151
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Szeto CC. Peritonitis rates of the past thirty years: from improvement to stagnation. Perit Dial Int 2015; 34:151-3. [PMID: 24676740 DOI: 10.3747/pdi.2014.00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine and Therapeutics Prince of Wales Hospital The Chinese University of Hong Kong Shatin, Hong Kong SAR, PR China
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152
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Schaepe C, Bergjan M. Educational interventions in peritoneal dialysis: a narrative review of the literature. Int J Nurs Stud 2015; 52:882-98. [PMID: 25616708 DOI: 10.1016/j.ijnurstu.2014.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 12/19/2014] [Accepted: 12/27/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To review the current literature on educational interventions used in peritoneal dialysis (PD). Educational interventions have become increasingly relevant because they play a key role in helping individuals to actively participate in their therapy and to manage their chronic condition. The paper will focus on two areas: (a) educational interventions for individuals living with PD and (b) educational interventions for PD nurses. DESIGN A narrative review of primary research. DATA SOURCES Electronic searches of the MEDLINE, CINAHL, EMBASE, ERIC and Cochrane Library (2006-2013) databases were undertaken using terms such as peritoneal dialysis, insertive training, curriculum, nursing education, train the trainer, coach the coach, tutor the tutor, and patient education were used. All studies were reviewed by two researchers. REVIEW METHODS Titles and abstracts of 555 studies were screened and read. Full text articles retrieved were further screened against the inclusion and exclusion criteria. Relevant data on the educational interventions for people receiving PD and nurse training programs were extracted and synthesized narratively. RESULTS Eighteen articles met the inclusion criteria. Most of them focused on educational intervention programs for people undergoing PD. Findings on the link between the PD trainer's background and peritonitis rates among individuals undergoing PD are inconsistent. PD learners should be taught self-management skills as well as technical skills. They might also benefit from receiving decision-making aids. Older people, people with co-morbidities and people with low educational status need more time to acquire self-care skills and are more likely to develop peritonitis. Home visits have the potential to improve learning outcomes. Re-training needs should be assessed and fulfilled as appropriate. Case and disease management programs have been shown to have positive outcomes for individuals receiving PD. CONCLUSIONS Educational interventions for PD remain an under-researched area, despite the potential they have to make this type of therapy more successful. Further research on education and training for people receiving PD and for PD nurses is needed. In the meantime, educational interventions used for other chronic conditions could provide guidance.
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Affiliation(s)
- Christiane Schaepe
- Institute of Health and Nursing Science, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Manuela Bergjan
- Institute of Health and Nursing Science, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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153
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Khashab MA, Chithadi KV, Acosta RD, Bruining DH, Chandrasekhara V, Eloubeidi MA, Fanelli RD, Faulx AL, Fonkalsrud L, Lightdale JR, Muthusamy VR, Pasha SF, Saltzman JR, Shaukat A, Wang A, Cash BD. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc 2015; 81:81-9. [PMID: 25442089 DOI: 10.1016/j.gie.2014.08.008] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 02/08/2023]
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154
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Chen CM, Chuang YW, Shen PS. Two-stage estimation for multivariate recurrent event data with a dependent terminal event. Biom J 2014; 57:215-33. [DOI: 10.1002/bimj.201400001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 09/14/2014] [Accepted: 10/01/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Chyong-Mei Chen
- Department of Statistics and Informatics Science; Providence University; Taichung 43301 Taiwan Republic of China
- Department of Financial and Computational Mathematics; Providence University; Taichung 43301 Taiwan Republic of China
| | - Ya-Wen Chuang
- Division of Nephrology; Department of Internal Medicine, Taichung Veterans General Hospital; Taichung 40705 Taiwan Republic of China
| | - Pao-Sheng Shen
- Department of Statistics; Tunghai University; Taichung 40704 Taiwan Republic of China
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155
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François K, Bargman JM. Evaluating the benefits of home-based peritoneal dialysis. Int J Nephrol Renovasc Dis 2014; 7:447-55. [PMID: 25506238 PMCID: PMC4260684 DOI: 10.2147/ijnrd.s50527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Peritoneal dialysis (PD) is an effective renal replacement strategy for patients suffering from end-stage renal disease. PD offers patient survival comparable to or better than in-center hemodialysis while preserving residual kidney function, empowering patient autonomy, and reducing financial burden to payors. The majority of patients suffering from kidney failure are eligible for PD. In patients with cardiorenal syndrome and uncontrolled fluid status, PD is of particular benefit, decreasing hospitalization rates and duration. This review discusses the benefits of chronic PD, performed by the patient or a caregiver at home. Recognition of the benefits of PD is a cornerstone in stimulating the use of this treatment strategy.
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Affiliation(s)
- Karlien François
- Division of Nephrology, University Health Network Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Joanne M Bargman
- Division of Nephrology, University Health Network Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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156
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Paudel K, Namagondlu G, Samad N, McKitty K, Fan SL. Lack of motivation: a new modifiable risk factor for peritonitis in patients undergoing peritoneal dialysis? J Ren Care 2014; 41:33-42. [PMID: 25410720 DOI: 10.1111/jorc.12101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Can we identify modifiable risk factors for peritonitis in patients undergoing peritoneal dialysis (PD)? We aimed to determine whether housing standard, PD exchange technique or patient motivation might be modifiable risks for peritonitis. We also explored the relationship between lack of motivation and depression. METHODS Nurse home visits assessed PD exchange technique, environment and patient motivation. Motivation scores were correlated separately with an Apathy Evaluation Score and a depression score using PHQ-9 questionnaires. RESULTS Home hygiene, exchange technique and motivation were above average in 53%, 56% and 60%, respectively in 104 patients undergoing PD. After 15 months, 25.9% patients developed peritonitis but nurses' ratings of homes and exchange techniques were not predictive. Low patient motivation was predictive. Patients rated to have above or below median motivation had significantly different Apathy Scores (p = 0.0002). Unmotivated depressed patients were significantly more likely to develop peritonitis compared to motivated depressed patients. CONCLUSION Lack of motivation predicted peritonitis particularly if associated with depression. Further studies are required focusing on specific motivation scoring schemes and the psychosocial support that might lead to better outcomes.
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Affiliation(s)
- Klara Paudel
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
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157
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Collier S, Davenport A. Reducing the risk of infection in end-stage kidney failure patients treated by dialysis. Nephrol Dial Transplant 2014; 29:2158-61. [PMID: 25297113 PMCID: PMC4240182 DOI: 10.1093/ndt/gfu321] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Sophie Collier
- Department of Medical Microbiology, Royal Free Hospital, London, UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
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158
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Campbell DJ, Johnson DW, Mudge DW, Gallagher MP, Craig JC. Prevention of peritoneal dialysis-related infections. Nephrol Dial Transplant 2014; 30:1461-72. [DOI: 10.1093/ndt/gfu313] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/02/2014] [Indexed: 11/12/2022] Open
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159
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Santos C, Pérez-Fontán M, Rodríguez-Carmona A, Calvo-Rodríguez M, López-Muñiz A, López-Calviño B, García-Falcón T. Identification of Targets for Prevention of Peritoneal Catheter Tunnel and Exit-Site Infections in Low Incidence Settings. Perit Dial Int 2014; 36:43-51. [PMID: 25292406 DOI: 10.3747/pdi.2014.00131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/29/2014] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND Peritoneal catheter tunnel and exit-site infection (TESI) complicates the clinical course of peritoneal dialysis (PD) patients. Adherence to recommendations for catheter insertion, exit-site care, and management of Staphylococcus aureus (SAu) carriage reduces, but does not abrogate the risk of these infections. ♦ OBJECTIVE To reappraise the risk profile for TESI in an experienced center with a long-term focus on management of SAu carriage and a low incidence of these infections. ♦ METHOD Following a retrospective, observational design, we investigated 665 patients incident on PD. The main study variable was survival to the first episode of TESI. We considered selected demographic, clinical, and technical variables, applying multivariate strategies of analysis. ♦ MAIN RESULTS The overall incidence of TESI was 1 episode/68.5 patient-months. Staphylococcus aureus carriage disclosed at inception of PD (but not if observed sporadically during follow-up) (hazard ratio [HR] 1.53, p = 0.009), PD started shortly after catheter insertion (HR 0.98 per day, p = 0.011), PD after kidney transplant failure (HR 2.18, p = 0.017), lower hemoglobin levels (HR 0.88 per g/dL, p = 0.013) and fast peritoneal transport rates (HR 2.92, p = 0.03) portended an increased risk of TESI. Delaying PD ≥ 30 days after catheter insertion markedly improved the probability of TESI. Carriage of methicillin-resistant SAu since the start of PD was associated with a high incidence of TESI by these bacteria. On the contrary, resistance to mupirocin did not predict such a risk, probably due to the use of an alternative regime in affected patients. ♦ CONCLUSIONS Adherence to current recommendations results in a low incidence of TESI in PD patients. Interventions on specific risk subsets have a potential to bring incidence close to negligible levels. Despite systematic screening and management, SAu carriage is still a predictor of TESI. Antibiotic susceptibility patterns may help to refine stratification of the risk of TESI by these bacteria. Early insertion of the peritoneal catheter should be considered whenever possible, to reduce the risk of later TESI.
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Affiliation(s)
- Clara Santos
- Division of Nephrology, Vilanova da Gaia/Espinho Hospital Center, Portugal
| | - Miguel Pérez-Fontán
- Health Sciences Faculty, University of A Coruña, Spain Division of Nephrology, University Hospital of A Coruña, Spain
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160
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Affiliation(s)
- Beth Piraino
- Renal Electrolyte Division University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania, USA
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161
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Baillie J, Lankshear A. Patient and family perspectives on peritoneal dialysis at home: findings from an ethnographic study. J Clin Nurs 2014; 24:222-34. [DOI: 10.1111/jocn.12663] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Jessica Baillie
- School of Healthcare Sciences; Cardiff University; Cardiff UK
| | - Annette Lankshear
- Cardiff School of Healthcare Sciences; Cardiff University; Cardiff UK
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162
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Figueiredo AE, de Moraes TP, Bernardini J, Poli-de-Figueiredo CE, Barretti P, Olandoski M, Pecoits-Filho R. Impact of patient training patterns on peritonitis rates in a large national cohort study. Nephrol Dial Transplant 2014; 30:137-42. [DOI: 10.1093/ndt/gfu286] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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163
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Rodrigues A, Maciel M, Santos C, Machado D, Sampaio J, Lima N, Carvalho MJ, Cabrita A, Martins M. Peritoneal dialysis infections: an opportunity for improvement. Am J Infect Control 2014; 42:1016-8. [PMID: 25179339 DOI: 10.1016/j.ajic.2014.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 10/24/2022]
Abstract
Peritoneal dialysis (PD) catheter-associated infections remain a challenging cause of technique failure. Patient training and preventive measures are key elements in the management of infection rates. Twenty-seven of the 167 PD catheter transfer sets analyzed (19%) yielded a positive microbial culture (58% gram-negative bacteria). These results show that subclinical contamination, particularly from environmental gram-negative bacteria, is a potential hazard, indicating the need for a protocol for regular transfer set changes.
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164
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Design of the standardizing care to improve outcomes in pediatric end stage renal disease collaborative. Pediatr Nephrol 2014; 29:1477-84. [PMID: 25055994 DOI: 10.1007/s00467-014-2891-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 06/13/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative is a North American multi-center quality transformation effort whose primary aim is to minimize exit-site infection and peritonitis rates among pediatric chronic peritoneal dialysis patients. The project, developed by the quality improvement faculty and staff at the Children's Hospital Association's Quality Transformation Network (QTN) and content experts in pediatric nephrology and pediatric infectious diseases, is modeled after the QTN's highly successful Pediatric Intensive Care Unit and Hematology-Oncology central line-associated blood-stream infection (CLABSI) Collaboratives. Like the Association's other QTN efforts, the SCOPE Collaborative is part of a broader effort to assist pediatric nephrology teams in learning about and using quality improvement methods to develop and implement evidence-based practices. In addition, the design of this project allows for targeted research that builds on high-quality, ongoing data collection. Finally, the project, while focused on reducing peritoneal dialysis catheter-associated infections, will also serve as a model for future pediatric nephrology projects that could further improve the quality of care provided to children with end stage renal disease.
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165
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Terawaki H, Nakano H, Ogura M, Kadomura M, Hosoya T, Nakayama M. Unroofing surgery with en bloc resection of the skin and tissues around the peripheral cuff. Perit Dial Int 2014; 33:573-6. [PMID: 24133083 DOI: 10.3747/pdi.2012.00262] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hiroyuki Terawaki
- Dialysis Center1 Fukushima Medical University Fukushima, Japan Department of Internal Medicine2 Kashima Hospital Iwaki, Japan Division of Kidney and Hypertension3 The Jikei University School of Medicine Tokyo, Japan Division of Nephrology4 National Hospital Organization Chiba-East Hospital Chiba, Japan
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166
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Johnson DW, Cho Y, Mehrotra R. Is female sex really a risk factor for infectious death in peritoneal dialysis? Perit Dial Int 2014; 33:475-8. [PMID: 24133080 DOI: 10.3747/pdi.2013.00191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- David W Johnson
- Department of Nephrology1 Princess Alexandra Hospital Translational Research Institute2 School of Medicine3 University of Queensland Brisbane, Australia Division of Nephrology4 University of Washington Seattle, Washington, USA
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167
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Dong J, Zhao MH. Clinical research in a modern Chinese peritoneal dialysis center. Perit Dial Int 2014; 34 Suppl 2:S49-54. [PMID: 24962963 DOI: 10.3747/pdi.2013.00119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A prerequisite for enhancing the quality of peritoneal dialysis is the continuous review and analysis of clinical data from routine clinical care and research. Here, we describe our strategy (Peking University First Hospital, Beijing, China) to achieve that objective.
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Affiliation(s)
- Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, PR China
| | - Ming-hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, PR China
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168
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Abebe M, Laveglia C, George S, Wadhwa NK. Pet-Related Peritonitis and its Prevention in Peritoneal Dialysis: A Case Study. Perit Dial Int 2014; 34:466-8. [DOI: 10.3747/pdi.2013.00054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Mekdess Abebe
- Division of Nephrology Department of Medicine School of Medicine State University of New York at Stony Brook Stony Brook, NY 11794–8166
| | - Cheryl Laveglia
- Stony Brook Kidney Center Dialysis Clinic Inc., Home Program Stony Brook, NY, 11733
| | - Sunil George
- Division of Nephrology Department of Medicine School of Medicine State University of New York at Stony Brook Stony Brook, NY 11794–8166
| | - Nand K. Wadhwa
- Division of Nephrology Department of Medicine School of Medicine State University of New York at Stony Brook Stony Brook, NY 11794–8166
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169
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Clinical causes of inflammation in peritoneal dialysis patients. Int J Nephrol 2014; 2014:909373. [PMID: 24895536 PMCID: PMC4033334 DOI: 10.1155/2014/909373] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/14/2014] [Accepted: 04/16/2014] [Indexed: 12/02/2022] Open
Abstract
Inflammation at both systemic and local intraperitoneal levels commonly affects peritoneal dialysis (PD) patients. Interest in inflammatory markers as targets of therapeutic intervention has been considerable as they are recognised as predictors of poor clinical outcomes. However, prior to embarking on strategies to reduce inflammatory burden, it is of paramount importance to define the underlying processes that drive the chronic active inflammatory status. The present review aims to comprehensively describe clinical causes of inflammation in PD patients to which potential future strategies may be targeted.
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170
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Cho Y, Johnson DW. Peritoneal dialysis-related peritonitis: towards improving evidence, practices, and outcomes. Am J Kidney Dis 2014; 64:278-89. [PMID: 24751170 DOI: 10.1053/j.ajkd.2014.02.025] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/20/2014] [Indexed: 11/11/2022]
Abstract
Peritonitis is a common serious complication of peritoneal dialysis that results in considerable morbidity, mortality, and health care costs. It also significantly limits the use of this important dialysis modality. Despite its importance as a patient safety issue, peritonitis practices and outcomes vary markedly and unacceptably among different centers, regions, and countries. This article reviews peritonitis risk factors, diagnosis, treatment, and prevention, particularly focusing on potential drivers of variable practices and outcomes, controversial or unresolved areas, and promising avenues warranting further research. Potential strategies for augmenting the existing limited evidence base and reducing the gap between evidence-based best practice and actual practice also are discussed.
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Affiliation(s)
- Yeoungjee Cho
- Centre for Kidney Disease Research, Translational Research Institute at University of Queensland, Brisbane, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Centre for Kidney Disease Research, Translational Research Institute at University of Queensland, Brisbane, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
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171
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van Diepen ATN, van Esch S, Struijk DG, Krediet RT. The first peritonitis episode alters the natural course of peritoneal membrane characteristics in peritoneal dialysis patients. Perit Dial Int 2014; 35:324-32. [PMID: 24711641 DOI: 10.3747/pdi.2014.00277] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 02/24/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Little or no evidence is available on the impact of the first peritonitis episode on peritoneal transport characteristics. The objective of this study was to investigate the importance of the very first peritonitis episode and distinguish its effect from the natural course by comparison of peritoneal transport before and after infection. PARTICIPANTS We analyzed prospectively collected data from 541 incident peritoneal dialysis (PD) patients, aged > 18 years, between 1990 and 2010. Standard Peritoneal Permeability Analyses (SPA) within the year before and within the year after (but not within 30 days) the first peritonitis were compared. In a control group without peritonitis, SPAs within the first and second year of PD were compared. MAIN OUTCOME MEASUREMENTS SPA data included the mass transfer area coefficient of creatinine, glucose absorption and peritoneal clearances of β-2-microglobulin (b2m), albumin, IgG and α-2-macroglobulin (a2m). From these clearances, the restriction coefficient to macromolecules (RC) was calculated. Also, parameters of fluid transport were determined: transcapillary ultrafiltration rate (TCUFR), lymphatic absorption (ELAR), and free water transport. Crude and adjusted linear mixed models were used to compare the slopes of peritoneal transport parameters in the peritonitis group to the control group. Adjustments were made for age, sex and diabetes. RESULTS Of 541 patients, 367 experienced a first peritonitis episode within a median time of 12 months after the start of PD. Of these, 92 peritonitis episodes were preceded and followed by a SPA within one year. Forty-five patients without peritonitis were included in the control group. Logistic reasons (peritonitis group: 48% vs control group: 83%) and switch to hemodialysis (peritonitis group: 22% vs control group: 3%) were the main causes of missing SPA data post-peritonitis and post-control. When comparing the slopes of peritoneal transport parameters in the peritonitis group and the control group, a first peritonitis episode was associated with faster small solute transport (glucose absorption, p = 0.03) and a concomitant lower TCUFR (p = 0.03). In addition, a discreet decrease in macromolecular transport was seen in the peritonitis group: mean difference in post- and pre-peritonitis values: IgG: -8 μL/min (p = 0.01), a2m: -4 μL/min (p = 0.02), albumin: -10 μL/min (p = 0.04). Accordingly, the RC to macromolecules increased after peritonitis: 0.09, p = 0.04. CONCLUSIONS The very first peritonitis episode alters the natural course of peritoneal membrane characteristics. The most likely explanation might be that cured peritoneal infection later causes long-lasting alterations in peritoneal transport state.
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Affiliation(s)
- Anouk T N van Diepen
- Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Sadie van Esch
- Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Nephrology Department and Internal Medicine, St Elisabeth Hospital, Tilburg, The Netherlands
| | - Dirk G Struijk
- Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Dianet, Amsterdam-Utrecht, The Netherlands
| | - Raymond T Krediet
- Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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172
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Lan PG, Johnson DW, McDonald SP, Boudville N, Borlace M, Badve SV, Sud K, Clayton PA. The association between peritoneal dialysis modality and peritonitis. Clin J Am Soc Nephrol 2014; 9:1091-7. [PMID: 24626434 DOI: 10.2215/cjn.09730913] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES There is conflicting evidence comparing peritonitis rates among patients treated with continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). This study aims to clarify the relationship between peritoneal dialysis (PD) modality (APD versus CAPD) and the risk of developing PD-associated peritonitis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study examined the association between PD modality (APD versus CAPD) and the risks, microbiology, and clinical outcomes of PD-associated peritonitis in 6959 incident Australian PD patients between October 1, 2003, and December 31, 2011, using data from the Australia and New Zealand Dialysis and Transplant Registry. Median follow-up time was 1.9 years. RESULTS Patients receiving APD were younger (60 versus 64 years) and had fewer comorbidities. There was no association between PD modality and time to first peritonitis episode (adjusted hazard ratio [HR] for APD versus CAPD, 0.98; 95% confidence interval [95% CI], 0.91 to 1.07; P=0.71). However, there was a lower hazard of developing Gram-positive peritonitis with APD than CAPD, which reached borderline significance (HR, 0.90; 95% CI, 0.80 to 1.00; P=0.05). No statistically significant difference was found in the risk of hospitalizations (odds ratio, 1.12; 95% CI, 0.93 to 1.35; P=0.22), but there was a nonsignificant higher likelihood of 30-day mortality (odds ratio, 1.33; 95% CI, 0.93 to 1.88; P=0.11) at the time of the first episode of peritonitis for patients receiving APD. For all peritonitis episodes (including subsequent episodes of peritonitis), APD was associated with lower rates of culture-negative peritonitis (incidence rate ratio [IRR], 0.81; 95% CI, 0.69 to 0.94; P=0.002) and higher rates of gram-negative peritonitis (IRR, 1.28; 95% CI, 1.13 to 1.46; P=0.01). CONCLUSIONS PD modality was not associated with a higher likelihood of developing peritonitis. However, APD was associated with a borderline reduction in the likelihood of a first episode of Gram-positive peritonitis compared with CAPD, and with lower rates of culture-negative peritonitis and higher rates of Gram-negative peritonitis. Peritonitis outcomes were comparable between both modalities.
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Affiliation(s)
- Patrick G Lan
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
| | - David W Johnson
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Stephen P McDonald
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Neil Boudville
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Monique Borlace
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sunil V Badve
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Kamal Sud
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Philip A Clayton
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Abstract
Reducing the frequency of peritonitis for patients undergoing peritoneal dialysis (PD) continues to be a challenge. This review focuses on recent updates in catheter care and other patient factors that influence infection rates. An experienced nursing staff plays an important role in teaching proper PD technique to new patients, but nursing staff must be cognizant of each patient's unique educational needs. Over time, many patients become less adherent to proper dialysis technique, such as washing hands or wearing a mask. This behavior is associated with higher risk of peritonitis and is modifiable with re-training. Prophylactic antibiotics before PD catheter placement can decrease the infection risk immediately after catheter placement. In addition, some studies suggest that prophylaxis against fungal superinfection after antibiotic exposure is effective in reducing fungal peritonitis, although larger randomized studies are needed before this practice can be recommended for all patients. Over time, exit site and nasal colonization with pathogenic organisms can lead to exit-site infections and peritonitis. For patients with Staphylococcus aureus colonization, exit-site prophylaxis with either mupirocin or gentamicin cream reduces clinical infection with this organism. Although there are limited data for support, antibiotic prophylaxis before gastrointestinal, gynecologic, or dental procedures may also help reduce the risk of peritonitis.
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Affiliation(s)
- Jonathan H Segal
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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174
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Stevenson S, Tang W, Cho Y, Mudge DW, Hawley CM, Badve SV, Johnson DW. The role of monitoring vancomycin levels in patients with peritoneal dialysis-associated peritonitis. Perit Dial Int 2014; 35:222-8. [PMID: 24584597 DOI: 10.3747/pdi.2013.00156] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/03/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is limited available evidence regarding the role of monitoring serum vancomycin concentrations during treatment of peritoneal dialysis (PD)-associated peritonitis. METHODS A total of 150 PD patients experiencing 256 episodes of either gram-positive or culture-negative peritonitis were included to investigate the relationship between measured serum vancomycin within the first week and clinical outcomes of cure, relapse, repeat or recurrence of peritonitis, catheter removal, temporary or permanent transfer to hemodialysis, hospitalization and death. RESULTS Vancomycin was used as an initial empiric antibiotic in 54 gram-positive or culture-negative peritonitis episodes among 34 patients. The median number of serum vancomycin level measurements in the first week was 3 (interquartile range; IQR 1 - 4). The mean day-2 vancomycin level, measured in 34 (63%) episodes, was 17.5 ± 5.2 mg/L. Hospitalized patients were more likely to have serum vancomycin levels measured on day 2 and ≥ 3 measurements in the first week. The peritonitis cure rates were similar between patients with < 3 and ≥ 3 measurements in the first week (77% vs 57%, p = 0.12) and if day-2 vancomycin levels were measured or not (68% vs 65%, p = 0.84). The average day-2 (18.0 ± 5.9 vs 16.6 ± 3.2, p = 0.5), first-week average (18.6 ± 5.1 vs 18.6 ± 4.3, p = 0.9) and nadir (14.5 ± 4.1 vs 13.6 ± 4.2, p = 0.5) vancomycin levels were comparable in patients who did or did not achieve peritonitis cure. Similar results were observed for all other clinical outcomes. CONCLUSION The clinical outcomes of gram-positive and culture-negative peritonitis episodes are not associated with either the frequency or levels of serum vancomycin measurements in the first week of treatment when vancomycin is dosed according to International Society for Peritoneal Dialysis (ISPD) Guidelines.
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Affiliation(s)
- Sarah Stevenson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Wen Tang
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Division of Nephrology, Peking University Third Hospital, Beijing, China
| | - Yeoungjee Cho
- Division of Nephrology, Peking University Third Hospital, Beijing, China
| | - David W Mudge
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Carmel M Hawley
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Sunil V Badve
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
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175
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Kumar VA, Sidell MA, Yang WT, Jones JP. Predictors of peritonitis, hospital days, and technique survival for peritoneal dialysis patients in a managed care setting. Perit Dial Int 2014; 34:171-8. [PMID: 24084841 PMCID: PMC3968102 DOI: 10.3747/pdi.2012.00165] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 12/17/2012] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Many clinicians perceive that peritoneal dialysis (PD) should be reserved for younger, healthier, more affluent patients. Our aim was to examine outcomes for PD patients in a managed care setting and to identify predictors of adverse outcomes. METHODS We identified all patients who initiated PD at our institution between 1 January 2001 and 31 December 2010. Predictor variables studied included age, sex, race, PD modality, cause of end-stage renal disease (ESRD), dialysis vintage, Charlson comorbidity index (CCI) score, education, and income level. Poisson models were used to determine the relative risk (RR) of peritonitis and the number of hospital days per patient-year. The log-rank test was used to compare technique survival by patient strata. RESULTS Among the 1378 patients who met the inclusion criteria, only female sex [RR: 0.85; 95% confidence interval (CI): 0.74 to 0.98; p = 0.02] and higher education (RR: 0.77; 95% CI: 0.60 to 0.98; p = 0.04) were associated with peritonitis. For hospital days, dialysis vintage (RR: 1.11; 95% CI: 1.04 to 1.18; p = 0.002), CCI score (RR: 1.06; 95% CI: 1.02 to 1.20; p = 0.002), and cause of ESRD (RR for glomerulonephritis: 0.59; 95% CI: 0.43 to 0.80; p = 0.0006; and RR for hypertension: 0.69; 95% CI: 0.55 to 0.88; p = 0.002) were associated with 1 extra hospital day per patient-year. The 2-year technique survival was 61% for patients who experienced at least 1 episode of peritonitis and 72% for those experiencing no peritonitis (p = 0.0001). Baseline patient age, primary cause of ESRD, and PD modality were the only other variables associated with technique survival in the study. CONCLUSIONS Neither race nor socio-economic status predicted technique survival or hospital days in our study. Female sex and higher education were the only two variables studied that had an association with peritonitis.
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Affiliation(s)
- Victoria A Kumar
- Department of Internal Medicine,1 Division of Nephrology, Southern California Permanente Medical Group, Los Angeles, and Research and Evaluation,2 Southern California Permanente Medical Group, Pasadena, California, USA
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176
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Abdel-Aal AK, Dybbro P, Hathaway P, Guest S, Neuwirth M, Krishnamurthy V. Best practices consensus protocol for peritoneal dialysis catheter placement by interventional radiologists. Perit Dial Int 2014; 34:481-93. [PMID: 24584622 DOI: 10.3747/pdi.2013.00029] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Peritoneal dialysis (PD) catheters can be placed by interventional radiologists, an approach that might offer scheduling efficiencies, cost-effectiveness, and a minimally invasive procedure. In the United States, changes in the dialysis reimbursement structure by the Centers for Medicare and Medicaid Services are expected to result in the increased use of PD, a less costly dialysis modality that offers patients the opportunity to receive dialysis in the home setting and to have more independence for travel and work schedules, and that preserves vascular access for future dialysis options. Placement of PD catheters by interventional radiologists might therefore be increasingly requested by nephrology practices, given that recent publications have demonstrated the favorable impact on PD practices of an interventional radiology PD placement capability. Earlier reports of interventional radiology PD catheter placement came from single-center practices with smaller reported experiences. The need for a larger consensus document that attempts to establish best demonstrated practices for radiologists is evident. The radiologists submitting this consensus document represent a combined experience of more than 1000 PD catheter placements. The authors submit these consensus-proposed best demonstrated practices for placement of PD catheters by interventional radiologists under ultrasonographic and fluoroscopic guidance. This technique might allow for expeditious placement of permanent PD catheters in late-referred patients with end-stage renal disease, thus facilitating urgent-start PD and avoiding the need for temporary vascular access catheters.
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Affiliation(s)
- Ahmed K Abdel-Aal
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; Interventional Radiology, Kaiser Permanente Hayward, Hayward, California; Interventional Radiology, Utah Vascular Clinic, Salt Lake City, Utah; Baxter Healthcare Corporation, Deerfield, Illinois; Vascular and Interventional Radiology, Carle Foundation Hospital and Carle Physician Group, Urbana, Illinois; and Radiology Services, VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Paul Dybbro
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; Interventional Radiology, Kaiser Permanente Hayward, Hayward, California; Interventional Radiology, Utah Vascular Clinic, Salt Lake City, Utah; Baxter Healthcare Corporation, Deerfield, Illinois; Vascular and Interventional Radiology, Carle Foundation Hospital and Carle Physician Group, Urbana, Illinois; and Radiology Services, VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Peter Hathaway
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; Interventional Radiology, Kaiser Permanente Hayward, Hayward, California; Interventional Radiology, Utah Vascular Clinic, Salt Lake City, Utah; Baxter Healthcare Corporation, Deerfield, Illinois; Vascular and Interventional Radiology, Carle Foundation Hospital and Carle Physician Group, Urbana, Illinois; and Radiology Services, VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Steven Guest
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; Interventional Radiology, Kaiser Permanente Hayward, Hayward, California; Interventional Radiology, Utah Vascular Clinic, Salt Lake City, Utah; Baxter Healthcare Corporation, Deerfield, Illinois; Vascular and Interventional Radiology, Carle Foundation Hospital and Carle Physician Group, Urbana, Illinois; and Radiology Services, VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Michael Neuwirth
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; Interventional Radiology, Kaiser Permanente Hayward, Hayward, California; Interventional Radiology, Utah Vascular Clinic, Salt Lake City, Utah; Baxter Healthcare Corporation, Deerfield, Illinois; Vascular and Interventional Radiology, Carle Foundation Hospital and Carle Physician Group, Urbana, Illinois; and Radiology Services, VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Venkat Krishnamurthy
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; Interventional Radiology, Kaiser Permanente Hayward, Hayward, California; Interventional Radiology, Utah Vascular Clinic, Salt Lake City, Utah; Baxter Healthcare Corporation, Deerfield, Illinois; Vascular and Interventional Radiology, Carle Foundation Hospital and Carle Physician Group, Urbana, Illinois; and Radiology Services, VA Ann Arbor Health System, Ann Arbor, Michigan, USA
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177
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Katavetin P, Theerasin Y, Treamtrakanpon W, Saiprasertkit N, Kanjanabuch T. Treatment failure in automated peritoneal dialysis and double-bag continuous ambulatory peritoneal dialysis. Nephrology (Carlton) 2014; 18:545-8. [PMID: 23730742 DOI: 10.1111/nep.12107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2013] [Indexed: 11/29/2022]
Abstract
AIM Automated peritoneal dialysis (APD) and double-bag continuous ambulatory peritoneal dialysis (CAPD) are the two current standard modalities of peritoneal dialysis (PD). Outcomes of these two modalities have not been well described. METHODS A single-centre, retrospective review was carried out to compare the treatment failure rate of APD and double-bag CAPD. Treatment failure was a combined endpoint including death and technique failure. Cox regression was used to compare risk (hazard ratio, HR) of treatment failure in APD and CAPD. RESULTS There were 121 patients included in this study, 55 with APD and 66 with CAPD. APD patients had significantly lower risk of treatment failure (death and technique failure) than CAPD patients (HR 0.58, 95% confidence interval [CI]: 0.37-0.91, P=0.02). The lower risk of treatment failure in APD compared to CAPD was mainly caused by the significantly lower risk of technique failure (HR 0.30, 95%CI: 0.10-0.93, P=0.04). The mortality rates of the two modalities were not significantly different (HR 0.69, 95%CI: 0.42-1.12, P=0.13). CONCLUSION Our data suggest that APD may have lower risk of treatment failure compared with double-bag CAPD. These potential benefits of APD might justify the use of this modality despite its higher cost.
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Affiliation(s)
- Pisut Katavetin
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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178
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Wilkie M, Hurst H. Does shared decision-making provide an opportunity to improve the outcome of peritoneal dialysis catheter insertion? ARCH ESP UROL 2014; 34:9-11. [PMID: 24525594 DOI: 10.3747/pdi.2013.00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Martin Wilkie
- Sorby Renal Unit1 Sheffield Kidney Institute Northern General Hospital Sheffield, South Yorkshire, UK CAPD Unit2 Manchester Royal Infirmary Manchester, Lancashire, UK
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179
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Kim Y, Song YR, Kim JK, Kim HJ, Kim S, Kim SG. Use of a new connector decreases peritoneal dialysis-related peritonitis. Perit Dial Int 2014; 34:128-30. [PMID: 24525602 DOI: 10.3747/pdi.2012.00329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Youngsu Kim
- Internal Medicine1 Hallym University Sacred Heart Hospital Anyang, Republic of Korea Hallym Kidney Research Institute2 Hallym University College of Medicine Chuncheon, Republic of Korea Internal Medicine3 Seoul National University College of Medicine Seoul, Republic of Korea
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180
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Nadeau-Fredette AC, Bargman JM. Characteristics and outcomes of fungal peritonitis in a modern North American cohort. Perit Dial Int 2014; 35:78-84. [PMID: 24497586 DOI: 10.3747/pdi.2013.00179] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Peritonitis remains a common complication of peritoneal dialysis (PD). Although representing only 1 - 12% of overall peritonitis in dialysis patients, fungal peritonitis (FP) is associated with serious complications, including technique failure and death. Only scarce data have been published regarding FP outcomes in modern cohorts in North America. In this study we evaluated the rates, characteristics and outcomes of FP in a major North American PD center. METHODS We conducted a retrospective cohort study including all fungal peritonitis episodes among peritoneal dialysis patients followed in a large PD center between January 2000 and February 2013. Our pre-specified endpoints included rates of FP, characteristics, outcomes and determinants of death. RESULTS Thirty-six episodes of FP were identified during the follow-up period (one episode per 671 patient-months), representing 4.5% of the total peritonitis events. Patients' mean age and peritoneal dialysis vintage were 61.3 ± 15.5 and 2.9 (1.5 - 4.8) years, respectively. Of the 36 episodes of FP, seven (19%) resulted in death and 17 (47%) led to technique failure with permanent transfer to hemodialysis. Surprisingly, PD was eventually resumed in 33% of cases with a median delay of 15 weeks (interquartile range 8 - 23) between FP and catheter reinsertion. In a univariable analysis, a higher Charlson comorbidity index (Odds ratio [OR] 3.25 per unit increase, 95% confidence interval [CI] 1.23 - 8.58) and PD fluid white blood cell (WBC) count greater than 3,000/mm(3) at presentation (OR 6.56, 95% CI 1.05 - 40.95) predicted death. CONCLUSION While fungal peritonitis is still associated with a high frequency of death and technique failure, one third of our patients eventually returned to PD. Patients with a high burden of comorbidities appear at higher risk of death. We postulate that the high mortality associated with FP is partially related to the severity of comorbidity among patients with FP, rather than the infection per se. Importantly, PD can be resumed in a significant proportion of cases.
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Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Toronto General Hospital, University Health Network, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Joanne M Bargman
- Toronto General Hospital, University Health Network, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
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181
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Tang W, Grace B, McDonald SP, Hawley CM, Badve SV, Boudville NC, Brown FG, Clayton PA, Johnson DW. Socio-Economic Status and Peritonitis in Australian Non-Indigenous Peritoneal Dialysis Patients. Perit Dial Int 2014; 35:450-9. [PMID: 24497587 DOI: 10.3747/pdi.2013.00004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 07/09/2013] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND The aim of the present study was to investigate the relationship between socio-economic status (SES) and peritoneal dialysis (PD)-related peritonitis. ♦ METHODS Associations between area SES and peritonitis risk and outcomes were examined in all non-indigenous patients who received PD in Australia between 1 October 2003 and 31 December 2010 (peritonitis outcomes). SES was assessed by deciles of postcode-based Australian Socio-Economic Indexes for Areas (SEIFA), including Index of Relative Socio-economic Disadvantage (IRSD), Index of Relative Socio-economic Advantage and Disadvantage (IRSAD), Index of Economic Resources (IER) and Index of Education and Occupation (IEO). ♦ RESULTS 7,417 patients were included in the present study. Mixed-effects Poisson regression demonstrated that incident rate ratios for peritonitis were generally lower in the higher SEIFA-based deciles compared with the reference (decile 1), although the reductions were only statistically significant in some deciles (IRSAD deciles 2 and 4 - 9; IRSD deciles 4 - 6; IER deciles 4 and 6; IEO deciles 3 and 6). Mixed-effects logistic regression showed that lower probabilities of hospitalization were predicted by relatively higher SES, and lower probabilities of peritonitis-associated death were predicted by less SES disadvantage status and greater access to economic resources. No association was observed between SES and the risks of peritonitis cure, catheter removal and permanent hemodialysis (HD) transfer. ♦ CONCLUSIONS In Australia, where there is universal free healthcare, higher SES was associated with lower risks of peritonitis-associated hospitalization and death, and a lower risk of peritonitis in some categories.
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Affiliation(s)
- Wen Tang
- Division of Nephrology, Peking University Third Hospital, Beijing, China ANZDATA Registry, Adelaide, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | | | - Stephen P McDonald
- ANZDATA Registry, Adelaide, Australia Department of Nephrology and Transplantation Services, University of Adelaide at Central Northern Adelaide Renal and Transplantation Services, Adelaide, Australia
| | - Carmel M Hawley
- ANZDATA Registry, Adelaide, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Sunil V Badve
- ANZDATA Registry, Adelaide, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Neil C Boudville
- ANZDATA Registry, Adelaide, Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Australia
| | - Fiona G Brown
- ANZDATA Registry, Adelaide, Australia Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Philip A Clayton
- ANZDATA Registry, Adelaide, Australia Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia School of Public Health, University of Sydney, Sydney, Australia
| | - David W Johnson
- ANZDATA Registry, Adelaide, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
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182
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Vikrant S. Long-term clinical outcomes of peritoneal dialysis patients: 9-year experience of a single center from north India. Perit Dial Int 2014; 34:426-33. [PMID: 24385327 DOI: 10.3747/pdi.2013.00050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE There is a paucity of published data on the outcome of maintenance peritoneal dialysis (PD) since the initiation of continuous ambulatory PD (CAPD) in India in 1991. The purpose of this study is to report long-term clinical outcomes of PD patients at a single center. DESIGN Retrospective study. SETTING A government-owned tertiary-care hospital in North India. PATIENTS Patients who were initiated on CAPD between October 2002 and June 2011, and who survived and/or had more than 6 months' follow-up on this treatment with last follow-up till December 31, 2011, were studied. RESULTS A total of 60 patients were included in the analysis. The mean age of the patients was 60.2 ± 9.2 years. The majority (65%) of the patients lived in rural areas. A high proportion (47%) were diabetic and 62% had ≥ 2 comorbidities. Total duration on peritoneal dialysis treatment was 1,773 patient-months (148 patient-years) with a mean duration of 29.6 ± 23 patient-months and median duration of 25 patient-months (range 6 - 110 patient-months). Overall patient and technique survival at 1, 2, 3, 4 and 5 years was 77%, 53%, 25%, 15%, and 10% respectively. Patient survival of diabetics vs non-diabetics at 1, 2, 3, 4, and 5 years was 68% vs 84%, 54% vs 53%, 14% vs 34%, 11% vs 19%, and 11% vs 13%, respectively. The mortality in non-diabetics (16/32) was less than that in diabetic (18/28) patients (p = not significant). The main cause of mortality in these patients was cardiac followed by sepsis. There were 58 episodes of peritonitis. The rate of peritonitis was 1 episode per 30.6 patient-months or 0.39 episodes per patient-year. Furthermore, the total number of episodes of peritonitis and number of episodes of peritonitis per patient were higher in the non-survival group (p < 0.05). The incidence of tuberculosis (TB), herpes zoster (HZ) and hernias was 15%, 10% and 5% respectively. CONCLUSION The study reports long-term outcomes of the PD patients, the majority of whom were elderly with a high burden of comorbidities. There was a high proportion of diabetics. The survival of diabetic vs non-diabetic and elderly vs non-elderly PD patients was similar in our study. The mortality in non-diabetics was less than that in diabetic patients. TB and HZ were common causes of morbidity. Peritonitis was associated with mortality in these patients.
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Affiliation(s)
- Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla (Himachal Pradesh), 171001 India
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183
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Figueiredo AE, de Siqueira SL, Poli-de-Figueiredo CE, d'Avila DO. Hand hygiene in peritoneal dialysis patients: a comparison of two techniques. Perit Dial Int 2013; 33:655-61. [PMID: 24179108 PMCID: PMC3862095 DOI: 10.3747/pdi.2012.00298] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 01/30/2013] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Hand hygiene is essential for preventing peritoneal dialysis (PD)-related infections. The present study compared the effectiveness of two hygiene techniques in reducing the number of colony-forming units (CFUs) on the hands of patients undergoing PD. METHODS In this controlled clinical trial, 22 participants enrolled in the same PD program underwent a two-hand evaluation for microbiologic flora. Participants participated in two treatments: a) simple hand hygiene plus antiseptic hand hygiene, in which the patients washed their hands with water and glycerin soap for 1 minute and then rubbed and dried their hands with 70% ethyl alcohol gel; and b) antiseptic hand hygiene, in which the patients rubbed their hands with 70% ethyl alcohol gel until fully dry. To sample distal finger surfaces, we asked the participants to touch sheep blood agar plates directly. RESULTS The CFU count for both hands was significantly higher in the regular hygiene group than in the gel-only group [69.0 (16.0 - 101.0) CFU vs 9.0 (2.2 - 55.5) CFU, p < 0.010]. Growth of coagulase-negative Staphylococcus colonies was significantly higher in right-hand cultures from the regular hygiene group than in those from the gel-only group [69.5 (26.25 - 101.0) CFU vs 9.5 (1.0 - 41.7) CFU; p < 0.050]. CONCLUSIONS Among patients undergoing PD, using 70% ethyl alcohol gel to cleanse the hands may be more effective than following the regular hygiene recommendations in reducing bacterial populations.
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Affiliation(s)
- Ana Elizabeth Figueiredo
- School of Nursing, Physiotherapy and Nutrition,1 and Postgraduate Program in Medicine and Health Sciences, School of Medicine,2 Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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184
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Li PKT, Chow KM. Peritoneal Dialysis–First Policy Made Successful: Perspectives and Actions. Am J Kidney Dis 2013; 62:993-1005. [DOI: 10.1053/j.ajkd.2013.03.038] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/19/2013] [Indexed: 12/31/2022]
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185
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Tsai CC, Lee JJ, Liu TP, Ko WC, Wu CJ, Pan CF, Cheng SP. Effects of age and diabetes mellitus on clinical outcomes in patients with peritoneal dialysis-related peritonitis. Surg Infect (Larchmt) 2013; 14:540-6. [PMID: 24116738 DOI: 10.1089/sur.2012.195] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD)-related peritonitis is the most common complication and the leading cause of technique failure for patients on PD therapy. The aim of this study was to review the episodes and outcomes of PD-related peritonitis, with special reference to the effects of age and diabetes status. METHODS The study comprised 204 consecutive peritonitis episodes between January 2001 and June 2011 from our registry database. Factors associated with treatment failure and mortality were analyzed with multi-variable logistic regression modeling. RESULTS The overall peritonitis rate was one episode per 65 patient-months or 0.187 episodes/patient-year. Older patients had lower probability of remaining free of peritonitis (log rank, p<0.001). Elderly patients and diabetic subjects had a higher risk of peritonitis-related dropout. Age (odds ratio [OR], 1.37; p=0.041), diabetes mellitus (OR, 3.64; p=0.005), and gram-negative peritonitis (OR, 3.55; p=0.011) were independent determinants of catheter removal. Age (OR, 1.93; p=0.026) and diabetes (OR, 5.98; p=0.015) were the only predictors of death from peritonitis. CONCLUSIONS Old age and diabetes mellitus are two major risk factors for adverse outcomes of PD-related peritonitis. Although they are not contraindications to PD, our results suggest that these patients need meticulous care when peritonitis occurs.
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Affiliation(s)
- Chia-Chi Tsai
- 1 Department of Surgery, Mackay Memorial Hospital , Taipei, Taiwan
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186
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Johnson DW, 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. Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT): a randomised trial. THE LANCET. INFECTIOUS DISEASES 2013; 14:23-30. [PMID: 24119840 DOI: 10.1016/s1473-3099(13)70258-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is a paucity of evidence to guide the best strategy for prevention of peritoneal-dialysis-related infections. Antibacterial honey has shown promise as a novel, cheap, effective, topical prophylactic agent without inducing microbial resistance. We therefore assessed whether daily application of honey at the exit site would increase the time to peritoneal-dialysis-related infections compared with standard exit-site care plus intranasal mupirocin prophylaxis for nasal carriers of Staphylococcus aureus. METHODS In this open-label trial undertaken in 26 centres in Australia and New Zealand, participants undergoing peritoneal dialysis were randomly assigned in a 1:1 ratio with an adaptive allocation algorithm to daily topical exit-site application of antibacterial honey plus standard exit-site care or intranasal mupirocin prophylaxis (only in carriers of nasal S aureus) plus standard exit-site care (control group). The primary endpoint was time to first infection related to peritoneal dialysis (exit-site infection, tunnel infection, or peritonitis). The trial is registered with the Australian New Zealand Clinical Trials Registry, number 12607000537459. FINDINGS Of 371 participants, 186 were assigned to the honey group and 185 to the control group. The median peritoneal-dialysis-related infection-free survival times were not significantly different in the honey (16·0 months [IQR not estimable]) and control groups (17·7 months [not estimable]; unadjusted hazard ratio 1·12, 95% CI 0·83-1·51; p=0·47). In the subgroup analyses, honey increased the risks of both the primary endpoint (1·85, 1·05-3·24; p=0·03) and peritonitis (2·25, 1·16-4·36) in participants with diabetes. The incidences of serious adverse events (298 vs 327, respectively; p=0·1) and deaths (14 vs 18, respectively; p=0·9) were not significantly different in the honey and control groups. 11 (6%) participants in the honey group had local skin reactions. INTERPRETATION The findings of this trial show that honey cannot be recommended routinely for the prevention of peritoneal-dialysis-related infections. FUNDING Baxter Healthcare, Queensland Government, Comvita, and Gambro.
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Affiliation(s)
- David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Translational Research Institute, Brisbane, QLD, Australia.
| | - Sunil V Badve
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - Elaine Beller
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia
| | - Alan Cass
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Menzies School of Health Research, Darwin, NT, Australia
| | - Carolyn Clark
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Nambour Hospital, Nambour, QLD, Australia
| | - Janak de Zoysa
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Renal Medicine, North Shore Hospital, Auckland, New Zealand
| | - Nicole M Isbel
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Steven McTaggart
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Child and Adolescent Renal Service, Royal Children's and Mater Children's Hospitals, Brisbane, QLD, Australia
| | - Alicia T Morrish
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - E Geoffrey Playford
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Anish Scaria
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - Paul Snelling
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Liza A Vergara
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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187
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Agarwal G, Foster D, Schlageter K, Jones L, Jorgensen L, Wilkinson S, Astor B, Chan M. Increase in Peritonitis Rates with the Reuse of Drain Tubing of the Fresenius Liberty Cycler. Perit Dial Int 2013; 33:583-5. [DOI: 10.3747/pdi.2012.00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G. Agarwal
- Division of Nephrology University of Wisconsin School of Medicine and Public Health Madison, Wisconsin, USA
| | - D. Foster
- Division of Nephrology University of Wisconsin School of Medicine and Public Health Madison, Wisconsin, USA
| | - K. Schlageter
- Division of Nephrology University of Wisconsin School of Medicine and Public Health Madison, Wisconsin, USA
| | - L. Jones
- Division of Nephrology University of Wisconsin School of Medicine and Public Health Madison, Wisconsin, USA
| | - L. Jorgensen
- Division of Nephrology University of Wisconsin School of Medicine and Public Health Madison, Wisconsin, USA
| | - S. Wilkinson
- Division of Nephrology University of Wisconsin School of Medicine and Public Health Madison, Wisconsin, USA
| | - B.C. Astor
- Division of Nephrology University of Wisconsin School of Medicine and Public Health Madison, Wisconsin, USA
- Department of Population Health Sciences University of Wisconsin School of Medicine and Public Health Madison, Wisconsin, USA
| | - M.R. Chan
- Division of Nephrology University of Wisconsin School of Medicine and Public Health Madison, Wisconsin, USA
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188
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Wilkie M. Classification, Measurement, and Debate—The Science of Peritoneal Dialysis. Perit Dial Int 2013; 33:471-2. [DOI: 10.3747/pdi.2013.00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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189
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Martins M, Rodrigues A, Pedrosa JM, Carvalho MJ, Cabrita A, Oliveira R. Update on the challenging role of biofilms in peritoneal dialysis. BIOFOULING 2013; 29:1015-1027. [PMID: 23998251 DOI: 10.1080/08927014.2013.824566] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Biofilms are commonly associated with an increased risk of patient infection. In peritoneal dialysis (PD), catheter associated infection, especially peritonitis, remains a clinically relevant problem. Although the presence of a biofilm is recognized in relapsing, repeat, and catheter-related peritonitis, it remains poorly characterized. In this review, an update on the role of biofilms in PD infections is presented. The emerging concept that host cells and tissue associated biofilms, in addition to the biofilms on the catheters themselves, contribute to the recalcitrance of infections is discussed. Furthermore, the evidence of biofilms on PD catheters, their developmental stages, and the possible influence of the PD environment are reviewed. The focus is given to ex vivo and in vitro studies that contribute to the elucidation of the interplay between host, microbial, and dialysis factors. The key issues that are still to be answered and the challenges to clinical practice are discussed.
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Affiliation(s)
- Margarida Martins
- IBB-Institute for Biotechnology and Bioengineering, Centre of Biological Engineering, University of Minho, Braga, Portugal
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190
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Wu HH, Li IJ, Weng CH, Lee CC, Chen YC, Chang MY, Fang JT, Hung CC, Yang CW, Tian YC. Prophylactic antibiotics for endoscopy-associated peritonitis in peritoneal dialysis patients. PLoS One 2013; 8:e71532. [PMID: 23936514 PMCID: PMC3731321 DOI: 10.1371/journal.pone.0071532] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 06/29/2013] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Continuous ambulatory peritoneal dialysis (CAPD) peritonitis may develop after endoscopic procedures, and the benefit of prophylactic antibiotics is unclear. In the present study, we investigated whether prophylactic antibiotics reduce the incidence of peritonitis in these patients. PATIENTS AND METHODS We retrospectively reviewed all endoscopic procedures, including esophagogastroduodenoscopy (EGD), colonoscopy, sigmoidoscopy, cystoscopy, hysteroscopy, and hysteroscopy-assisted intrauterine device (IUD) implantation/removal, performed in CAPD patients at Chang Gung Memorial Hospital, Taiwan, between February 2001 and February 2012. RESULTS Four hundred and thirty-three patients were enrolled, and 125 endoscopies were performed in 45 patients. Eight (6.4%) peritonitis episodes developed after the examination. Antibiotics were used in 26 procedures, and none of the patients had peritonitis (0% vs. 8.1% without antibiotic use; p=0.20). The peritonitis rate was significantly higher in the non-EGD group than in the EGD group (15.9% [7/44] vs. 1.2% [1/81]; p<0.005). Antibiotic use prior to non-EGD examinations significantly reduced the endoscopy-associated peritonitis rate compared to that without antibiotic use (0% [0/16] vs. 25% [7/28]; p<0.05). Peritonitis only occurred if invasive procedures were performed, such as biopsy, polypectomy, or IUD implantation, (noninvasive procedures, 0% [0/20] vs. invasive procedures, 30.4% [7/23]; p<0.05). No peritonitis was noted if antibiotics were used prior to examination with invasive procedures (0% [0/10] vs. 53.8% [7/13] without antibiotic use; p<0.05). Although not statistically significant, antibiotics may play a role in preventing gynecologic procedure-related peritonitis (antibiotics, 0% [0/4] vs. no antibiotics, 55.6% [5/9]; p=0.10). CONCLUSION Antibiotic prophylaxis significantly reduced endoscopy-associated PD peritonitis in the non-EGD group. Endoscopically assisted invasive procedures, such as biopsy, polypectomy, IUD implantation/removal, and dilatation and curettage (D&C), pose a high risk for peritonitis. Prophylactic antibiotics for peritonitis prevention may be required in colonoscopic procedures and gynecologic procedures.
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Affiliation(s)
- Hsin-Hsu Wu
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao Yuan, Taiwan
| | - I-Jung Li
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao Yuan, Taiwan
| | - Cheng-Hao Weng
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao Yuan, Taiwan
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
| | - Yung-Chang Chen
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
| | - Ming-Yang Chang
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
| | - Ji-Tseng Fang
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
| | - Cheng-Chieh Hung
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
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191
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Rodríguez-Carmona A, Pérez-Fontán M, López-Muñiz A, Ferreiro-Hermida T, García-Falcón T. Correlation between glycemic control and the incidence of peritoneal and catheter tunnel and exit-site infections in diabetic patients undergoing peritoneal dialysis. Perit Dial Int 2013; 34:618-26. [PMID: 23818005 DOI: 10.3747/pdi.2012.00185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diabetes mellitus, especially if complicated by poor glycemic control, portends an increased risk of infection. The significance of this association in the case of diabetic patients undergoing peritoneal dialysis (PD) has not been assessed. METHODS Using a retrospective observational design, we analyzed the association between glycemic control at the start of PD (estimated from glycosylated hemoglobin levels) and the risk of peritoneal and catheter tunnel and exit-site infections during follow-up in 183 incident patients on PD. We used the median value of glycosylated hemoglobin to classify patients into good (group A) or poor (group B) glycemic control groups. We applied multivariate strategies of analysis to control for other potential predictors of PD-related infection. RESULTS Groups A and B differed significantly in age, dialysis vintage, use of insulin, and rate of Staphylococcus aureus carriage. Neither the incidence (0.60 episodes in group A vs 0.56 episodes in group B per patient-year) nor the time to a first peritoneal infection (median: 42 months vs 38 months) differed significantly between the study groups. In contrast, group B had a significantly higher incidence of catheter tunnel and exit-site infections (0.23 episodes vs 0.12 episodes per patient-year) and shorter time to a first infection episode (64 months vs 76 months, p = 0.004). The difference persisted in multivariate analysis (adjusted hazard ratio: 2.65; 95% confidence interval: 1.13 to 6.05; p = 0.013). We observed no differences between the study groups in the spectrum of causative organisms or in the outcomes of PD-related infections. CONCLUSIONS Poor glycemic control is a consistent predictor of subsequent risk of catheter tunnel and exit-site infection, but not of peritoneal infection, among diabetic patients starting PD therapy.
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Affiliation(s)
- Ana Rodríguez-Carmona
- Division of Nephrology, University Hospital A Coruña, and Health Sciences Faculty, University of A Coruña, A Coruña, Spain
| | - Miguel Pérez-Fontán
- Division of Nephrology, University Hospital A Coruña, and Health Sciences Faculty, University of A Coruña, A Coruña, Spain
| | - Andrés López-Muñiz
- Division of Nephrology, University Hospital A Coruña, and Health Sciences Faculty, University of A Coruña, A Coruña, Spain
| | - Tamara Ferreiro-Hermida
- Division of Nephrology, University Hospital A Coruña, and Health Sciences Faculty, University of A Coruña, A Coruña, Spain
| | - Teresa García-Falcón
- Division of Nephrology, University Hospital A Coruña, and Health Sciences Faculty, University of A Coruña, A Coruña, Spain
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192
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Abstract
Peritoneal dialysis is now a well established, mature treatment modality for advanced chronic kidney disease. The medium term (at least 5 year) survival of patients on peritoneal dialysis is currently equivalent to that of those on haemodialysis, and is particularly good in patients who are new to renal replacement therapy and have less comorbidity. Nevertheless the modality needs to keep pace with the constantly evolving challenges associated with the provision and delivery of health care. These challenges, which are gradually converging at a global level, include ageing of the population, multimorbidity of patients, containment of cost, increasing self care and environmental issues. In this context, peritoneal dialysis faces particular challenges that include multiple barriers to the therapy and unsatisfactory and poorly defined technique survival as well as limitations relating to intrinsic aspects of the therapy, such as peritoneal membrane longevity and hypoalbuminaemia. To move the therapy forward and favourably influence health-care policy, the peritoneal dialysis community needs to integrate their research effort more effectively by undertaking clinically meaningful studies-with a strong focus on technique survival--that are supported by multidisciplinary expertise in patient-centred outcomes, study design and analysis.
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Affiliation(s)
- Simon J Davies
- Department of Nephrology, University Hospital of North Staffordshire, Newcastle Road, Stoke on Trent, Staffordshire ST4 6QG, UK.
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193
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Prevention of peritoneal dialysis catheter infections in Saudi peritoneal dialysis patients: the emergence of high-level mupirocin resistance. Int J Artif Organs 2013; 36:473-83. [PMID: 23897229 DOI: 10.5301/ijao.5000207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE Exit-site infection (ESI) and peritonitis remain the major causes of morbidity and mortality in peritoneal dialysis (PD) patients. This study compared the effectiveness of local mupirocin ointment and gentamicin cream in preventing both gram-positive and gram-negative bacterial infections in PD patients. METHODS Patients from two centers (n = 203) were assigned to daily mupirocin ointment or gentamicin cream application. Infections were tracked prospectively by organisms and expressed as episodes per patient-year for both ESI and peritonitis. RESULTS The rate of gram-positive ESI was 0.31/episode/patient-year and 0.22 episodes/patient-year (p<0.05), whereas the rate of gram-negative ESI was 0.28 episode/patient-year and 0.11 episode/patient-year (p<0.01) in the mupirocin group and gentamicin group, respectively. Gram-positive ESI occurred in 17.1% vs 10.2% of patients (p<0.05), whereas 20% of and 5.1% of patients (p<0.001) had gram-negative ESI in the 2 groups respectively. S.aureus was cultured at exit-site in the mupirocin group in 27.8% patients, 60% (16.7% of the total Gram-positive isolates) of them being with high-level mupirocin-resistance. Pseudomonas aeruginosa was cultured in 21.8% of ESI in the mupirocin group, and in only 6.7% in the gentamicin group (p<0.01). Peritonitis rates were lower using gentamicin cream, 0.17 episode/patient-year compared with mupirocin, 0.39 episode/patient-year (p<0.01). With multivariate analysis, only gentamicin exit-site use was a significant predictor for lower catheter infection rate. CONCLUSION Prolonged use of mupirocin for ESI-prophylaxis is associated with the emergence of mupirocin-resistant S. aureus. Gentamicin cream is superior to mupirocin ointment in the prevention of PD catheter infections.
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194
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Johnson DW, Brown FG, Clarke M, Boudville N, Elias TJ, Foo MWY, Jones B, Kulkarni H, Langham R, Ranganathan D, Schollum J, Suranyi MG, Tan SH, Voss D. The effects of biocompatible compared with standard peritoneal dialysis solutions on peritonitis microbiology, treatment, and outcomes: the balANZ trial. Perit Dial Int 2013; 32:497-506. [PMID: 22991015 DOI: 10.3747/pdi.2012.00052] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A multicenter, multi-country randomized controlled trial (the balANZ study) recently reported that peritonitis rates significantly improved with the use of neutral-pH peritoneal dialysis (PD) solutions low in glucose degradation products ("biocompatible") compared with standard solutions. The present paper reports a secondary outcome analysis of the balANZ trial with respect to peritonitis microbiology, treatment, and outcomes. METHODS Adult incident PD patients with residual renal function were randomized to receive either biocompatible or conventional (control) PD solutions for 2 years. RESULTS The safety population analysis for peritonitis included 91 patients in each group. The unadjusted geometric mean peritonitis rates in those groups were 0.30 [95% confidence interval (CI): 0.22 to 0.41] episodes per patient-year for the biocompatible group and 0.49 (95% CI: 0.39 to 0.62) episodes per patient-year for the control group [incidence rate ratio (IRR): 0.61; 95% CI: 0.41 to 0.90; p = 0.01]. When specific causative organisms were examined, the rates of culture-negative, gram-positive, gram-negative, and polymicrobial peritonitis episodes were not significantly different between the biocompatible and control groups, although the biocompatible group did experience a significantly lower rate of non-pseudomonal gram-negative peritonitis (IRR: 0.41; 95% CI: 0.18 to 0.92; p = 0.03). Initial empiric antibiotic regimens were comparable between the groups. Biocompatible fluid use did not significantly reduce the risk of peritonitis-associated hospitalization (adjusted odds ratio: 0.80; 95% CI: 0.48 to 1.34), but did result in a shorter median duration of peritonitis-associated hospitalization (6 days vs 11 days, p = 0.05). Peritonitis severity was more likely to be rated as mild in the biocompatible group (37% vs 10%, p = 0.001). Overall peritonitis-associated technique failures and peritonitis-related deaths were comparable in the two groups. CONCLUSIONS Biocompatible PD fluid use was associated with a broad reduction in gram-positive, gram-negative, and culture-negative peritonitis that reached statistical significance for non-pseudomonal gram-negative organisms. Peritonitis hospitalization duration was shorter, and peritonitis severity was more commonly rated as mild in patients receiving biocompatible PD fluids, although other peritonitis outcomes were comparable between the groups.
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Affiliation(s)
- David W Johnson
- Department of Nephrology, University of Queensland, Brisbane, Australia.
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195
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Increased peritoneal dialysis exit site infections using topical antiseptic polyhexamethylene biguanide compared to mupirocin: results of a safety interim analysis of an open-label prospective randomized study. Antimicrob Agents Chemother 2013; 57:2026-8. [PMID: 23403425 DOI: 10.1128/aac.02079-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Prophylactic mupirocin for peritoneal catheter exit sites reduces exit site infection (ESI) risk but engenders antibiotic resistance. We present early interim safety analysis of an open-label randomized study comparing polyhexamethylene biguanide (PHMB) and mupirocin. A total of 106 patients randomized to 53 in each group were followed up for a mean of 12.68 months per patient. On safety analysis, the PHMB group had a significantly greater ESI rate than the mupirocin group (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.09 to 0.80), leading to discontinuation of the trial.
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196
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Lin CY, Kift-Morgan A, Moser B, Topley N, Eberl M. Suppression of pro-inflammatory T-cell responses by human mesothelial cells. Nephrol Dial Transplant 2013; 28:1743-50. [PMID: 23355626 DOI: 10.1093/ndt/gfs612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Human γδ T cells reactive to the microbial metabolite (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate (HMB-PP) contribute to acute inflammatory responses. We have previously shown that peritoneal dialysis (PD)-associated infections with HMB-PP producing bacteria are characterized by locally elevated γδ T-cell frequencies and poorer clinical outcome compared with HMB-PP negative infections, implying that γδ T cells may be of diagnostic, prognostic and therapeutic value in acute disease. The regulation by local tissue cells of these potentially detrimental γδ T-cell responses remains to be investigated. METHODS Freshly isolated γδ or αβ T cells were cultured with primary mesothelial cells derived from omental tissue, or with mesothelial cell-conditioned medium. Stimulation of cytokine production and proliferation by peripheral T cells in response to HMB-PP or CD3/CD28 beads was assessed by flow cytometry. RESULTS Resting mesothelial cells were potent suppressors of pro-inflammatory γδ T cells as well as CD4+ and CD8+ αβ T cells. The suppression of γδ T-cell responses was mediated through soluble factors released by primary mesothelial cells and could be counteracted by SB-431542, a selective inhibitor of TGF-β and activin signalling. Recombinant TGF-β1 but not activin-A mimicked the mesothelial cell-mediated suppression of γδ T-cell responses to HMB-PP. CONCLUSIONS The present findings indicate an important regulatory function of mesothelial cells in the peritoneal cavity by dampening pro-inflammatory T-cell responses, which may help preserve the tissue integrity of the peritoneal membrane in the steady state and possibly during the resolution of acute inflammation.
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Affiliation(s)
- Chan-Yu Lin
- Cardiff Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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197
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Mehrotra R, Singh H. Peritoneal Dialysis–Associated Peritonitis with Simultaneous Exit-Site Infection. Clin J Am Soc Nephrol 2012; 8:126-9; discussion 129-30. [DOI: 10.2215/cjn.06910712] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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198
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Wilkie M. Article Commentary: The Balanz Study—Strengthening the Evidence for Neutral-PH Solutions Low in Glucose Degradation Products. Perit Dial Int 2012; 32:489-92. [DOI: 10.3747/pdi.2012.00204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Martin Wilkie
- Sheffield Kidney Institute Sorby Renal Unit Northern General Hospital Sheffield, UK
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199
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Cho Y, Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville N, Wiggins KJ, Bannister KM, Clayton P, Johnson DW. Effects of climatic region on peritonitis risk, microbiology, treatment, and outcomes: a multicenter registry study. Perit Dial Int 2012; 33:75-85. [PMID: 22942270 DOI: 10.3747/pdi.2011.00317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The impact of climatic variations on peritoneal dialysis (PD)-related peritonitis has not been studied in detail. The aim of the current study was to determine whether various climatic zones influenced the probability of occurrence or the clinical outcomes of peritonitis. METHODS Using ANZDATA registry data, the study included all Australian patients receiving PD between 1 October 2003 and 31 December 2008. Climatic regions were defined according to the Köppen classification. RESULTS The overall peritonitis rate was 0.59 episodes per patient-year. Most of the patients lived in Temperate regions (65%), with others residing in Subtropical (26%), Tropical (6%), and Other climatic regions (Desert, 0.6%; Grassland, 2.3%). Compared with patients in Temperate regions, those in Tropical regions demonstrated significantly higher overall peritonitis rates and a shorter time to a first peritonitis episode [adjusted hazard ratio: 1.15; 95% confidence interval (CI): 1.01 to 1.31]. Culture-negative peritonitis was significantly less likely in Tropical regions [adjusted odds ratio (OR): 0.42; 95% CI: 0.25 to 0.73]; its occurrence in Subtropical and Other regions was comparable to that in Temperate regions. Fungal peritonitis was independently associated with Tropical regions (OR: 2.18; 95% CI: 1.22 to 3.90) and Other regions (OR: 3.46; 95% CI: 1.73 to 6.91), where rates of antifungal prophylaxis were also lower. Outcomes after first peritonitis episodes were comparable in all groups. CONCLUSIONS Tropical regions were associated with a higher overall peritonitis rate (including fungal peritonitis) and a shorter time to a first peritonitis episode. Augmented peritonitis prophylactic measures such as antifungal therapy and exit-site care should be considered in PD patients residing in Tropical climates.
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Affiliation(s)
- Yeoungjee Cho
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
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200
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A brief recap of tips and surgical manoeuvres to enhance optimal outcome of surgically placed peritoneal dialysis catheters. Int J Nephrol 2012; 2012:251584. [PMID: 22888425 PMCID: PMC3408654 DOI: 10.1155/2012/251584] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 06/11/2012] [Accepted: 06/21/2012] [Indexed: 11/18/2022] Open
Abstract
Background. Peritoneal dialysis (PD) is an effective option of renal replacement therapy for ESRF, offering advantages over haemodialysis. Peritoneal dialysis catheter (PDC) placement is thought to be the key to successful PD and the economic advantages are lost if a patient switches to HD in the 1st year. This paper is a brief document elaborating a recap of published literature, looking at various surgical tips and manoeuvres to enhance optimal outcome of PDC placement. Methods. A search strategy assessing for access team, preoperative antibiotic prophylaxis, type of catheter, catheter exit site, intraoperative catheter trial, optimal time to commence PD, hernia repairs, number of cuffs, catheter-embedding procedures, rectus sheath tunnelling, laparoscopic fixing, omentopexy, omentectomy, the "Y"-Tec system, resection of epiploic appendages, adhesiolysis, a trained surgeon, and perioperative catheter care protocol was used looking at various databases. Findings. The complications of catheterrelated dysfunction can be reduced with advanced planning of access placement, immaculate surgery, and attention to catheter insertion techniques. Conclusion. The success of a peritoneal dialysis programme depends upon functional and durable long term access to the peritoneal cavity; this depends on placement techniques and competent surgeons and psychosocial support to the patient. The various technical tips and manoeuvres elaborated here should be considered options carried out to improve outcome and reduce catheter dysfunction.
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