The International Society for Peritoneal Dialysis (ISPD) opened a call for Research Proposals at the end of 2020, aiming to support research projects to advance the knowledge of PD fostering international cooperation.
We received only two applications, probably because of the COVID-related extreme pressure for nephrologists all over the world. These two projects were evaluated by a board of experts of the International Studies Committee. The result of this evaluation process was submitted to the Council, together with a recommendation for funding.
We are excited to announce that the ISPD Council and the International Studies Committee have decided to endorse and support financially both projects!
1.- Rachael Walker et al – Patient perspectives and involvement in co-design of a trial evaluating interventions to improve gut health in peritoneal dialysis – GUT PD Study
2.- Paul Bennet et al – International Peritoneal Dialysis Exercise Practices and Perceptions (IPEP)
We would like to thank both teams for their well-thought project proposals. We hope that the respective teams succeed in implementing these two projects with ISPD support.
There will be a new Call for Research Projects at the end of 2021 or the first weeks of 2022.
1) Mayoor V Prabhu, MD,DNB(Neph), FASN
Associate Professor of Nephrology
Kasturba Medical College & KMC Hospital, Dr. Ambedkar Circle, Mangalore, India (Manipal Academy of Higher Education, Manipal, India)
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2) Sreedhar Reddy,DNB(Neph)
Krishna Institute of Medical Sciences, Hyderabad, India
COVID-19, caused by the SARS-Coronavirus 2 has been sweeping across the globe since 2020 (it was declared a global pandemic by WHO in March 2020). No nation large or small, developed or underdeveloped, rich or poor has been spared from its relentless march. Ranging from an asymptomatic infection to severe respiratory distress, the infection is still a matter of much debate and research, as the medical profession toils day and night to contain it. One year down the line while the disease is still very much being understood and its long-term effects still a matter of conjecture, there is general agreement that patients with systemic illnesses and comorbidities are at higher risk of symptomatic and severe disease, and higher morbidity and mortality. In this regard, patients with kidney disease on dialysis pose a unique challenge to the medical teams. Dialysis requires frequent hospital visits, close interaction with several medical staff, frequent sampling and monitoring, prolonged in-hospital stay in case of Hemodialysis (HD), tend to have more frequent hospitalization, and this poses a high risk of COVID infection. Peritoneal Dialysis (PD) has the unique advantages of being a home-based therapy thereby obviating the need for hospital visits and automatically ensuring social distancing- the cornerstone of breaking the chain of spread of COVID-19. With many parts of the world including India witnessing travel bans and lockdowns, home-based therapies are definitely safer and convenient to the patients and their families. Patients on PD require less exposure to medical personnel, less travel to dialysis facilities thus less need to depend on public transportation, all decreasing the chance of being exposed to the disease. Further encouraging PD as a modality of Renal Replacement Therapy (RRT) in ESRD patients may help preserve supplies and manpower, for patients who require haemodialysis , as explained by Eapen JJ (1). Further, barring the most critically ill patients, PD is also a valid option for AKI in the setting of COVID-19. On 28 March 2020, the International Society of Peritoneal Dialysis published its strategy regarding COVID-19 prevention in PD patients. This statement endorses the strategy of keeping people on PD at home and suggests that hospital visits should be minimized for only urgent indications (such as suspected peritonitis or fluid overload), and that consultations should otherwise be conducted by telehealth (2). In the UK, by 29 April 2020, 2.9% of patients on PD were reported to have contracted COVID-19, compared with 9% of patients on HD (3). As more literature accumulates over time, we might be able to comment more conclusively on these issues.
India is one of the most severely affected countries in the world. Even though India rolled out the world’s largest COVID-19 vaccination programme and covered most of the healthcare workers in early 2020, it still saw a second wave of infections which peaked at more than 400,000 cases per day and a cumulative number of 28 million-plus at the time of writing. The number of daily cases is now around 120,000 per day. This crisis overwhelmed the healthcare system leading to increased mortality. There were infections in healthcare workers which stressed an already overburdened healthcare workforce. Without a doubt, kidney and dialysis care bore the brunt of hospital bed shortages, oxygen shortages, travel restrictions, supply chain interruption, and other logistical issues. Kidney care in India tends to be mostly available in the larger cities and in the private sector. Most patients (more than a quarter) requiring dialysis live as far as 100 km away, and up to 60% live more than 50 km from these centers according to a 2017 study. Prasad N. et al (4) published a paper in KI Reports, which attempted to
evaluate and quantify the morbidity and mortality in ESRD patients who were impacted by COVID-19 pandemic-related service disruptions in public and private hospitals in India. They found that 28% of patients missed one or more sessions of HD, many without informing the Unit. Some patients were advised by the treating nephrologists to reduce dialysis frequency because of accommodating potential dialysis required for the COVID-19–positive patients and curbs imposed by the hospitals. Complete drop-out was noted in up to 4% of patients. This drop-out was more in patients receiving dialysis at public sector hospitals. In some cases, large public sector hospitals were converted in their entirety into COVID care facilities, virtually shutting down long-running dialysis centers temporarily. It was a herculean task to overnight accommodate these patients into other dialysis centers, most of which were in the private sector. Impact on PD services was comparatively less, with very few centers reporting difficulties in procuring essential PD supplies. Unfortunately, PD penetrance in India remains very low compared to HD. India’s IT hubs Bangalore and Hyderabad were among the worst hit by the pandemic. Dr. P Vidyashankar, Head of Nephrology and Transplantation services at Bangalore’s Aster CMI hospital, has completed 150 CAPD catheter insertions under local anesthesia without complications and a cosmetically acceptable technique. He says during the pandemic period he found patients more willing to accept CAPD as therapy given its inherent advantage as a home-based treatment. Many patients (up to 20%) were in NYHA Class 4 and benefited from avoiding general anesthesia (in publication, personal communication). Kidney transplantation services, especially deceased donor transplants, came to a grinding halt in the early days of the pandemic, only to restart gradually over a few months. Many transplant recipients contracted COVID-19 over the past year, but data remains sparse as to the outcomes seen in this subset. Renal care teams including Nephrologists, postgraduates/fellows, dialysis and transplant unit staff also saw infections among themselves, fortunately with low morbidity and mortality.
The COVID-19 Working Group of the Indian Society of Nephrology came up with working guidelines to help PD practitioners in India to handle COVID-19 patients on PD. (5). This included guidelines for PD in AKI, in CKD, and comprehensive guidance for patients, caregivers, hospital visits, supplies, effluent disposal and treatment of COVID-19 in PD patients. As data and experience accumulate, these strategies might be refined further; however, this serves at present as an excellent tool to guide clinicians and patients alike. Going ahead, and with the hindsight gained from our experiences during this pandemic, encouraging PD as a modality of RRT should gain more traction. The inclusion of PD in the National Dialysis Programme is a welcome step in this direction. More public sector hospitals should be encouraged to set up PD programs to help cater to the ever-increasing case load. With the incorporation of remote monitoring technology, quality PD can be offered to patients at an affordable cost with Governmental/ NGO support. PD appears to be a therapy much more convenient and safe during a crisis like this and can help healthcare systems around the world deal better with patients needing RRT in these demanding times.
Competing Interests : None
(1)Eapen JJ. Peritoneal dialysis – ideal renal replacement therapy during coronavirus (COVID-19) pandemic. Indian J Perit Dial 2020;38:11-2.
(2) Cozzolino M,et al. COVID-19 pandemic era: is it time to promote home dialysis and peritoneal dialysis?, Clinical Kidney Journal, Volume 14, Issue Supplement_1, March 2021, Pages i6–i13, https://doi.org/10.1093/ckj/sfab023
(3) UK Renal Registry: Weekly COVID-19 Surveillance. Report for Renal Centres in the UK. Bristol: UK Renal Registry,2020
(4) Prasad N et al. The Adverse Effect of COVID Pandemic on the Care of Patients With Kidney Diseases in India .Kidney International Reports. Volume 5, Issue 9, September 2020, Pages 1545-1550
(5) Jeloka T, Gupta A, Prasad N, Varughese S, Mahajan S, Nayak K S, Agarwal SK, Abraham G, On behalf of COVID-19 Working Group of Indian Society of Nephrology. Peritoneal dialysis patients during COVID 19 pandemic. Indian J Nephrol 2020;30:171-3
GOING VIRTUAL! Due to the ongoing COVID situation, the joint ISPD and EuroPD congress will be held as a fully virtual meeting over new dates Sunday 28th February – Tuesday 2nd March 2021.
The new programme can be consulted HERE and it has been updated with the latest content. Our registration fees have been significantly discounted to enable as many of our colleagues around the world to participate. Delegates who had already registered and paid for the original dates have been refunded the difference in fees.
More information: www.ispd-europd2021.com
Do you have any questions? Please contact us and we will be pleased to help you.
At the beginning of 2020 the publishing contract for Peritoneal Dialysis International was taken over by SAGE and you will have noted the new look and website – https://journals.sagepub.com/home/ptd. ISPD members get access to the full Journal through the ISPD website after log in (the old site www.pdiconnect.com has been discontinued, so please update your bookmarks to the new site).
Unsurprisingly COVID-19 featured strongly through the year and we published several papers on that topic including reports from Sichuan Province China, use of remote patient management during the pandemic from Italy, PD for COVID associated acute kidney injury, as well as a report of paediatric inflammatory multisystem syndrome (PIMS) from South Africa. Reports on the Saving Young Lives program continued to feature strongly in the journal. For more details of the most read articles from PDI in 2020, please visit the PDI Journal website.
In May we published a Special issue: Prescribing High Quality Goal-Directed Peritoneal Dialysis – a new guideline from the International Society for Peritoneal Dialysis. This comprehensive series of paper examined the topic from a range of perspectives and if you have not read it already it is to be recommended.
Our most read articles continue to be the important guidelines from the ISPD – with infection, access and prescribing guidelines being an important resource for clinical teams around the world. I am pleased to share that in the near future there will be updated guidelines on acute kidney injury for adults and children as well as a detailed guideline on the evaluation of peritoneal membrane dysfunction.
Our most cited papers have been Creating and Maintaining Optimal Peritoneal Dialysis Access in the Adult Patient: 2019 Update (John Crabtree et al); Standardized Outcomes in Nephrology—Peritoneal Dialysis (SONG-PD): Study Protocol (Karine Manera et al; and Advanced Laparoscopic Peritoneal Dialysis Catheter Insertion: Systematic Review and Meta-Analysis (Badri Shrestha et al).
I will be handing over as Editor in Chief to Jeff Perl on January 1st 2021. He is going to take the journal to a new level with his boundless energy and well proven scientific and editorial skills. He will be supported by an excellent editorial team and our publisher SAGE. I intend to remain accessible to the journal to provide support during the transition. It has been my privilege to work with PDI over the last 8 years, to work with wonderful people from our society from across the world and to have been able to take a role in supporting the dissemination of high quality information to support patient care. I am grateful to everyone who supports PDI and its objectives including our authors, dedicated reviewers, readers, editors and publisher. I have every confidence that it will continue to enable clinical teams in their important work of caring for people who require peritoneal dialysis for decades to come.
The ISPD is pleased to announce the second round of the ISPD Fellowship Program for 2020 is now open. The deadline to submit applications is 30th September, 2020. Please read carefully for COVID-19 specific recommendations.
Do you want to know how this experience can be? Read this article about two ISPD fellows from Nigeria getting trained in Colorado.
Click here to view full details about the program, the eligibility, and the application process; including how the ISPD Fellowship Program will adapt to the COVID-19..
For any question, please contact our Society Coordinator firstname.lastname@example.org
The novel coronavirus disease COVID-19 emerged in December 2019 and within 6 months has developed into a pandemic with more than 5 million people affected globally. This has had a major impact on the peritoneal dialysis world. The disease focus shifted from China to Europe and North America by March. Theoretically, people doing PD in their own homes should fare better than those cohorted on HD units. In March, as the COVID epidemic escalated in Europe and N America, there was no guidance how PD units should operate. Amazingly, considering the simultaneous clinical pressures for the individuals in the ISPD guidelines and standards committee, we managed to produce a document “Strategies regarding COVID-19 in PD patients” within a couple of weeks. This document can be found in our website The translations into French, Spanish, Chinese, Polish, Hungarian, Portuguese and Japanese that were then spontaneously offered and completed by members of the ISPD demonstrate the truly global nature of COVID-19. The strategy is simple – keep people doing PD in their own home and away from renal units and hospitals.
The next PD-related crisis was the unexpected demand for renal support in ICUs. Around 25% of patients on ventilators for COVID-19 develop AKI. International focus had been on acquiring large numbers of ventilators. Suddenly there was a shortage of the hardware for renal support in ICU – machines and filters – exacerbated by a clotting problems. There was therefore an urgent need for alternative ways to deliver renal replacement in the ICU setting – and this led to a demand in many centres to explore PD. There are, of course, many hurdles – most centres have no experience of PD in ICU, never mind the challenges of catheter insertion, developing appropriate prescriptions, finding staff to manage the PD in the ICU – just to mention a few. Fortunately, there were a few centres in the UK and US who had started doing PD for these patients, and the ISPD guideline for PD in AKI which had been published in 2014 was in the process of being updated with a final version almost ready. Given the urgency of the situation, the ISN and the ISPD collaborated in putting together a webinar on PD in COVID-related AKI highlighting the new guideline and UK and US experience – it can be found at this link. This was so popular (almost 1000 people ‘attended’), that a 2nd webinar was run 2 weeks later (link). The COVID experience has taught us that PD is a viable renal replacement option for AKI in ICU. The COVID era is with us for some time ahead – perhaps an opportunity for an international multicentre randomised study with haemofiltration?
And now, in many countries we are beyond the peak. Certainly, in the UK, at least, the experience of COVID-19 in HD units has resulted in an awareness that dialysis at home has many advantages. There has been a dramatic increase in people choosing PD, even patients with functioning fistulas who were about to start HD. There will therefore be many clinicians needing PD education. It is fortuitous that the two most recently published are related to PD access and PD prescribing.
Edwina Brown, Chair of ISPD guideline and standards committee
Hammersmith Hospital, London, UK
GENERAL ASSEMBLY NOTICE
The ISPD General Assembly 2020 will take place on an online format, due to the postponement of the ISPD-EuroPD Congress 2020 to March 2021.
A private link to access the General Assembly will be sent to the members a few days before the meeting together with any last minute information.
The Scholarship and Awards Committee will receive applications for the second round of ISPD Fellowships until 31 March 2020.