This scoping review aimed to map home-visit nursing practices for patients undergoing peritoneal dialysis and to synthesise reported outcomes and research gaps. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines and a pre-registered protocol. Search strategies were developed using controlled vocabulary and free-text terms in English and Japanese, organised into concept blocks for peritoneal dialysis and home-visit nursing and adapted to each database without language restrictions. Records were independently screened by reviewer pairs, and data were charted using a standardised form, with disagreements resolved through discussion or adjudication by a third reviewer. Overall, 21 studies from Japan, Italy, Canada, the UK, China, France, and 1 multi-country study in Australia and Canada met the inclusion criteria. Reported home-visit nursing practices encompassed observing and coaching exchange techniques, setting up automated peritoneal dialysis, providing exit-site care, conducting environmental and supply checks, delivering retraining, offering psychosocial support and coordinating multidisciplinary care. Reported clinical findings included lower peritonitis rates, fewer technique failures, longer technique survival, better dialysis adequacy and fewer complications in individual studies. Reported patient-centred findings included better quality of life, reassurance and lower caregiver burden, with some studies also reporting fewer hospitalisations, longer technique survival or a lower risk of transfer to haemodialysis. However, variability in definitions, intervention components and visit schedules, together with the limited use of comparative study designs and non-standardised outcomes, constrained the strength of inferences. The literature mapped in this review described home-visit nursing as providing technical oversight, education, psychosocial care and multidisciplinary coordination, with favourable outcomes reported across several domains. Practices identified across studies included structured monitoring, variable visit schedules according to patient needs and digital follow-up approaches; however, their optimal timing, frequency, intensity and effectiveness remain to be established prospectively.
Hemodialysis (HD) patients exhibit elevated oxidative stress (OS). In these patients, vitamin E-coated membranes decrease OS, with reported clinical benefits including reductions in inflammatory markers and improvements in anemia. Here, we evaluated the efficacy of a newly developed vitamin E-coated membrane hemodiafilter, v-era® V-RA. This single-center, single-arm, prospective interventional study enrolled 12 patients (median [interquartile range (IQR)] age: 62.5 [52.8–71.0] years; median [IQR] dialysis vintage: 6.5 [4.2–8.8] years). All patients were undergoing postdilution online hemodiafiltration (post-OHDF) three times weekly for 4 h per session using the FIX-210Seco (an Asymmetric Triacetate Membrane® hemodiafilter). Patients were then switched from post-OHDF with FIX-210Seco to post-OHDF with V-22RA. Baseline data immediately prior to switching were compared with data obtained after patients were switched to V-22RA. No significant difference in removal efficiency was observed between before and after switching to V-22RA. Oxidized low-density lipoprotein (ox-LDL) significantly increased from 77.5 [74.0–93.5] to 89.5 [76.8–114.8] U/L with FIX-210Seco (p = 0.041). In contrast, with V-22RA, ox-LDL nonsignificantly decreased from 73.0 [58.0–81.0] to 67.5 [59.7–102.5] U/L (p = 0.084). The verbal rating scale score for postdialysis fatigue significantly decreased at 2 months, from 1.0 [1.0–2.0] to 0 [0–0.3] (p = 0.003). Similarly, dialysis recovery time was significantly shortened at 2 months, from 2.0 [1.0–2.3] to 0 [0–0.6] h (p = 0.004). At 6 months, ox-LDL levels significantly decreased from 77.5 [58.0–81.0] to 60.5 [50.3–68.5] U/L (p < 0.001). Post-OHDF use of V-22RA may contribute to the improvement of postdialysis fatigue and dialysis recovery time by reducing ox-LDL and alleviating OS.
Abstract Background Erythropoiesis resistance in hemodialysis patients is associated with multiple clinical factors, including nutritional impairment, inflammation, and intercurrent illness. We examined whether the number of selected clinical abnormalities present within the same patient-month was associated with concurrent erythropoiesis resistance index (ERI). Methods We conducted a single-center retrospective study using repeated patient-month data over 12 months. Patients receiving hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors were excluded. For each patient-month, we calculated an unweighted count of four prespecified clinical abnormalities: low body mass index (BMI; < 20.0 kg/m 2 ), hypoalbuminemia (albumin < 3.5 g/dL), elevated C-reactive protein (CRP ≥ 0.3 mg/dL), and an acute clinical event. Linear mixed-effects models with patient-specific random intercepts were used to evaluate the contemporaneous association between the abnormality count and log(ERI + 1), with adjustment for TSAT and ferritin. Results A total of 56 patients contributed 672 patient-month observations. ERI increased across categories of 0, 1, and ≥ 2 selected clinical abnormalities. In the mixed-effects model, each additional abnormality was associated with higher log(ERI + 1) ( β = 0.082, 95% CI 0.049–0.115, p < 0.001), corresponding to approximately 8.6% higher ERI + 1. Findings were consistent in sensitivity analyses using alternative component thresholds, categorical modeling of the abnormality count, weekly ESA dose as the outcome, and exclusion of patient-months with absolute iron deficiency. Conclusions In maintenance hemodialysis patients, a greater number of selected clinical abnormalities was associated with higher concurrent ERI across repeated patient-month observations. This contemporaneous association does not establish temporal precedence or validate the abnormality count as a clinical prediction score.
Subcutaneous embedding of a peritoneal dialysis (PD) catheter at the time of PD discontinuation has been proposed as a strategy to avoid invasive catheter removal while preserving the option of resuming PD in the future. However, the risk of peritonitis after catheter embedding remains poorly understood. We describe all six patients treated at our institution, focusing on the two who developed peritonitis. Since 2020, six patients (four men; age range, 32–88 years) underwent secondary catheter embedding at PD discontinuation. PD duration ranged from 3 to 96 months, and five patients had prior PD-related peritonitis. At embedding, three had hypoalbuminemia and three had mildly elevated serum C-reactive protein levels. Embedding was selected to preserve a possible future PD option or reduce procedural burden because of frailty, comorbidity, or refusal of further surgery. During 14–63 months of follow-up, two patients developed three episodes of presumed endogenous peritonitis, whereas four had no documented peritonitis; no catheter was re-exteriorized. Both affected patients had discontinued PD because of ultrafiltration failure after long-term PD and had persistent ascites. Case 1 developed culture-negative, neutrophil-predominant peritonitis after antimicrobial exposure. Case 2 developed Campylobacter enteritis-associated peritonitis and later culture-positive peritonitis with Streptococcus mitis despite a low ascitic cell count. Antibiotics improved the acute inflammatory findings in both patients; persistent ascites and gastrointestinal symptoms prompted corticosteroid treatment for suspected evolving encapsulating peritoneal sclerosis (EPS). This small, heterogeneous series cannot estimate peritonitis incidence or establish risk factors. Nevertheless, the occurrence of presumed endogenous peritonitis in two patients with persistent ascites after PD discontinuation suggests that careful patient selection and monitoring may be warranted.
Peritoneal dialysis (PD) catheter-related infections can lead to catheter loss, peritonitis, and technique failure. Although nontuberculous mycobacteria are increasingly recognized as causative pathogens, optimal management of infections caused by the Mycobacterium abscessus complex (MABC) remains unclear, particularly when isolates are identified to the subspecies level. This report presents a pediatric PD catheter-related infection caused by M. abscessus subsp. massiliense, in which PD was temporarily continued after simultaneous catheter removal and replacement and prolonged multidrug therapy. A 14-year-old girl with Sensenbrenner syndrome developed end-stage renal disease and was started on PD. At 8 months after initiation, she developed localized pain and purulent discharge at the catheter exit site. Initial cultures were negative; however, repeated cultures detected acid-fast bacilli, and MABC was identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Magnetic resonance imaging (MRI) showed a small abscess adjacent to the catheter. Intravenous imipenem/cilastatin, oral linezolid, and an oral macrolide were initiated. On hospital day 4, the catheter was completely removed and replaced through a separate contralateral tissue tract; PD was resumed 1 week later. Intraoperative findings revealed purulent drainage from the subcutaneous tunnel. Amikacin was added for persistent drainage but discontinued after audiometry demonstrated worsening hearing thresholds. Multiplex polymerase chain reaction (PCR) identified M. abscessus subsp. massiliense. The patient was discharged on hospital day 103. After 6 months, MABC was reisolated from the new exit site without abscess formation on MRI, and subsequent mycobacterial cultures were negative. Antimicrobial therapy was continued for approximately 30 months and discontinued at deceased-donor kidney transplantation and PD catheter removal. No clinical recurrence was observed during approximately 20 months of post-transplant immunosuppression. Repeated cultures and rapid identification methods may be useful for persistent or initially culture-negative PD catheter-related infections. Subspecies-level identification may inform antimicrobial selection. In this patient with localized infection and no overt peritonitis, prompt catheter exchange and prolonged macrolide-containing multidrug therapy enabled temporary continuation of PD until kidney transplantation. However, microbiological eradication could not be established while the catheter remained in situ, and this strategy should not be generalized.
