Bulletin de la Dialyse à Domicile

A perspective on integrated dialysis access management: in advance of integrated care plan

Beatriz Gil Braga — 2024-09-08

(To read the full article, in English or French, click on the pdf logo on the right).

We would like to draw attention to the critical issue of dialysis access management and vascular access (VA) options in patients transitioning to chronic renal replacement therapy and from peritoneal dialysis (PD) to hemodialysis (HD). We advocate for the establishment of dedicated consultation services for integrated dialysis access management to optimize patient outcomes. We highlight specific cases where a tailored approach to VA selection is essential, emphasizing the importance of risk stratification and timely access preparation. The preferred use of arteriovenous fistula in HD patients and the challenges surrounding its maturation are discussed. We also explore circumstances necessitating urgent versus planned transitions to HD, incorporating considerations for patient-centered care and education. Sonography’s role in managing PD-related infections and the potential benefits of home HD in the transition process are also examined. We suggest the development of scoring systems to predict patient transitions and emphasize the need for an integrated approach to dialysis access management. Overall, we advocate for proactive measures to prevent vascular access failure and ensure a safe and effective transition process for patients with chronic kidney disease.

Riots in New Caledonia: Impact of constrained management on peritoneal dialysis patients

Noemie Baroux — 2024-09-08

(To read the full article, in English or French, click on the pdf logo on the right.)

New Caledonia is a French collectivity—a group of islands and archipelagos—in the South Pacific region. The riots in New Caledonia that began on the evening of May 13, 2024, caused sudden, unannounced disruption to many areas of public life. They led to the healthcare system’s total disorganization, disrupting the care provided to home peritoneal dialysis patients. This article describes the experience of the peritoneal dialysis team at the Association pour le traitement et la prévention de l’insuffisance rénale en Nouvelle-Calédonie (ATIR) in caring for home peritoneal dialysis patients during the first seven weeks of the riots.

These difficulties have led to changes in dialysis management (reuse of single-use devices, non-use of home care self-employed nurses, and reduction in dialysis volume and/or frequency). Our study concerns 35 nonhospitalized peritoneal dialysis patients as of May 12, 2024. The adjustments in management required the care team to be vigilant by getting updates concerning the patients via phone calls. No serious events occurred during the seven-week study period.

Based on this research, the main aspects that are essential to good responsiveness were as follows: 1) a team medical referent with good knowledge of patients and geography, 2) a coordinated team of peritoneal dialysis caregivers accustomed to working together, 3) shared tools accessible online for teleworking people involved in the care of peritoneal dialysis patients, and 4) harmonized training on the usual care pathway for patients and home independent nurses.

Renal graft intolerance syndrome in peritoneal dialysis: a report on 3 cases

Sara El Maakoul — 2024-09-08

(To read the full article, in English or French, click on the pdf logo on the right).

Introduction:
Renal graft intolerance syndrome is a serious complication following return to dialysis, which may present as an atypical clinical picture. Transplantectomy is almost systematic.
We report the observation of three renal transplant patients currently on peritoneal dialysis who underwent renal graft nephrectomy with maintenance of peritoneal dialysis.
Observation:
These were 3 patients, 2 men and one woman with an average age of 40 years. The average duration of renal transplantation was 11 years. The cause of the return to dialysis was chronic graft dysfunction. After an average delay in PD of 22 months, 2 patients presented with asthenia and significant weight loss. One patient presented with acute fever and severe graft pain. This was associated with a chronic inflammatory syndrome. All patients underwent nephrectomy of the graft without interruption of the dialysis technique, with early resumption of exchanges. Pathological examination showed necrosis of the renal graft.
Conclusion:
Deterioration of general condition associated with an inflammatory syndrome and resistance to erythropoietin may reveal a renal graft intolerance syndrome. Transplantectomy is indicated to improve survival in these patients without compromising the peritoneal dialysis technique.