It is not known how widely used in Italy an incremental start to in peritoneal dialysis (Incr-PD) is.

Peritoneal ultrafiltration (PUF) is proposed in the long-term treatment of congestive heart insufficiency. However, the data in literature available at present do not allow for conclusive meta-analysis. A systematic review of the literature (MEDLINE–EMBASE, 01/01/2003–31/12/2013, studies with ≥4 patients, adults, non-ESRD) to highlight which patients PUF has been used in, how and with what results. Consideration was given to 14 papers for a total of 471 patients. (1) Characteristics of the patients. Average age 71.6 years; diabetes mellitus (DM) 47 %; New York Heart Association (NYHA) class III 38.9 %–class IV 59.8 %; ischemic cardiopathy 67.8 %; mean LVEF 35 %. (2) PUF modality. Only continuous ambulatory peritoneal dialysis (CAPD) in ten studies, only APD in two studies, both in two studies. Overall CAPD was used in 56.2 % of the pts. A single exchange of icodextrin was used to treat 51 % of patients on CAPD. The volume of ultrafiltration obtained varied between 390 and 1,180 ml/die. (3) Effects of PUF. Significant improvement in NYHA class and reduction in hospitalizations. Survival at 12 months varying between 47 and 95 %. Mortality seems to be associated with DM, higher basal glomerular filtration rate, less change in ejection fraction after PUF and less use of ICOs. The main limitation of the selected studies, mostly retrospective and with a limited number of patients, remains the lack of clarity and uniformity of the selection criteria used. For this reason extrapolations about survival require extreme caution and are not currently possible. PUF improves symptomatology and reduces hospitalizations.

The management of end-stage kidney disease (ESKD) has been constantly evolving over the last decade with the development of targeted approaches. In this field, telemedicine and remote monitoring are based on the availability of new cyclers that allow for bidirectional communication (between patient and physician) and for the application of the Sharesource cloud-based platform. These technologies allow patients with ESKD to undergo automated peritoneal dialysis (APD) at home. However, these approaches are not well standardized and largely applied yet. Therefore, this study aimed to elaborate a protocol for the utilization of the Sharesource platform to facilitate the practical management of patients treated with APD. A series of expert meetings were held between September 2022 and January 2023 in Italy. The participants (ten nephrologists and five nurses) from nine Italian public dialysis centers shared their opinions, examined the current scientific literature in the field, and reviewed the key characteristics of the Sharesource system to achieve a common position on this topic. A detailed and practical document containing experts’ opinions and suggestions on the use of the Sharesource platform for the management of patients treated with APD was produced. This expert opinion might represent a new useful instrument in clinical practice for managing patients undergoing home-based peritoneal dialysis (PD) through the Sharesource platform, which is valid not only for Italy. These recommendations pave the way to novel patient-centered and personalized therapeutic approaches for ESKD and highlight the advantages of telemedicine and remote monitoring in the management of patients with ESKD undergoing PD and its positive impact on their quality of life.

Background: In an attempt to overcome the space-time limitations of traditional training we used a new telemedicine home-training model (Videotraining). We report our analysis of Videotraining for automated peritoneal dialysis (APD) carried out between October 1, 2017 and September 30, 2023. Methods: Videotraining is standardized by breaking down the APD procedures (cycler preparation, connection, disconnection) into steps and recording whether they are performed correctly or not using dedicated software (Recorded Training Procedure-Videotraining). The nurse decides when training is terminated, which can occur only after at least three consecutive error-free procedures. Participants: Patients or non-professional caregivers. First-time experience with PD. Training outcomes: Number of procedures performed; frequency, trend and type of errors made. Peritonitis, hospitalizations, survival. Predictors: age, gender, native speaker, education, type of trainee (“patient”/“caregiver”), errors made during learning. Results: We identified 42 subjects (9 patients and 33 caregivers of 24 patients) that required 414 cycler preparations (median 8/training course; IQR 5–13), 358 connections (median 6/training course; Q1-Q3 5–10), and 307 disconnections (median 6/training course; Q1-Q3 5–8) with great variability among trainees. All successfully completed the Videotraining course. The percentage of errors (7.5% over 27 670 steps) declined rapidly as training proceeded, depending on the type of procedure and step. Both the number of errors during the third procedure and age predicted the duration of training. The nurse's assessment regarding the end of Videotraining coincided with the Recorded Training Procedure-Videotraining’s requisite criteria for termination in 78.6% of cases. In the remainder of cases, the nurse deemed it necessary to proceed with further executions. No peritonitis occurred during Videotraining. Conclusions: Recorded Training Procedure-Videotraining makes it possible to personalize training, predict its duration, and help the nurse decide when to end the videotraining course.

Background: Commencing peritoneal dialysis (PD) with a lower dose (incremental PD) is a common strategy to improve patient acceptance and reduce treatment burden. However, specific dietary protein recommendations for incremental PD are lacking. Methods: An interim analysis of the I-COPE PD study cohort aimed to assess one-year changes in serum albumin, body mass index (BMI), and metabolic parameters in a cohort of patients on incremental PD. Following local protocols, patients were categorized into two groups according to protein diet prescription: protein diet (PrD) ≤ 0.6 and PrD > 0.6 g/kg/day. Longitudinal changes at baseline, 6 and 12 months were analyzed using mixed-effects models adjusted for age, sex, diabetes, residual kidney function and serum albumin at baseline. Results: We included 205 patients (mean age 63.3 ± 14.2 years; 66% male; 30% diabetes; 92.2% CAPD) and in 45.4% a PrD ≤ 0.6 g/kg/day was prescribed. Baseline demographic, clinical, lab and therapeutic characteristics were well-balanced between the two diet groups. After one year of follow-up, the prevalence of patients persisting in incremental PD was not different between the two dietary groups (59.1% in PrD ≤ 0.6 vs. 63.3% in PrD > 0.6, log-rank test = 0.759), and both groups showed a similar trend in serum albumin, characterized by an initial decline followed by stabilization (p = 0.647), with no significant differences in BMI (p = 0.461). Despite comparable dialysis adequacy, patients on PrD ≤ 0.6 exhibited significantly lower serum urea, phosphate, and potassium levels over time compared to the PrD > 0.6 group. Conclusions: In patients starting incremental PD, the prescription of a lower protein diet could be associated with better control of uremic toxins, while serum albumin levels over time remain comparable to those observed in patients under a higher-protein diet.