1. Dr Mohamed Alameen

2. PD: Patient selection
Dr M Alamin

3. : Strong need for independence and
control of own care.

to set up a safe area in
their home for treatment
PD: Patient selection
Dr M Alamin

4. : Ability to learn and apply theory,
principles, and practical procedures
—employed or desire to travel
PD: Patient selection
Dr M Alamin

5. especially if they have a
motivated caregiver to assist
PD: Patient selection
Dr M Alamin

6. : Any new ESRD patient with severe
cardiovascular disease.

‡ Reduction in dialysis-associated symptoms
A patient whose blood pressure is
not well controlled with medications.
PD: Patient selection
Dr M Alamin

7. : Patients with hemodialysis
access failure or fear of needles.
 ‡ No vascular access required
 ‡ Blood sugar can be well-controlled even though sugar
is the base of PD solution
PD: Patient selection
Dr M Alamin

8. Inclusion Criteria for PD
Choose the modality.
CVD, CHF.
Want “control.”
Geriatric.
Prefer home for
Pediatric.
dialysis.
Have residual renal
function.
PD: Patient selection
Social support
system.
Dr M Alamin

9. PD: Patient selection
Dr M Alamin

10.  No/unreliable electricity
 †Homeless
 †Poor personal hygiene
 †Dementia, poor short-term memory, brain injury
without a helper
 † Uncontrolled seizure disorder
PD: Patient selection
Dr M Alamin

11. PD: Patient selection
Dr M Alamin

12.  Step 1: Promote Pre-Dialysis Care.
 Step 2: Identify all patients who start dialysis without pre-
dialysis care.
 Step 3: Identify all patients who are eligible for PD.
 Step 4: Overcome barriers to PD by offering support
(Home Care).
 Step 5: Educate patients about PD in the home and
support them.
PD: Patient selection
Dr M Alamin

13. PD: Patient selection
Dr M Alamin

14.  Continuous ambulatory peritoneal dialysis (CAPD)
 Continuous cycling peritoneal dialysis (CCPD)
 Conventional in-center HD (4 hoursX3 times/weekthree times




per week for three to four hours per treatment)
Nocturnal in-center HD (6-8 hours X 3-4 times/week)
Nocturnal HHD (three to six times per week for eight to 10 hours
per treatment)
Short daily HHD ( five to seven times per week for two to three
hours per treatment)
Transplant
PD: Patient selection
Dr M Alamin

15. :
 Assuages concerns and misconceptions.
 Provides objective information.
 Promotes self-care
 Helps patients make an informed modality decision.
 Dramatically increase patient choice of home dialysis.
PD: Patient selection
Dr M Alamin

16.  Who are the pre dialysis patients ??????
 Proved CKD patient.
 SCr > 250 umol/l or GFR < 30 ml/min.
 How to reach to those patients ????
 Informing the referring physicians about the importance
of early referral: Family Physicians, ER Physicians, Specialists (General
Internal Medicine, Urology, Cardiology, Emergency; Hypertension specialists;
Endocrine Clinics), Walk-In Clinics.
PD: Patient selection
Dr M Alamin

17.  Who will give predialysis care ????
 Nephrologist
 Nurses
 Social workers
 Dietitians
 Social workers
 Often include: a surgeon, a cardiologist, a
psychologist, a psychiatrist, a physiotherapist etc.
PD: Patient selection
Dr M Alamin

18.  What is the predialysis care topics ????
1.
2.
3.
4.
5.
6.
What is CKD?
Anemia of CKD.
Blood pressure.
CKD nutrition.
Conservative therapy
RRT: Transplantation, PD and HD
PD: Patient selection
Dr M Alamin

19.  Most patients with ESRD are anxious and unwell and
will be nervous about participating in their own
treatment
 Getting them to do PD requires encouragement and
support and is best done in advance before they
become very uremic
PD: Patient selection
Dr M Alamin

20. PD: Patient selection
Dr M Alamin

21. PD: Patient selection
Dr M Alamin

22. PD: Patient selection
Dr M Alamin

23.  All patients, including acute HD starts, should be offered
the various options of RRT that they are suitable for.
 Once patients are medically stable, they are to be rapidly
assessed to determine what components of pre-dialysis
care they have received.
 Education about home dialysis to be completed prior to
discharge.
PD: Patient selection
Dr M Alamin

24.  Absolute contraindications for PD
1. Documented loss of peritoneal membrane function or
extensive abdominal adhesions that limit dialysate
flow.
2. Uncorrectable mechanical defects that prevent
effective PD or increase the risk of infection (eg,
surgically irreparable hernia, omphalocele,
gastroschisis, diaphragmatic hernia, and bladder
extrophy)
PD: Patient selection
Dr M Alamin

25. Absolute contraindications
for PD
PD: Patient selection
Dr M Alamin

26. Absolute contraindications
for PD
PD: Patient selection
Dr M Alamin

27. Absolute contraindications
for PD
PD: Patient selection
Dr M Alamin

28. Absolute contraindications
for PD
PD: Patient selection
Dr M Alamin

29. Relative contraindications for PD
Fresh intra-abdominal foreign bodies (eg, 4-month wait
after abdominal vascular prostheses, recent ventricularperitoneal shunt)
2. Body size limitations i.e. Morbid obesity (in short
individuals)
3. Intolerance to PD volumes necessary to achieve adequate
PD dose
1.
PD: Patient selection
Dr M Alamin

30. Relative contraindications for PD
4. Inflammatory or ischemic bowel disease
5. Abdominal wall or skin infection
6. Severe malnutrition
7. Frequent episodes of diverticulitis.
PD: Patient selection
Dr M Alamin

31. Social Contraindications to PD
A patient lives in a residence that does not permit PD.
A patient requires rehabilitation in a centre that does not
permit PD.
3. A patient’s residence has insufficient storage space for PD
supplies and equipment.
4. A patient’s family is not supportive of PD in the home.
1.
2.
PD: Patient selection
Dr M Alamin

32. Recommendations
 Assess all patients starting chronic dialysis to
determine if they are eligible for PD in the home (no
contraindication).
 Modality options for patients are determined by
conducting multidisciplinary assessments in
partnership with the patient and their families.
PD: Patient selection
Dr M Alamin

33. Recommendations
 Communication between pre-dialysis and home
dialysis health care teams to be conducted on an
ongoing basis to assist in the assessment process.
 Involvement of home dialysis nurses in the pre-dialysis
clinic to be part of the strategy.
PD: Patient selection
Dr M Alamin

34. PD: Patient selection
Dr M Alamin

35. The following conditions should not be considered as contraindications to PD
 Physical or mental inability to




perform PD
Older age
Poor adherence/noncompliance to therapy
Obesity
Congestive heart failure
PD: Patient selection
 Polycystic kidney disease
 Diverticulosis
 Abdominal hernias
 Portal hypertension
 Liver transplantation
Dr M Alamin

36.  Theoretical:




CKD
Acceptance of chronic disease
Conservative therapy
RRT options
 Practical:


Conducted by experienced PD nurse
Using educational materials
PD: Patient selection
Dr M Alamin

37. Factors in Favour of PD







Young child
Full time work
Desire for autonomy
Mother with young children
Good family support
Good motivation
Early transplant likely
PD: Patient selection
Dr M Alamin

38. ‘ PD FIRST ‘
Advances of PD as Initial Modality
1.
2.
3.
4.
5.
6.
7.
Preserves residual renal function better
May allow better blood pressure and volume control
with cardiovascular benefits
May give better quality of life
Has less anemia and lower EPO doses
Lower risk of Hepatitis C
Equal or better survival in early years
Cost advantages - in many countries

39. Conclusion
 Several factors must be in place in order to maximize
patient compliance.
 First, the health care professionals and treatment
setting have to be positive and inspire hope and trust.
 Patients should be seen as colleagues in the design and
implementation of their treatment plan.
 Treatment plans should be realistic based on what the
patient should and will do.
PD: Patient selection
Dr M Alamin

40. PD: Patient selection
Dr M Alamin