By establishing a one-stop dialysis center in the hospital, providing services of pre-examination, dialysis, patient education, rehabilitation, etc., the efficiency of medical management and patient experience are improved. In the home scene, combined intelligent products and digital medical treatment can help PD patients reduce their incidence of cardiovascular, anemia, peritonitis and other related complications.
On September 18, the global first smart peritoneal dialysis center was completed and started in our hospital. This is the first PD scientific management mode demonstration center integrated with assessment, training, diagnosis and treatment and outside remote treatment to solve the pain points of traditional PD diagnosis and treatment, such as the lack of patient management, education and follow-up, alleviate the difficulty of hemodialysis for patients in remote areas at the grass-roots level, and provide patients with an intelligent diagnosis and treatment management platform "from hospital to home".
China is one of the countries with the highest rate of chronic kidney disease. At present, there are about 120 million chronic kidney disease patients, and the adult prevalence rate is as high as 10.8%. Over recent years, with the increasing incidence of metabolic diseases such as hypertension, diabetes and obesity, the number of patients with chronic end-stage renal disease has been gradually increasing, leading to higher demand for dialysis.
Hemodialysis (“HD”) and peritoneal dialysis (PD) are two renal replacement therapies for the treatment of end-stage renal disease. PD is different from commonly referred HD. A PD patient should have a dialysis catheter implanted in the abdomen, through which dialysis fluid is pumped into the abdomen. The abundant capillary network of the peritoneum of the human body is used to drain the metabolic waste and excess water into the peritoneal dialysis solution through physical principles such as dispersion and ultrafiltration. After the substance exchange, the waste liquid is drained out and new peritoneal dialysis solution is refilled through a catheter. The liquid is exchanged for four to five times a day or exchanged during sleep at night by an automatic PD machine. Patients can also do this by themselves at home.
HD is the substance exchange between blood and dialysate through hemodialyzer and dialyzer outside the body to remove toxins and excess water. Patients must go to hospital for treatment 2-3 times a week.
At present, HD is still the first choice for most of the patients. Data shows that the ratio of HD patients to PD patients in China is about 7:1. In fact, PD technology has its unique advantages: as a home treatment method, it is relatively simple to use, with less dependence on the treatment site and hardware equipment, so that patients can complete the treatment at home at a relatively low medical cost .
However, the development of PD technology in China is unbalanced, lack of management, education and follow-up of PD patients, with lower management level of dialysis centers. These factors all affect the life expectancy and life quality of patients. In 2008, Yu Xueqing , president of the International Society of Peritoneal Dialysis and president of Guangdong Provincial People's Hospital, implemented the “peritoneal dialysis satellite center” program to promote the advanced management mode and experience of the PD center to grassroots areas, so that more patients with chronic kidney disease can receive effective treatment.
"The ‘Guangzhou Model’ of PD has played an important role during the epidemic period, supporting treatment of PD patients, especially those at remote grass-roots area." Yu Xueqing said that during the COVID-19 outbreak, HD centers in many medical institutions were closed, which affected the normal treatment of some patients. At the same time, PD patients could still choose home treatment, which effectively solved the problem of difficulty to receive medical treatment.
The development of the Internet will provide more possibilities for promoting PD technology. Yu said that the Smart Peritoneal Dialysis Center covers the links of pre-examination, dialysis, patient education, rehabilitation etc., which can not only improve the efficiency of medical management and patient experience, but also help patients realize early screening, diagnosis and treatment to promote and maintain the health of the whole life cycle.
One of the reasons why patients prefer HD to PD is the fear of the risks involved in the procedure. Yu said that in the home scenario, healthcare providers will monitor the patient's PD-related complications in real time and give early warning using the combination of home peritoneal dialysis products and smart PD chronic disease management system to ultimately improve safety.
Patient’s standard operation is of equal importance. Yu said that the next step is to start a training class for patients, where they will receive a 7-day standardized training in the hospital, and be checked by the medical staff. Only after passing the examination can they go home for self-help operation. "In subsequent operations, they will be corrected by the medical staff via the cloud in case of any non-standard operation to ensure the safety".
PD is a treatment plan highly recommended in the international community. In 2013, the National Kidney Foundation (NKF) in Singapore offered home visits for dialysis patients, as well as additional benefits including free blood tests, home renovations and food.
Yu Xueqing said that the global first smart peritoneal dialysis center will promote and establish a close medical alliance of smart peritoneal dialysis centers year by year through multi-level coordination of core units, demonstration centers and satellite centers, and bring the technology and concept of PD to the grass-roots market to comprehensively improve PD’s accessibility. At the same time, the center will combine the strength of industry, universities and research institutes to create a smart peritoneal dialysis ecosystem based on PD, and promote the implementation of favorable policy for PD in China through real world research.
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