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S 05 Parallel Session
Programme of the Session
Title: Peritoneal Dialysis
GS: Tony Goovaerts (Belgium)
Peritoneal testing: What can we learn from it?
O 01
Haemodialysis and peritoneal dialysis patients’ health perceptions: a comparative study
Tai Mooi Ho Wong (Spain)
O 02
Applied nursing protocols in peritoneal dialysis in Greece
Maria Androulaki (Greece)
O 03
Peritoneal dialysis or haemodialysis in pregnancy: nephrologist choice or patient choice?
Anne Hurley (UK)
O 04
Developing a shared care plan to improve patient care in peritoneal dialysis
Zehra Aydin (Turkey)
Abstracts
GUEST SPEAKER
Peritoneal testing: what can we learn from it?
T. Goovaerts1
1Cliniques Universitaires St. Luc, Brussels, Belgium
The peritoneal membrane is a physiologic, living tissue, which, in case of peritoneal dialysis, is being (re)used daily.
The functional characteristics can change over time. Monitoring these eventual changes is mandatory in order to adapt the prescription of the dialysis regimen
The initial Peritoneal Equilibration Test (PET) with a 2.27% glucose solution, described by Twardowski in 1987, allows to categorize the membrane in 4 groups, according to solute transport capacities of the peritoneum, and to individualize the PD prescription.
Over time, more tests, derived or based on the PET have been developed: PET with 3.86 %glucose solution, Mini-PET, double Mini-PET and finally the Uni-PET, a combination of all these tests. They provide more information on the function of the peritoneal membrane, more particularly on the water transport or ultrafiltration capacity!
Recent evidence has demonstrated the importance of testing, to detect changements of the membrane, to identify patients at risk and to avoid severe complications such as Encapsulating Peritoneal Sclerosis (EPS)
BIOGRAPHY OF THE GUEST SPEAKER
O 01
Haemodialysis and peritoneal dialysis patients’ health perceptions: a comparative study
E. Barbero Narbona1, E. Tejeda Araez1, C. Herrera Morales1, N. Gascó Coscojuela1, T.M. Ho Wong1, E. Junyent Iglesias1
1Servei de Nefrologia, Hospital del Mar - Parc de Salut Mar, Barcelona, Spain
Background
Patients with stage 5 of chronic kidney disease on dialysis have cardiovascular, musculoskeletal and psychosocial disorders that affect their physical and functional capacity. The lack of physical activity contributes to the development of chronic diseases and an increase in mortality. Health-related quality of life (HRQoL) is the self-assessment of the individual regarding their own health.
Objectives
The aim of this study was to assess and compare the health perceptions, functional capacity and psychological status of patients on haemodialysis (HD) and peritoneal dialysis (PD).
Methods
A descriptive study was performed to include all dialysis patients in our centre. A database was created and data collected were analysed using SPSS version 21. Five tools were used for assessment: the Charlson comorbidity Index, the Medical Outcomes Study Short Form scale (SF-12), the Barthel ADL index, the Lawton-Brody IADL scale and the Geriatric Depression Scale (GDS).
Results
The sample size was 42 patients (21 HD + 21 PD). The results show a homogeneous group in terms of average age (HD 64.8 ±12.9 / PD 65.6 ±11.3 years), Barthel ADL index >75 (HD 80.9% / PD 90.5%) and Lawton-Brody IADL >5 (HD 76.2% / PD 80.9%). However, HD patients were comparatively more sedentary, resulting in them feeling worse psychologically and physically than PD patients.
Conclusion/Application to practice
The results reveal that our HD patients have worse HRQoL than PD patients. We therefore plan to launch a fitness programme to improve their health and monitor those patients detected with possible depression by the GDS.
O 02
Applied nursing protocols in Peritoneal Dialysis in Greece
M. Androulaki1, D. Haniotaki1, M. Christoforaki1, K. Tzanaki1, M. Kenourgiakis1, G. Mantziou1, H. Maniadis1, M. Sfakianaki1, E. Frosinaki1, P. Nzilepi1
1Peritoneal Dialysis Unit, University Hospital of Heraklion, Heraklion, Greece
Background
Peritoneal Dialysis Protocols are regarded as necessary, as the patient is directly affected by his self-care.
Objectives
This research involves the nursing protocols applied in the PD Units in Greece and their possible correlation with complications like days of hospitalization and the number of staff members in the units.
Methods
The research took place in 31 Units, in Greece. Data was collected through questionnaires that investigated the nursing practice in patient training, connection and disconnection to CAPD and APD, exit site care, patient monitoring, peritoneal catheter insertion, infections managment, along with the frequency of them.
The completed questionnaires were evaluated with spreadsheets and valid statistical methods. All trials were two tailed and the level of significance was set at 5% (p<0,05).
Results
The duration of the training did not seem to affect the incidence of peritonitis.
The incidence of the exit site infection did not seem to be affected by:
• The frequency of care
• The way of care and coverage
• The use of antibiotic ointment
The hookup to CAPD with simple wash, no gloves with the use of antiseptic appears not to have an effect to the appearance of infection.
In APD there is a statistically significant difference in the use of gloves and the incidence of peritonitis. The use only of antiseptic seems to ensure protection.
Conclusion/Application to practice
In all units there are written protocols for the application of PD. There is differentiation from unit to unit. Isolated evidence in some protocols seem to surpass in what concerns the complications but mainly the days of hospitalization.
O 03
Peritoneal dialysis or haemodialysis in pregnancy: nephrologist choice or patient choice?
A . Hurley1, J. Williams1
1Peritoneal Dialysis Department, South West Thames Renal and Transplantation Unit, St. Helier hospital, Carshalton, United Kingdom
Background
Pregnancy outcomes in patients with end-stage renal disease on dialysis are improving. Recent literature supports intensive haemodialysis as the modality of choice in pregnancy in ESRD. The author will describe a successful delivery of a healthy baby, to a mother on PD reluctant to switch to HD, achieved by using PD with HD.
Methods
This is a case study of a 28 year old with CKD, since first pregnancy started PD in 2011. In November 2014 it was discovered she was 7 weeks pregnant.
The patient was reluctant to have HD due to childcare and geographical distance and due to minimal literature supporting the use of PD exclusively in pregnancy; a patient centred approach was used. Close monitoring of the progress of mother and foetus was planned with the need to maximise PD adequacy. A combination of APD and CAPD was commenced.
At 19 weeks some HD was required to improve clearances and was commenced, 5 days per week for 3 hour sessions to fit in with childcare, creating issues with transport and current HD shifts. A room was utilised in the PD unit to accommodate the HD and monitoring of PD.
Conclusion/Application to practice
A healthy baby girl was born on 17th July at 38 weeks gestation, by caesarean section, not associated with any renal complication. Patient choice was a significant factor in designing a treatment plan that caused the least disruption to family life, whilst achieving adequate dialysis to support foetal growth and wellbeing.
O 04
Developing a shared care plan to improve patient care in peritoneal dialysis
Z. Aydin1, S. Ozcan2, N. Sagnak1, A. Badir2, E. Turkmen2
1Health Science Institute, Koc University, Istanbul, Turkey; 2School of Nursing, Koc University, Istanbul, Turkey
Background
A multidisciplinary approach for the management of chronic diseases may improve the quality and effectiveness of care. Since Chronic Kidney Disease is a major health problem, implementing multidisciplinary care plans may improve patient care and reduce complications.
Objectives
This study aimed to develop a shared care plan that can be used by multidisciplinary dialysis teams to treat, care and follow up with patients undergoing peritoneal dialysis.
Methods
This descriptive study was designed as action research carried out in two stages. Approval was given by the Koc University Ethics Board (No: 2014.154.IRB3.107)
In the first stage, a questionnaire was used to collect data to assess the multidisciplinary care approach in our country. The study comprised 182 nurses from 140 centers.
In the second stage, the "Peritoneal Dialysis (PD) Shared Care Plan" was prepared based on the literature and the findings and expert opinions were obtained through two focus groups were conducted with multidisciplinary teams consisting of doctors, nurses, dietitians, psychologists and social workers to assess the validity of the content.
Results
Edema, catheter function, dialysis procedure assessments and the management of complications were found to be the most frequently followed parameters (82.5%, 82.5%, 72.7%, 74.8% respectively).
Depression, quality of life, educational needs, and nutritional assessments were found to be the least frequently followed parameters (9%, 5%, 2.8%, 3.5% respectively).
Conclusion/Application to practice
It was found that there was no systematic implementation of an adequate multidisciplinary care approach in peritoneal dialysis treatment. A Shared care plan would help to create a coordinated multidisciplinary care approach in these settings.