Peritoneal dialysis

And then three months later, they re- they re-advertised it and I was like, "Right, this is, this is the message, this is, this is what I'm applying for," and I set off and, you know, I knew nothing really.

Like I spent the first two weeks, I think, really confused because the people-- there's two sorts of dialysis, hemodialysis and peritoneal dialysis, and they call, um, peritoneal dialysis PD, and everyone was talking about PD and I kept thinking, "How are there so many personality disorders in In kidneys.

And then suddenly I realized that they were actually talking about peritoneal dialysis.

So I had lots and lots to learn about kidneys, and I've just stayed sort of working, working in that area.

So when you lower that 350 to 500 liters of water that you use a treatment to 30, 40, 50 liters of treatment, you see a significant reduction.

PD uses a small fraction of the water that in-center dialysis does as well.

And so this focus on efficiency is really one that... brings sustainability.

Additionally, though, for HHD, you have onsite or on-demand generation of dialysis that helps even further, or dialysate that helps even further, because you're making what you need and not shipping premixed fluid in bags and boxes across the country.

So you remove most of those trips and you end up with a greener modality.

And the third part I'll say is resilience because the other half of sustainability is what happens when a disaster hits.

So you have a patient on a home therapy with supplies on hand, they're doing CAPD, they can do manual bags if a disaster hits.

So they don't need power.

Heart failure, diabetes, blood pressure.

She also has a PD catheter in her abdomen.

I'm unfamiliar with that.

Yeah, I don't know what that is.

A PD catheter?

PD catheter.

I don't know what it is.

I'm interested to know how, if at all, you would modify the Starting Strength program specifically for someone in her condition.

So the sodium basically has no choice but to remain in the lumen and pull water out with it.

And for end stage cases where profound diuretic resistance has set in, they note that continuous ambulatory peritoneal dialysis, or CAPD, becomes highly effective for ultrafiltration.

Yeah,

it's a very powerful tool.

Um, thank you again.

Um, uh, if we go back to after your, you know, your first transplant's failed and you're, you're back on dialysis, are you, are you back on, uh, are you on hemo then or you're on PD at that time?

Yeah, no, I, um, I went onto hemo because, uh, my dad was already, like, lined up to be my se- second donor.

Um-

Yeah

...

so they thought, "Oh, we're not go- gonna bother, you know, putting another Pimco catheter in for the, for the PD.

Let's just, you know, pop a line in her neck for the hemo." Um, but it ended up being, I was on hemo for over a year.

So thinking about lipophilic drugs, it's going to distribute more in adults who have more adipose tissue than in babies.

And then can you tell us more about the amount of data or lack thereof on antibiotic dosing in renal replacement therapy? Because I was very surprised at how little pediatric data there seems to be, especially when loss of dialysis catheters, both HD and PD catheters significantly harm our patients.

It was just very surprising to me how in 2024, a study of ceftriaxone, which is one of our most used hospital antibiotics, the dosing of that in three pediatric CRT patients was enough to get a published study.

That really hit home to me about the lack of data we have on dosing in our patients.

So we worked together, our co-presenter for this session, Dr. Shannon Reiner, is a third year nephrology fellow at Cincinnati Children's at the time of this recording.

She's graduating soon.

And she led a narrative review of antimicrobial pharmacokinetics in pediatric placements on all kidney replacement therapies types, so CRT, HD, and PD.

And just to summarize, CRT is actually the most studied.