Treatment data during pediatric home peritoneal teledialysis.
Peritoneal teledialysis (telePD) is a modem-based communication link between the patients' cyclers and a computer in the dialysis unit that allows the transmission and storage of a series of automated peritoneal dialysis (APD) treatment data. In order to evaluate the usefulness of telePD in quantifying the problems that may occur during pediatric APD, we retrospectively studied four patients with a median age of 14.1+/-1.8 years during their initial months of telePD. The selection criteria were potential non-compliance in two cases (patients 1 and 2) and catheter malposition or fibrin occlusion in two (patients 3 and 4). The patients were treated using a Fresenius PD Night Cycler with teledialysis software. Thirty consecutive treatments per patient in the 1st and 4th months were examined, and a series of treatment parameters was calculated. The percentage of treatments with alarms and the number of alarms per treatment were high in both the 1st and the 4th month, particularly in patients 3 and 4. The main causes of the alarms were tube kinking, catheter malfunction, fibrin occlusion, and failure of electrical power. The number of shortened treatments significantly decreased in the 4th month of telePD. One non-compliant family was identified during the 1st month of PD, but psychosocial support helped to decrease the number of shortened treatments due to non-compliance in the 4th month. During the 4th month of telePD, the dwell time/total treatment time ratio (which represents the time of contact between the peritoneum and dialysis fluid) increased as a result of technical interventions aimed at reducing the infusion plus drain time. In conclusion, telePD proved to be useful in detecting and solving the clinical and technical problems of APD.
Pediatric Renal Unit, 1st Department of Pediatrics, University of Milan Medical School, Milan, Italy. aedefonti@hotmail.com
Alberto
A
Edefonti
Salvatore
S
Boccola
Marina
M
Picca
Fabio
F
Paglialonga
Gianluigi
G
Ardissino
Giuseppina
G
Marra
Luciana
L
Ghio
Maria Teresa
MT
Parisotto
D000293:Adolescent; D000328:Adult; D002648:Child; D006699:Home Care Services; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D010530:Peritoneal Dialysis / Q000295:instrumentation / Q000379:methods* / Q000523:psychology; D012189:Retrospective Studies; D017216:Telemedicine; D016312:Treatment Refusal