) remains greatly underutilized despite mounting evidence of equipoise with HD for a significant proportion of patients. PD is technically simpler, requires less infrastructure, and costs less. However, the structure of our healthcare system, hospital logistics, and the current state of nephrology training all contribute to the reflexive consult for a central venous catheter...
July 2016: Seminars in Dialysis
Charmaine E Lok
Worldwide, there is a steady incident rate of patients with end-stage kidney disease (ESKD) who require renal replacement therapy. Of these patients, approximately one-third have an "unplanned" or "urgent" start to dialysis. This can be a very challenging situation where patients have either not had adequate time for education and decision making regarding dialysis modality and appropriate dialysis access, or a decision was made and plans were altered due to unforeseen circumstances. Despite such unplanned starts, clinicians must still consider the patient's ESKD "life-plan", which includes the best initial dialysis modality and access to suit the patient's individual goals and their medical, social, logistic, and facility circumstances...
March 2016: Journal of Vascular Access
Dayana Bitencourt Dias, Vanessa Banin, Marcela Lara Mendes, Pasqual Barretti, Daniela Ponce
AIM: Starting dialysis in an unplanned manner is frequent situation in dialysis center even for patients with regular nephrology follow-up. Peritoneal dialysis (PD) appears as an option for unplanned initiation of chronic dialysis, offering the advantage of not using central venous catheters and preserving of residual renal function. Since July 2014, we have offered PD as urgent start for chronic kidney disease (CKD) patients. METHODS: It was a prospective study that aimed to evaluate the mortality rate in hospitalized patients who started unplanned urgent PD in the first 90 days...
June 2016: International Urology and Nephrology
Johan V Povlsen, Anette Bagger Sørensen, Per Ivarsen
Unplanned start on dialysis remains a major problem for the dialysis community worldwide. Late-referred patients with end-stage renal disease (ESRD) and urgent need for dialysis are overrepresented among older people. These patients are particularly likely to be started on in-center hemodialysis (HD), with a temporary vascular access known to be associated with excess mortality and increased risks of potentially lethal complications such as bacteremia and central venous thrombosis or stenosis.The present paper describes in detail our program for unplanned start on automated peritoneal dialysis (APD) right after PD catheter implantation and summarizes our experiences with the program so far...
November 2015: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Ali M A Alkatheeri, Peter G Blake, Daryl Gray, Arsh K Jain
UNLABELLED:BACKGROUND: Many patients start renal replacement therapy urgently on in-center hemodialysis via a central venous catheter, which is considered suboptimal. An alternative approach to manage these patients is to start them on peritoneal dialysis (PD). In this report, we describe the first reported Canadian experience with an urgent-start PD program. Additionally we reviewed the literature in this area. ♦ METHODS: In this prospective observational study, we report on our experience in a single academic center...
March 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Cheryl Groenhoff, Edna Delgado, Marilyn McClernon, Alicia Davis, Latasha Malone, Janet Majirsky, Steven Guest
Urgent-start peritoneal dialysis (PD) refers to the initiation of dialysis soon after a PD catheter placement and is a treatment option available to the late-referred patient with advanced kidney disease. This article reviews nursing aspects of urgent-start PD and can serve as a guide for this evolving clinical pathway that can provide renal replacement therapy for a critical segment of the population with Stage 5 chronic kidney disease who require renal replacement therapy.
July 2014: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Rex L Mahnensmith
No abstract text is available yet for this article.
May 2014: Seminars in Dialysis
Jean-Philippe Rioux, Harpaul Cheema, Joanne M Bargman, Diane Watson, Christopher T Chan
BACKGROUND AND OBJECTIVES: The effect of in-hospital education on the adoption of home dialysis (peritoneal dialysis [PD] and home hemodialysis [HHD]) after an unplanned dialysis start is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Clinical demographics of consecutive patients acutely initiating hemodialysis (HD) from January 2005 to December 2009 were abstracted using institutional electronic records. All patients received multimedia chronic kidney disease education by the same advanced care nurse practitioner before discharge from the hospital...
April 2011: Clinical Journal of the American Society of Nephrology: CJASN
Allison Masseur, Steven Guest, Vijay Kumar
In the United States, interest has recently been renewed in the more urgent initiation of peritoneal dialysis (PD) to avoid temporary vascular access catheters in appropriate patients presenting late in the course of their kidney disease. Urgent-start PD programs have been established across the country, requiring new infrastructure and processes of care. Less is known about early technique success after urgent initiation of PD. In this report, we describe 90-day technique success and causes of hospitalization in 81 patients initiating PD in our urgent-start pathway...
2014: Advances in Peritoneal Dialysis
Per Ivarsen, Johan V Povlsen
Late referral of patients with chronic kidney disease (CKD) and unforeseeable deterioration of residual renal function in known CKD patients remain a major problem leading to the need of unplanned start on chronic dialysis without a mature access for dialysis. In most centres worldwide, these patients are started on haemodialysis (HD) using a temporary tunnelled central venous catheter (CVC) for access. However, during the last decade, increasing clinical experience with unplanned start on peritoneal dialysis (PD) right after PD catheter implantation has been published...
December 2014: Nephrology, Dialysis, Transplantation
Arshia Ghaffari, Vijay Kumar, Steven Guest
Patients with advanced chronic kidney disease nearing dialysis but without pre-established access almost uniformly initiate dialysis with a temporary central venous catheter. These catheters are associated with high rates of infection and flow disturbances, requiring removal and subsequent replacement. Many of these patients might be candidates for peritoneal dialysis (PD), but because of the absence of prior catheter placement, the default initial modality is hemodialysis. Recent reports, however, have demonstrated the feasibility of initiating PD urgently despite the late referral for access placement...
November 2013: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Frank Xiaoqing Liu, Arshia Ghaffari, Harman Dhatt, Vijay Kumar, Cristina Balsera, Eric Wallace, Quresh Khairullah, Beth Lesher, Xin Gao, Heather Henderson, Paula LaFleur, Edna M Delgado, Melissa M Alvarez, Janett Hartley, Marilyn McClernon, Surrey Walton, Steven Guest
Patients presenting late in the course of kidney disease who require urgent initiation of dialysis have traditionally received temporary vascular catheters followed by hemodialysis. Recent changes in Medicare payment policy for dialysis in the USA incentivized the use of peritoneal dialysis (PD). Consequently, the use of more expeditious PD for late-presenting patients (urgent-start PD) has received new attention. Urgent-start PD has been shown to be safe and effective, and offers a mechanism for increasing PD utilization...
December 2014: Medicine (Baltimore)
Rohini Arramreddy, Sijie Zheng, Anjali B Saxena, Scott E Liebman, Leslie Wong
Peritoneal dialysis (PD) remains greatly underutilized in the United States despite the widespread preference of home modalities among nephrologists and patients. A hemodialysis-centric model of end-stage renal disease care has perpetuated for decades due to a complex set of factors, including late end-stage renal disease referrals and patients who present to the hospital requiring urgent renal replacement therapy. In such situations, PD rarely is a consideration and patients are dialyzed through a central venous catheter, a practice associated with high infection and mortality rates...
March 2014: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Chang Yin Chionh, Sachin S Soni, Fredric O Finkelstein, Claudio Ronco, Dinna N Cruz
BACKGROUND AND OBJECTIVES: The role of peritoneal dialysis in the management of AKI is not well defined, although it remains frequently used, especially in low-resource settings. A systematic review was performed to describe outcomes in AKI treated with peritoneal dialysis and compare peritoneal dialysis with extracorporeal blood purification, such as continuous or intermittent hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: MEDLINE, CINAHL, and Central Register of Controlled Trials were searched in July of 2012...
October 2013: Clinical Journal of the American Society of Nephrology: CJASN
Alberto Casaretto, Reinaldo Rosario, Wayne R Kotzker, Yaselly Pagan-Rosario, Cheryl Groenhoff, Steven Guest
Urgent-start peritoneal dialysis (PD) can be defined as initiation of PD within 2 weeks of catheter insertion. Urgent-start PD can be offered to patients who are referred late to a nephrologist and who would typically be initiated on hemodialysis with a temporary vascular access. An urgent-start PD capability requires expedited options education, catheter placement, unique change in the PD unit infrastructure, and new processes of care. This report describes the urgent-start PD program established by a nephrology private practice in the United States...
2012: Advances in Peritoneal Dialysis
Arshia Ghaffari
BACKGROUND: Compared with hemodialysis, peritoneal dialysis (PD) is a cost-effective and patient-centered option with an early survival advantage, yet only 7% of patients with end-stage renal disease in the United States receive PD. PD underutilization is due in part to nephrologists' unfamiliarity with directly starting PD in patients who present with kidney failure requiring urgent initiation of dialysis. DESIGN: Quality improvement report. SETTING & PARTICIPANTS: Single-center study whereby 18 patients who presented urgently with chronic kidney disease stage 5 without a plan for dialysis modality were offered PD as the initial modality of dialysis...
March 2012: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Johan V Povlsen
The present paper describes a program for an unplanned start on assisted automated peritoneal dialysis for late referred patients with chronic kidney disease stage V and urgent need for initiation of dialysis. Using a standard prescription for 12 h overnight APD right after PD catheter placement, analysis of our data showed that unplanned start on APD has no detrimental effects on patients, combined patient and technique, peritonitis-free survivals or the risk of infectious complications, while the risk of mechanical complications and the need of replacement of displaced or malfunctioning PD catheters may be increased...
2009: Contributions to Nephrology
Johan V Povlsen, Per Ivarsen
BACKGROUND: Peritoneal dialysis (PD) has become a well-established complementary alternative to haemodialysis (HD) as first-line renal replacement modality. At our department, approximately 50% of the end-stage renal disease patients are started urgently on chronic dialysis due to late referral or unexpected deterioration of residual renal function. These patients--although suitable for PD--were previously started on HD via a temporary central venous catheter. Since January 2000, patients have been offered urgent start on chronic PD right after PD-catheter insertion by open surgery...
July 2006: Nephrology, Dialysis, Transplantation
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