101
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Gayen S, Ziemba Y, Jaiswal S, Frank A, Brahmbhatt Y. CDC Group EO-4 and Candida tropicalis Peritonitis in a Patient on Peritoneal Dialysis after Upper Endoscopy, Colonoscopy and Coil Embolization of the Gastroduodenal Artery. Case Rep Gastroenterol 2017; 10:728-732. [PMID: 28100993 PMCID: PMC5216208 DOI: 10.1159/000452201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022] Open
Abstract
Peritoneal dialysis (PD) is an excellent form of renal replacement therapy for many patients with end-stage renal disease (ESRD). Over 10,000 patients receive PD in the United States [United States Renal Data System: 2015 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States, 2015]. PD has superior outcomes compared to hemodialysis in the first 2 years of ESRD [Sinnakirouchenan and Holley: Adv Chronic Kidney Dis 2011;18: 428-432]. However, peritonitis is a known complication and may result in significant morbidity and necessitate transition to hemodialysis, which increases medical costs [Holley and Piraino: Semin Dial 1990;3: 245-248]. We report the first case of a PD patient who underwent endoscopy, colonoscopy and CT angiogram with coil embolization for gastrointestinal bleeding without antibiotic prophylaxis and subsequently developed CDC group EO-4 organism and fungal peritonitis.
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Affiliation(s)
| | - Yonah Ziemba
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Adam Frank
- Thomas Jefferson University, Philadelphia, PA, USA
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102
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Piraino B. Innovations in Treatment Delivery, Risk of Peritonitis, and Patient Retention on Peritoneal Dialysis. Semin Dial 2017; 30:158-163. [PMID: 28066919 DOI: 10.1111/sdi.12571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Early innovations in the delivery of peritoneal dialysis (PD) markedly improved its acceptability and lowered peritonitis rates. The standard osmotic agent was, and continues to be dextrose, an agent that is not ideal as it is readily absorbed. The development of icodextrin-containing dialysis fluid has allowed a long dwell time to provide more effective ultrafiltration. The development of a smaller, more easily used automated cycler, led to an increase in the proportion of patients on the cycler as opposed to CAPD. Recently, new cyclers with better teaching tools and ease of use and communication with the training team have come on the market; data on outcomes using these cyclers are not yet available. Peritonitis continues to be a serious complication of PD although improvements in connectology and research on Staphylococcus aureus carriage have decreased peritonitis risk. Peritonitis rates continue to vary tremendously from one program to another, which may be in part due to failure to follow best demonstrated practices in training, care of the l catheter exit site, and prevention of peritonitis. Peritonitis rates should be expressed as episodes per year at risk and as organism-specific rates to allow comparisons from one program to another, from one period to another and from a program to the published literature. The term technique failure is misused in PD. Patients leave PD for a host of reasons including transplantation. Transfer from PD to hemodialysis can be planned and have an excellent outcome or can be delayed or done emergently and have a less optimal outcome. The life plan of the patient with ESRD needs to be not only considered but also periodically revised as circumstances and patient wishes change.
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Affiliation(s)
- Beth Piraino
- Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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103
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104
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Abstract
Technical innovations in peritoneal dialysis (PD), now used widely for the long-term treatment of ESRD, have significantly reduced therapy-related complications, allowing patients to be maintained on PD for longer periods. Indeed, the survival rate for patients treated with PD is now equivalent to that with in-center hemodialysis. In parallel, changes in public policy have spurred an unprecedented expansion in the use of PD in many parts of the world. Meanwhile, our improved understanding of the molecular mechanisms involved in solute and water transport across the peritoneum and of the pathobiology of structural and functional changes in the peritoneum with long-term PD has provided new targets for improving efficiency and for intervention. As with hemodialysis, almost half of all deaths on PD occur because of cardiovascular events, and there is great interest in identifying modality-specific factors contributing to these events. Notably, tremendous progress has been made in developing interventions that substantially reduce the risk of PD-related peritonitis. Yet the gains have been unequal among individual centers, primarily because of unequal clinical application of knowledge gained from research. The work to date has further highlighted the areas in need of innovation as we continue to strive to improve the health and outcomes of patients treated with PD.
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Affiliation(s)
- Rajnish Mehrotra
- Kidney Research Institute and
- Harborview Medical Center, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, Université Catholique de Louvain Medical School, Brussels, Belgium
| | - Simon J Davies
- Department of Nephrology, Keele University, Staffordshire, United Kingdom; and
| | - David W Johnson
- Department of Nephrology, Division of Medicine, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
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105
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Abstract
With appropriate training and adequate support, it is possible to keep the peritonitis rate of elderly peritoneal dialysis (PD) patients at a highly respectable level. In general, the latest recommendations for the treatment and prevention of PD-related infections by the International Society for Peritoneal Dialysis (ISPD) are applicable to older patients. However, there are minor differences in the spectrum of causative organisms amongst elderly patients, with coagulase-negative staphylococcal species (CNSS) and Enterobacteriaceae species being more common in elderly patients. Elderly PD patients who develop peritonitis have an excessive short-term mortality, and, amongst elderly patients, a high burden of comorbid load increases the risk of relapsing episodes. In addition, technical problems, social difficulties, and concomitant comorbid diseases often have profound effects on the risk of peritonitis as well as its management.
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Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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106
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Campbell DJ, Craig JC, Mudge DW, Brown FG, Wong G, Tong A. Patients' Perspectives on the Prevention and Treatment of Peritonitis in Peritoneal Dialysis: A Semi-Structured Interview Study. Perit Dial Int 2016; 36:631-639. [PMID: 27680766 DOI: 10.3747/pdi.2016.00075] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/27/2016] [Indexed: 11/15/2022] Open
Abstract
♦ BACKGROUND: Peritoneal dialysis (PD) is recommended for adults with residual kidney function and without significant comorbidities. However, peritonitis is a serious and common complication that is associated with hospitalization, pain, catheter loss, and death. This study aims to describe the beliefs, needs, and experiences of PD patients about peritonitis, to inform the training, support, and care of these patients. ♦ METHODS: Qualitative semi-structured interviews were conducted with 29 patients from 3 renal units in Australia who had previous or current experience of PD. The interviews were conducted between November 2014 and November 2015. Transcripts were analyzed thematically. ♦ RESULTS: We identified 4 themes: constant vigilance for prevention (conscious of vulnerability, sharing responsibility with family, demanding attention to detail, ambiguity of detecting infection, ineradicable inhabitation, jeopardizing PD success); invading harm (life-threatening, wreaking internal damage, debilitating pain, losing control and dignity); incapacitating lifestyle interference (financial strain, isolation and separation, exacerbating burden on family); and exasperation with hospitalization (dread of hospital admission, exposure to infection, gruelling follow-up schedule, exposure to harm). ♦ CONCLUSIONS: Patients perceived that peritonitis could threaten their health, treatment modality, and lifestyle, which motivated vigilance and attention to hygiene. They felt a loss of control due to debilitating symptoms including pain and having to be hospitalized, and they were uncertain about how to monitor for signs of peritonitis. Providing patients with education about the causes and signs of peritonitis and addressing their concerns about lifestyle impact, financial impact, hospitalization, and peritonitis-related anxieties may improve treatment satisfaction and outcomes for patients requiring PD.
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Affiliation(s)
- Denise J Campbell
- Sydney School of Public Health, University of Sydney, Sydney, Australia .,Centre for Kidney Research, Sydney Children's Hospital Network (Westmead), Westmead, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Centre for Kidney Research, Sydney Children's Hospital Network (Westmead), Westmead, Australia
| | - David W Mudge
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Fiona G Brown
- Department of Nephrology, Monash Medical Centre, Clayton, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Centre for Kidney Research, Sydney Children's Hospital Network (Westmead), Westmead, Australia
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107
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Debowski JA, Wærp C, Kjellevold SA, Abedini S. Cuff extrusion in peritoneal dialysis: single-centre experience with the cuff-shaving procedure in five patients over a 4-year period. Clin Kidney J 2016. [PMID: 28638613 PMCID: PMC5469562 DOI: 10.1093/ckj/sfw089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Catheter-related infections in peritoneal dialysis (PD) remain a significant complication, and some patients with recurrent exit-site (ESI) and/or tunnel infections may experience external cuff extrusion. In these cases, cuff-shaving has been described as a possible course of treatment. During a 4-year period, there were 44 patients with PD at our department; all received double-cuffed Tenckhoff catheters. Six (13%) never started on PD. Five (13%) of the 38 active PD patients experienced cuff extrusion. Causes of end-stage renal disease (ESRD) were diabetic nephropathy (n = 1), toxic nephropathy (n = 1), hypertensive nephrosclerosis (n = 1), systemic disease (n = 1) and one with unknown cause. PD catheters were inserted by the Department of Surgery and our patients waited a mean of 3.71 weeks (0.57–7.86) from catheter insertion to PD start. Patients were followed up by monthly and even fortnightly during infections. Our cohort experienced two (1–5) ESIs per patient prior to cuff extrusion. Cultures showed growth of Staphylococcus aureus and the patients received dicloxacillin orally 500 mg qid for 3–4 weeks. Of the 38 active PD patients, 5 (13%) developed cuff extrusion with an incidence of 0.20 episodes/patient/year, manifesting on average at 32 weeks (17.3–40.6), due to repeated ESI in four patients and substantial weight loss in one patient. All five underwent cuff-shaving and the ESIs resolved completely in 80% of the cases assisted by supplemental treatment with mupirocin and/or dicloxacillin. There were no complications to the cuff-shaving procedure itself. None of the five patients experienced new ESIs after cuff-shaving had been performed. Cuff-shaving reduces the rate of recurring ESIs. The procedure is safe, if performed correctly, and poses no risk to the patient or the catheter.
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Affiliation(s)
| | - Cora Wærp
- Department of Nephrology, Sykehuset i Vestfold HF, Tonsberg, Norway
| | | | - Sadollah Abedini
- Division of Nephrology, Department of Medicine, Sykehuset i Vestfold, Tonsberg, Norway
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108
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Vargas E, Blake PG, Sanabria M, Bunch A, López P, Vesga J, Buitrago A, Astudillo K, Devia M, Sánchez R. Early Peritonitis in a Large Peritoneal Dialysis Provider System in Colombia. Perit Dial Int 2016; 37:30-34. [PMID: 27605683 DOI: 10.3747/pdi.2016.00030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/03/2016] [Indexed: 11/15/2022] Open
Abstract
♦ BACKGROUND: Peritonitis is the most important complication of peritoneal dialysis (PD), and early peritonitis rate is predictive of the subsequent course on PD. Our aim was to calculate the early peritonitis rate and to identify characteristics and predisposing factors in a large nationwide PD provider network in Colombia. ♦ METHODS: This was a historical observational cohort study of all adult patients starting PD between January 1, 2012, and December 31, 2013, in 49 renal facilities in the Renal Therapy Services in Colombia. We studied the peritonitis rate in the first 90 days of treatment, its causative micro-organisms, its predictors and its variation with time on PD and between individual facilities. ♦ RESULTS: A total of 3,525 patients initiated PD, with 176 episodes of peritonitis during 752 patient-years of follow-up for a rate of 0.23 episodes per patient year equivalent to 1 every 52 months. In 41 of 49 units, the rate was better than 1 per 33 months, and in 45, it was better than 1 per 24 months. Peritonitis rates did not differ with age, ethnicity, socioeconomic status, or PD modality. We identified high incidence risk periods at 2 to 5 weeks after initiation of PD and again at 10 to 12 weeks. ♦ CONCLUSION: An excellent peritonitis rate was achieved across a large nationwide network. This occurred in the context of high nationwide PD utilization and despite high rates of socioeconomic deprivation. We propose that a key factor in achieving this was a standardized approach to management of patients.
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Affiliation(s)
- Edgar Vargas
- Renal Therapy Services RTS, Bogotá, D.C. Colombia
| | - Peter G Blake
- London Health Sciences Centre and Western University, London, ON, Canada
| | | | - Alfonso Bunch
- Renal Therapy Services RTS Latin America, Bogotá, D.C. Colombia
| | | | - Jasmín Vesga
- Renal Therapy Services RTS, Bogotá, D.C. Colombia
| | | | | | - Martha Devia
- Renal Therapy Services RTS, Bogotá, D.C. Colombia
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109
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Grothe C, Taminato M, Belasco A, Sesso R, Barbosa D. Prophylactic treatment of chronic renal disease in patients undergoing peritoneal dialysis and colonized by Staphylococcus aureus: a systematic review and meta-analysis. BMC Nephrol 2016; 17:115. [PMID: 27527505 PMCID: PMC4986188 DOI: 10.1186/s12882-016-0329-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/21/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study was performed to evaluate the clinical effectiveness of alternative strategies for the prevention and treatment of patients with chronic kidney disease undergoing peritoneal dialysis and colonized by Staphylococcus aureus. METHODS A systematic review and meta-analysis were performed. The literature search involved the following databases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. The descriptors were "Staphylococcus aureus," "MRSA," "MSSA," "treatment," "decolonization," "nasal carrier," "colonization," "chronic kidney disease," "dialysis," and "peritoneal dialysis." Randomized controlled trials that exhibited agreement among reviewers as shown by a kappa value of >0.80 were included in the study; methodological quality was evaluated using the STROBE statement. Patients who received various antibiotic treatments (antibiotic group) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or placebo (control group). Patients in the antibiotic group were also compared with those in the mupirocin group. RESULTS In total, nine studies involving 839 patients were included in the analysis, 187 (22.3 %) of whom were nasal carriers of S. aureus. The probability of S. aureus infection at the catheter site for peritoneal dialysis was 74 % lower in the mupirocin than control group (odds ratio [OR], 0.26; 95 % confidence interval [CI], 0.14-0.46; p < 0.001), 56 % lower in the antibiotic than control group (OR, 0.44; 95 % CI, 0.19-0.99; p = 0.048), and 52 % lower in the mupirocin than antibiotic group (OR, 0.48; 95 % CI, 0.21-1.10; p = 0.084). The difference in the probability of S. aureus peritonitis in patients undergoing peritoneal dialysis was not statistically significant among the three groups. CONCLUSIONS Mupirocin and topical antibiotics were effective for reduction of S. aureus catheter site infection in patients undergoing peritoneal dialysis when compared with no treatment or placebo. However, evidence was insufficient to identify the optimal agent, route, or duration of antibiotics to treat peritonitis.
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Affiliation(s)
- Cibele Grothe
- Paulista School of Nursing, Federal University of São Paulo - EPE/UNIFESP, R. Napoleão de Barros 754, São Paulo, 04024-002 Brazil
| | - Mônica Taminato
- Paulista School of Nursing, Federal University of São Paulo - EPE/UNIFESP, R. Napoleão de Barros 754, São Paulo, 04024-002 Brazil
| | - Angélica Belasco
- Paulista School of Nursing, Federal University of São Paulo - EPE/UNIFESP, R. Napoleão de Barros 754, São Paulo, 04024-002 Brazil
| | - Ricardo Sesso
- Division of Nephrology, Paulista School of Medicine, Federal University of São Paulo - EPM/UNIFESP), R. Botucatu 740, São Paulo, 04023-900 Brazil
| | - Dulce Barbosa
- Paulista School of Nursing, Federal University of São Paulo - EPE/UNIFESP, R. Napoleão de Barros 754, São Paulo, 04024-002 Brazil
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110
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Liuzzi AR, Kift-Morgan A, Lopez-Anton M, Friberg IM, Zhang J, Brook AC, Roberts GW, Donovan KL, Colmont CS, Toleman MA, Bowen T, Johnson DW, Topley N, Moser B, Fraser DJ, Eberl M. Unconventional Human T Cells Accumulate at the Site of Infection in Response to Microbial Ligands and Induce Local Tissue Remodeling. THE JOURNAL OF IMMUNOLOGY 2016; 197:2195-207. [PMID: 27527598 PMCID: PMC5009878 DOI: 10.4049/jimmunol.1600990] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/12/2016] [Indexed: 12/13/2022]
Abstract
The antimicrobial responsiveness and function of unconventional human T cells are poorly understood, with only limited access to relevant specimens from sites of infection. Peritonitis is a common and serious complication in individuals with end-stage kidney disease receiving peritoneal dialysis. By analyzing local and systemic immune responses in peritoneal dialysis patients presenting with acute bacterial peritonitis and monitoring individuals before and during defined infectious episodes, our data show that Vγ9/Vδ2+ γδ T cells and mucosal-associated invariant T cells accumulate at the site of infection with organisms producing (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate and vitamin B2, respectively. Such unconventional human T cells are major producers of IFN-γ and TNF-α in response to these ligands that are shared by many microbial pathogens and affect the cells lining the peritoneal cavity by triggering local inflammation and inducing tissue remodeling with consequences for peritoneal membrane integrity. Our data uncover a crucial role for Vγ9/Vδ2 T cells and mucosal-associated invariant T cells in bacterial infection and suggest that they represent a useful predictive marker for important clinical outcomes, which may inform future stratification and patient management. These findings are likely to be applicable to other acute infections where local activation of unconventional T cells contributes to the antimicrobial inflammatory response.
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Affiliation(s)
- Anna Rita Liuzzi
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Ann Kift-Morgan
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Melisa Lopez-Anton
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom; Wales Kidney Research Unit, Heath Park Campus, Cardiff CF14 4XN, United Kingdom
| | - Ida M Friberg
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Jingjing Zhang
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Amy C Brook
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Gareth W Roberts
- Wales Kidney Research Unit, Heath Park Campus, Cardiff CF14 4XN, United Kingdom; Directorate of Nephrology and Transplantation, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Kieron L Donovan
- Wales Kidney Research Unit, Heath Park Campus, Cardiff CF14 4XN, United Kingdom; Directorate of Nephrology and Transplantation, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Chantal S Colmont
- Wales Kidney Research Unit, Heath Park Campus, Cardiff CF14 4XN, United Kingdom
| | - Mark A Toleman
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Timothy Bowen
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom; Wales Kidney Research Unit, Heath Park Campus, Cardiff CF14 4XN, United Kingdom
| | - David W Johnson
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Queensland 4102, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia 5001, Australia
| | - Nicholas Topley
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom; and Systems Immunity Research Institute, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Bernhard Moser
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom; Systems Immunity Research Institute, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Donald J Fraser
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom; Wales Kidney Research Unit, Heath Park Campus, Cardiff CF14 4XN, United Kingdom; Directorate of Nephrology and Transplantation, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom; Systems Immunity Research Institute, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Matthias Eberl
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom; Systems Immunity Research Institute, Cardiff University, Cardiff CF14 4XN, United Kingdom
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111
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Kotera N, Tanaka M, Aoe M, Chikamori M, Honda T, Ikenouchi A, Miura R, Sugahara M, Furuse S, Saito K, Mise N. Age-Related Differences of Organism-Specific Peritonitis Rates: A Single-Center Experience. Ther Apher Dial 2016; 20:655-660. [PMID: 27500906 DOI: 10.1111/1744-9987.12449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 04/01/2016] [Accepted: 04/26/2016] [Indexed: 11/27/2022]
Abstract
Peritonitis remains an important cause of morbidity and mortality in peritoneal dialysis (PD) patients, but its incidence and the distribution of causative organisms vary widely between institutions and age groups. This study was performed to investigate the recent status and risk factors of PD-related peritonitis and to clarify differences between age groups. We retrospectively reviewed the medical records of 119 PD patients treated at our department between January 2002 and January 2013. We calculated both overall and organism-specific peritonitis rates and also analyzed risk factors. Sixty-three episodes of peritonitis occurred during 261.5 patient-years for an incident rate of 0.24 episodes/patient-year. Multivariate analysis showed that older age (≥65 years) and hypoalbuminemia (<3.0 g/dL) were associated with an increased risk of peritonitis (P = 0.035 and P = 0.029, respectively). In elderly patients (≥65 years old), the rate of peritonitis due to Gram-positive and Gram-negative bacteria was 0.17 and 0.08 episodes/patient-year, respectively, and Gram-positive peritonitis was markedly more frequent than in younger patients (<65 years old). In particular, there was a high frequency of Staphylococcus aureus peritonitis in elderly patients (0.09 episodes/patient-year) and it had a poor outcome. At our department, the risk of peritonitis was increased in older patients and patients with hypoalbuminemia. The distribution of causative organisms was markedly different between age groups and analysis of organism-specific peritonitis rates helped to identify current problems with our PD program.
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Affiliation(s)
- Nagaaki Kotera
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan.,Kugayama Kidney Clinic, Tokyo, Japan
| | - Mototsugu Tanaka
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan.,Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mari Aoe
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Masatomo Chikamori
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Tomoko Honda
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Ayako Ikenouchi
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Rika Miura
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Mai Sugahara
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Satoshi Furuse
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Katsunori Saito
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Naobumi Mise
- Department of Nephrology, Division of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
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112
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Chlorhexidine for routine PD catheter exit-site care. Int Urol Nephrol 2016; 48:1543-6. [PMID: 27432412 DOI: 10.1007/s11255-016-1370-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Although guidelines suggest the routine use of mupirocin or gentamicin at the exit site of PD catheter, our PD unit has been using chlorhexidine gluconate 0.5 % as exit-site care protocol. The aim of this study was to ascertain whether mupirocin application is superior to the traditionally applied chlorhexidine-regarding prevention of exit-site infections and peritonitis in our unit. METHODS Stable incident and prevalent patients of our unit were randomized to apply mupirocin or chlorhexidine at exit site. The study started on July 1, 2010, and continued till December 2014. End point was the first episode of exit-site infection or peritonitis. RESULTS Sixty-two patients (mean age 58.5 ± 14.6 years) were randomized. At the end of follow-up, there were 33 patients on mupirocin treatment and 29 on chlorhexidine. The two groups had no differences in age, sex, PD vintage or PD mode. The only difference between the two groups was the percentage of patients with diabetes, 28 % in chlorhexidine group versus 10 % in mupirocin group. Mean time of follow-up was 28.46 ± 16.37 months. Twenty-four episodes of infections (peritonitis and exit site) were recorded. Time to first infection episode was 32 months in mupirocin group (95 % CI 21.4-42.5) versus 29 months (95 % CI 8.6-49.4) in chlorhexidine group. The Kaplan-Meier survival analysis revealed no difference in the infections between the two protocols (log-rank test, p = 0.477). CONCLUSIONS Mupirocin is not superior in preventing infections comparing with chlorhexidine in this cohort of patients.
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113
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Ma TKW, Chow KM, Kwan BCH, Pang WF, Leung CB, Li PKT, Szeto CC. Peritonitis before Peritoneal Dialysis Training: Analysis of Causative Organisms, Clinical Outcomes, Risk Factors, and Long-Term Consequences. Clin J Am Soc Nephrol 2016; 11:1219-1226. [PMID: 27269302 PMCID: PMC4934830 DOI: 10.2215/cjn.00830116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/14/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Peritonitis before peritoneal dialysis (PD) training (pretraining peritonitis [PTP]) is an uncommon event. The study aim was to examine the causative organisms, clinical outcomes, risk factors, and long-term consequences of PTP. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this single-center, retrospective, observational study involving all incident patients on PD who developed PTP between 1998 and 2012, we examined the causative organisms, primary response rate, complete cure rate, risk factors, and associations of PTP with peritoneal equilibration test (PET) and patient survival. For each patient in the PTP group, the patients who underwent catheter insertion immediately before and after the index case were identified as controls. RESULTS Among 1252 incident patients on PD, 52 (4.2%) patients developed PTP, and 104 patients were identified as controls. The two groups were similar in age, sex distribution, comorbidities, and residual renal function, but the PTP group had significantly lower hemoglobin and serum albumin. Patients were followed up for a median of 37.5 months (interquartile range [IQR], 16.3-62.2 months). The most common causative organisms of PTP were Staphylococcus aureus (30.8%) and polymicrobial (21.2%); 25% had negative growth. The primary response and complete cure rates were 82.7% and 78.8%, respectively. In the PTP group, 7.7% of patients died, 9.6% of patients required catheter removal, and PD training was significantly delayed (median =42.0; IQR, 26.0-65.8 days versus 27.5; IQR, 23.0-35.0 days; P=0.01). Multivariate logistic regression analysis showed that serum albumin was the only predictor of PTP (adjusted odds ratio, 0.89 per 1-g/dl increase; 95% confidence interval, 0.82 to 0.97). There were no differences in PET results and dialysis adequacy (measured around 1 month after PD training). The PTP group had significantly worse patient survival (median =41.2; IQR, 21.8-60.5 months versus 55.8; IQR, 40.4-71.2 months; P=0.02). Technique failure occurred in 11.5% and 10.6% of patients in the PTP and control groups, respectively. CONCLUSIONS S. aureus is the most common causative organism of PTP. Nutritional interventions in patients who are hypoalbuminemic before catheter insertion deserve additional study.
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Affiliation(s)
- Terry King-Wing Ma
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Ma TKW, Leung CB, Chow KM, Kwan BCH, Li PKT, Szeto CC. Newer antibiotics for the treatment of peritoneal dialysis-related peritonitis. Clin Kidney J 2016; 9:616-23. [PMID: 27478608 PMCID: PMC4957733 DOI: 10.1093/ckj/sfw059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/06/2016] [Indexed: 01/16/2023] Open
Abstract
Peritonitis is a debilitating infectious complication of peritoneal dialysis (PD). Drug-resistant bacterial peritonitis typically has a lower response rate to antibiotics. In the past 15 years, newer antibiotics with activities against drug-resistant Gram-positive bacteria have been developed. In most circumstances, peritonitis due to methicillin-resistant staphylococci responds to vancomycin. If vancomycin cannot be used due to allergy and/or non-susceptibility, there is increasing evidence that linezolid and daptomycin are the drugs of choice. It is reasonable to start linezolid orally or intravenously, but subsequent dose reduction may be necessary in case of myelosuppression. Daptomycin can be given intravenously or intraperitoneally and has excellent anti-biofilm activity. Other treatment options for drug-resistant Gram-positive bacterial peritonitis include teicoplanin, tigecycline and quinupristin/dalfopristin. Teicoplanin is not available in some countries (e.g. the USA). Tigecycline can only be given intravenously. Quinupristin/dalfopristin is ineffective against Enterococcus faecalis and there is only low-quality evidence to support its efficacy in the treatment of peritonitis. Effective newer antibiotics against drug-resistant Gram-negative bacteria are lacking. Polymyxins can be considered, but evidence on its efficacy is limited. In this review, we will discuss the potential use of newer antibiotics in the treatment of drug-resistant bacterial peritonitis in PD patients.
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Affiliation(s)
- Terry King-Wing Ma
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital , The Chinese University of Hong Kong , Shatin , Hong Kong
| | - Chi Bon Leung
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital , The Chinese University of Hong Kong , Shatin , Hong Kong
| | - Kai Ming Chow
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital , The Chinese University of Hong Kong , Shatin , Hong Kong
| | - Bonnie Ching-Ha Kwan
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital , The Chinese University of Hong Kong , Shatin , Hong Kong
| | - Philip Kam-Tao Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital , The Chinese University of Hong Kong , Shatin , Hong Kong
| | - Cheuk Chun Szeto
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital , The Chinese University of Hong Kong , Shatin , Hong Kong
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Li PKT, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, Fish DN, Goffin E, Kim YL, Salzer W, Struijk DG, Teitelbaum I, Johnson DW. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int 2016; 36:481-508. [PMID: 27282851 PMCID: PMC5033625 DOI: 10.3747/pdi.2016.00078] [Citation(s) in RCA: 612] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Beth Piraino
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Javier de Arteaga
- Department of Nephrology, Hospital Privado and Catholic University, Cordoba, Argentina
| | - Stanley Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | - Ana E Figueiredo
- Nursing School-FAENFI, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas N Fish
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Eric Goffin
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Belgium
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - William Salzer
- University of Missouri-Columbia School of Medicine, Department of Internal Medicine, Section of Infectious Disease, MI, USA
| | - Dirk G Struijk
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
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Dalgaard LS, Nørgaard M, Povlsen JV, Jespersen B, Jensen-Fangel S, Ellermann-Eriksen S, Østergaard L, Schønheyder HC, Søgaard OS. Risk and Prognosis of Bacteremia and Fungemia Among Peritoneal Dialysis Patients: A Population-Based Cohort Study. Perit Dial Int 2016; 36:647-654. [PMID: 27147288 DOI: 10.3747/pdi.2015.00197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/02/2016] [Indexed: 11/15/2022] Open
Abstract
♦ BACKGROUND: The incidence of bacteremia and fungemia (BAF) is largely unknown in end-stage renal disease (ESRD) patients initiating peritoneal dialysis (PD). ♦ OBJECTIVE: The main objective was to estimate and compare incidence rates of first episodes of BAF in incident PD patients and a comparison cohort. A secondary objective was to compare causative agents and 30-day post-BAF mortality between PD patients and the comparison cohort. ♦ METHODS: Design: Observational cohort study. SETTING Central and North Denmark regions. PARTICIPANTS patients who initiated PD during 1995 - 2010. For each patient we sampled up to 10 controls from the general population matched on age, sex, and municipality. ♦ MAIN OUTCOME: Data on positive blood cultures were retrieved from electronic microbiology databases covering the 2 regions. We calculated incidence rates (IRs) of first-time BAF for PD patients and population controls. Incidence-rate ratios (IRRs) were calculated to compare these rates. Thirty-day mortality was estimated by Kaplan-Meier analysis. ♦ RESULTS: Among 1,024 PD patients and 10,215 population controls, we identified 75 and 282 episodes of BAF, respectively. Incidence rates of BAF were 4.7 (95% confidence interval [CI], 3.8 - 5.9) per 100 person-years of follow-up (PYFU) in PD patients and 0.5 (95% CI, 0.4 - 0.5) per 100 PYFU in population controls (IRR = 10.4; 95% CI, 8.1 - 13.5). In PD patients, the most frequent microorganisms were Escherichia coli (18.7%) and Staphylococcus aureus (13.3%). Escherichia coli (27.3%) also ranked first among population controls. Thirty-day mortality following BAF was 20.8% (95% CI, 12.6 - 31.0) and 20.7% (95% CI, 16.3 - 25.9) among PD patients and population controls, respectively. ♦ CONCLUSIONS: Peritoneal dialysis patients are at markedly higher risk of BAF than population controls. Causative agents and the 30-day post-BAF mortality were similar in the 2 cohorts.
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Affiliation(s)
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | | | - Bente Jespersen
- Department of Nephrology, Aarhus University Hospital, Denmark
| | | | | | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Denmark.,Department of Clinical Medicine, Aalborg University, Denmark
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Sun TYT, Voss D, Beechey D, Lam-Po-Tang M. Comparison of peritoneal dialysis catheter insertion techniques: Peritoneoscopic, radiological and laparoscopic : A single-centre study. Nephrology (Carlton) 2016; 21:416-22. [DOI: 10.1111/nep.12621] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/02/2015] [Accepted: 08/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Tina Y-T Sun
- Department of Renal Medicine; Counties Manukau DHB; Auckland New Zealand
| | - David Voss
- Department of Renal Medicine; Counties Manukau DHB; Auckland New Zealand
| | - Denise Beechey
- Department of Renal Medicine; Counties Manukau DHB; Auckland New Zealand
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Bergjan M, Schaepe C. Educational strategies and challenges in peritoneal dialysis: a qualitative study of renal nurses' experiences. J Clin Nurs 2016; 25:1729-39. [PMID: 27074958 DOI: 10.1111/jocn.13191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of the study was to explore renal nurses' experiences, strategies and challenges with regard to the patient education process in peritoneal dialysis. BACKGROUND Patient education in peritoneal dialysis is essential to developing a successful home-based peritoneal dialysis program. In this area research is scarce and there is a particular lack of focus on the perspective of the renal nurse. DESIGN Qualitative design formed by thematic qualitative text analysis. METHODS Five group interviews (n = 20) were used to explore the challenges peritoneal dialysis nurses face and the training strategies they use. The interviews were analyzed with thematic qualitative content analysis using deductive and inductive subcategory application. RESULTS The findings revealed the education barriers perceived by nurses that patients may face. They also showed that using assessment tools is important in peritoneal dialysis patient education, as is developing strategies to promote patient self-management. There is a need for a deeper understanding of affective learning objectives, and existing teaching activities and materials should be revised to incorporate the patient's perspective. Patients usually begin having questions about peritoneal dialysis when they return home and are described as feeling overwhelmed. Adapting existing conditions is considered a major challenge for patients and nurses. CONCLUSIONS The results provided useful insights into the best approaches to educating peritoneal dialysis patients and served to raise awareness of challenges experienced by renal nurses. Findings underline the need for nosogogy - an approach of teaching adults (andragogy) with a chronic disease. Flexibility and cooperation are competencies that renal nurses must possess. RELEVANCE TO CLINICAL PRACTICE Still psychomotor skills dominate peritoneal dialysis patient training, there is a need of both a deeper understanding of affective learning objectives and the accurate use of (self-)assessment tools, particularly for health literacy.
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Affiliation(s)
- Manuela Bergjan
- Institute of Health and Nursing Science, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Christiane Schaepe
- Institute of Health and Nursing Science, Charité - Universitaetsmedizin Berlin, Berlin, Germany
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Wong PN, Tong GMW, Wong YY, Lo KY, Chan SF, Lo MW, Lo KC, Ho LY, Tse CWS, Mak SK, Wong AKM. Alternating Mupirocin/Gentamicin is Associated with Increased Risk of Fungal Peritonitis as Compared with Gentamicin Alone - Results of a Randomized Open-Label Controlled Trial. Perit Dial Int 2016; 36:340-6. [PMID: 27044796 DOI: 10.3747/pdi.2015.00237] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/30/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND AND OBJECTIVES Catheter-related infection, namely exit-site infection (ESI) and peritonitis, is a major infectious complication and remains a main cause of technique failure for patients receiving peritoneal dialysis (PD). Topical application of antibiotic cream might reduce catheter-related infection but emergence of resistant or opportunistic organisms could be a concern. Optimal topical agents and regimens remain to be determined. We did a study to examine the effect of an alternating topical antibiotic regimen in preventing catheter-related infection. ♦ METHOD We performed a single-center, randomized, open-label study to compare daily topical application of gentamicin cream with a gentamicin/mupirocin alternate regimen to the exit site. Patients randomized to alternating regimen were asked to have daily application of gentamicin cream in odd months and mupirocin cream in even months. Primary outcomes were ESI and peritonitis. Secondary outcomes were catheter removal or death caused by catheter-related infection. A total of 146 patients (71, gentamicin group; 75, alternating regimen group) were enrolled with a total follow-up duration of 174 and 181 patient-years for gentamicin and alternating groups, respectively. All patients were followed up until catheter removal, death, transfer to another unit, transplantation or the end of the study on March 31, 2014. There were no significant differences in the age, sex, dialysis vintage, and rate of diabetes, helper-assisted dialysis and methicillin-resistant Staphylococcus aureus (MRSA) carriage state. ♦ RESULTS No difference was seen in the time to first ESI or peritonitis. However, the time to first gram-negative peritonitis seemed longer for the gentamicin group (p = 0.055). The 2 groups showed a similar rate of ESI (0.17/yr vs 0.19/yr, p = 0.93) but P. aeruginosa ESI was less common in the gentamicin group (0.06/yr vs 0.11/yr, p < 0.001). There was no difference in the incidence of ESI due to non-tuberculous mycobacteria. Peritonitis rate was significantly lower in the gentamicin group (0.22/yr vs 0.32/yr, p < 0.001), with a striking decrease in gram-negative peritonitis (0.08/yr vs 0.14/yr, p < 0.001), and fungal peritonitis (0.006/yr vs 0.03/yr, p < 0.001), which was all antibiotics-related episodes with antecedent use of systemic antibiotics for the treatment of catheter-related infections. There was no significant difference in the catheter loss or death related to catheter-related infection. ♦ CONCLUSION Alternating gentamicin/mupirocin cream application appeared as effective as gentamicin alone in preventing ESI except for P. aeruginosa. However, it was inferior to gentamicin in the prevention of peritonitis episodes, especially for those caused by gram-negative organisms. It was also not useful in reducing catheter-related infection due to opportunistic organisms but instead associated with a higher incidence of antibiotic-related fungal peritonitis.
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Affiliation(s)
- Ping-Nam Wong
- Renal Unit, Department of Integrated Medical Service, Kwong Wah Hospital, Hong Kong SAR, China
| | - Gensy M W Tong
- Renal Unit, Department of Integrated Medical Service, Kwong Wah Hospital, Hong Kong SAR, China
| | - Yuk-Yi Wong
- Renal Unit, Department of Integrated Medical Service, Kwong Wah Hospital, Hong Kong SAR, China
| | - Kin-Yee Lo
- Renal Unit, Department of Integrated Medical Service, Kwong Wah Hospital, Hong Kong SAR, China
| | - Shuk-Fan Chan
- Renal Unit, Department of Integrated Medical Service, Kwong Wah Hospital, Hong Kong SAR, China
| | - Man-Wai Lo
- Renal Unit, Department of Integrated Medical Service, Kwong Wah Hospital, Hong Kong SAR, China
| | - Kwok-Chi Lo
- Renal Unit, Department of Integrated Medical Service, Kwong Wah Hospital, Hong Kong SAR, China
| | - Lo-Yi Ho
- Renal Unit, Department of Integrated Medical Service, Kwong Wah Hospital, Hong Kong SAR, China
| | - Cindy W S Tse
- Department of Microbiology, Kwong Wah Hospital, Hong Kong SAR, China
| | - Siu-Ka Mak
- Renal Unit, Department of Integrated Medical Service, Kwong Wah Hospital, Hong Kong SAR, China
| | - Andrew K M Wong
- Renal Unit, Department of Integrated Medical Service, Kwong Wah Hospital, Hong Kong SAR, China
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Guillouët S, Veniez G, Verger C, Béchade C, Ficheux M, Uteza J, Lobbedez T. Estimation of the Center Effect on Early Peritoneal Dialysis Failure: A Multilevel Modelling Approach. Perit Dial Int 2016; 36:519-25. [PMID: 27044794 DOI: 10.3747/pdi.2015.00245] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/29/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ INTRODUCTION This study was carried out to investigate the center effect on the risk of peritoneal dialysis (PD) failure within the first 6 months of therapy using a multilevel approach. ♦ METHODS This was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analyzed 5,406 incident patients starting PD between January 2008 and December 2012 in 128 PD centers. The end of the observation period was December 31, 2013. ♦ RESULTS Of the 5,406 patients, 415 stopped PD within the first 6 months. There was a significant heterogeneity between centers (variance of the random effect: 0.10). Only 3% of the variance of the event of interest was attributable to differences between centers. At the individual level, only treatment before PD (odds ratio [OR]: 1.93 for hemodialysis and OR: 2.29 for renal transplantation) and underlying nephropathy (p < 0.01) were associated with early PD failure. At the center level, only center experience was associated (OR: 0.78) with the risk of PD failure. Center effect accounted for 52% of the disparities between centers. ♦ CONCLUSION Center effect on early PD failure is significant. Center experience is associated with a lower risk of transfer to hemodialysis.
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121
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Firanek C, Szpara E, Polanco P, Davis I, Sloand J. Comparison of Disinfection Procedures on the Catheter Adapter-Transfer Set Junction. Perit Dial Int 2016; 36:225-7. [PMID: 27006440 DOI: 10.3747/pdi.2014.00319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Peritonitis is a significant complication of peritoneal dialysis (PD), contributing to mortality and technique failure. Suboptimal disinfection and/or a loose connection at the catheter adapter-transfer set junction are forms of touch contamination that can compromise the integrity of the sterile fluid path and lead to peritonitis. Proper use of the right disinfectants for connections at the PD catheter adapter-transfer set interface can help eliminate bacteria at surface interfaces, secure connections, and prevent bacteria from entering into the sterile fluid pathway. Three studies were conducted to assess the antibacterial effects of various disinfecting agents and procedures, and ensuing security of the catheter adapter-transfer set junction. An open-soak disinfection procedure with 10% povidone iodine improves disinfection and tightness/security of catheter adapter-transfer set connection.
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Affiliation(s)
- Catherine Firanek
- Renal Division, Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL 60015, USA
| | - Edward Szpara
- Research and Development, Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL 60015, USA
| | - Patricia Polanco
- Research and Development, Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL 60015, USA
| | - Ira Davis
- Global Medical Affairs, Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL 60015, USA
| | - James Sloand
- Global Medical Affairs, Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL 60015, USA
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A Quality Improvement Intervention to Reduce Indwelling Tunneled Pleural Catheter Infection Rates. Ann Am Thorac Soc 2016; 12:847-53. [PMID: 25871702 DOI: 10.1513/annalsats.201411-511oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The indwelling tunneled pleural catheter has altered the management of patients with dyspnea related to malignant pleural effusions. However, indwelling tunneled pleural catheter placement does not remain free from risk. The most commonly reported risk is infection. OBJECTIVES The aim of this paper is to describe our continuous quality improvement program for infection rate recognition, the process changes implemented for improvement, and subsequent outcomes. METHODS All patients undergoing indwelling tunneled pleural catheter placement at The Johns Hopkins Medical Institutions between May 2009 and April 2014 were identified. The primary outcome was the incidence of infection within the preintervention and intervention cohorts. Intervention was identified as use of preoperative antibiotics, full sterile draping, and limiting placement to a single defined location. MEASUREMENTS AND MAIN RESULTS A total of 225 indwelling tunneled pleural catheter placements were performed in 201 patients during the study period, and the overall infection rate was 5.8%. During the preintervention period, 134 placements were performed, and 91 placements occurred during the intervention period. A preintervention infection rate was identified as 8.2%, with a significant decrease to 2.2% (P = 0.049) within the intervention cohort. CONCLUSIONS The use of a continuous quality improvement program to review indwelling tunneled pleural catheter practices can result in the identification of infectious complications and lead to implementation of measures to improve patient outcomes.
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123
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Basu B, Mahapatra TKS. Regular Deworming: A Missed Opportunity to Prevent Peritoneal Dialysis-Related Infections in Children. Perit Dial Int 2016; 36:223-4. [DOI: 10.3747/pdi.2014.00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic peritoneal dialysis (PD) is a common dialysis treatment modality used to treat children with end-stage renal disease. Dialysis-related infections are the leading cause of technique failure. Enterobius vermicularis infestation indirectly increases the infection rate by causing pruritus around the anus, especially at night. We observed a significant decrease in the total infection rate (2.3 vs 5.4 per patient-year) following regular deworming over a 1-year study period. Regular deworming may be considered to prevent secondary bacterial infections in children on chronic PD.
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Affiliation(s)
- Biswanath Basu
- Division of Pediatric Nephrology, Department of Pediatrics NRS Medical College & Hospital, Kolkata, India
| | - TKS Mahapatra
- Department of Pediatrics, NRS Medical College & Hospital Kolkata, India
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Figueiredo AE, Bernardini J, Bowes E, Hiramatsu M, Price V, Su C, Walker R, Brunier G. A Syllabus for Teaching Peritoneal Dialysis to Patients and Caregivers. Perit Dial Int 2016; 36:592-605. [PMID: 26917664 DOI: 10.3747/pdi.2015.00277] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/10/2016] [Indexed: 01/16/2023] Open
Abstract
Being aware of controversies and lack of evidence in peritoneal dialysis (PD) training, the Nursing Liaison Committee of the International Society for Peritoneal Dialysis (ISPD) has undertaken a review of PD training programs around the world in order to develop a syllabus for PD training. This syllabus has been developed to help PD nurses train patients and caregivers based on a consensus of training program reviews, utilizing current theories and principles of adult education. It is designed as a 5-day program of about 3 hours per day, but both duration and content may be adjusted based on the learner. After completion of our proposed PD training syllabus, the PD nurse will have provided education to a patient and/or caregiver such that the patient/caregiver has the required knowledge, skills and abilities to perform PD at home safely and effectively. The course may also be modified to move some topics to additional training times in the early weeks after the initial sessions. Extra time may be needed to introduce other concepts, such as the renal diet or healthy lifestyle, or to arrange meetings with other healthcare professionals. The syllabus includes a checklist for PD patient assessment and another for PD training. Further research will be needed to evaluate the effect of training using this syllabus, based on patient and nurse satisfaction as well as on infection rates and longevity of PD as a treatment.
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Affiliation(s)
- Ana E Figueiredo
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Elaine Bowes
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Valerie Price
- Atlantic Health Sciences Corporation, Saint John, New Brunswick, Canada
| | - Chunyan Su
- Peking University Third Hospital, Beijing, China
| | - Rachael Walker
- Hawke's Bay District Health Board, New Zealand, University of Sydney, Sydney, Australia
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Nadeau-Fredette AC, Johnson DW, Hawley CM, Pascoe EM, Cho Y, Clayton PA, Borlace M, Badve SV, Sud K, Boudville N, McDonald SP. Center-Specific Factors Associated with Peritonitis Risk-A Multi-Center Registry Analysis. Perit Dial Int 2016; 36:509-18. [PMID: 26764341 DOI: 10.3747/pdi.2015.00146] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/20/2015] [Indexed: 01/08/2023] Open
Abstract
UNLABELLED ♦ BACKGROUND Previous studies have reported significant variation in peritonitis rates across dialysis centers. Limited evidence is available to explain this variability. The aim of this study was to assess center-level predictors of peritonitis and their relationship with peritonitis rate variations. ♦ METHODS All incident peritoneal dialysis (PD) patients treated in Australia between October 2003 and December 2013 were included. Data were accessed through the Australia and New Zealand Dialysis and Transplant Registry. The primary outcome was peritonitis rate, evaluated in a mixed effects negative binomial regression model. Peritonitis-free survival was assessed as a secondary outcome in a Cox proportional hazards model. ♦ RESULTS Overall, 8,711 incident PD patients from 51 dialysis centers were included in the study. Center-level predictors of lower peritonitis rates included smaller center size, high proportion of PD, low peritoneal equilibration test use at PD start, and low proportion of hospitalization for peritonitis. In contrast, a low proportion of automated PD exposure, high icodextrin exposure and low or high use of antifungal prophylaxis at the time of peritonitis were associated with a higher peritonitis rate. Similar results were obtained for peritonitis-free survival. Overall, accounting for center-level characteristics appreciably decreased peritonitis variability among dialysis centers (p = 0.02). ♦ CONCLUSION This study identified specific center-level characteristics associated with the variation in peritonitis risk. Whether these factors are directly related to peritonitis risk or surrogate markers for other center characteristics is uncertain and should be validated in further studies.
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Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada
| | - David W Johnson
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Carmel M Hawley
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Yeoungjee Cho
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Nephrology, Prince of Wales Hospital, Sydney, Australia Faculty of Medicine, University of Sydney, Nepean Clinical School, Kingswood, Australia
| | - Monique Borlace
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Sunil V Badve
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
| | - Kamal Sud
- Faculty of Medicine, University of Sydney, Nepean Clinical School, Kingswood, Australia Departments of Renal Medicine, Nepean and Westmead Hospitals, Sydney, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, University of Western Australia, Australia
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
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Gosmanova EO, Ezumba I, Fisher KR, Cleveland KO. A Case Report of Rash at Peritoneal Dialysis Exit Site. J Investig Med High Impact Case Rep 2015; 3:2324709615618222. [PMID: 26668811 PMCID: PMC4674992 DOI: 10.1177/2324709615618222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The International Society for Peritoneal Dialysis recommends the regular application of topical antibiotic-containing preparations in addition to a routine exit site care to reduce the risk of exit site infection (ESI). Among these prophylactic antimicrobial preparations, topical gentamicin is one of the widely used and effective antibiotics for prevention of ESI and peritonitis in peritoneal dialysis (PD) patients. Overall, topical gentamicin is well tolerated; however, its use can be associated with the development of allergic contact dermatitis (ACD). We describe a first reported case of PD catheter exit site contact ACD due to topical gentamicin mimicking ESI. The patient in this report developed worsening violaceous in color and pruritic rash surrounding the PD catheter exit site that appeared 3 weeks after the initiation of gentamicin cream. The association between development of rash and initiation of topical gentamicin led to a suspicion of local reaction to gentamicin rather than ESI. Skin biopsy confirmed ACD. Discontinuation of the provoking agent and subsequent treatment with topical hydrocortisone application led to a resolution of the exit site rash. Any rash at a PD catheter exit site should be considered infectious until proven otherwise. However, it is important to be aware of noninfectious etiologies of exit site rashes as the treatment of these 2 conditions differs.
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Affiliation(s)
- Elvira O Gosmanova
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ikena Ezumba
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kristopher R Fisher
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kerry O Cleveland
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Chen SS, Sheth H, Piraino B, Bender F. Long-Term Exit-Site Gentamicin Prophylaxis and Gentamicin Resistance in a Peritoneal Dialysis Program. Perit Dial Int 2015; 36:387-9. [PMID: 26634567 DOI: 10.3747/pdi.2015.00162] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/06/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND Daily gentamicin cream exit-site prophylaxis reduces peritoneal dialysis (PD)-related gram-negative infections. However, there is a concern about the potential for increasing gentamicin resistance with the long-term use of prophylactic gentamicin. This study evaluated the incidence of gentamicin-resistant PD-related infections over more than 2 decades. ♦ METHODS Study data on prevalent PD patients were retrieved from a prospectively maintained institutional review board (IRB)-approved PD registry at a single center from January 1, 1991, to December 31, 2000, and January 1, 2004, to December 31, 2013. The rates of gram-negative infections, fungal infections and those infections with organisms resistant to gentamicin were examined for the 2 periods. Period 1 from 1991 to 2000 when S. aureus prophylaxis consisted initially of oral rifampin to treat nasal carriage with S. aureus, and was then daily exit-site mupirocin ointment for all PD patients, was compared to the period from 2004 to 2013 when daily exit-site gentamicin cream was prescribed as prophylaxis (Period 2). ♦ RESULTS The study included a total of 444 PD patients (265 and 179 in Period 1 and Period 2, respectively). No significant difference was noted in demographics between the 2 periods except race. The gram-negative exit-site infection rates for Period 1 and Period 2 were 0.109 versus 0.027 (p < 0.0001). Gram-negative peritonitis rates were similar. There were 3 episodes of gentamicin-resistant infections in each period. Fungal infections remained consistently low. ♦ CONCLUSION Despite a decade of exit-site gentamicin prophylaxis, gentamicin-resistant PD-related infections and fungal infections remained very low and similar to the prior period.
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Affiliation(s)
- Shan Shan Chen
- Nephrology Division, Department of Medicine at the University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Heena Sheth
- Renal-Electrolyte Division, Department of Medicine at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Beth Piraino
- Renal-Electrolyte Division, Department of Medicine at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Filitsa Bender
- Renal-Electrolyte Division, Department of Medicine at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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128
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Choy ASM, Li PKT. Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong. Blood Purif 2015; 40:320-5. [PMID: 26657278 DOI: 10.1159/000441580] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In Hong Kong, the average annual cost of haemodialysis (HD) per patient is more than double of that of peritoneal dialysis (PD). As the number of patients with end-stage renal disease (ESRD) has surged, it has posed a great financial burden to the government and society. A PD-first policy has been implemented in Hong Kong for three decades based on its cost-effectiveness, and has achieved successful outcomes throughout the years. A successful PD-first policy requires medical expertise in PD, the support of dedicated staff and a well-designed patient training programme. Addressing patients' PD problems is the key to sustainability of the PD-first policy. In this article, we highlight three important groups of patients: those with frequent peritonitis, ultrafiltration failure or inadequate dialysis. Potential strategies to improve the outcomes of these groups will be discussed. Moreover, enhancing HD as back-up support and promoting organ transplantation are needed in order to maintain sustainability of the PD-first policy.
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Affiliation(s)
- Agnes Shin-Man Choy
- CUHK Carol & Richard Yu PD Research Center, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR, China
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129
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Overcoming the Underutilisation of Peritoneal Dialysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:431092. [PMID: 26640787 PMCID: PMC4658397 DOI: 10.1155/2015/431092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/20/2015] [Indexed: 11/23/2022]
Abstract
Peritoneal dialysis is troubled with declining utilisation as a form of renal replacement therapy in developed countries. We review key aspects of therapy evidenced to have a potential to increase its utilisation. The best evidence to repopulate PD programmes is provided for the positive impact of timely referral and systematic and motivational predialysis education: average odds ratio for instituting peritoneal dialysis versus haemodialysis was 2.6 across several retrospective studies on the impact of predialysis education. Utilisation of PD for unplanned acute dialysis starts facilitated by implantation of peritoneal catheters by interventional nephrologists may diminish the vast predominance of haemodialysis done by central venous catheters for unplanned dialysis start. Assisted peritoneal dialysis can improve accessibility of home based dialysis to elderly, frail, and dependant patients, whose quality of life on replacement therapy may benefit most from dialysis performed at home. Peritoneal dialysis providers should perform close monitoring, preventing measures, and timely prophylactic therapy in patients judged to be prone to EPS development. Each peritoneal dialysis programme should regularly monitor, report, and act on key quality indicators to manifest its ability of constant quality improvement and elevate the confidence of interested patients and financing bodies in the programme.
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Leelahavanichkul A, Pongpirul K, Thongbor N, Worasilchai N, Petphuak K, Thongsawang B, Towannang P, Lorvinitnun P, Sukhontasing K, Katavetin P, Praditpornsilpa K, Eiam-Ong S, Chindamporn A, Kanjanabuch T. (1→3)-β-d-Glucan and Galactomannan for Differentiating Chemical "Black Particles" and Fungal Particles Inside Peritoneal Dialysis Tubing. Perit Dial Int 2015; 36:402-9. [PMID: 26526048 DOI: 10.3747/pdi.2014.00235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 08/17/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND Aseptic, sheet-like foreign bodies observed inside Tenckhoff (TK) catheter lumens (referred to as "black particles") are, on gross morphology, hardly distinguishable from fungal colonization because these contaminants adhere tightly to the catheter. Detection of fungal cell wall components using (1→3)-β-d-glucan (BG) and galactomannan index (GMI) might be an alternative method for differentiating the particles. ♦ METHODS Foreign particles retrieved from TK catheters in 19 peritoneal dialysis patients were examined microscopically and cultured for fungi and bacteria. Simultaneously, a Fungitell test (Associates of Cape Cod, Falmouth, MA, USA) and a Platelia Aspergillus ELISA assay (Bio-Rad Laboratories, Marnes-La-Coquette, France) were used to test the spent dialysate for BG and GMI respectively. ♦ RESULTS Of the 19 patients, 9 had aseptic black particles and 10 had fungal particles in their tubing. The fungal particles looked grainy, were tightly bound to the catheter, and appeared more "colorful" than the black particles, which looked sheet-like and could easily be removed by milking the tubing. Compared with effluent from patients having aseptic particles, effluent from patients with fungal particles had significantly higher levels of BG (501 ± 70 pg/mL vs. 46 ± 10 pg/mL) and GMI (10.98 ± 2.17 vs. 0.25 ± 0.05). Most of the fungi that formed colonies inside the catheter lumen were molds not usually found in clinical practice, but likely from water or soil, suggesting environmental contamination. Interestingly, in all 10 patients with fungal colonization, visualization of black particles preceded a peritonitis episode and TK catheter removal by approximately 1-3 weeks; in patients with aseptic particles, a 17-week onset to peritonitis was observed. ♦ CONCLUSIONS In all patients with particle-coated peritoneal dialysis tubing, spent dialysate should be screened for BG and GMI. Manipulation of the TK catheter by squeezing, hard flushing, or even brushing to dislodge black particles should be avoided. Replacement of the TK catheter should be suspended until a cause for the particles is determined.
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Affiliation(s)
- Asada Leelahavanichkul
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Navaporn Worasilchai
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kwanta Petphuak
- Kidney and Metabolic Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok
| | - Bussakorn Thongsawang
- Kidney and Metabolic Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok
| | - Piyaporn Towannang
- Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok
| | | | - Kanya Sukhontasing
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pisut Katavetin
- Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ariya Chindamporn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Talerngsak Kanjanabuch
- Kidney and Metabolic Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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131
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Kumar PS, Mauriello CT, Hair PS, Rister NS, Lawrence C, Raafat RH, Cunnion KM. Glucose-based dialysis fluids inhibit innate defense against Staphylococcus aureus. Mol Immunol 2015; 67:575-83. [DOI: 10.1016/j.molimm.2015.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/03/2015] [Accepted: 07/16/2015] [Indexed: 01/09/2023]
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Kitterer D, Latus J, Pöhlmann C, Alscher MD, Kimmel M. Microbiological Surveillance of Peritoneal Dialysis Associated Peritonitis: Antimicrobial Susceptibility Profiles of a Referral Center in GERMANY over 32 Years. PLoS One 2015; 10:e0135969. [PMID: 26405797 PMCID: PMC4583423 DOI: 10.1371/journal.pone.0135969] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/28/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives Peritonitis is one of the most important causes of treatment failure in peritoneal dialysis (PD) patients. This study describes changes in characteristics of causative organisms in PD-related peritonitis and antimicrobial susceptibility. Methods In this single center study we analyzed retrospective 487 susceptibility profiles of the peritoneal fluid cultures of 351 adult patients with peritonitis from 1979 to 2014 (divided into three time periods, P1-P3). Results Staphylococcus aureus decreased from P1 compared to P2 and P3 (P<0.05 and P<0.01, respectively). Methicillin-resistant S. aureus (MRSA) occurred only in P3. Methicillin-resistant Staphylococcus epidermidis (MRSE) increased in P3 over P1 and P2 (P <0.0001, respectively). In P2 and P3, vancomycin resistant enterococci were detected. The percentage of gram-negative organisms remained unchanged. Third generation cephalosporin resistant gram-negative rods (3GCR-GN) were found exclusively in P3. Cefazolin-susceptible gram-positive organisms decreased over the three decades (93% in P1, 75% in P2 and 58% in P3, P<0.01, P<0.05 and P<0.0001, respectively). Vancomycin susceptibility decreased and gentamicin susceptibility in gram-negatives was 94% in P1, 82% in P2 and 90% in P3. Ceftazidim susceptibility was 84% in P2 and 93% in P3. Conclusions Peritonitis caused by MSSA decreased, but peritonitis caused by MRSE increased. MRSA peritonitis is still rare. Peritonitis caused by 3GCR-GN is increasing. An initial antibiotic treatment protocol should be adopted for PD patients to provide continuous surveillance.
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Affiliation(s)
- Daniel Kitterer
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Joerg Latus
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Christoph Pöhlmann
- Department of Diagnostic and Laboratory Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - M. Dominik Alscher
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Martin Kimmel
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
- * E-mail:
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133
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Gould AL, Chahla E, Hachem C. Peritonitis following Endoscopy in a Patient on Peritoneal Dialysis with a Discussion of Current Recommendations on Antibiotic Prophylaxis. Case Rep Gastroenterol 2015; 9:302-6. [PMID: 26483616 PMCID: PMC4608652 DOI: 10.1159/000437291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Patients on peritoneal dialysis (PD) are at increased risk for peritonitis. We report a case of a patient with end-stage renal disease on continuous ambulatory PD (CAPD) who developed peritonitis within 24 h of upper endoscopy with biopsy and colonoscopy with polypectomy. He had a previous history of peritonitis unrelated to invasive procedures and eventually was transitioned to hemodialysis because of his recurrent peritonitis. The International Society for Peritoneal Dialysis (ISPD) and newly revised American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend prophylactic antibiotics for CAPD patients undergoing endoscopic procedures. Other guidelines do not address this issue, and there has been limited evidence to support recommendations.
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Affiliation(s)
- Amy L Gould
- Saint Louis University School of Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Elie Chahla
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Christine Hachem
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Mo., USA
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134
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Kussmann M, Schuster L, Zeitlinger M, Pichler P, Reznicek G, Wiesholzer M, Burgmann H, Poeppl W. The influence of different peritoneal dialysis fluids on the in vitro activity of ampicillin, daptomycin, and linezolid against Enterococcus faecalis. Eur J Clin Microbiol Infect Dis 2015; 34:2257-63. [PMID: 26337433 DOI: 10.1007/s10096-015-2477-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/20/2015] [Indexed: 11/28/2022]
Abstract
Intraperitoneal administration of antibiotics is recommended for the treatment of peritoneal dialysis-related peritonitis. However, little data are available on a possible interference between peritoneal dialysis fluids and the activity of antimicrobial agents. Thus, the present in vitro study set out to investigate the influence of different peritoneal dialysis fluids on the antimicrobial activity of ampicillin, linezolid, and daptomycin against Enterococcus faecalis. Time-kill curves in four different peritoneal dialysis fluids were performed over 24 h with four different concentrations (1 × MIC, 4 × MIC, 8 × MIC, 30 × MIC) of each antibiotic evaluated. Cation-adjusted Mueller-Hinton broth was used as the comparator solution. All four peritoneal dialysis fluids evaluated had a bacteriostatic effect on the growth of Enterococcus faecalis. Compared to the cation-adjusted Mueller-Hinton broth comparator solution, the antimicrobial activity of all antibiotics tested was reduced. For ampicillin and linezolid, no activity was found in any peritoneal dialysis fluid, regardless of the concentration. Daptomycin demonstrated dose-dependent activity in all peritoneal dialysis fluids. Bactericidal activity was observed at the highest concentrations evaluated in Dianeal® PDG4 and Extraneal®, but not in concentrations lower than 30 × MIC and not in Nutrineal® PD4 and Physioneal® 40. The antimicrobial activity of ampicillin and linezolid is limited in peritoneal dialysis fluids in vitro. Daptomycin is highly effective in peritoneal dialysis fluids and might, thus, serve as an important treatment option in peritoneal dialysis-related peritonitis. Further studies are needed to evaluate the clinical impact of the present findings.
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Affiliation(s)
- M Kussmann
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - L Schuster
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M Zeitlinger
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - P Pichler
- Department of Internal Medicine I, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - G Reznicek
- Department of Pharmacognosy, University of Vienna, Vienna, Austria
| | - M Wiesholzer
- Department of Internal Medicine I, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - H Burgmann
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - W Poeppl
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Department of Dermatology, Medical University of Vienna, Vienna, Austria
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135
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Ziolkowski SL, Malabanan MH, Liebman SE. Proton Pump Inhibitor-Associated C. Difficile Infection in a Peritoneal Dialysis Patient. Perit Dial Int 2015; 35:586-7. [DOI: 10.3747/pdi.2014.00057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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136
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Zhang L, Badve SV, Pascoe EM, Beller E, Cass A, Clark C, de Zoysa J, Isbel NM, McTaggart S, Morrish AT, Playford EG, Scaria A, Snelling P, Vergara LA, Hawley CM, Johnson DW. The Effect of Exit-Site Antibacterial Honey Versus Nasal Mupirocin Prophylaxis on the Microbiology and Outcomes of Peritoneal Dialysis-Associated Peritonitis and Exit-Site Infections: A Sub-Study of the Honeypot Trial. Perit Dial Int 2015. [PMID: 26224790 DOI: 10.3747/pdi.2014.00206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
UNLABELLED ♦ BACKGROUND The HONEYPOT study recently reported that daily exit-site application of antibacterial honey was not superior to nasal mupirocin prophylaxis for preventing overall peritoneal dialysis (PD)-related infection. This paper reports a secondary outcome analysis of the HONEYPOT study with respect to exit-site infection (ESI) and peritonitis microbiology, infectious hospitalization and technique failure. ♦ METHODS A total of 371 PD patients were randomized to daily exit-site application of antibacterial honey plus usual exit-site care (N = 186) or intranasal mupirocin prophylaxis (in nasal Staphylococcus aureus carriers only) plus usual exit-site care (control, N = 185). Groups were compared on rates of organism-specific ESI and peritonitis, peritonitis- and infection-associated hospitalization, and technique failure (PD withdrawal). ♦ RESULTS The mean peritonitis rates in the honey and control groups were 0.41 (95% confidence interval [CI] 0.32 - 0.50) and 0.41 (95% CI 0.33 - 0.49) episodes per patient-year, respectively (incidence rate ratio [IRR] 1.01, 95% CI 0.75 - 1.35). When specific causative organisms were examined, no differences were observed between the groups for gram-positive (IRR 0.99, 95% CI 0.66 - 1.49), gram-negative (IRR 0.71, 95% CI 0.39 - 1.29), culture-negative (IRR 2.01, 95% CI 0.91 - 4.42), or polymicrobial peritonitis (IRR 1.08, 95% CI 0.36 - 3.20). Exit-site infection rates were 0.37 (95% CI 0.28 - 0.45) and 0.33 (95% CI 0.26 - 0.40) episodes per patient-year for the honey and control groups, respectively (IRR 1.12, 95% CI 0.81 - 1.53). No significant differences were observed between the groups for gram-positive (IRR 1.10, 95% CI 0.70 - 1.72), gram-negative (IRR: 0.85, 95% CI 0.46 - 1.58), culture-negative (IRR 1.88, 95% CI 0.67 - 5.29), or polymicrobial ESI (IRR 1.00, 95% CI 0.40 - 2.54). Times to first peritonitis-associated and first infection-associated hospitalization were similar in the honey and control groups. The rates of technique failure (PD withdrawal) due to PD-related infection were not significantly different between the groups. ♦ CONCLUSION Compared with standard nasal mupirocin prophylaxis, daily topical exit-site application of antibacterial honey resulted in comparable rates of organism-specific peritonitis and ESI, infection-associated hospitalization, and infection-associated technique failure in PD patients.
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Affiliation(s)
- Lei Zhang
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Sunil V Badve
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Elaine Beller
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia
| | - Alan Cass
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Menzies School of Health Research, Darwin, Australia
| | - Carolyn Clark
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Nambour Hospital, Nambour, Australia
| | - Janak de Zoysa
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Renal Medicine, North Shore Hospital, Auckland, New Zealand
| | - Nicole M Isbel
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Steven McTaggart
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Child & Adolescent Renal Service, Royal Children's and Mater Children's Hospitals, Brisbane, Australia
| | - Alicia T Morrish
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - E Geoffrey Playford
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Anish Scaria
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Paul Snelling
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Liza A Vergara
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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137
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Mid-upper arm circumference for detection of severe acute malnutrition in infants aged between one and six months. Indian Pediatr 2015; 52:528-9. [DOI: 10.1007/s13312-015-0671-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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138
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Honey in the Prevention and Treatment of Infection in the CKD Population: A Narrative Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:261425. [PMID: 26167189 PMCID: PMC4488250 DOI: 10.1155/2015/261425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/11/2015] [Indexed: 01/22/2023]
Abstract
Infection is a major cause of morbidity and mortality at all stages of chronic kidney disease (CKD). Multiresistant organisms are becoming increasingly common, particularly in the CKD population. Unfortunately, the rapid evolution of antibiotic resistance has not been mirrored by innovation in new antibiotic agents. Novel treatments are therefore urgently needed. Honey has garnered much interest due to its broad-spectrum antibacterial properties based on extensive experimental data. Unlike conventional antibiotics, honey has an added advantage as it appears to avoid inducing antimicrobial resistance in bacteria. This review discusses the potential mechanisms of action and role of honey in infection management in the general population, epidemiology and special challenges of infections in CKD populations, and the clinical trial evidence pertaining to the safety and efficacy of honey for the prevention and treatment of infections in CKD population.
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139
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Nadeau-Fredette AC, Bargman JM. Gastroscopy-related peritonitis in peritoneal dialysis patients. Perit Dial Int 2015; 34:667-70. [PMID: 25228218 DOI: 10.3747/pdi.2012.00340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Joanne M Bargman
- Division of Nephrology University Health Network Toronto, Ontario, Canada
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140
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Ozisik L, Ozdemir FN, Tanriover MD. The changing trends of peritoneal dialysis related peritonitis and novel risk factors. Ren Fail 2015; 37:1027-32. [PMID: 26042343 DOI: 10.3109/0886022x.2015.1052952] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM Continuous ambulatory peritoneal dialysis (PD) has become a treatment modality for end stage renal disease with a peak of its use in 1990 s. The aim of this study was to examine the peritonitis rates, causative organisms and the risk factors of peritonitis in a large group of patients in our center. METHODS The study was conducted in the Nephrology Department of a University Hospital in Turkey. Patients in the PD programme between January 2000 and January 2006 were included. Cohort-specific and subject specific peritonitis incidence, and peritonitis-free survival were calculated. Causative organisms and risk factors were evaluated. RESULTS Totally 620 episodes of peritonitis occurred in 440 patients over the six years period. Peritonitis rates showed a decreasing trend through the years (0.79 episodes/patient-year 2000-2003 and 0.46 episodes/patient-year 2003-2006). Cohort-specific peritonitis incidence was 0.62 episodes/patient-years and median subject-specific peritonitis incidence was 0.44 episodes/patient-years. The median peritonitis-free survival was 15.25 months (%95 CI, 9.45-21.06 months). The proportion of gram-negative organisms has increased from 9.8% to 17.3%. There was a significant difference in the percentage of culture negative peritonitis between the first three and the last three years (53.1% vs. 43.2%, respectively). Peritonitis incidence was higher in patients who had been transferred from HD, who had catheter related infection and who had HCV infection without cirrhosis. CONCLUSIONS Our study showed significant trends in the peritonitis rates, causative organisms and antibiotic resistance. Prior HD therapy, catheter related infections and HCV infection were found to be risk factors for peritonitis.
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Affiliation(s)
- Lale Ozisik
- a Department of Internal Medicine , Hacettepe University Faculty of Medicine, Ankara , Turkey and
| | - Fatma Nurhan Ozdemir
- b Department of Nephrology , Baskent University Faculty of Medicine, Ankara , Turkey
| | - Mine Durusu Tanriover
- a Department of Internal Medicine , Hacettepe University Faculty of Medicine, Ankara , Turkey and
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141
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Howard K, Hayes A, Cho Y, Cass A, Clarke M, Johnson DW. Economic Evaluation of Neutral-pH, Low–Glucose Degradation Product Peritoneal Dialysis Solutions Compared With Standard Solutions: A Secondary Analysis of the balANZ Trial. Am J Kidney Dis 2015; 65:773-9. [DOI: 10.1053/j.ajkd.2014.12.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/26/2014] [Indexed: 11/11/2022]
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Campbell DJ, Brown FG, Craig JC, Gallagher MP, Johnson DW, Kirkland GS, Kumar SK, Lim WH, Ranganathan D, Saweirs W, Sud K, Toussaint ND, Walker RG, Williams LA, Yehia M, Mudge DW. Assessment of current practice and barriers to antimicrobial prophylaxis in peritoneal dialysis patients. Nephrol Dial Transplant 2015; 31:619-27. [PMID: 25906780 DOI: 10.1093/ndt/gfv115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/23/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Existing Australasian and international guidelines outline antibiotic and antifungal measures to prevent the development of treatment-related infection in peritoneal dialysis (PD) patients. Practice patterns and rates of PD-related infection vary widely across renal units in Australia and New Zealand and are known to vary significantly from guideline recommendations, resulting in PD technique survival rates that are lower than those achieved in many other countries. The aim of this study was to determine if there is an association between current practice and PD-related infection outcomes and to identify the barriers and enablers to good clinical practice. METHODS This is a multicentre network study involving eight PD units in Australia and New Zealand, with a focus on adherence to guideline recommendations on antimicrobial prophylaxis in PD patients. Current practice was established by asking the PD unit heads to respond to a short survey about practice/protocols/policies and a 'process map' was constructed following a face-to-face interview with the primary PD nurse at each unit. The perceived barriers/enablers to adherence to the relevant guideline recommendations were obtained from the completion of 'cause and effect' diagrams by the nephrologist and PD nurse at each unit. Data on PD-related infections were obtained for the period 1 January 2011 to 31 December 2011. RESULTS Perceived barriers that may result in reduced adherence to guideline recommendations included lack of knowledge, procedural lapses, lack of a centralized patient database, patients with non-English speaking background, professional concern about antibiotic resistance, medication cost and the inability of nephrologists and infectious diseases staff to reach consensus on unit protocols. The definitions of PD-related infections used by some units varied from those recommended by the International Society for Peritoneal Dialysis, particularly with exit-site infection (ESI). Wide variations were observed in the rates of ESI (0.06-0.53 episodes per patient-year) and peritonitis (0.31-0.86 episodes per patient-year). CONCLUSIONS Despite the existence of strongly evidence-based guideline recommendations, there was wide variation in adherence to these recommendations between PD units which might contribute to PD-related infection rates, which varied widely between units. Although individual patient characteristics may account for some of this variability, inconsistencies in the processes of care to prevent infection in PD patients also play a role.
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Affiliation(s)
- Denise J Campbell
- Centre for Kidney Research, Sydney Children's Hospital Network (Westmead), Westmead, NSW, Australia School of Public Health, University of Sydney, Sydney, NSW, Australia
| | | | - Jonathan C Craig
- Centre for Kidney Research, Sydney Children's Hospital Network (Westmead), Westmead, NSW, Australia School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Martin P Gallagher
- University of Sydney and George Institute for Global Health, Sydney, NSW, Australia
| | - David W Johnson
- University of Queensland at Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | | | - Wai H Lim
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Walaa Saweirs
- Whangarei Hospital, Northland District Health Board, Whangarei, New Zealand University of Auckland, Auckland, New Zealand
| | - Kamal Sud
- Nepean Clinical School, University of Sydney, Sydney, NSW, Australia Westmead and Nepean Hospitals, NSW, Australia
| | - Nigel D Toussaint
- Western Health, Footscray, VIC, Australia The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Rowan G Walker
- The Royal Melbourne Hospital, Parkville, VIC, Australia The Alfred Hospital, Prahran, VIC, Australia
| | | | - Maha Yehia
- Auckland City Hospital, Auckland, New Zealand
| | - David W Mudge
- University of Queensland at Princess Alexandra Hospital, Brisbane, QLD, Australia
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143
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Lu R, Muciño-Bermejo MJ, Ribeiro LC, Tonini E, Estremadoyro C, Samoni S, Sharma A, Zaragoza Galván JDJ, Crepaldi C, Brendolan A, Ni Z, Rosner MH, Ronco C. Peritoneal dialysis in patients with refractory congestive heart failure: a systematic review. Cardiorenal Med 2015; 5:145-56. [PMID: 25999963 PMCID: PMC4427136 DOI: 10.1159/000380915] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Refractory congestive heart failure (RCHF) is associated with a high mortality rate and is a major contributor to hospital admissions. Peritoneal dialysis (PD) is an option to control volume overload and perhaps improve outcomes in this challenging patient population. The aim of this systematic review is to describe the relative risk-benefit ratio based on data reported regarding the use of PD in RCHF. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An electronic search of PubMed, Embase, and the Cochrane Library was performed to identify relevant studies published from January 1951 to February 2014. Eligible studies selected were prospective or retrospective adult population studies on PD in the setting of RCHF. The following clinical outcomes were used to assess PD therapy: (1) hospitalization rates; (2) heart function; (3) renal function; (4) fluid overload, and (5) adverse clinical outcomes. SUMMARY Of 864 citations, we excluded 843 citations and included 21 studies (n = 673 patients). After PD, hospitalization days declined significantly (p = 0.0001), and heart function improved significantly (left ventricular ejection fraction: p = 0.0013; New York Heart Association classification: p = 0.0000). There were no statistically significant differences in glomerular filtration rate after PD treatment in non-chronic kidney disease stage 5D patients (p = 0.1065). Among patients treated with PD, body weight decreased significantly (p = 0.0006). The yearly average peritonitis rate was 14.5%, and the average yearly mortality was 20.3%. KEY MESSAGES This systematic review suggests that PD may be an effective and safe therapeutic tool for patients with RCHF.
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Affiliation(s)
- Renhua Lu
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - María-Jimena Muciño-Bermejo
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Leonardo Claudino Ribeiro
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Enrico Tonini
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Carla Estremadoyro
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Sara Samoni
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Aashish Sharma
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - José de Jesús Zaragoza Galván
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Carlo Crepaldi
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Alessandra Brendolan
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Zhaohui Ni
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mitchell H. Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, Va., USA
| | - Claudio Ronco
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
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Yu X, Yang X, Huang N. Management of a rapidly growing peritoneal dialysis population at the First Affiliated Hospital of Sun Yat-sen University. Perit Dial Int 2015; 34 Suppl 2:S31-4. [PMID: 24962960 DOI: 10.3747/pdi.2013.00122] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Managing a rapidly growing peritoneal dialysis program with more than 1000 patients involves multiple challenges, labor constraints, logistics, and excessive geographic distance. This paper describes how Sun Yat-sen University, Guangzhou, China, manages those issues, while simultaneously improving quality of the care and, subsequently, clinical outcomes.
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Affiliation(s)
- Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, and Key Laboratory of Nephrology, Ministry of Health, Guangzhou, PR ChinaDepartment of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, and Key Laboratory of Nephrology, Ministry of Health, Guangzhou, PR China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, and Key Laboratory of Nephrology, Ministry of Health, Guangzhou, PR ChinaDepartment of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, and Key Laboratory of Nephrology, Ministry of Health, Guangzhou, PR China
| | - Naya Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, and Key Laboratory of Nephrology, Ministry of Health, Guangzhou, PR ChinaDepartment of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, and Key Laboratory of Nephrology, Ministry of Health, Guangzhou, PR China
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145
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Fang W, Ni Z, Qian J. Key factors for a high-quality peritoneal dialysis program--the role of the PD team and continuous quality improvement. Perit Dial Int 2015; 34 Suppl 2:S35-42. [PMID: 24962961 DOI: 10.3747/pdi.2013.00120] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The proportion of end-stage renal disease (ESRD) patients on peritoneal dialysis (PD) has increased very fast in China over the last decade. Renji Hospital, affiliated with Shanghai Jiaotong University School of Medicine, is a recognized high-quality PD unit with a high PD utilization rate, excellent patient and technique survival (1-year and 5-year patient survival rate of 93% and 71%, and 1-year and 5-year technique survival of 96% and 82%, respectively), low peritonitis rate and a well-documented good quality of life of the treated patients. We believe that a dedicated and experienced PD team, a structured patient training program, continuous patient support, establishing and utilizing standardized protocols, starting PD with low dialysis dose, monitoring key performance indicators (KPIs), and continuous quality improvement (CQI) are the key factors underlying this successful PD program.
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Affiliation(s)
- Wei Fang
- Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai 200127, China
| | - Zhaohui Ni
- Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai 200127, China
| | - Jiaqi Qian
- Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai 200127, China
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Courivaud C, Bardonnet K, Crepin T, Bresson-Vautrin C, Rebibou JM, Ducloux D. Serum immunoglobulin G levels and peritonitis in peritoneal dialysis patients. J Nephrol 2015; 28:511-5. [PMID: 25757532 DOI: 10.1007/s40620-015-0176-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/28/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peritonitis is a frequent and serious complication of peritoneal dialysis (PD). Whether low immunoglobulin level is associated with PD-related peritonitis is unknown. METHODS We conducted a prospective study to assess whether immunoglobulin levels at PD onset could predict the occurrence of peritonitis. All patients starting peritoneal dialysis between 01/2005 and 12/2010 at the University hospital of Besançon, France, were included in the study. RESULTS Of 240 consecutive PD patients enrolled (mean follow-up 25 ± 12 months), 76 (32%) had at least one episode of peritonitis. Mean immunoglobulin (Ig)G level at PD start was lower in patients who subsequently experienced peritonitis (7.9 + 3.4 vs. 9.7 + 3.4 g/l, p = 0.005). An increased IgG level at PD onset was associated with a reduced risk of peritonitis [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.80-0.97 for each increase of 1 g/l in IgG, p = 0.008]. IgG level ≤6.4 g/l ("low IgG") was the best predictive value for the occurrence of subsequent peritonitis: 52 patients (24%) had low IgG levels. At multivariate analysis, both low IgG level (HR 2.49, 95% CI 1.32-4.69, p = 0.005) and diabetes (HR 2.78, 95% CI 1.49-5.20, p = 0.001) were predictive of the occurrence of peritonitis. CONCLUSION Low IgG levels predict the occurrence of PD-related peritonitis. Randomized studies should determine whether such patients could benefit from intravenous immunoglobulin administration.
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Affiliation(s)
- Cécile Courivaud
- INSERM UMR1098, Fédération Hospitalo-Universitaire INCREASE, 25020, Besançon, France
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147
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Wang J, Zhu N, Yuan W. Effect of Neutral pH and Low-Glucose Degradation Product-Containing Peritoneal Dialysis Solution on Residual Renal Function in Peritoneal Dialysis Patients: A Meta-Analysis. Nephron Clin Pract 2015; 129:155-63. [DOI: 10.1159/000368235] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 09/09/2014] [Indexed: 11/19/2022] Open
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Makkar V, Kumar M, Mahajan R, Khaira NS. Comparison of Outcomes and Quality of Life between Hemodialysis and Peritoneal Dialysis Patients in Indian ESRD Population. J Clin Diagn Res 2015; 9:OC28-31. [PMID: 25954652 DOI: 10.7860/jcdr/2015/11472.5709] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 11/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hemodialysis (HD) and peritoneal dialysis (PD) are important renal replacement treatments in end stage renal disease (ESRD). There is paucity of data comparing outcomes and quality of life (QOL) between the two modalities in Indian scenario. MATERIALS AND METHODS We followed 60 End stage renal disease patients (30 CAPD and 30 Maintenance hemodialysis) for a period of one year. Patients were analysed and compared for complications, physical quality of life and psychological well being with a two part self reported questionnaire at baseline and subsequently at six and twelve months. For the physical component appropriate sections of the McMaster Health Index Questionnaire (MHIQ) and for psychological component Psychological General Well-Being Index (PGWB) developed by Dupey was applied. RESULTS The number of males and females in both groups were comparable (p-value > 0.05).The prevalence of diabetes mellitus, coronary artery disease, obesity and ischaemic heart disease was comparable in both groups (p-value>0.05). Significantly higher mortality was observed in patients undergoing HD (20% vs 0 %, p-value <0.05) at the end of study. At the end of study, 16.6% of patients undergoing HD were found to be anti HCV positive as compared to 3.33% in CAPD. Six episodes of CAPD peritonitis were observed (0.2 episodes per catheter year). Significantly higher number of CAPD patients had negative responses between 2-4 at baseline and subsequently on follow ups in Part A of QOL questionnaire(86.7 vs 23.3 % at baseline, 80 vs 26.7% at 6 months, 80 vs16.7 % at 12 months; p <0.05 ). Mean score in Part B of questionnaire was significantly higher in CAPD patients at baseline and at all follow ups (66.7±11 vs 50.1±17 at baseline, 66.7±12.1 vs 53.32±16.3 at 6 months, 65.3±9.5 vs 48.8±16.7 at 12 months , p <0.05) . CONCLUSION CAPD patients have significantly better quality of life in physical as well as psychological aspects and have significantly lower mortality when compared with hemodialysis patients.
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Affiliation(s)
- Vikas Makkar
- Associate Professor, Department of Nephrology, Dayanand Medical College and Hospital , Ludhiana, India
| | - Manish Kumar
- Ex-Resident, Department of Medicine, Dayanand Medical College and Hospital , Ludhiana, India
| | - Rajesh Mahajan
- Professor, Department of Medicine, Dayanand Medical College and Hospital , Ludhiana, India
| | - N S Khaira
- Professor and Head, Department of Nephrology, Fortis Hospital , Ludhiana, India
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Baillie J, Lankshear A. PATIENTS’ AND RELATIVES’ EXPERIENCES OF PERITONITIS WHEN USING PERITONEAL DIALYSIS. J Ren Care 2015; 41:177-86. [DOI: 10.1111/jorc.12118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jessica Baillie
- School of Healthcare Sciences; Cardiff University; Cardiff UK
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Toussaint ND, McMahon LP, Dowling G, Soding J, Safe M, Knight R, Fair K, Linehan L, Walker RG, Power DA. Implementation of renal key performance indicators: Promoting improved clinical practice. Nephrology (Carlton) 2015; 20:184-93. [DOI: 10.1111/nep.12366] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Nigel D Toussaint
- Department of Nephrology; The Royal Melbourne Hospital; Bendigo Victoria Australia
- Department of Medicine; The University of Melbourne; Bendigo Victoria Australia
| | | | - Gregory Dowling
- Department of Health Victoria; Monash Health; Bendigo Victoria Australia
| | - Jenny Soding
- Department of Health Victoria; Monash Health; Bendigo Victoria Australia
| | - Maria Safe
- Department of Nephrology; The Royal Melbourne Hospital; Bendigo Victoria Australia
| | - Richard Knight
- Department of Nephrology; Barwon Health; Bendigo Victoria Australia
| | - Kathleen Fair
- Department of Nephrology; Bendigo Health; Bendigo Victoria Australia
| | - Leanne Linehan
- Department of Nephrology; Monash Health; Bendigo Victoria Australia
| | - Rowan G Walker
- Department of Nephrology; Alfred Hospital; Bendigo Victoria Australia
| | - David A Power
- Department of Nephrology; Austin Health; Bendigo Victoria Australia
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