Part of the book: An Update on Glomerulopathies
Peritoneal dialysis (PD) has become a real alternative to hemodialysis (HD) in recent decades, with comparable survival rates, lower costs, and improved patient quality of life. Nevertheless, PD‐related infections, including peritonitis, exit‐site infections (ESI), and tunnel infections, are important complications, resulting in significant morbidity and a 3.5–10.0% risk of death. Patients with peritonitis usually present with cloudy PD‐fluid and abdominal pain; however, PD‐associated peritonitis should always be included in differential diagnosis of PD patients with abdominal pain. The most common causative organisms for PD‐associated peritonitis are gram‐positive bacteria; however, gram‐negative species are clinically important, due to the antibiotic resistance. The selection of empiric antibiotics depends on the center‐specific distribution of microorganisms and antimicrobial susceptibility profiles. Typically, a first‐generation cephalosporin is used in combination with broad gram‐negative coverage (e.g., aminoglycoside, ceftazidime, or cefepime). High levels of methicillin‐resistant Staphylococcus epidermidis or Enterococcus spp. strains require the use of vancomycin in many centers. Furthermore, for patients without clinical improvement after 5 days, or with fungal peritonitis, catheter removal is indicated.
Part of the book: Some Special Problems in Peritoneal Dialysis
The number of patients depending on dialysis therapies increases worldwide. The home-based dialysis modalities offer some advantages especially for elderly patients. In the case of peritoneal dialysis (PD), the life quality is superior compared to in-center hemodialysis (HD), and other advantages are existent. Due to the effect that a lot of elderly PD patients are frail, a concept covering the different modalities of PD must include the assistance at home or the living environment (assisted PD) for the bag exchanges that often cannot be performed reliably by elderly and frail patients by themselves. Nowadays, we have enough data to safely offer assisted peritoneal dialysis (aPD) in a cost-saving manner. Putting all these aspects together, aPD is a safe and in some countries widely used modality. The issue of reimbursement and education of home nurse staff must be solved. However, for elderly and frail patients, aPD offers a change to use the advantages of PD for these population, and on a local level, the provider should seek ways to establish aPD programs.
Part of the book: Evolving Strategies in Peritoneal Dialysis
Regarding the practice of medicine, we have to face the chances and challenges of all aspects of e-Health; however, the term “digitalization” is broader and spanning all aspects. However, the digitalization of medicine offers solutions for pressing problem. We know the factors that lead to excellence in medicine. Without the right amount of experiences based on a solid ground of knowledge, no excellence is achievable. The problem, nowadays, is that due to restriction of working hours, to the goals of life (“life-work-balance”) and the restrictions of Generation Y, almost no education in medicine is spanning the needed 10,000 h experiences in practical medicine for excellence. Therefore, we will see the fading of medical excellence, if we could not establish other systems. A solution can be searched in decision-support systems. However, a requirement before is the need of a digitalization of all health data. We surely do not have enough evidences for all aspects of the practice of medicine, the intuition is fading away and therefore, we have to look around for other solutions. Big data generated by the digitalization of all health data could be the problem solver. In combination, IT will help to improve the quality of care.
Part of the book: eHealth