1. James Heaf Herlev Hospital University of Copenhagen
Peritoneal Dialysis
James Heaf
Herlev Hospital
University of Copenhagen

2. Choice of dialysis modality Herlev 2012

3. Peritonitis-free Survival Denmark 2000-2014

4. PD as a viable long term dialysis option
James Heaf
University of Copenhagen
Herlev Hospital

5. The Poor and the Smart Home Dialysis World Leaders 2011
GDP/capita USD
36,667 38,222
10,247
7,855
67,723
56,202
55,158
46,098
5,678
52,232
46,142
38,589 99,622 3,113
38,589
USRDS 2013

6. Countries with High Home HD Prevalence

7. Corruption Index
Transparency International 2011

8. Dialysis Costs Danish National Health Service Medical Technology Assessment Report 2006
Aim: 45% on Home Dialysis
within 10 years
1 € = 85p

9. Two basic types
Automatic PD, APD
CAPD

10. PD Variations
Night Cycler
APD
CAPD
Night (9 hours)
Day (15 hours)

11. CAPD Variations Possibly Night cycler CAPD x 5 Gentle start PD
Night (9 hours)
Day (15 hours)

12. APD: Wet and Dry Days APD with wet day APD with Dry day
Night (9 hours)
Day (15 hours)

13. Osmotic Pressure and Ultrafiltration
Icodextrin
Extraneal®
4,25%
2,5%
1,5%
KI 62;S81,

14. Peritoneal Equilibration Test (PET) Twardowski Perit Dial Bull 7:138 198782 68 52

15. 2 year Survival in CAPD CANUSA Studiet. Churchill et al
2 year Survival in CAPD CANUSA Studiet. Churchill et al. J Am Soc Nephrol. 1998; 9:
Technique Patient Combined
Survival Survival Survival
Slow
Slow average
Fast average
Fast

16. PET og Ultrafiltration
2000 ml medium strength ( %) for 4 hours
Transport Type UF
Slow
>650 ml
Slow average ml
Fast Average ml
Fast
<85 ml

17. Ultrafiltration og transportstatus
Neg UF
CAPD
Night
This slide shows the results of computer modeling that characterizes the ultrafiltration (UF) potential of 1.5% dextrose by peritoneal membrane transport pattern—low, low-average, high-average, and high—using actual peritoneal transport data from patients on continuous ambulatory peritoneal dialysis.1
As expected, patients with high transport patterns exhibited the greatest decline in UF potential over time, while those with low transport patterns exhibited the most gradual declines.
Nevertheless, during long dwell exchanges of about hours, the majority of patients would likely experience negative net UF, regardless of transport status. This is explained by the relatively low concentration of glucose and its rapid diffusion across the peritoneal membrane, resulting in progressive loss of osmotic driving forces.1
APD
Day
Mujais S, Vonesh E. Kidney Int. 2002;62(suppl 81):S17-S22.
1.5% Glucose
1Mujais S, Vonesh E. Profiling peritoneal ultrafiltration. Kidney Int. 2002;62(suppl 81):S17-S22.

18. Outcome in high transporters is improved during recent years
Commencing
Commencing
Davies SJ, Kidney Int 70: S76-S83, 2006

19. ADP vs CAPD: Transport Status
Multivariate analysis
Johnson NDT 25,

20. PD Prevalance Denmark 1990-2010
Mortality

21. HD vs. PD: Status 2014

22. PD vs. HD: Effect of Cohort Denmark 1990-2010
Adjusted for
age, sex,
renal diagnosis
Comorbidity,
& referral pattern
Heaf PlosOne 2014

23. Effect of Cohort & Diabetes
Heaf PlosOne 2014

24. Effect of Cohort & Age
Heaf PlosOne2014

25. Effect of Cohort & Referral
Early Referral
Planned, out-patient
Dialysis initiation
Heaf PlosOne2014

26. Risk Factors for Residual Renal Function Loss Moist JASN 11:556-565, 2000**
***
*** * * **
***
*** *
*:p<0.05
**:p<0.01
***:p<0.001
1843 patients
50% PD
50% HD
Odds Ratio Multivariate Analyse

27. Peritoneal and Renal Clearance: Different Effects on Mortality
Creatinine Clearance:
Change per 1 ml/min
Kt/V: Change per 0.1/week

28. Wu: QOL after 1 Year Wu JASN 15,743 2004** * ** ** * *
* p<0.05
**p<0.01

29. CAPD på en tømmerflåde
With thanks to
Johan Povlsen

30. Conclusions Economical compared to Center HD Popular in Scandinavia
Better patient survival the first two years, possibly due to better preservation of renal function
Not a longterm therapy
CAPD and APD choice based on transport characteristics and patient wishes
A sensible choice for patients who want freedom from hospital and freedom to travel