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Surgical Techniques for Catheter Placement and 5/6 Nephrectomy in Murine Models of Peritoneal Dialysis
Published on: July 19, 2018
Peritoneal dialysis update 1994
1Department of Internal Medicine, University of Missouri-Columbia, 65212, USA.
Abstract:
Each year there are over 400 papers published in the field of peritoneal dialysis. In this review I have touched on only a few highlights of some of the more active areas of investigation and development. The advances in controlling peritonitis rates with the Y-set have been dramatic and have resulted in peritonitis rates in many centers less than one episode per 24 patient months. Technique survivals have also improved with lower peritonitis rates. The enormous literature on new approaches to treatment and new understandings of host defenses are beyond the scope of this review. There are also many advances in peritoneal access. We now have many new types of catheters under investigation such as the Swan-Neck Missouri catheter and the Moncrief-Popovich catheter, with complete burial of the catheter until eventual externalization for CAPD training. There have been major advances in understanding the normal healing of exit sites and the early diagnosis and treatment of exit-site infections. All the extensive literature on catheter development in the management of exit sites will be reviewed elsewhere. I have focused primarily on an update of worldwide demographics, some of the new findings in peritoneal transport, the use of low-calcium solutions, experiences with EPO, new thinking about adequacy and nutrition, and finally, on recent comparisons of CAPD and hemodialysis.
Insights
Peritoneal dialysis advancements significantly reduce peritonitis rates, improving technique survival. New catheter designs and improved exit-site care enhance patient outcomes in peritoneal dialysis.
Area of Science:
- Nephrology
- Renal Replacement Therapy
Background:
- Peritoneal dialysis (PD) is a major renal replacement therapy with over 400 papers published annually.
- Significant progress has been made in managing PD complications and improving patient outcomes.
Purpose of the Study:
- To review recent advancements in peritoneal dialysis, focusing on key areas of investigation.
- To provide an update on worldwide demographics, peritoneal transport, and treatment modalities.
Main Methods:
- Review of recent literature on peritoneal dialysis.
- Focus on peritonitis control, catheter technology, exit-site management, peritoneal transport, low-calcium solutions, EPO use, adequacy, nutrition, and CAPD vs. hemodialysis comparisons.
Main Results:
- Dramatic reduction in peritonitis rates (less than 1 episode per 24 patient months) using Y-set technology, leading to improved technique survival.
- Advances in peritoneal access include new catheter designs (e.g., Swan-Neck Missouri, Moncrief-Popovich) and improved exit-site healing and infection management.
- New findings in peritoneal transport, use of low-calcium solutions, erythropoietin (EPO) experiences, and evolving concepts of adequacy and nutrition.
Conclusions:
- Recent advancements in peritoneal dialysis, particularly in peritonitis control and catheter technology, have significantly improved patient outcomes and technique survival.
- Ongoing research in peritoneal transport, supportive therapies like EPO, and nutritional management continue to refine PD as a treatment option.
- Comparative studies of continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis provide crucial data for treatment selection.
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