Quantifying the Waste Associated with Icodextrin in Patients Undergoing Continuous Cycling Peritoneal Dialysis
Bibliographic record
Abstract
Background: Effective healthcare waste (HCW) management and HCW reduction are important considerations for medical programs. Dialysis is associated with significant hazardous and non hazardous HCW. Icodextrin is commonly used in patients undergoing continuous cycling peritoneal dialysis (CCPD). In Canada, Icodextrin for CCPD is only available as 2.5 L, single-use bags. Patient’s often have Icodextrin fill volumes < 2L, with the remainder of the volume being discarded as non-hazardous HCW. We sought to quantify the volume of discarded Icodextrin solution in the CCPD population of the Alberta Kidney Care South (AKC-S) program. Methods: A cross sectional audit was performed of the AKC-S program including all patients utilizing CCPD in 2022. Data included Icodextrin dwell volume, patient demographics, and estimated costs associated with Icodextrin use in 2021. Descriptive statistics were used to report the data. Results: Among 205 patients in the AKC-S program on CCPD, the mean age and PD vintage (± standard error of mean) was 62.7 ± 0.9 years and 27.5 ± 2.1 months respectively. The average Icodextrin dwell volume was 1200 mL. 87% of the patients using Icodextrin were using dwell volumes up to 1500 mL. Our patient population tended to be similar in weight compared to those in previous studies evaluating Icodextrin for the long dwell. In 2021, Icodextrin for CCPD cost AKC-S $1.27 million (CAD). Conclusion: Among patients in the AKC-S program, there is a notable difference in the average fill volume (1200 mL) and available bags of Icodextrin (2.5L) available. This suggests that a large portion of purchased Icodextrin is being discarded as non-hazardous HCW. This practice pattern may also be reflected in other home dialysis programs and further work is needed to (1) understand the large-scale costs and environmental impact associated with Icodextrin waste, (2) develop effective methods to manage HCW in dialysis programs, and (3) implement quality improvement initiatives to reduce HCW associated with peritoneal dialysis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".