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Warady BA, Same R, Borzych-Duzalka D, Neu AM, El Mikati I, Mustafa RA, Begin B, Nourse P, Bakkaloglu SA, Chadha V, Cano F, Yap HK, Shen Q, Newland J, Verrina E, Wirtz AL, Smith V, Schaefer F. Clinical practice guideline for the prevention and management of peritoneal dialysis associated infections in children: 2024 update. Perit Dial Int 2024; 44:303-364. [PMID: 39313225 DOI: 10.1177/08968608241274096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Infection-related complications remain the most significant cause for morbidity and technique failure in infants, children and adolescents who receive maintenance peritoneal dialysis (PD). The 2024 update of the Clinical Practice Guideline for the Prevention and Management of Peritoneal Dialysis Associated Infection in Children builds upon previous such guidelines published in 2000 and 2012 and provides comprehensive treatment guidance as recommended by an international group of pediatric PD experts based upon a review of published literature and pediatric PD registry data. The workgroup prioritized updating key clinical issues contained in the 2012 guidelines, in addition to addressing additional questions developed using the PICO format. A variety of new guideline statements, highlighted by those pertaining to antibiotic therapy of peritonitis as a result of the evolution of antibiotic susceptibilities, antibiotic stewardship and clinical registry data, as well as new clinical benchmarks, are included. Recommendations for future research designed to fill important knowledge gaps are also provided.
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Affiliation(s)
- Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Rebecca Same
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dagmara Borzych-Duzalka
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicia M Neu
- Division of Pediatric Nephrology, Johns Hopkins Children's Hospital, Baltimore, Maryland, USA
| | - Ibrahim El Mikati
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brandy Begin
- Doernbecher Children's Hospital at Oregon Health & Science University, Portland, Oregon, USA
| | - Peter Nourse
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | | | - Vimal Chadha
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Francisco Cano
- Luis Calvo Mackenna Children's Hospital, Santiago, Chile
| | - Hui Kim Yap
- Division of Pediatric Nephrology, National University Hospital, Singapore, Singapore
| | - Qian Shen
- Children's Hospital of Fudan University, Shanghai, China
| | - Jason Newland
- Division of Pediatric Infectious Diseases, St. Louis Children's Hospital, St Louis, Missouri, USA
| | - Enrico Verrina
- Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini Children's, Genoa, Italy
| | - Ann L Wirtz
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Valerie Smith
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Franz Schaefer
- Heidelberg University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
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Yuan D, Sun Z, Shi Y, Zhou J, Shi C, Li Z. Analysis of risk factors for refractory peritonitis in patients undergoing peritoneal dialysis. Am J Transl Res 2024; 16:3832-3841. [PMID: 39262754 PMCID: PMC11384409 DOI: 10.62347/ckoj5736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/02/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVE To explore the risk factors for refractory peritonitis in patients undergoing peritoneal dialysis. METHODS We retrospectively collected data from 130 patients who underwent peritoneal dialysis (PD) and received peritonitis treatment at the Renal Disease Center of Beijing Luhe Hospital affiliated with Capital Medical University from January 1, 2016 to January 30, 2023. According to clinical treatment results, patients with refractory peritonitis were classified as the refractory group (n=52 cases), and those with non-refractory peritonitis were classified as the non-refractory group (n=78 cases). Baseline information and laboratory indicators of patients in each group were collected, and Logistic regression model was used to identify the risk factors for the poor prognosis of peritonitis patients. RESULTS There were statistically significant differences in dialysis time, dialysate sugar concentration and inducement type between the refractory group and the non-refractory group (P<0.05). The values of peripheral white blood cells (pWBC), T helper 2 cell (Th2), T regulatory cell (Treg), Treg/Th17 and C-reactive protein (CRP) in the refractory group were significantly higher than those in the non-refractory group, while the values of T helper 17 cell (Th17) and albumin (ALB) were significantly lower (all P<0.05). There were no significant differences in serum creatinine, blood urea, Th1, hemoglobin (Hb) and blood calcium levels between the two groups (all P>0.05). Gram-positive bacteria were the main pathogenic bacteria of peritonitis in all groups. The proportion of enterococcus/streptococcal peritonitis in the refractory group was higher than that in the non-refractory group (P<0.05). Logistic regression identified elevated pWBC, higher dialysate sugar concentration, exit-site infection and gram-negative bacteria infection as independent risk factors for refractory peritonitis in patients undergoing PD (all P<0.05). CONCLUSION Elevated pWBC, high glucose dialysate concentration, exit-site infection, and gram-negative bacteria infection are risk factors for refractory peritonitis in patients undergoing PD.
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Affiliation(s)
- Dan Yuan
- Department of Nephrology, Beijing Luhe Hospital, Capital Medical University Beijing 101100, China
| | - Zhenxing Sun
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing 102218, China
| | - Yanan Shi
- Department of Nephrology, Beijing Luhe Hospital, Capital Medical University Beijing 101100, China
| | - Jingjing Zhou
- Department of Nephrology, Beijing Luhe Hospital, Capital Medical University Beijing 101100, China
| | - Chunxia Shi
- Department of Nephrology, Beijing Luhe Hospital, Capital Medical University Beijing 101100, China
| | - Zhongxin Li
- Department of Nephrology, Beijing Luhe Hospital, Capital Medical University Beijing 101100, China
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Xie R, Ling Y, Huang Y, Qin L, Bao K, Qin X. A rare case of successful treatment of peritoneal dialysis patient with Serratia marcescens peritonitis without catheter removal: case report and literature review. Front Cell Infect Microbiol 2024; 14:1373036. [PMID: 38873095 PMCID: PMC11169698 DOI: 10.3389/fcimb.2024.1373036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Serratia marcescens, as a Gram-negative opportunistic pathogen, is a rare cause of peritonitis and has worse clinical outcomes than Gram-positive peritonitis. In this case report, we describe a case of Serratia marcescens associated peritonitis that was successfully cured without catheter removal. A 40-year-old male patient with peritoneal dialysis who worked in the catering industry was admitted to the hospital for 16 hours after the discovery of cloudy peritoneal dialysate and abdominal pain. Ceftazidime and cefazolin sodium were immediately given intravenously as an empirical antibiotic regimen. After detecting Serratia marcescens in the peritoneal diasate culture, the treatment was switched to ceftazidime and levofloxacin. The routine examination of peritoneal dialysate showed a significant decrease in white blood cells, the peritoneal dialysate became clear, and the peritoneal dialysis catheter was retained. The patient was treated for 2 weeks and treated with oral antibiotics for 1 week. It is necessary to further strengthen the hygiene of work environment to prevent Serratia marcescens infection in peritoneal dialysis patients. We recommend that patients with Serratia marcescens associated peritonitis should be treated with a combination of antibiotics as early as possible empirically, and at the same time, the peritoneal dialysis fluid culture should be improved, and the antibiotic regimen should be timely adjusted according to the drug sensitivity results. For patients with clinical symptoms for more than 3 days, considering the strong virulence of Serratia marcescens, whether to use meropenem directly or not can provide a reference for clinical decision-making. Further clinical studies are needed to achieve more precise anti-infective treatment.
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Affiliation(s)
- Ruizhi Xie
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ying Ling
- The Sixth Clinical Medical College, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Yaru Huang
- The College of Basic Medical Sciences of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lulu Qin
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kun Bao
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Nephrology Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases, Guangzhou, China
| | - Xindong Qin
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Nephrology Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases, Guangzhou, China
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4
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Ibrahim R, Hijazi MM, AlAli F, Hamad A, Bushra A, Mirow L, Siepmann T. Diagnostic Accuracy of MMP-8 and IL-6-Based Point-of-Care Testing to Detect Peritoneal Dialysis-Related Peritonitis: A Single-Center Experience. Diagnostics (Basel) 2024; 14:1113. [PMID: 38893639 PMCID: PMC11171716 DOI: 10.3390/diagnostics14111113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Peritoneal dialysis-related peritonitis (PDRP) is the most common complication of peritoneal dialysis (PD), which can lead to poor outcomes if not diagnosed and treated early. We aimed to investigate the diagnostic accuracy of MMP-8 and IL-6-based point-of-care tests (POCTs) in diagnosing PDRP in PD patients. METHODS This retrospective chart review study was conducted at a comprehensive kidney center in Qatar. It involved all adult PD patients who underwent PDRP from July 2018 to October 2019 and for whom MMP-8 and IL-6-based POCTs were used to diagnose presumptive peritonitis. Measures of diagnostic accuracy were computed. Peritoneal fluid effluent analysis was the reference standard. RESULTS We included 120 patients (68 [56.7%] females, ages 55.6 ± 15.6 years, treatment duration 39.5 ± 30.4 months [range: 5-142 months]). In this population, MMP-8 and IL-6-based POCTs yielded 100% in all dimensions of diagnostic accuracy (sensitivity, specificity, positive and negative predictive values). CONCLUSIONS MMP-8 and IL-6-based POCTs might be helpful in the early detection of PDRP. This monocentric observation requires further confirmation in a prospective multicentric setting.
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Affiliation(s)
- Rania Ibrahim
- Department of Nephrology, Dialysis Division, Fahad Bin Jassim Kidney Center, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.I.); (F.A.); (A.H.); (A.B.)
- Division of Health Care Sciences, Dresden International University, Freiberger Str. 37, 01067 Dresden, Germany
| | - Mido Max Hijazi
- Department of Neurosurgery, Division of Spine Surgery, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany;
| | - Fadwa AlAli
- Department of Nephrology, Dialysis Division, Fahad Bin Jassim Kidney Center, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.I.); (F.A.); (A.H.); (A.B.)
| | - Abdullah Hamad
- Department of Nephrology, Dialysis Division, Fahad Bin Jassim Kidney Center, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.I.); (F.A.); (A.H.); (A.B.)
| | - Ahlam Bushra
- Department of Nephrology, Dialysis Division, Fahad Bin Jassim Kidney Center, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.I.); (F.A.); (A.H.); (A.B.)
| | - Lutz Mirow
- Department of Surgery, Klinikum Chemnitz gGmbH, Medical Faculty and University Hospital Carl Gustav Carus, Medical Campus Chemnitz, Technische Universität Dresden, Flemmingstraße 2, 09116 Chemnitz, Germany;
| | - Timo Siepmann
- Division of Health Care Sciences, Dresden International University, Freiberger Str. 37, 01067 Dresden, Germany
- Department of Neurology, Technische Universität Dresden, Medical Faculty and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany
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5
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Kim JH, Kim SM, Kang M, Kang E, Park SH, Kim YL, Pecoits-Filho R, Bieber B, Pisoni RL, Oh KH. Characteristics of patients and facility of peritoneal dialysis in Korea: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) Korea. Perit Dial Int 2024:8968608241252015. [PMID: 38738926 DOI: 10.1177/08968608241252015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Varying peritoneal dialysis (PD)-related clinical outcomes have been reported in different countries. As a participant of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), this study investigated the characteristics of Korean PD patients, PD facilities and the incidence rates of clinical outcomes including mortality and PD-related outcomes. METHODS From July 2019 to December 2021, a total of 766 Korean PD patients were included for analysis. Poisson regression analysis was used to explore the incidence rates of various clinical events including mortality, modality transfer, exit site or catheter tunnel infection and peritonitis. RESULTS Among the 766 patients (median age 55.5 years, males 59.5%), 276 were incident and 490 were prevalent PD patients. The incidence rates of events were as follows: all-cause mortality (0.048), modality transfer (0.051), exit site or catheter tunnel infection (0.054) and peritonitis (0.136) events per person year. The most common causative organism for exit site or tunnel infection was staphylococcus species (47%) and that for peritonitis was streptococcus (28%) followed by staphylococcus (27%) species. CONCLUSIONS Up to now, PDOPPS Korea has recruited 766 Korean PD patients and started documentation of major PD-related outcomes which occurred during the follow-up period. The overall incidence rates of clinical outcomes in Korean PD patients were relatively favourable. There was no statistically significant difference in the incidence rates of clinical outcomes according to both facility and patient factors.
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Affiliation(s)
- Ji Hye Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Seon-Mi Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Minjung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun-Hee Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | | | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
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6
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Cho Y, Chow KM, Kam-Tao Li P, Runnegar N, Johnson DW. Peritoneal Dialysis-Related Infections. Clin J Am Soc Nephrol 2024; 19:641-649. [PMID: 37574658 PMCID: PMC11108252 DOI: 10.2215/cjn.0000000000000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
Peritoneal dialysis (PD) represents an important treatment choice for patients with kidney failure. It allows them to dialyze outside the hospital setting, facilitating enhanced opportunities to participate in life-related activities, flexibility in schedules, time and cost savings from reduced travel to dialysis centers, and improved quality of life. Despite its numerous advantages, PD utilization has been static or diminishing in parts of the world. PD-related infection, such as peritonitis, exit-site infection, or tunnel infection, is a major concern for patients, caregivers, and health professionals-which may result in hesitation to consider this as treatment or to cease therapy when these complications take place. In this review, the definition, epidemiology, risk factors, prevention, and treatment of PD-related infection on the basis of the contemporary evidence will be described.
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Affiliation(s)
- Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Kai-Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - David W. Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
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7
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Htay H, Choo JCJ, Huang DH, Jayaballa M, Johnson DW, Koniman R, Oei EL, Suai TC, Wu SY, Foo MWY. Rapid point-of-care test for diagnosis of peritonitis in peritoneal dialysis patients. Perit Dial Int 2024:8968608241234728. [PMID: 38453893 DOI: 10.1177/08968608241234728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Periplex® is a rapid point-of-care test based on the detection of interleukin-6 (IL-6) or matrix metalloproteinase-8 (MMP-8) to diagnose peritonitis in peritoneal dialysis (PD) patients. METHODS This single-centre study was conducted in Singapore General Hospital from 2019 to 2022. The study recruited PD patients suspected of having peritonitis. Periplex was performed at the presentation and recovery of peritonitis. Primary outcomes were sensitivity and specificity of Periplex at presentation. The positive and negative predictive values of tests were also performed. RESULTS A total of 120 patients were included in the study. The mean age was 60.9 ± 14.9 years, 53% were male, 79% were Chinese and 47.5% had diabetes mellitus. Periplex was positive in all patients with peritonitis (n = 114); sensitivity of 100%; 95% confidence interval (CI): 100-100%. Periplex was falsely positive in three patients with non-infective eosinophilic peritonitis, resulting in a low specificity of 50%; 95% CI: 41.1-59.0%. Periplex had a positive predictive value of 97.4% and a negative predictive value of 100%. During recovery from peritonitis, Periplex had high specificity (93.6%) and negative predictive value (98.7%) to indicate the resolution of infection. MMP-8 was more sensitive than IL-6 in detecting peritonitis. Periplex was positive in all patients with peritonitis regardless of the types of PD solutions used. CONCLUSIONS Periplex had high sensitivity, and positive and negative predictive values in the diagnosis of peritonitis can be considered as a screening tool for peritonitis. Given its high specificity and negative predictive value, it may also be used to document the resolution of peritonitis.
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Affiliation(s)
- Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
| | - Jason Chon Jun Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
| | | | - Mathini Jayaballa
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Kidney Disease Research, University of Queensland, Brisbane, QLD, Australia
| | - Riece Koniman
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
| | - Elizabeth Ley Oei
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
| | - Tan Chieh Suai
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
| | - Sin Yan Wu
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Marjorie Wai Yin Foo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
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Liang Q, Zhao H, Wu B, Niu Q, Lu L, Qiao J, Men C, He Y, Chu X, Zuo L, Wang M. Effect of different dialysis duration on the prognosis of peritoneal dialysis-associated peritonitis: a single-center, retrospective study. Ren Fail 2023; 45:2177496. [PMID: 36786676 PMCID: PMC9930808 DOI: 10.1080/0886022x.2023.2177496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD)-associated peritonitis is a serious complication observed in peritoneal dialysis patients. Herein, we investigated the clinical characteristics and treatment outcomes of PD peritonitis in patients with different PD durations. METHODS All peritonitis episodes from January 2007 to December 2020 at Peking University People's hospital PD center were retrospectively analyzed and divided into the long-dialysis duration (≥60 months, LDD) and short-dialysis duration (<60 months, SDD) groups. Clinical characteristics and outcomes were compared between these groups. The risk factors for treatment failure were analyzed using a logistic regression model. RESULTS During 14 years, 156 patients had 267 peritonitis episodes. There were 83 (31.1%) peritonitis episodes in the LDD group and 184 (68.9%) in the SDD group. No statistical difference was noted in peritonitis causes and the composition of causative pathogens between the two groups. The hospitalization, treatment failure, and transfer-to-hemodialysis rates, and peritonitis-related mortality were significantly higher in the LDD group than in the SDD group (all p < .05). Logistic regression analysis revealed that PD duration was an independent risk factor for PD-associated hospitalization, treatment failure and peritonitis-related death (p < .05). The receiver operating characteristic curve analysis results showed that when the cutoff value of PD duration was 5.5 years, the sensitivity of predicting PD peritonitis treatment failure was 51.1%, specificity was 78.8%, and the area under the curve was 0.679 (95% confidence interval: 0.594-0.765, p < .001). CONCLUSIONS PD duration is an independent risk factor for poor prognosis in PD peritonitis. Careful and active attention should be paid to the prevention of peritonitis in PD patients with long PD duration.
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Affiliation(s)
- Qichen Liang
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Huiping Zhao
- Department of Nephrology, Peking University People’s Hospital, Beijing, China,CONTACT Huiping Zhao Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Bei Wu
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Qingyu Niu
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Lixia Lu
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Jie Qiao
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Chuncui Men
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Yuting He
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Xinxin Chu
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Mei Wang
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
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9
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Meng L, Yang L, Zhu X, Zhang X, Li X, Cheng S, Guo S, Zhuang X, Zou H, Cui W. Development and Validation of a Prediction Model for the Cure of Peritoneal Dialysis-Associated Peritonitis: A Multicenter Observational Study. Front Med (Lausanne) 2022; 9:875154. [PMID: 35559352 PMCID: PMC9086557 DOI: 10.3389/fmed.2022.875154] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/24/2022] [Indexed: 12/03/2022] Open
Abstract
Aim Peritoneal dialysis (PD)-associated peritonitis (PDAP) is a severe complication of PD. It is an important issue about whether it can be cured. At present, there is no available prediction model for peritonitis cure. Therefore, this study aimed to develop and validate a prediction model for peritonitis cure in patients with PDAP. Methods Patients with PD who developed PDAP from four dialysis centers in Northeast China were followed up. According to the region of PD, data were divided into training and validation datasets. Initially, a nomogram for peritonitis cure was established based on the training dataset. Later, the nomogram performance was assessed by discrimination (C-statistic), calibration, and decision curves. Results Totally, 1,011 episodes of peritonitis were included in the final analysis containing 765 in the training dataset and 246 in the validation dataset. During the follow-up period, peritonitis cure was reported in 615 cases from the training dataset and 198 from the validation dataset. Predictors incorporated in the final nomogram included PD duration, serum albumin, antibiotics prior to admission, white cell count in peritoneal dialysate on day 5 (/μl) ≥ 100/μl, and type of causative organisms. The C-statistic values were 0.756 (95% CI: 0.713–0.799) in the training dataset and 0.756 (95% CI: 0.681–0.831) in the validation dataset. The nomogram exhibited favorable performance in terms of calibration in both the training and validation datasets. Conclusion This study develops a practical and convenient nomogram for the prediction of peritonitis cure in patients with PDAP, which assists in clinical decision-making.
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Affiliation(s)
- Lingfei Meng
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Liming Yang
- Department of Nephrology, The First Hospital of Jilin University-The Eastern Division, Changchun, China
| | - Xueyan Zhu
- Department of Nephrology, Jilin Central Hospital, Jilin, China
| | - Xiaoxuan Zhang
- Department of Nephrology, Jilin FAW General Hospital, Changchun, China
| | - Xinyang Li
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Siyu Cheng
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Shizheng Guo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Xiaohua Zhuang
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Hongbin Zou
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Wenpeng Cui
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
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10
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Li PKT, Chow KM, Cho Y, Fan S, Figueiredo AE, Harris T, Kanjanabuch T, Kim YL, Madero M, Malyszko J, Mehrotra R, Okpechi IG, Perl J, Piraino B, Runnegar N, Teitelbaum I, Wong JKW, Yu X, Johnson DW. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int 2022; 42:110-153. [PMID: 35264029 DOI: 10.1177/08968608221080586] [Citation(s) in RCA: 225] [Impact Index Per Article: 112.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.
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Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Stanley Fan
- Translational Medicine and Therapeutic, William Harvey Research Institute, Queen Mary University, London, UK
| | - Ana E Figueiredo
- Nursing School Escola de Ciências da Saúde e da Vida Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tess Harris
- Polycystic Kidney Disease Charity, London, UK
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Magdalena Madero
- Division of Nephrology, Department of Medicine, National Heart Institute, Mexico City, Mexico
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Diseases, The Medical University of Warsaw, Poland
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, DC, USA
| | - Ikechi G Okpechi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, South Africa
| | - Jeff Perl
- St Michael's Hospital, University of Toronto, ON, Canada
| | - Beth Piraino
- Department of Medicine, Renal Electrolyte Division, University of Pittsburgh, PA, USA
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Isaac Teitelbaum
- Division of Nephrology, Department of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Xueqing Yu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangzhou, China
- Guangdong Academy of Medical Sciences, Guangzhou, China
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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