The #PDExchange Podcast

Dr Nikhil Shah from the University of Alberta and Dr Jeff Perl from the University of Toronto, host today's discussion with Dr Caroline Stigant on sustainable Nephrology with a PD focus.

Pregnancy in ESKD: Dialysis Modality, Intensive Hemodialysis, and Multidisciplinary Care

Peritoneal Dialysis InternationalHosts Dr. Nikhil Shah and Dr. Jeff Perl discuss pregnancy in the ESKD population featured in the May issue of Peritoneal Dialysis International with experts Dr. Michelle Hladunewich and Dr. Ghada Ankawi. They review counseling young women starting kidney replacement therapy about family planning, transplant wait times, and modality choice, noting pregnancy is about half as likely on peritoneal dialysis as on hemodialysis. Intensive hemodialysis improves fertility and yields live birth rates and gestational ages similar to transplantation, though babies remain smaller; contraception is important for women not desiring pregnancy. They address equity and logistical barriers to intensifying dialysis, individualized management including hybrid PD/HD, the role of residual kidney function, monitoring issues such as dry weight, hypotension, anemia/ESA needs, phosphate, and polyhydramnios, and use of sFlt-1/PlGF ratio to aid preeclampsia diagnosis. The episode emphasizes OB-nephrology collaboration, multidisciplinary supports, postpartum planning, and establishing pregnancy–kidney disease clinics.00:00 Show Intro And Guests02:37 Why Pregnancy Nephrology03:58 Building Pregnancy Clinics05:51 Family Planning On Dialysis07:29 PD Versus HD Fertility10:42 Intensive Dialysis Outcomes12:59 Saudi Experience And Home HD14:26 When Pregnancy Is Detected17:32 Monitoring And Dry Weight20:56 Staying On PD Or Hybrid25:18 Shared Decision PD Case25:53 PD Pregnancy Success Story27:20 Residual Function Matters29:01 Diagnosing Preeclampsia29:26 Placenta Biomarkers Explained31:57 Building A Pregnancy Clinic33:53 Making OB Collaboration Work36:50 Multidisciplinary Team Support38:27 Dialysis Pregnancy Rapid Fire41:23 Postpartum Counseling And Support46:17 Wrap Up And Takeaways

Podcast: PD Exchange Podcast Hosts: Dr. Nikhil Shah (University of Alberta), Dr. Jeff Perl (St. Michael's Hospital, Toronto) Guests: Dr. Josephine Chow (Sydney, Australia), Dr. Ana Figueiredo (Brazil)

Paper - Teaching peritoneal dialysis: A position paper for the International Society for Peritoneal Dialysis - Josephine SF Chow, Gillian Brunier, Ana E Figueiredo, Helen Hurst, Diana Perez Moran, Joanna Lee Neumann, Rajnish Mehrotra, Lily Mushahar, Trudi Fuge, Carla Maria Avesani, Ngar Yee CHOW, David W Johnson, 2025

Summary

Dr. Nikhil Shah and Dr. Jeff Perl discuss the 2025 ISPD position paper on teaching Peritoneal Dialysis (PD). Guests and Authors of the position paper Dr. Josephine Chow and Dr. Ana Figueiredo outline the shift from a rigid training syllabus to a comprehensive educational intervention that emphasizes pre-assessment, adult learning principles, and post-training support.

Key Takeaways

Evolution of Guidelines: This is the third generation of guidelines (previous: 2006). The focus has shifted from a "recipe" or day-by-day syllabus to a broader process involving Pre-assessment, Training, and Post-assessment.

The "Education Intervention": Training is defined not just as technical exercise but as relationship building. It requires assessing the patient's home environment, health literacy, and learning style (visual, auditory, kinesthetic) before training begins.

Nurse Competency: The nurse is identified as the most critical variable. There is a strong emphasis on "training the trainer"—nurses need mentorship and time to learn how to teach, rather than just knowing the clinical procedure.

Adult Learning Principles:

Motivation: Identify the patient's specific life goal (e.g., attending a daughter's wedding) to drive adherence.

Experience: Leverage the patient's past experiences (e.g., brewing coffee) to explain PD concepts like flow or sterility.

Health Literacy & Bias: High literacy does not guarantee competency, and low literacy does not preclude it. The podcast warns against clinician bias regarding who can learn PD based on educational background.

Group vs. Individual Training: While individual training is standard, group retraining (refresher courses) can be beneficial for generating innovative ideas and peer support, though logistical challenges exist.

Technology & AI Integration

Future of Training: The discussion acknowledges that technology (AI, VR, remote monitoring) is outpacing written guidelines.

The "Dream RCT": Dr. Jeff Perl proposes a "tongue in cheek" theoretical randomized control trial allocated $5 million to test new training interventions (VR, simulation) against standard care to measure infection rates and technique survival.

Automation: The potential for AI chatbots and virtual reality to augment patient education and troubleshooting was highlighted as a necessary evolution for modern PD programs.

Quotes

"The nurse is the most important take home point. We should prepare the nurse to train." — Dr. Ana Figueiredo

"No one wakes up one day and says, 'Okay, let's do it. I'm going to learn PD today.'... Finding out what is the motivation for them to carry on their life is the first thing." — Dr. Ana Figueiredo

"Technically, it is not just a teaching exercise... It is the relationship to build between the nurse and the patient... to build the trust, empower, and basically build the patient autonomy." — Dr. Josephine Chow

Exercise and Peritoneal Dialysis: Enhancing Patient Quality of Life

In this episode of the PD Exchange, hosts Dr. Nikhil Shah and Dr. Jeff Perl discuss the crucial topic of exercise and its impact on peritoneal dialysis (PD) patients. The discussion features a panel of experts including Dr. Stephanie Thompson, Dr. Clara Bohm, and Dr. Paul Bennett. They delve into the importance of tailored exercise interventions for improving patients' physical and mental health, overcoming barriers to activity, and implementing feasible exercise programs within PD care. Key issues addressed include swimming, lifting weights, and the benefits of prehabilitation. The conversation underscores the necessity of making exercise a fundamental component of PD treatment and calls for more research and better resources to support this cause.

00:00 Introduction and Host Welcome

00:59 Introducing the Expert Panel

02:20 Discussion on Exercise Guidelines for PD

05:02 Research and Evidence on Exercise Benefits

08:16 Challenges and Solutions in Prescribing Exercise

13:46 Types of Exercise and Their Impact

16:51 Practical Advice and Patient Motivation

26:19 Swimming and PD: Guidelines and Considerations

30:32 Debating Swimming with PD Catheters

32:22 Covering and Caring for Catheters

34:00 Scuba Diving with PD Catheters

34:49 Swimming and Daily Exercise with PD

36:31 Lifting and Exercise Guidelines

42:00 Prehabilitation and Exercise Programs

43:24 Resources and Patient Education

51:56 Future Research and Final Thoughts

Links to Exercise Resources -

1. GREX Guidelines and Home page - https://grexercise.arizona.edu/

2. Kidney health Manitoba - https://www.kidneyhealth.ca/living-with-kidney-disease/fitness-wellness/

Celebrating Women in Peritoneal Dialysis

In this special episode of the PD Exchange, hosts Dr. Nikhil Shah and Dr. Jeff Perl celebrate International Women's Day by highlighting three extraordinary female nephrologists from around the world: Dr. Anabela Guedes from Portugal, Dr. Yeoung Jee Cho from Australia, and Dr. Annie-Claire Nadeau-Fredette from Canada.

These leading women in peritoneal dialysis share their inspiring personal and professional journeys, discuss their challenges, and reflect on the importance of mentorship and work-life balance.

The episode delves into their motivations, the impact of gender biases in the field, and the unique ways they manage their demanding careers alongside family responsibilities.

It concludes with valuable advice for future women nephrologists and a discussion on the rewarding nature of working in nephrology and in peritoneal dialysis.

00:00 Introduction to the PD Exchange Podcast

00:45 Celebrating Women in Peritoneal Dialysis

01:49 Meet the Extraordinary Women in PD

02:10 Anabela's Journey into Nephrology

07:14 Yeoungjee's Path to PD

09:34 Annie Claire's Story and Balancing Family

12:09 Balancing Career and Family

19:23 Job Sharing and Work-Life Balance

28:04 Balancing Career and Family

28:56 Challenges of Managing a Busy Life

33:45 Experiencing Sexism in the Workplace

39:11 Reflections and Advice

43:51 The Rewards of Nephrology

47:34 Conclusion and Final Thoughts

Women in PD - Part 1 Link

https://open.spotify.com/episode/2LhdzRkp0mvHuLM8gc5cOF?si=xgJVmPCiQmSkSTBun9Sn0w

Women in PD: Venus envy?

Celebrating Women in Peritoneal Dialysis: Inspiring Careers in PD

In this special episode of the PD Exchange podcast, hosts Dr. Nikhil Shah and Dr. Jeff Perl commemorate International Women's Day and InternationalDay of Women and Girls in Science, focusing on women in Peritoneal Dialysis.

Joined by Dr. Joanne Bargman, Dr. Edwina Brown, and Dr. Ana Elizabeth Figueredo, the discussion dives into their extraordinary career trajectories, challenges faced as women in a predominantly male profession, and their significant contributions to peritoneal dialysis. The conversation covers themes of mentorship, overcoming gender biases, balancing family and career, and the evolving role of women in nephrology.

The episode is both informative and engaging, offering valuable insights and advice for aspiring professionals in the field.

00:00 Introduction to the PD Exchange Podcast

00:25 Celebrating Women in Peritoneal Dialysis

01:34 Ana's Journey in PD Nursing

09:54 Joanne's Career in Peritoneal Dialysis

16:01 Edwina's Path to Nephrology

23:56 Balancing Family and Career

28:30 Changes and Challenges in Nephrology

39:01 Final Thoughts and Reflections

In the first PD Exchange podcast episode of 2025, Dr. Nikhil Shah and Dr. Jeff Perl introduce a groundbreaking topic—the ELIXIR trial to evaluate Xylocore, an innovative glucose-sparing solution for peritoneal dialysis. They are joined by experts Dr. Arduino Arduini and Dr. Richard Corbett, who delve into the formulation, rationale, and design of Xylocore, detailing the incorporation of xylitol and carnitine to optimize dialysis outcomes while minimizing glucose exposure. The discussion covers the scientific, clinical, and logistical aspects of the ongoing phase three trial, implications for diabetic patients, and future research directions, emphasizing the potential cardiometabolic benefits and improved patient engagement in PD therapy.

Welcome to another episode of the PD Exchange with your host Dr Nikhil Shah and your co-host Dr Jeff Perl.

Today, we discuss the newly released Clinical Practice Guideline for the Prevention and Management of Peritoneal Dialysis-Associated Infections in Children.

Drs Brad Warady, Claus Schmitt, Rebecca Same, and Brandy Begin RN discuss these guidelines and the changes from the previous ones!

Enjoy!

Drs Jeff Perl and Nikhil Shah discuss the latest ISPD position paper on Assisted PD with Drs Matthew Oliver (Toronto, Canada), Thierry Lobbedez (Caen, France), and Janet Graham RN (Ottawa, Canada).

Enjoy a wide-ranging discussion that covers everything from why Assisted PD is important to how a new program can start considering planning and implementing it.

Open Access Paper -

Assisted peritoneal dialysis: Position paper for the ISPD - Matthew J Oliver, Graham Abra, Clémence Béchade, Edwina A Brown, Ana Sanchez-Escuredo, David W Johnson, Anabela Malho Guedes, Janet Graham, Natalia Fernandes, Vivekanand Jha, Nadia Kabbali, Talerngsak Knananjubach, Philip Kam-Tao Li, Ulrika Hahn Lundström, Page Salenger, Thierry Lobbedez, 2024 (sagepub.com)

Email - [email protected]

Drs Jeff Perl (@PD_Perls) and Nikhil Shah(@dr_nikhilshah), are joined by the creator of NephMadness Dr Matthew Sparks (@NephroSparks) and Nephrology fellow from Duke University Dr Tim Hopper to discuss the Peritoneal Dialysis Teams in Nephmadness.

The competition -

Team 1 - PD First vs Team 2 - Beyond kt/v

Links -

AJKD Blog Nephmadness PD Region Page

#NephMadness