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      Efficacy of APD in perioperative period of non-abdominal operation for peritoneal dialysis patients

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          Abstract

          Objectives: Whether automated peritoneal dialysis (APD) is a feasible strategy in perioperative period of uremic patients undergoing nonabdominal surgery remains unclear. This study was conducted to research the perioperative management and the best choice of dialysis modalities for peritoneal dialysis patients.

          Materials and methods: A retrospective analysis was made on the clinical data of 58 ESRD patients who had received peritoneal dialysis for more than three months were treated with APD during perioperative period from July 2015 to March 2018 in the Second Affiliated Hospital of Soochow University. The differences of clinical parameters, such as urine volume, ultrafiltration volume, hemoglobin, renal function and electrolytes were collected and analyzed before and after APD.

          Results: The vital signs of 58 patients were stable after APD treatment, and there were no significant differences in 24-hour urine volume, hemoglobin and electrolytes (calcium, phosphorus, potassium, sodium) before and after surgery ( P>0.05). Compared with those before treatment, the amount of ultrafiltration increased significantly ( P<0.05), creatinine, urea nitrogen and parathyroid hormone decreased significantly ( P<0.05), while albumin decreased ( P<0.05).

          Conclusion: Application of APD for peritoneal dialysis patients undergoing nonabdominal surgery during the perioperative period is safe and effective.

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          Most cited references28

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          Vascular access morbidity and mortality: trends of the last decade.

          Charmaine E. Lok, Robert Foley (2013)
          During the past decade, clear trends in the types of incident and prevalent hemodialysis vascular access can be observed. There has been a steady increase and recent stabilizaton of patients initiating hemodialysis with a central venous catheter, representing approximately 80% of all incident accesses. There has also been a steady increase in prevalent fistula use, currently greater than 50% within 4 months of hemodialysis initiation. Patient and vascular access related morbidity and mortality are reflected in the type of vascular access used at initiation and for long-term maintenance dialysis. There is a three- to fourfold increase in risk of infectious complications in patients initiating dialysis with a catheter compared with either a fistula or graft and a sevenfold higher risk when the catheter is used as a prevalent access. Procedure rates have increased two- to threefold for all types of access. There is a significant increased risk of mortality associated with catheter use, especially within the first year of dialysis initiation.
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            High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock.

            Luis Castillo, Ricardo Castro, Max Andresen … (2006)
            To evaluate the effect of short-term (12-h) high-volume hemofiltration (HVHF) in reversing progressive refractory hypotension and hypoperfusion in patients with severe hyperdynamic septic shock. To evaluate feasibility and tolerance and to compare observed vs. expected hospital mortality. Prospective, interventional, nonrandomized study in the surgical-medical intensive care unit of an academic tertiary center. Twenty patients with severe septic shock, previously unresponsive to a multi-intervention approach within a goal-directed, norepinephrine-based algorithm, with increasing norepinephrine (NE) requirements (>0.3 microg kg(-1) min(-1)) and lactic acidosis. Single session of 12-h HVHF. We measured changes in NE requirements and perfusion parameters every 4h during HVHF and 6h thereafter. Eleven patients showed decreased NE requirements and lactate levels (responders). Nine patients did not fulfill these criteria (nonresponders). The NE dose, lactate levels, and heart rates decreased and arterial pH increased significantly in responders. Hospital mortality (40%) was significantly lower than predicted (60%): 67% (6/9) in nonresponders vs. 18% (2/11) in responders. Of 12 survivors 7 required only a single 12-h HVHF session. On logistic regression analysis the only statistically significant predictor of survival was theresponse to HVHF (odds ratio 9). A single session of HVHF as salvage therapy in the setting of a goal-directed hemodynamic management algorithm may be beneficial in severe refractory hyperdynamic septic-shock patients. This approach may improve hemodynamics and perfusion parameters, acid-base status, and ultimately hospital survival. Moreover, it is feasible, and safe.
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              A Global Overview of the Impact of Peritoneal Dialysis First or Favored Policies: An Opinion

              Frank Liu, Xin Gao, Gary Inglese … (2015)
              Given the ever-increasing burden of end-stage renal disease (ESRD) in a global milieu of limited financial and health resources, interested parties continue to search for ways to optimize dialysis access. Government and payer initiatives to increase access to renal replacement therapies (RRTs), particularly peritoneal dialysis (PD) and hemodialysis (HD), may have meaningful impacts from clinical and health-economic perspectives; and despite similar clinical and humanistic outcomes between the two dialysis modalities, PD may be the more convenient and resource-conscious option. This review assessed country-specific PD-First/Favored policies and their associated background, implementation, and outcomes. It was found that barriers to policy-implementation are broadly associated with government policy, economics, provider or healthcare professional education, modality-related factors, and patient-related factors. Notably, the success of a given country's PD-Favored policy was inversely associated with the extent of HD infrastructure. It is hoped that this review will provide a foundation across countries to share lessons learned during the development and implementation of PD-First/Favored policies.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Gen Med
                Journal ID (iso-abbrev): Int J Gen Med
                Journal ID (publisher-id): IJGM
                Journal ID (pmc): ijgm
                Title: International Journal of General Medicine
                Publisher: Dove
                ISSN (Electronic): 1178-7074
                Publication date (Electronic): 24 May 2019
                Publication date Collection: 2019
                Volume: 12
                Pages: 207-212
                Affiliations
                [1 ]Department of Nephrology, The Second Affiliated Hospital of Soochow University , Suzhou, Jiangsu Province, People’s Republic of China
                Author notes
                Correspondence: Huaying ShenDepartment of Nephrology, The Second Affiliated Hospital of Soochow University, 1055 San-Xiang Road , Suzhou215004, Jiangsu Province, People’s Republic of ChinaTel +861 391 550 2916Email shenhy513@ 123456sina.com
                [*]

                These authors contributed equally to this work

                Article
                Publisher ID: 203158
                DOI: 10.2147/IJGM.S203158
                PMC ID: 6538830
                SO-VID: 4053ffbf-5f4f-44c2-bde5-3d2eac828de6
                Copyright © © 2019 Zhang et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 28 January 2019
                Date accepted : 11 April 2019
                Page count
                Tables: 2, References: 38, Pages: 6
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Medicine
                Keywords: automated peritoneal dialysis,peritoneal dialysis,nonabdominal surgery,perioperative period
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: automated peritoneal dialysis, peritoneal dialysis, nonabdominal surgery, perioperative period

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