ped pd ismailia
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Pediatric Peritoneal Dialysis
Dr. Osama El-ShahatDr. Osama El-ShahatConsultant Nephrologist
Head of Nephrology Department New Mansoura General Hospital (international)
ISN Educational Ambassador
11stst steps towards peritoneal steps towards peritoneal dialysis.dialysis.
Ancient Egypt were probably the first people to get a look at the peritoneum
The word preitoneum refers to the Greek word “peritononionperitononion” and means to stretch.
PD … the modality first used for the PD … the modality first used for the treatment of KItreatment of KI
Managing New Patient with ESRD
“Complementary Not Competitive” Coles 1998
“The right modality at the right time. Peter Blake, MD, John Burkart, MD
Early referral of patient With CKD to renal center
Pre-emptive Transplantation
PD as first option if medically suitable Allowing for patient chioce
Patient education program
HD Transplant
PDPD
Why to start with PD ?
Preservation of RRFHigher Hb concentrationLess risk of acquiring blood borne infections e.g. HCVBetter quality of lifeTravel , employment It allows expansion with limited resources Lower staff / patient ratiosaves vascular access preferred for children (APD)
Peritoneal dialysis (PD) is in general the preferred treatment modality for pediatric patients to bridge the time until transplantation.
It is easier to perform, less invasive than extracorporeal treatments and does not require anticoagulation. However, what counts most for the child and the family is that PD can be carried out at home.
PD is more compatible with a “normal” lifestyle and allows a better psychosocial integration of the little patient.
Patient selection
PositivePositive NegativeNegative
Selecting RRT modalit ies is influenced by a number of considerations such as Patient Preference . Availabi l i ty And Convenience. Underlying Medical Problems and Comorbid Conditions. Socioeconomic and Dialysis Center Factors. The Patient's Home Situation Medical staff Training.
PD-PD- Requirements Requirements
PD .PD .catheters PDPD. solution
Technique &TypesTechnique &Types of Chronic PDof Chronic PD
1.1. Fil l Phase Fil l Phase (<15 minutes)* Disconnect
2. 2. Dwell phase Dwell phase (4-8 hours)
3.3. Drain phaseDrain phase (<20 minutes )
CAPD ( ContinuousContinuous AmbulatoryAmbulatory PeritonealPeritoneal DialysisDialysis)
APD (Automated Peritoneal DialysisAutomated Peritoneal Dialysis)
CCPD ( Continuous Cycling Peritoneal DialysisContinuous Cycling Peritoneal Dialysis )
IPD ( Intermittent Peritoneal DialysisIntermittent Peritoneal Dialysis)
NIPD ( Nocturnal Intermittent Peritoneal DialysisNocturnal Intermittent Peritoneal Dialysis ) TPD ( Tidal Peritoneal DialysisTidal Peritoneal Dialysis)
Automated Peritoneal Dialysis(Automated Peritoneal Dialysis(APDAPD))
IndicationsIndications1. Children2. Inadequate solute or fluid removal3. High intraperitoneal pressure Hernia4. Polycystic disease5. (Recurrent) dialysate leaks6. Loss of appetite7. Lifestyle
DisadvantagesDisadvantagesMore difficult to learn Disturbed sleep
Attached to machine Sexual problems
More expensive
ESNT-CNE 1st Course Cairo Sept 10-14, 2012
Optimizing PD prescription for volume control: the importance of varying dwell time and dwell volume. M
Fischbach et al.Pediatr Nephrol 2014
Easy-to-use preassembled system◦ PD-Paed Plus is designed to perform PD manually in
premature babies, neonates and infants. It is an easy-to-use preassembled system for in-center use.
Flexible treatment adaptation◦ Capacity for inflow volumes of up to 240 mL◦ Option to connect two fluid bags at the same time
Safety features give confidence◦ An integrated ball valve in the inflow burette ensures that only
the prescribed volume is given to the patient◦ Improved therapeutic efficiency with a low recirculation
volume of only 2 mlOur patented PIN technology reduces the number of risk steps associated with disconnection and reconnection◦ DEHP-free materials ensure biocompatibility
Sleep safe is a reliable and popular device to treat children on automated PD, in general during the night time at home. It stands out for its flexibility to tailor a treatment according to the individual needs of the patient:
Adjustable flow rates for low volume treatments Special pediatric disposable set for low volumes Option to perform ‘Adapted APD (aAPD)’ to improve
patient outcome by varying dwell time, and fill volume and glucose concentration in one treatment3
Giving parents the confidence in the treatment and its comfort
Integrated continuous pressure monitoring helps to prevent outflow pain
Quiet operation Automatic bag connection and PIN technology reduce
contamination risk steps to one per day
Complications of PD therapy
infectious Non infectious
Peritonitis
Acute Chronic
Catheter MalfunctionCatheter Malfunction
.
Hyperglycaemia
Hyperlipidemia
Malnutrition
Hypokalemia
Hypermagnesaemia
Such variation from 2% to 80% !Can not be for medical reasons?
PD utilization in various countries worldwide (from USRDS data 1999(.
ConclusionsIn conclusion, PD continues to be underutilized in many
countries, including the United States. There are many
factors that contribute to this underutilization (e.ge.g.,
modality, system, and patient-related factors).
Clin J Am Soc Nephrol 6: 447–456, 2011Clin J Am Soc Nephrol 6: 447–456, 2011
Damanhor
PD program in PD program in EgyptEgypt
Transports
Hospitalisation
Pharmaceuticals )e.g. EPO(
Equipment costs )Lease, depreciation,
maintenance(
Disposables
Labor
Water Treatment
Infrastructure
Transports
Hospitalisation
Pharmaceuticals )e.g. EPO(
Equipment costs
Disposables
Labor
Infrastructure
Hemo
PD
Schematic Schematic RRT Cost RRT Cost Comparison Comparison Available ModalitiesAvailable Modalities
PD in Mansoura PD in Mansoura
PD in Mansoura PD in Mansoura
ConclusionConclusion
Thank YOUThank YOU
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