How To Practice Assisted Peritoneal Dialysis
May 22, 2024
For patients with end-stage kidney disease (ESKD), peritoneal dialysis (PD) is an optional treatment option that is favored by many patients. Compared with hemodialysis (HD), PD is more independent and can be performed at home without the need to visit a dialysis center or hospital three times a week. In addition, in many countries or regions, PD is cheaper and more accessible than HD. However, a considerable number of ESKD patients are older, frail, and have reduced cognitive function, and therefore cannot receive PD treatment alone.
Click to Cistanche for kidney disease
Recently, the International Society for Peritoneal Dialysis (ISPD) issued a position paper on auxiliary PD, which recommends that patients who cannot receive PD treatment alone should receive auxiliary PD. This opinion paper details the definition of assisted PD, the reasons for accepting assisted PD, the classification of assisted PD, the training of assisted PD, the quality management of assisted PD, and its impact on society. This article compiles them to help more doctors choose the appropriate PD model for patients.
Definition of auxiliary PD
Assisted PD is defined as helping patients who are unable to complete PD-related self-care content on their own to carry out PD treatment. The performer/assistant of auxiliary PD can be the patient's family, friends, home nurse, domestic worker, etc. The main readers of this opinion paper are nurses, PD doctors in charge, or other medical staff who have received professional training.
Reasons for receiving assisted PD
Currently, there are three major types of problems that prevent ESKD patients from choosing PD.
question:
1. Physical impairment
2. Impaired vision, reduced flexibility, weakness, inability to lift heavy objects (such as dialysate), and hearing impairment
3 Cognitive/Language Impairments
reason:
1. Impaired memory, anxiety, dementia, mental illness such as depression, learning or language difficulties
2. Behavioral disorders
3. Low compliance and poor hygiene habits, etc.
It is worth noting that these problems may still occur after starting PD treatment. For example, Oliver et al. found that for patients without PD contraindications, 63% of patients were found to have physical disabilities or disorders after starting PD treatment. Cognitive/language impairment. Another study suggested that patients' physical impairment should be paid attention to in the first 6 months after the onset of PD, because frailty, cognitive impairment and other related problems are likely to occur. For such patients with new problems, they should also receive adjuvant PD treatment.
ISPD has 5 recommendations for this:
①The status of PD patients should be evaluated across disciplines to determine whether the patient has related disorders.
②Caregivers (such as nurses, family members) should assess the care burden of PD patients.
③ Self-care PD patients or home-assisted PD patients should be regularly evaluated to see if new obstacles arise so that assistance and intervention can be implemented in a timely manner.
④The care burden of caregivers of PD patients should be regularly monitored so that auxiliary PD can be implemented as needed.
⑤ Assisted PD can become an emergency public health strategy to reduce infectious diseases.
Classification of auxiliary PD
Currently, the specific implementation methods of assisted PD vary widely around the world. For example, in some European and American countries, the service charges for nurses who perform auxiliary PD are mainly borne by medical insurance, while in other areas, they may be paid out of pocket. In terms of specific executors of assisted PD, some European and American regions are mainly registered nurses, others are part-time nurses or nurse assistants; and some are internship nurses. In some remote areas, caregivers or technicians are mainly the executors/assistants of auxiliary PD. In addition, depending on the region, the visit cycle of these executives may be daily or every other day, but some studies have found that for some patients, they can visit once every 4 days.
For this situation, ISPD recommends:
Assisted PD models vary widely, so their key features should be clearly considered before implementation and described when reporting on their outcomes, including their geographical scope, funding sources, types of assistants, precise work content of the assistants, and the duration of the assisted work and specific location.
This suggestion can help clinical workers conduct relevant clinical research and explore the best or most suitable auxiliary PD model.
Assist PD training
It must be clear that even for nurses with PD experience, training in assisting PD is necessary. For this, the ISPD has put forward 4 important recommendations.
① Standardized courses should be set up to educate auxiliary PD practitioners/assistants. The educator may be an experienced nurse in charge of PD.
②All executors/assistants need to participate in corresponding training tasks according to their own conditions.
③A sufficient number of executors/assistants should be trained, and redundant personnel need to be set up to deal with emergencies (such as absence);
④ A sound communication system should be established among doctors, nurses, practitioners/assistants, and patients.
Assisting PD quality management
Continuous Care Improvement (CQI) is defined as a structured organizational process that enables continuous improvement of projects to sustainably improve the quality of health care services. ISPD recommends using CQI methods in PD and auxiliary PD to improve PD quality and protect patient interests.
ISPD believes that there are some basic data that can help medical workers monitor whether there are problems with the quality of recent PD and auxiliary PD. They include mortality, cardiovascular disease incidence, PD treatment time, and other test results (such as blood calcium, blood Phosphorus, etc.), the incidence of peritonitis, the incidence of PD catheter-related complications and the incidence of conversion to HD.
In addition, ISPD suggests that in clinical trials, PD quality standards should be established with reference to patient-reported outcome measures (PROMs). In addition to basic data, patients' quality of life, mental health status and impact on society should also be included in the investigation. However, ISPD currently does not recommend measuring the above quality standards in a routine manner.
However, CQI is particularly effective in reducing the incidence of peritonitis. Fang et al. found that CQI can reduce the risk of PD patients converting to HD. Oliver found that with the help of CQI, there was no significant difference in the hospitalization rate between central PD patients and auxiliary PD patients, and the risk of conversion to HD and peritonitis was reduced.
Based on the above evidence, ISPD makes three recommendations:
① The outcomes of auxiliary PD patients should be regularly monitored and continuously improved in order to obtain outcomes similar to those of central PD patients. These improvement measures should take into account local requirements and be coordinated with ISPD guidelines;
②Result reporting should be stratified according to the use of aid;
③ Outcome reporting should take into account individual differences among patients receiving auxiliary PD (for example: older age, more comorbidities).
impact on society
In some clinical studies, adjuvant PD can enable more patients to receive PD treatment. A Canadian study showed that compared with the control group that did not receive auxiliary PD, more (10% more) patients in the intervention group that provided auxiliary PD services chose to use PD as the initial method of renal replacement therapy. British research suggests that adjuvant PD can significantly improve the initial treatment rate of PD (HR = 1.78; 95% CI, 1.21~2.61).
In addition, some studies suggest that auxiliary PD can help people at high risk of peritonitis reduce the risk of peritonitis. Two French studies suggest that auxiliary PD in which professionals such as nurses serve as performers/assistants has a lower incidence of peritonitis and has a better protective effect on patients with diabetes or the elderly.
For the above reasons, ISPD recommends:
① In view of the impact of auxiliary PD on patients, auxiliary PD should be actively promoted to reduce the incidence of peritonitis and conversion of PD to HD.
② Before implementing auxiliary PD in a region, the PD usage in the region should be studied. If possible, a control group without auxiliary PD should be set up to evaluate the impact of auxiliary PD on patients.
How Does Cistanche Treat Kidney Disease?
Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.
Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.
Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.
Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.
Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.
Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.
Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.
In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.
In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.
