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SUMMARY Background Starting dialysis in a non-planned manner or in a ‘suboptimal’ manner is a frequent situation in dialysis centres, even for patients with a regular nephrology follow-up. Unplanned dialysis initiation can be defined as a patient beginning dialysis with no functional vascular access or peritoneal dialysis catheter. These patients start haemodialysis with a temporary catheter, frequently converted to a tunnelled catheter pending native fistula creation or whilst waiting for fistula maturation. In this case, conventional in-centre haemodialysis (ICH) is more frequently used than peritoneal dialysis (PD) or home haemodialysis (HHD). Review findings This review found that patients who start dialysis in an unplanned way are significantly older and have more heart and peripheral vascular diseases. Home-based dialysis therapies showed better outcomes than ICH (PD for the first two to three years and HHD for the long-term). Recommendations This review proposes a paradigm shift in the initial form of dialysis offered to new patients starting dialysis in an unplanned way. Even if they require a temporary catheter, it is possible for them to receive a pre-dialysis education programme (PDEP). The PDEP should be based on both individualised information session(s) given by an experienced nurse to the patient and family and therapeutic education (educative diagnosis, individualised and group session(s)) in order to relieve anxiety and promote home modalities.

Gueutin V, Ficheux M, Châtelet V, Lecouf A, Henri P, Hurault de Ligny B, Ryckelynck J-P, Lobbedez T. Hydration status of patients with end-stage renal disease after kidney transplantation. Clin Transplant 2011: 25: E656–E663. © 2011 John Wiley & Sons A/S. Abstract: Background: This study was carried out to estimate the modification of hydration status within the first three months of renal transplantation. Subjects and methods: Fifty patients who underwent a first kidney allograft were prospectively followed for three months after renal transplantation to assess hydration status by bioimpedance spectroscopy. Results: Two hours before the transplant procedure, 10/42 (23.8%) patients were overhydrated. Two days after surgery, 32/40 (80.0%) patients were overhydrated and at three months, 14/27 (51.9%) patients remained fluid-overloaded. Peritoneal dialysis (PD) patients had a lower hydration status (−0.60 L) than hemodialysis (HD) patients (0.70 L; p

The main objective of this study is to determine whether a single dose of iron dextran can correct iron deficiency during a period of four months in peritoneal dialysis patients.This was a prospective observational study in peritoneal dialysis patients who had anemia (hemoglobin11g/dL) and iron deficiency (ferritin100μg/L and/or transferrin saturation20%). Patients who were resistant to oral iron or who could not tolerate oral iron were included in the study. At baseline, based on the iron deficiency estimation, a single dose of iron dextran was infused over four hours.Of 17 patients included, 12 completed the study. The mean iron dose infused was 742±150mg. No clinically significant adverse event was reported during the infusion. Four months after the iron dextran infusion there was a significant increase of the mean hemoglobin level (10.1±0.7g/dl vs 11.4±1.2g/dL, P0.05), the mean blood ferritin level (66±46mg/L vs 212±121mg/L, P0.05) and the mean transferrin saturation (14±5% vs 23±8, P0.05). Four months after the iron infusion 10 patients had a blood ferritin level higher than 100μg/L and a transferrin saturation higher than 20%. There was no significant modification of the erythropoietin dose during the four months period.In patients treated by peritoneal dialysis, the anemia due to iron deficiency can be treated by a single infusion of iron dextran for a period of four months.

Peritoneal dialysis is commonly used in patients awaiting renal transplantation. The occurrence of delayed graft function is lower in CAPD patients than in hemodialysis patients. This could be explained by the fluid expansion observed in CAPD patients before renal transplantation. Acute allograft rejection incidence is similar in peritoneal dialysis patients and hemodialysis patients. There are controversial data regarding the rate of renovascular thrombosis after renal transplantation in peritoneal dialysis patients. The dialysis modality selected prior to transplantation may explain the rate of renovascular thrombosis in peritoneal dialysis patients. There is an increasing number of patients returning to dialysis after transplantation failure. However, peritoneal dialysis is underused in failed transplant patients. There are few data available regarding the impact of dialysis modality on the outcome of failed transplant patients. Immunosuppression and transplant nephrectomy may affect the outcome of these patients on peritoneal dialysis. The aim of this article is to review the use of peritoneal dialysis in patients awaiting renal transplantation and in failed transplant patients.

Peritoneal dialysis is commonly used in patients awaiting renal transplantation. The occurrence of delayed graft function is lower in CAPD patients than in hemodialysis patients. This could be explain

Starting dialysis in an unplanned manner is a frequent situation in a dialysis centre even for patients with a regular nephrology follow-up. For no clear reason, chronic haemodialysis (HD) is more frequently used than peritoneal dialysis for unplanned dialysis patients.The purpose of this study was to evaluate the results of a dialysis policy dedicated to unplanned dialysis patients. The aim of this policy was to increase the use of peritoneal dialysis (PD) in an attempt to reduce the need for tunnelled catheter.One hundred seventy-one patients from a single centre, who started dialysis between 1 January 2004 and 31 December 2006, were prospectively followed until 31 December 2006. Unplanned dialysis patients were defined as patients entering in dialysis with no vascular access or peritoneal dialysis catheter. PD was presented as a modality of choice for renal replacement therapy to avoid the need for a tunnelled HD catheter.There were 60 unplanned dialysis patients during the study period. Among these patients, 34 agreed to be treated by PD. Compared with unplanned peritoneal dialysis patients, unplanned haemodialysis patients had a greater modified Charlson's comorbidity index (5.9 +/- 2.4 versus 4.4 +/- 1.9, P0.05). The mean duration of the temporary catheter period was 32 +/- 29 days (median: 24 days) for haemodialysis patients compared with 26 +/- 21 days (median: 25 days) for peritoneal dialysis patients (P = NS). The initial hospitalization duration was similar in haemodialysis patients and peritoneal dialysis patients (24 +/- 28 versus 30 +/- 33 days; median value: 17 versus 20 days, P = NS). PD was started 8.6 +/- 10 days (median: 4 days) after catheter insertion. A tunnelled catheter was used only in three patients until peritoneal dialysis was initiated. Acute automated peritoneal dialysis was used in 19 patients. Among 26 haemodialysis patients, 23 were dialyzed through a tunnelled catheter. Of these 23 patients, 15 were successfully converted to fistula. Median time for fistula creation was 2.6 months after dialysis initiation; median time for fistula utilization was 4.4 months. Actuarial patients survival at 1 year was 79% on haemodialysis compared with 83% on peritoneal dialysis (P = NS). After adjustment of the initial modified Charlson's comorbidity index, dialysis modality had no impact on patient's survival. There was no significant difference between haemodialysis patients and peritoneal dialysis patients regarding survival free of re-hospitalization. Actuarial survival free of peritonitis was 73% at 6 months and 58% at 1 year.Peritoneal dialysis is a safe and efficient alternative to haemodialysis for unplanned dialysis patients. Peritoneal dialysis offers the advantage of reducing the need for tunnelled catheter in unplanned dialysis patients.