Menu
To return to your session overview use the "Go Back" button in your Internet browser.
S 05 Parallel Session
S 05 PD
Saal 2, 27th September 2015, 9:00 – 10:30
Programme of the Session:
GS: Rob Beelen (The Netherlands)
A follow up of The EuTRiPD programme (European Research and Training in Peritoneal Dialysis)
O 05
Peritoneal dialysis for patients with congestive heart failure to improve quality of life
Rachel Morgenstern (Israel)
O 06
Live-changes on peritoneal dialysis
Maria Arminda Tavares (Potugal)
O 07
A new approach to peritoneal dialysis catheter implantation
Mieke Moses (The Netherlands)
O 08
Insulin resistance in peritoneal dialysis patients
Guzide Ogut (Turkey)
Abstracts:
GUEST SPEAKER
Follow-up of EuTRiPD (European Research and Training in Peritoneal Dialysis)
R.H.J. Beelen1, also on behalf of the EuTRiPD group
1Molecular cell Biology and Immunology VU University Medical Center (and others), VU University Medical Center, Amsterdam, Netherlands
Background: European Training and Research in Peritoneal Dialysis (EuTRiPD) is an EU funded reaearch programme for 3 years to train yountg researchers in a collaborative framework with experienced PD focused principal investigators. EuTRiPD aims to adress the underutalization of PD by training young multidisciplinary researchers who are qualified to understand and work within and beyond all the disciplines, sectors and audiences in PD. The specific aim of the programme is to develop a minimum of 5 biomarkers that allow the prediction of outcome in PD and 3 therapeutic treatments to improve outcome in PD. 12 ESR's (early stage researchers) were appointed who are trained through research in their host institute, but also taking advantage of the knowledge and expertise of the other network partners. The programme has a clear emphasasis on providing translational training that integrates all possible aspects of PD and exposure to academic as well as private and public sector partners.
All meet in biannual EuTRiPD academies, with workshops, networking and cover socio-ecomonic topics as well as patient care and decision making (including role of nurses) amde private sector interests, We use in vitro PD cell cultures, in vivo rodent PD models and material of biobanks to achieve the goals.
Sofar exciting data have been found, wyhich will be presentede at the meeting. EuTRiPD will continue to make a contribution to combining academic, public and private interests in PD. The impact of EuTRiPD on social, econimic and scientific aspects terefore can and will be enormous.
Disclosure: No conflict of interest declared
BIOGRAPHY OF THE GUEST SPEAKER
O 05
Peritoneal dialysis for patients with congestive heart failure to improve quality of life
R. Morgenstern1, M. Vorobiov1, E. Livne1, L. Shwarz1
1Nephrology, Soroka University Medical Center, Beer-Sheva, Israel
Background: With the increase in life expectancy of patients with congestive heart failure (CHF), there is an increase in CHF patients in cardiology clinics. Most of them require multiple hospitalizations due to respiratory difficulties and very poor quality of life with congestive heart failure progression. Some also develop chronic kidney disease over time.
Objectives: Reduced hospitalizations and improved quality of life of CHF patients, by ultrafiltration using home peritoneal dialysis (PD).
Methods:CHF patients were introduced to the PD program suitable for fluids removal by ultra-filtration. Follow up for a year was performed for hospitalizations related to CHF one year before and after starting PD treatment. Function and symptom assessment was carried out using the WHO and Edmonton Scale questionnaires.
Results: Seven patients entered into the PD programme. Average treatment was 8.6 months; 2 pts drop-outs: 1 died after one year of treatment; 1 transferred to hemodialysis for pleuro-peritoneal leak.
A year before the start of treatment: average patient's hospitalizations associated with CHF: 4.8 full hospitalization + 9 daily hospitalizations for breathing difficulties and diuretics treatment. Since PD starting there were no hospital admissions for CHF related breathing problems and fluid-excess.
Conclusion/Application to practice: We saw considerable improvement of the functioning of these patients in addition to definite decline in hospitalization for CHF background. Outcomes encourage cardiologists to refer patients to UF in PD system, if capable of carrying out. We continue collecting data and monitoring these patients.
Disclosure: No conflict of interest declared
O 06
Life-changes on peritoneal dialysis
M. Tavares1, I. Moreira2
1Nefrologia/Diálise, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 2Nursing School, Nursing School of Coimbra, Coimbra, Portugal
Background: Chronic Kidney disease has been increasing progressively in our country and about sixteen thousand people are on dialysis or transplanted. One of the therapeutics approaches is peritoneal dialysis (PD). In the process of starting dialysis the renal patient experiences new transitions related to the change of his clinical condition, namely, the need to learn how to do dialysis at home. The nurses have a prime role in those changes by facilitating this process.
Objectives: The main objective of this study is to understand the patient’s perspective when initiating the PD treatment.
Methods: A qualitative phenomenological study was conducted. The information was collected by doing a semi-structured interview to twelve patients undergoing PD. The analysis of the data was done in according with Colaizzi methodology which was described by Streubert and Carpenter (2002).
Results: The main point for the understanding of these people’s experiences emerged from their declarations, that is, their personal dispositions, the facilitating or inhibiting conditions, the answers, their changes, and the (re)construction of their daily life. The family and social support network together with the personalized professional intervention of the nurse appear to be essential elements which ease some of the transitional conditions in a PD situation.
Conclusion/Application to practice: Understanding how patients perceive PD treatment allow us to be aware of the complexity of this stage in life, as well as contributes professionally to the development of scientific knowledge in nursing. The implementation of a predialysis nursing consultation to integrate the patient and family in the PD process would be advisable.
Disclosure: No conflict of interest declared
O 07
A new approach to peritoneal dialysis catheter implantation
W.J. Moses-van Leeuwen1, A. Gaasbeek1
1LUMC, Leiden, Netherlands
Background: In order to optimize the care of peritoneal dialysis (PD) treatment within the Leiden University Medical Center (LUMC) there were some issues that warranted improvement. Our aim was to reduce waiting time for catheter implantation, improve communication between the different disciplines and improve effectiveness and quality of care.
Methods: Consultation between the departments of nephrology and interventional radiology led to the decision to perform PD catheter implantation at the radiology department. Therefore the protocol was changed.
Results: To date, five catheters have been inserted according to the newly adapted protocol. During the procedure, other interventional radiologists were taught how to perform the procedure. The waiting time has been reduced to a maximum of one week. Patients no longer need to undergo a general anaesthetic. For the procedure patients are admitted to the out-patients department and may go home 2-3 hours after the intervention. All patients were satisfied with the procedure, particularly about the short hospitalization and local anaesthetic instead of general anaesthetic. An abdominal x-ray was performed before initiating therapy. Position and patency was achieved in all implantations. There were no infections. Dialysis initiation proceeded without problems.
Conclusion/Application to practice: The placement of PD catheters by interventional radiology is a safe, and feasible procedure and is non-inferior to placement by the surgeon under general anaesthetic. Furthermore it is more efficient and there are a number of radiologists who can perform the procedure. Because of the short stay at the hospital, the use of local anaesthetic and adequate pain management, patients are more satisfied.
Disclosure: No conflict of interest declared
O 08
Insulin resistance in peritoneal dialysis patients
G. Ogut1, S. Kahvecioglu1, C.B. Gul1, E. Acar1, S. Alsancak1
1Peritoneal Dialysis, Bursa Sevket Yılmaz Research Hospital, Bursa, Turkey
Background: One of the main complications of chronic renal disease (CRD) is carbon-hydrate metabolism disorder.Spontaneous hypoglycemia and hunger hyperinsulinemia may be observed in uraemic patients. Insulin secretion is corrupted in pancreas islets and insulin peripheral vulnerability decreased. In CRD, factors responsible for insulin resistance include uraemic toxins, hyper-parathyroidism, anaemia, malnutrition and metabolic acidosis. In peritoneal dialysis (PD) patients, insulin resistance is somewhat different. The positive difference is that peritoneum dialysis clearance of medium molecular weighted uremic toxins is better. The negative difference is that the patients are continuously exposed to glucose load by means of their dialysis solution. In this study, we aimed to research the frequency of insulin resistance in our patients on PD. Methods: Average time on PD was 19±7months. 26 patients (average age:45.7±17.3 years) on PD for a minimum 6 months were included. Patients with diabetes and patients using statins were excluded from the study. All biochemical properties of patients were recorded. Insulin resistance of all patients was calculated with Homa IR values.
Results:Insulin resistance was detected in 5 patients(19%).Glucose absorption from peritoneal gap is 60-80% in 6 hours.Daily glucose absorption of 100-300mg occurs. Exposition to glucose load due to existence of glucose in dialysis solutions despite better estranging of medium molecular weighted toxins in PD patients and resulting hyperglycemia,obesity and hyperlipidemia are responsible for insulin resistance. For this reason,it is necessary to follow up PD patients in terms of insulin resistance,hyperglycaemia,to adopt an active life style,to restrict sodium and water taking,to correct acidosis,to use carbon-hydrate and fat-poor diet, and use physiological dialysis solutions.
Disclosure: No conflict of interest declared