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Background: Creation and maintenance of dialysis vascular access (VA) is a major component of healthcare resource utilization and cost for patients newly started on hemodialysis (HD). Different VA format arises due to patient acceptance of anticipatory care versus late preparation, and clinical characteristics. This study reviews the clinical journey and resource utilization required for different VA formats in the first year of HD., Method: Data of patients newly commenced on HD between July 2015 and June 2016 were reviewed. Patients were grouped by their VA format: (A) pre-emptive surgically created VA (SCVA), (B) tunneled central venous catheter (CVC) followed by SCVA creation, (C) long-term tunneled CVC only. Clinical events, number of investigations and procedures, hospital admissions, and incurred costs of the three groups were compared., Results: In the multivariable analysis, the cost incurred by the group A patients had no significant difference to that incurred in the group B patients ( p  = 0.08), while the cost of group C is significantly lower ( p  < 0.001). Both the 62.7% of group A with successful SCVA who avoided tunneled CVC usage, and those with a functionally matured SCVA in group B (66.1%), used fewer healthcare resources and incurred less cost for their access compared to those did not ( p  = 0.01, p  = 0.02, respectively) during the first year of HD., Conclusion: With comparable cost, a pre-emptive approach enables avoidance of tunneled CVC. Tunneled CVC only access format incurred lower cost and is suitable for carefully selected patients. Successful maturation of SCVA greatly affects patients' clinical journey and healthcare cost., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Dialysis nurses play a paramount role in vascular access (VA) management. The aim of this study is to evaluate dialysis nurses' knowledge, attitude, practice and self-efficacy (KACP-SE) pertaining to VA cannulation and evaluation., Method: An anonymous self-administered survey was administered to dialysis nurses from two tertiary hospitals (four dialysis units) and two community dialysis centres from April to May 2022. The 37-items survey consists of four dimensions of questions relating to VA cannulation and management: knowledge, attitude, practice and self-efficacy. The content validity and face validity of the survey was reviewed by three experienced VA professionals and five dialysis nurses respectively. The internal consistency and construct validity of the survey have been assessed with psychometric tests., Results: There were 23 and 47 nurses, working in the participated community and tertiary hospital dialysis centres respectively, responded to the survey. The internal consistency coefficients indicated acceptable reliability of the instrument (KR-20 coefficient was 0.55 and 0.76 for knowledge and practice domains; Cronbach's α was 0.85 and 0.64 for self-efficacy and attitude domains). In the exploratory factor analysis for attitude and self-efficacy, the instrument could account for 64.0% and 53.0% of the total variance respectively. In the knowledge domain, five out of eight single-select multiple-choice questions were correctly answered by >70% of the participants. Overall, the mean (±SD) of participants' total self-efficacy score was 24.3 (±3.1) over total score of 30. The majority of the participants (82.4%) either agreed or strongly agreed that ultrasound guidance is useful for cannulation., Conclusion: This KAP-SE instrument can be used to evaluate knowledge, attitude, practice and self-efficacy of dialysis nurses toward VA management. The participants demonstrated acceptable knowledge level, but with some knowledge gaps identified. It also revealed nurses' good self-efficacy level and welcoming attitude towards adopting ultrasound in VA cannulation among the participants.

We report a rare case of carbapenemase-producing enterobacte-riaceae peritonitis in a patient undergoing automated peritoneal dialysis (APD). The PD catheter had to be removed as the patient remained unwell despite antibiotics. Antimicrobial resistance in PD peritonitis is a concern in this era of multi-drug resistant bacteria., (Copyright © 2019 International Society for Peritoneal Dialysis.)

A structured peritoneal dialysis (PD) initiation service provided by a dedicated team of nephrologists, interventionists, and PD nurses, taking patients through the stages of predialysis education and monitoring, dialysis catheter insertion, dialysis initiation, and follow-up in the immediate post-dialysis initiation period, can go a long way in expanding PD prevalence. The authors noticed a rapid expansion of their PD program following the introduction of such a service, and they share their experience in this article. A multidisciplinary team providing 1-stop coordinated care may help in alleviating the differences in patient selection criteria, minimize delays in PD catheter insertions, ensure timely initiation of dialysis, reduce the need to start dialysis urgently, actively identify and sort any teething issues, enhance patients' confidence, and reduce technique failures., (Copyright © 2018 International Society for Peritoneal Dialysis.)