1
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Zheng S, Bargman JM. Unusual and complicated peritonitis: Your questions answered. Perit Dial Int 2024:8968608241237400. [PMID: 38532707 DOI: 10.1177/08968608241237400] [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: 03/28/2024] Open
Abstract
Effective treatment of infections is a growing challenge owing to antimicrobial resistance. Peritoneal dialysis (PD) patients experience more frequent hospitalisations than the general population and have greater exposure to antibiotics, making them particularly vulnerable to this threat. Over the last decade, we have noted a surge in cases of complicated peritoneal dialysis-associated peritonitis (PD peritonitis) caused by antimicrobial-resistant organisms, including extended-spectrum beta-lactamase (ESBL), AmpC beta-lactamase-producing Enterobacterales, Pseudomonas aeruginosa and fungi. Practitioners must be alert to these organisms, seek early recognition of these resistance patterns and make timely adjustments in order to avoid delay in treatment that may increase risk of PD catheter removal and technique failure. We present a case of successful treatment of ESBL peritonitis, highlight its challenges, while providing guidance on management of other unusual and complicated PD peritonitis.
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Affiliation(s)
- Sijia Zheng
- Division of Nephrology, University of Toronto, University Health Network/Toronto General Hospital, Toronto, ON, Canada
| | - Joanne M Bargman
- Division of Nephrology, University of Toronto, University Health Network/Toronto General Hospital, Toronto, ON, Canada
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2
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Cheng CI, Lin WJ, Liu HT, Chen YT, Chiang CK, Hung KY. Implementation of artificial intelligence Chatbot in peritoneal dialysis nursing care: Experience from a Taiwan medical center. Nephrology (Carlton) 2023; 28:655-662. [PMID: 37698229 DOI: 10.1111/nep.14239] [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: 04/20/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Coronavirus disease pandemic makes high requirements in delivering remote and efficient communication, and patient education. Because of the increases of digital and social media applications in Taiwan, we aim to apply Artificial Intelligence of LINE Chatbot to improve the self-care ability of patients undergoing peritoneal dialysis. MATERIALS AND METHODS We conducted the project since 1 May 2021 to 30 April 2022. We designed an automatically replied Chatbot system, and divided into six scopes of interaction interfaces, including peritoneal dialysis technique operation video, clinical reminder, home caring, hospital registration service, dietary guideline, and Automatic Peritoneal dialysis guidance. We surveyed patients' satisfaction with the LINE Chatbot 3 months later by the Likert 1-5 score-based questionnaire and the higher score indicated higher satisfaction. RESULTS There were 440 patients who joined the PD AI Chatbot study and use the Chatbot, but the satisfaction questionnaire recovery rate was only 297 patients. We found that 91.7% of participants agreed 'Overall satisfaction with patient intelligent Chatbot application'. More than 4 points accounted for 86.6%. We traced every click in each section of the Chatbot and explored the potential scenario patients face. The Chatbot statistically significant reduced infection rate of exit site and tunnel infection before using (p = .049 and .024). Furthermore, peritonitis rate decreased from 0.93 to 0.8/100 patient month after using Artificial Intelligence technique. Peritoneal dialysis Artificial Intelligence Chatbot had similar effect with face-to-face education. CONCLUSION The innovative Chatbot allowed delivering remote and digital information's to improve patients' self-care ability. Peritoneal dialysis patients were highly recognized and satisfied with the tools. It deserves to further explore the long-term impact of Artificial Intelligence Chatbot in peritoneal dialysis care.
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Affiliation(s)
- Ching-I Cheng
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Woan-Jean Lin
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Ting Liu
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ting Chen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Blood Purification, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Kang Chiang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Blood Purification, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kung-Yu Hung
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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3
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Yu J, Zhu L, Ni J, Tong M, Wang H. Technique failure in peritoneal dialysis-related peritonitis: risk factors and patient survival. Ren Fail 2023; 45:2205536. [PMID: 37125594 PMCID: PMC10134955 DOI: 10.1080/0886022x.2023.2205536] [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: 05/02/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the association between patient clinical characteristics and technique failure in peritoneal dialysis-related peritonitis (PDRP). The effect of peritonitis-associated technique failure on patient survival was also assessed. METHODS Patients diagnosed with PDRP from January 1, 2010 to June 30, 2022 were retrospectively reviewed and analyzed. Relevant demographic, biochemical, and clinical data were collected. Univariate and multivariate logistic regression analyses were used to determine the predictors of peritonitis-associated technique failure in PD. Patients were divided into technique failure (F group) and nontechnique failure (NF group) groups. Patients were followed until death or until the date of Oct 1, 2022. Kaplan-Meier survival curves and landmark analysis were used to assess the survival of the PDRP cohort. Cox regression models were used to assess the association between potential risk factors and mortality. RESULTS A total of 376 patients with 648 cases of PDRP were included in this study. Multivariate logistic regression analysis demonstrated that peritoneal dialysis (PD) duration (OR = 1.12 [1.03, 1.21], p = 0.005), dialysate WBC count on Day 3 after antibiotic therapy (OR = 1.41 [1.22, 1.64], p = 0.001), blood neutrophil-to-lymphocyte ratio (NLR) (OR = 1.83 [1.25, 2.70], p = 0.002), and serum lactate dehydrogenase (LDH) (OR = 4.13 [1.69, 10.11], p = 0.002) were independent predictors for technique failure in PDRP. Furthermore, serum high-density lipoprotein (HDL) (OR = 0.28 [0.13, 0.64], p = 0.002) was a protective factor against technique failure. According to the Kaplan-Meier analysis, patients experiencing peritonitis-associated technique failure had lower postperitonitis survival (log-rank = 4.326, p = 0.038). According to the landmark analysis, patients with a history of peritonitis-associated technical failures had a higher 8-year mortality after peritoneal dialysis. A Cox model adjusted for plausible predetermined confounders showed that technique failure was independently associated with all-cause mortality. CONCLUSIONS Dialysate WBC count on Day 3, PD duration, NLR, and LDH were independent risk factors for technique failure, whereas HDL was a protective factor. Peritonitis-associated technique failure had a higher risk of mortality and adverse effects on postperitonitis survival.
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Affiliation(s)
- Jin Yu
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University), Hangzhou, P. R. China
| | - Lingli Zhu
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University), Hangzhou, P. R. China
| | - Jun Ni
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University), Hangzhou, P. R. China
| | - Mengli Tong
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University), Hangzhou, P. R. China
| | - Hua Wang
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University), Hangzhou, P. R. China
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4
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Virzì GM, Milan Manani S, Marturano D, Clementi A, Lerco S, Tantillo I, Giuliani A, Battaglia GG, Ronco C, Zanella M. Eryptosis in Peritoneal Dialysis-Related Peritonitis: The Potential Role of Inflammation in Mediating the Increase in Eryptosis in PD. J Clin Med 2022; 11:jcm11236918. [PMID: 36498493 PMCID: PMC9737953 DOI: 10.3390/jcm11236918] [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] [Received: 10/21/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Peritonitis and exit site infections are the main complications of patients treated with peritoneal dialysis (PD). Erythrocytes (red blood cells—RBCs) are very sensitive cells, and they are characterized by eryptosis (programmed cell death). The purpose of this research was to assess eryptosis in PD patients with PD-related peritonitis and its connection to inflammatory markers in vivo and in vitro. Material and Methods: In this study, we included 65 PD patients: 34 PD patients without systemic inflammation nor PD-related peritonitis in the previous 3 months, and 31 PD patients with an acute episode of PD-related peritonitis. We measured C-reactive protein (CRP) and cytokine (IL-1β, IL-6, and IL-18) levels as systemic inflammatory markers. Eryptosis was evaluated by flow cytometric analyses in freshly isolated RBCs. The induction of eryptosis due to in vitro exposure to IL-1β, IL-6, and IL-18 was verified. Results: Eryptosis was significantly higher in PD patients with peritonitis (9.6%; IQR 4.2−16.7), compared to the those in the other group (2.7%; IQR 1.6−3.9) (p < 0.0001). Significant positive correlations were noticed between eryptosis and CRP, IL-1β, and IL-6. RBCs, incubated with greater concentrations of all cytokines in vitro, resulted in significantly higher occurrences of eryptosis in comparison with those incubated with lower concentration and with untreated cell (p < 0.05), and for those with extensive exposure (p < 0.05). Conclusion: In conclusion, we investigated a potential relationship between systemic eryptosis and the in vivo and in vitro inflammatory damage of the peritoneal membrane during peritonitis. Thus, the presented results revealed that upregulated inflammatory markers and immune system dysregulation could be the cause of high levels of systemic eryptosis during PD-related peritonitis.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
- Correspondence: ; Tel.: +39-0444757714
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
| | - Davide Marturano
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
- Department of Medicine (DIMED), University of Padua, 35100 Padua, Italy
| | - Anna Clementi
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
- Department of Medicine (DIMED), University of Padua, 35100 Padua, Italy
| | - Silvia Lerco
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
- Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, 95024 Catania, Italy
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
| | | | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
- Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, 95024 Catania, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy
- International Renal Research Institute, Vicenza (IRRIV), 36100 Vicenza, Italy
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5
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Runnegar N, Chow KM, Johnson D, Li PKT. Reply to: ISPD 2022 recommendations for identification of causative organisms in peritonitis. ARCH ESP UROL 2022; 42:654-655. [PMID: 36201352 DOI: 10.1177/08968608221126834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.,Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - David Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.,Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
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6
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Rasmussen SK. An overview of pediatric peritoneal dialysis and renal replacement therapy in infants: A review for the general pediatric surgeon. Semin Pediatr Surg 2022; 31:151193. [PMID: 35725048 DOI: 10.1016/j.sempedsurg.2022.151193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Currently, there are about 10,000 pediatric patients in the United States who rely on dialysis for renal replacement therapy. Dialysis allows children with chronic kidney disease a means of support until renal transplant is feasible. All forms of renal replacement therapy require a surgical intervention, whether the modality is hemodialysis or peritoneal dialysis. Despite peritoneal dialysis being the most common modality of dialysis in children, there is not prospectively collected much evidence in the literature which can guide the pediatric surgeon about best practices on access placement, management of complications, and timing of removal. Most available studies are small, single-center retrospective reviews. This limits the power of the data collected to help guide decision-making in the management of peritoneal dialysis catheters. The purpose of this review is to provide a consolidated source of best available evidence and identify important areas for future study. Furthermore, this is an area of pediatric surgical care that lacks up to date outcomes research with robust surgeon participation. Lack of coordinated, evidence-based best practices likely results in heterogenous surgical practices and uneven strategies for managing complications. Furthermore, with improvements in neonatal critical care and fetal interventions available for obstructive uropathies and other congenital kidney disorders, there is increased likelihood of the need for dialysis access in more infants, who represent a particularly vulnerable patient population. Importantly, peritoneal dialysis access should be instituted into the national PEDScore curriculum for pediatric surgical fellows, as this procedure is common enough that any pediatric surgeon could be consulted for catheter placement and management. Surgeon awareness of, and participation in the formulation, of guidelines and prospective studies is of paramount importance to ensure optimal care of this vulnerable population of children.
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Affiliation(s)
- Sara K Rasmussen
- Seattle Children's Hospital/University of Washington Department of Surgery, 4800 Sand Point Way NE Seattle, WA 98105, United States.
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7
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Guía clínica de la Sociedad Española de Nefrología para la prevención y tratamiento de la infección peritoneal en diálisis peritoneal. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.007] [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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8
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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: 184] [Impact Index Per Article: 92.0] [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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9
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Li R, Zhang D, He J, Ou J, Zhang L, Hu X, Wu J, Liu H, Peng Y, Xu Y, Hou H, Liu X, Lu F. Characteristics Analysis, Clinical Outcome and Risk Factors for Fungal Peritonitis in Peritoneal Dialysis Patients: A 10-Year Case-Control Study. Front Med (Lausanne) 2021; 8:774946. [PMID: 34926517 PMCID: PMC8671457 DOI: 10.3389/fmed.2021.774946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/10/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Fungal peritonitis (FP) is a rare but severe complication that can appear in patients receiving peritoneal dialysis (PD). This study aimed to investigate the incidence rate and clinical characteristics of FP, evaluate clinical outcomes between FP and bacterial peritonitis (BP) patients on PD, and especially estimate the risk factors for FP outbreak. Methods: All episodes of FP diagnosed in our hospital from January 1, 2011, to December 31, 2020, were reviewed in this single-center study. FP cases were analyzed and compared with patients diagnosed with BP in a 1:6 ratio matching for case-control study. Patient information, including clinical information, biochemical analysis, and outcomes, was recorded. Univariate and multivariate logistic regression model were used to analyze the risk factors for FP. Results: A total of 15 FP episodes were observed in 15 PD patients, with an FP rate of 0.0071 episodes per patient-year. Seventeen strains of fungi were isolated and identified. Candida was the most common pathogen (15 strains, 88.2%), followed by Aspergillus fumigatus (2 strains, 11.8%). Between the groups, FP group showed a higher rate of HD transfer and catheter removal, and a lower rate of PD resumption in the short-term outcome (all P < 0.01), while no significant difference in the mortality was noted during the whole study period. The multivariate logistic regression analysis showed that longer PD duration (odds ratio [OR] 1.042, 95% confidence interval [CI] 1.012–1.073, P < 0.01), higher serum potassium (OR 3.373, 95% CI 1.068–10.649, P < 0.05), elevated estimated glomerular filtration rate (eGFR) (OR 1.845, 95% CI 1.151–2.955, P < 0.05), reduced serum albumin level (OR 0.820, 95% CI 0.695–0.968, P < 0.05) and peritoneal effluent polymorphonuclear (PMN) count (OR 0.940, 95%CI 0.900–0.981, P < 0.01) were significantly increased the risk for FP. Conclusion: These results suggested that FP leads to higher rate of catheter removal and HD transfer, and a lower rate of PD resumption than BP, and that additional attention should be paid to hypoalbuminemia, increased serum potassium, long PD duration, and low peritoneal effluent PMN in PD patients.
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Affiliation(s)
- Rongrong Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Difei Zhang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Jingwen He
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianjun Ou
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - La Zhang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Xiaoxuan Hu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Jianfeng Wu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Hui Liu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yu Peng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yuan Xu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Haijing Hou
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Xusheng Liu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Fuhua Lu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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10
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Sachar M, Shah A. Epidemiology, management, and prevention of exit site infections in peritoneal dialysis patients. Ther Apher Dial 2021; 26:275-287. [PMID: 34435734 DOI: 10.1111/1744-9987.13726] [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: 02/24/2021] [Revised: 08/04/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022]
Abstract
Exit site infection (ESI) is a leading complication of peritoneal dialysis (PD), at an incidence of 0.6 episodes per year in the United States, and a major risk factor for catheter removal and peritonitis. An estimated 20% of all peritonitis cases are preceded by an ESI, with up to 50% of Staphylococcus aureus peritonitis associated with ESI. Gram-negative ESIs are less associated with succeeding peritonitis than their gram-positive counterparts, though when present, are associated with a lower peritonitis cure rate. The rate of catheter removal for refractory ESI is relatively highest in ESI due to mycobacteria (up to 40%), S. aureus (35%), Pseudomonas aeruginosa (28%), followed by Corynebacterium, Serratia, and fungi. In review of relevant literature, we found no prophylactic benefit of dressings over nondressings, specific antiseptics over normal saline, or topical honey over topical antibiotic prophylaxis, and thus recommend individualized exit site hygiene. We found topical gentamicin effective for prevention of most ESIs, including gram-negative ESIs, and thus recommend consideration of prophylactic topical gentamicin in areas of high gram-negative peritonitis incidence. With long-term use, observational studies detect up to 25% of gram-positive and 14% of gram-negative ESIs may be mupirocin and gentamicin resistant, respectively. We review empiric and targeted ESI management, including indications for ultrasound, anti-VMRSA, anti-Pseudomonal, and anti-mycobacterial antibiotic use, and catheter removal. We recommend further investigation into the earlier use of second-line treatment agents and the utility of treating post-infectious exit site colonization as avenues to decrease refractory and repeat ESI.
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Affiliation(s)
- Moniyka Sachar
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ankur Shah
- Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Nephrology, Rhode Island Hospital, Providence, Rhode Island, USA.,Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
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11
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Wang Z, Li Z, Luo S, Yang Z, Xing Y, Pu C, Dong J. Cefoperazone and sulbactam-related eosinophilic peritonitis: a case report and literature review. J Int Med Res 2021; 49:3000605211025367. [PMID: 34162261 PMCID: PMC8236785 DOI: 10.1177/03000605211025367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Eosinophilic peritonitis (EP) is a well-described complication of peritoneal dialysis that occurs because of an overreaction to constituents that are related to the catheter or tubing, peritoneal dialysate, pathogenic infection, or intraperitoneal drug use. EP caused by antibiotic use is rare. We present the case of a patient with cefoperazone and sulbactam-related EP. A 59-year-old woman who was undergoing peritoneal dialysis presented with peritonitis with abdominal pain and turbid peritoneal dialysis. Empiric intraperitoneal cefazolin in combination with cefoperazone and sulbactam was started after peritoneal dialysis effluent cultures were performed. Her peritonitis achieved remission in 2 days with the help of cephalosporin, but she developed EP 1 week later, when her dialysate eosinophil count peaked at 49% of the total dialysate white blood cells (absolute count, 110/mm3). We excluded other possible causes and speculated that cefoperazone and sulbactam was the probable cause of EP. The patient continued treatment with cefoperazone and sulbactam for 14 days. EP resolved within 48 hours after stopping cefoperazone and sulbactam. Thus, EP can be caused by cefoperazone and sulbactam use. Physicians should be able to distinguish antibiotic-related EP from refractory peritonitis to avoid technique failure.
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Affiliation(s)
- Zi Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, People's Republic of China.,Institute of Nephrology, Peking University, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China
| | - Zhiying Li
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, People's Republic of China.,Institute of Nephrology, Peking University, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China
| | - Suping Luo
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, People's Republic of China.,Institute of Nephrology, Peking University, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China
| | - Zhikai Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, People's Republic of China.,Institute of Nephrology, Peking University, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China
| | - Ying Xing
- Department of Clinical Laboratory, 26447Peking University First Hospital, Peking University First Hospital, Beijing, People's Republic of China
| | - Chengwei Pu
- Department of Clinical Laboratory, 26447Peking University First Hospital, Peking University First Hospital, Beijing, People's Republic of China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, People's Republic of China.,Institute of Nephrology, Peking University, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China
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12
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Lin J, Ye H, Li J, Qiu Y, Wu H, Yi C, Lu S, Chen J, Mao H, Huang F, Yu X, Yang X. Prevalence and risk factors of exit-site infection in incident peritoneal dialysis patients. Perit Dial Int 2021; 40:164-170. [PMID: 32072873 DOI: 10.1177/0896860819886965] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Exit-site infection (ESI) is a common complication in peritoneal dialysis (PD) patients. Clearly understanding the risk factors may be useful for the prevention of ESI. This study was to explore the prevalence and risk factors of ESI in incident PD patients. METHODS We evaluated ESI in incident PD patients who had catheter insertion in our center between 1 January 2009 and 31 December 2013, with follow-up for 1 year. We collected data on demographics, clinical features, and nursing care methods of the exit site (ES). RESULTS We recruited 1133 incident PD patients (687 male (60.6%); mean age 47.0 ± 15.1 years), and 245 (21.6%) had diabetes. Median follow-up was 12.0 months. One hundred and thirty-one patients had 139 episodes of ESI with a rate of 92.8 patient-months per episode (0.13 episodes per year). Coagulase-negative staphylococcus was the main pathogen, accounting for 33.8% of the ESIs. Gram-positive rods, Staphylococcus aureus, Pseudomonas, fungi, and other organisms accounted for 23.0%, 15.8%, 1.4%, 1.4%, and 2.9%, respectively. No bacterial growth was found in 15.1%. There were no differences in demographic and laboratory data (age, gender, primary kidney disease, hemoglobin, white blood cell, serum albumin, blood urea nitrogen, serum creatinine, and C-reactive protein) between the ESI and non-ESI groups. Poor competency of ES care, poor catheter immobilization, history of catheter-pulling injury, and mechanical stress on the ES were significantly associated with increased risk of ESI. CONCLUSIONS The prevalence of ESI was 0.13 episodes per year. Poor competency of ES care, catheter mobilization, history of catheter-pulling injury, and mechanical stress by waist belt or the protective bag of PD on ES were risk factors for ESI.
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Affiliation(s)
- Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Jianying Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Yagui Qiu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Haishan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Shuchao Lu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Jingjing Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
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13
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Zandi P, Ghasemy E, Khedri M, Rashidi A, Maleki R, Miri Jahromi A. Shedding Light on Miniaturized Dialysis Using MXene 2D Materials: A Computational Chemistry Approach. ACS OMEGA 2021; 6:6312-6325. [PMID: 33718722 PMCID: PMC7948252 DOI: 10.1021/acsomega.0c06118] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/16/2021] [Indexed: 05/09/2023]
Abstract
Materials science can pave the way toward developing novel devices at the service of human life. In recent years, computational materials engineering has been promising in predicting material performance prior to the experiments. Herein, this capability has been carefully employed to tackle severe problems associated with kidney diseases through proposing novel nanolayers to adsorb urea and accordingly causing the wearable artificial kidney (WAK) to be viable. The two-dimensional metal carbide and nitride (MXene) nanosheets can leverage the performance of various devices since they are highly tunable along with fascinating surface chemistry properties. In this study, molecular dynamics (MD) simulations were exploited to investigate the interactions between urea and different MXene nanosheets. To this end, detailed analyses were performed that clarify the suitability of these nanostructures in urea adsorption. The atomistic simulations were carried out on Mn2C, Cd2C, Cu2C, Ti2C, W2C, Ta2C, and urea to determine the most appropriate urea-removing adsorbent. It was found that Cd2C was more efficient followed by Mn2C, which can be effectively exploited in WAK devices at the service of human health.
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Affiliation(s)
- Pegah Zandi
- School
of Metallurgy and Materials Engineering, College of Engineering, University of Tehran, Tehran 1417466191, Iran
| | - Ebrahim Ghasemy
- Nanotechnology
Department, School of New Technologies, Iran University of Science and Technology, Tehran 1684613114, Iran
| | - Mohammad Khedri
- Department
of Chemical Engineering, Amirkabir University
of Technology (Tehran Polytechnic), 424 Hafez Avenue, Tehran 1591634311, Iran
| | - Alimorad Rashidi
- Nanotechnology
Research Center, Research Institute of Petroleum
Industry (RIPI), Tehran 1485733111, Iran
| | - Reza Maleki
- Computational
Biology and Chemistry Group (CBCG), Universal
Scientific Education and Research Network (USERN), Tehran 1449614535, Iran
| | - Ahmad Miri Jahromi
- Computational
Biology and Chemistry Group (CBCG), Universal
Scientific Education and Research Network (USERN), Tehran 1449614535, Iran
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14
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Li L, Pei H, Liu Z, Zhang J. Analysis of risk factors and construction of prediction model of drop out from peritoneal dialysis. Medicine (Baltimore) 2021; 100:e24195. [PMID: 33546035 PMCID: PMC7837897 DOI: 10.1097/md.0000000000024195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 12/15/2020] [Indexed: 12/05/2022] Open
Abstract
This study is to investigate the risk factors for the drop out from peritoneal dialysis.We retrospectively analyzed patients who underwent catheterization between January 1, 2009 and September 30, 2019. The follow-up period ended on November 30, 2019. End point events were the cessation of peritoneal dialysis, including death, conversion to hemodialysis, and kidney transplantation. Kaplan-Meier method was used to analyze peritoneal dialysis curve. Significant factors were included in the multivariate Cox proportional hazards model. Calibration curve was plotted.A total of 377 patients were included in this study. The dropout rate of peritoneal dialysis was 41.38%. The main drop out reason was conversion to hemodialysis, accounting for 41.67% of the total number of drop out, followed by kidney transplantation (28.21%) and death (25%). According to multivariable Cox proportional hazards model analysis, the medium education level (hazard ratio (HR): 2.53, 95% confidence interval (CI): 1.08-5.91, P = .03), high education level (HR: 2.47, 95% CI: 1.03-5.93, P = .04), diabetes (HR: 1.87, 95% CI: 1.24-2.83, P < .03), hypertension (HR: 2.40, 95% CI: 1.64-3.51, P < .01), repeated peritonitis (HR: 5.18, 95% CI: 3.04-8.80, P < .01), and repeated chest complications (HR: 4.98, 95% CI: 2.79-8.89, P < .01) were independent risk factors for dropping out from peritoneal dialysis, while the number of hospitalizations after catheterization (HR: 0.94, 95% CI: 0.89-0.98, P = .01) was protective factor for maintenance of peritoneal dialysis. The C index of the prediction model was 0.74.Higher education level, diabetes, hypertension, repeated peritonitis, and repeated chest complications were the risk factors of dropping out from peritoneal dialysis, while higher number of hospitalizations after catheterization was a protective factor for the maintenance of peritoneal dialysis. The nomogram could predict the probability of dropping out from peritoneal dialysis.
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Affiliation(s)
- Li Li
- Department of Nephrology
- Department of Urological Surgery, First Affiliated Hospital of Xinjiang Medical University
| | - Hualian Pei
- RICU of First Affiliated Hospital of Xinjiang Medical University
| | - Zhenhui Liu
- Department of Microrepair and Reconstruction, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
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15
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Ding XR, Huang HE, Liao YM, Zhu JR, Tang W, Fang XW, Su CY. Daily self-care practices influence exit-site condition in patients having peritoneal dialysis: A multicenter cross-sectional survey. J Adv Nurs 2021; 77:2293-2306. [PMID: 33432661 DOI: 10.1111/jan.14751] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/16/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023]
Abstract
AIMS To investigate practice patterns in exit-site care and identify the risk factors for exit-site infection. DESIGN A quantitative cross-sectional design. METHODS Data were collected in 12 peritoneal dialysis (PD) centres in 2018. Daily exit-site care practice patterns and exit-site status of patients receiving PD were assessed through interviews and questionnaires. RESULTS/FINDINGS Most of the 1,204 patients adhered with the protocols about main aspects of exit-site care, such as cleansing agents selection, frequency of cleansing, catheter fixation, and following the catheter protective measures. However, their adherence levels on hand hygiene, mask wearing, observing exit site, examining secretion, and communicating with PD staff were rather low. Eighty-four patients' exit sites were evaluated as problematic exit site (PES). And 186 patients had catheter-related infection (CRI) history. After multivariable logistic regression analysis, diabetes (OR = 1.631), traction bleeding history (OR = 2.697), antibiotic agents use (OR = 2.460), compliance on mask wearing (OR = 0.794), and observing exit site (OR = 0.806) were influencing factors of CRI history. Traction bleeding history (OR = 2.436), CRI history (OR = 10.280), and effective communication (OR = 0.808) with PD staff were influencing factors for PES. CONCLUSIONS The adherence levels on different aspects of exit-site care were varied in patients having PD. Their self-care behaviours did correlate with the exit-site status. IMPACT The adherence level of patients' exit-site care practice needs attention of medical staff. Further studies about the optimal procedure in exit-site care were warranted.
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Affiliation(s)
- Xiao-Rong Ding
- Nursing Department, Peking University Shenzhen Hospital, Guangdong, China
| | - Hui-E Huang
- Renal Department, Peking University Shenzhen Hospital, Guangdong, China
| | - Yu-Mei Liao
- Renal Department, Peking University Shenzhen Hospital, Guangdong, China
| | - Jin-Rong Zhu
- Renal Department, Peking University Third Hospital, Beijing, China
| | - Wen Tang
- Renal Department, Peking University Third Hospital, Beijing, China
| | - Xiao-Wan Fang
- Renal Department, Peking University International Hospital, Beijing, China
| | - Chun-Yan Su
- Renal Department, Peking University Third Hospital, Beijing, China
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16
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Santos JE, Rodríguez Magariños C, García Gago L, Astudillo Jarrín D, Pértega S, Rodríguez-Carmona A, García Falcón T, Pérez Fontán M. Long-term trends in the incidence of peritoneal dialysis-related peritonitis disclose an increasing relevance of streptococcal infections: A longitudinal study. PLoS One 2020; 15:e0244283. [PMID: 33347487 PMCID: PMC7751873 DOI: 10.1371/journal.pone.0244283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
Background The selective impact of strategies for prevention of PD-related peritonitis (PDrP) may have modified, in the long term, the causal spectrum, clinical presentation and outcomes of these infections. Objectives To compare trends in the incidence of PDrP by different microorganisms during a 30-year period, with a particular focus on streptococcal infections. To analyze the clinical presentation and outcomes of these infections. Secondarily, to investigate how the isolation of different species of streptococci can influence the clinical course of PDrP by this genus of bacteria. Method Following a retrospective, observational design we investigated 1061 PDrP (1990–2019). We used joinpoint regression analysis to explore trends in the incidence of PDrP by different microorganisms, and compared the risk profile (Cox), clinical presentation and outcomes (logistic regression) of these infections. Main results Our data showed a progressive decline in the incidence of PDrP by staphylococci and Gram negative bacteria, while the absolute rates of streptococcal (average annual percent change +1.6%, 95% CI -0.1/+3.2) and polymicrobial (+1.8%, +0.1/+3.5) infections tended to increase, during the same period. Remarkably, streptococci were isolated in 58.6% of polymicrobial infections, and patients who suffered a streptococcal PDrP had a 35.8% chance of presenting at least one other infection by the same genus. The risk profile for streptococcal infections was comparable to that observed for PDrP overall. Streptococcal PDrP were associated with a severe initial inflammatory response, but their clinical course was generally nonaggressive thereafter. We did not observe a differential effect of different groups of streptococci on the clinical presentation or outcome of PDrP. Conclusions Time trends in the incidence of PDrP by different microorganisms have granted streptococci an increasing relevance as causative agents of these infections, during the last three decades. This behaviour suggests that current measures of prevention of PDrP may not be sufficiently effective, in the case of this genus of microorganisms.
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Affiliation(s)
| | | | | | | | - Sonia Pértega
- Division of Epidemiology, University Hospital A Coruña, A Coruña, Spain
| | | | | | - Miguel Pérez Fontán
- Division of Nephrology, University Hospital A Coruña, A Coruña, Spain
- Health Sciences Faculty, University of A Coruña, A Coruña, Spain
- * E-mail:
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17
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Morimoto K, Terawaki H, Washida N, Kasai T, Tsujimoto Y, Yuasa H, Ryuzaki M, Ito Y, Tomo M, Nakamoto H. The impact of intraperitoneal antibiotic administration in patients with peritoneal dialysis-related peritonitis: systematic review and meta-analysis. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00270-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Peritonitis is a common and clinically important complication in patients receiving peritoneal dialysis (PD). Antibiotic administration is essential for PD-related peritonitis, but routes of administration have not been established enough. Here, we performed a systematic review to assess the efficacy and safety of intraperitoneal (IP) antibiotic administration compared to intravenous (IV) antibiotic administration in patients with PD-related peritonitis.
Methods
Cochrane CENTRAL, MEDLINE, and Ichushi-Web were searched in June 2017. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed, and articles were screened by four independent reviewers.
Results
Two randomized controlled trials (113 patients) were identified. IP antibiotic administration was more effective than IV antibiotic administration. The pooled risk difference between IP and IV was 0.13 (95% CI − 0.17 to 0.43). Safety assessment indicated less frequency of side effects in patients receiving IP antibiotic administration. The pooled risk ratios of IV to IP regarding adverse drug reaction-related and administration route-related side effects were 5.13 (0.63 to 41.59) and 3.00 (0.14 to 65.90), respectively.
Conclusion
The systematic review and meta-analysis suggested that IP antibiotic administration is more effective and safer in patients with PD-related peritonitis compared to IV antibiotic administration.
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18
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Papasotiriou M, Liakopoulos V, Kehagias I, Vareta G, Ntrinias T, Papachristou E, Goumenos DS. Favorable effects of peritoneal dialysis in patients with refractory heart failure and overhydration. Perit Dial Int 2020; 42:48-56. [PMID: 33250003 DOI: 10.1177/0896860820970097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients with refractory to optimal pharmacological treatment heart failure (HF) require frequent hospitalization. Peritoneal dialysis (PD) has been part of the management of such patients mainly for promoting ultrafiltration and management of overhydration independently of kidney function. The aim of this study was to evaluate the efficacy of PD, especially the use of icodextrin solutions and intermittent PD, in the hospitalization rate and cardiac functional status of patients with HF. METHODS We conducted a retrospective study involving patients with New York Heart Association (NYHA) class IV HF and preserved renal function (estimated glomerular filtration rate (eGFR) > 25 ml/min), who were refractory to conservative treatment. Clinical data on weight loss, hospitalization rate before and after PD initiation, cardiac functional status, and technique complications during a 6-month observational period were analyzed. RESULTS PD treatment was performed in 32 patients with a mean age of 63.8 ± 11.9 years and a follow-up of 20.78 ± 14.24 months. Hospitalizations were significantly reduced from 20.7 ± 13.7 to 7.7 ± 8.9 days/patients at 6 months. All patients showed improvement in NYHA class as well as in left ventricular ejection fraction. Overall, eGFR showed a significant decrease but only six patients reached end-stage renal disease. Complications included 18 cases of peritonitis. PD was well tolerated and no patient dropped out of the method. Survival rate reached 72% at 12 months but mortality rate was high with 23 patients dying at 16.65 ± 12.3 months after the initiation of treatment. Patients survival was not influenced by the type of PD modality or weight reduction achieved. CONCLUSIONS PD showed to be a viable option for the treatment of patients with refractory HF leading to a better cardiac functional status and diminishing the number of hospital admissions.
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Affiliation(s)
- Marios Papasotiriou
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Greece
| | - Vassilios Liakopoulos
- 1st Department of Internal Medicine, Division of Nephrology and Hypertension, Aristotle University of Thessaloniki, Greece
| | | | - Georgia Vareta
- 1st Department of Internal Medicine, Division of Nephrology and Hypertension, Aristotle University of Thessaloniki, Greece
| | - Theodoros Ntrinias
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Greece
| | - Evangelos Papachristou
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Greece
| | - Dimitrios S Goumenos
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Greece
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Abstract
BACKGROUND We aimed to identify the 100 most cited articles published on peritoneal dialysis (PD) and analyze their characteristics to provide information on the achievements and developments of PD research over the past decades. METHODS The Science Citation Index Expanded (SCIE) in the Web of Science Core Collection was comprehensively searched from 2000 to 2018, using the keywords "Peritoneal dialysis" or "Dialyses, Peritoneal" or "Dialysis, Peritoneal" or "Peritoneal Dialyses". The top 100 cited articles were retrieved by reading titles and abstracts. Significant information was further elicited, including the authors, journals, countries, institutions, and publication year. RESULTS The United States was the most productive country (n = 51), Li Pkt published the highest number of papers (n = 7), the Journal of the American Society of Nephrology produced the highest number of contributions (n = 28), and Baxter International Inc., the University of California System, and the University of Toronto were the institutions with the highest number of articles (n = 10). CONCLUSIONS This is the first bibliometric study to identify the most influential papers in PD research. This report describes the major changes and advances in research regarding PD as a guide for writing a citable article.
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Affiliation(s)
| | - Hui Li
- Department of Respiratory Medicine, The First Hospital of Changsha, Changsha, Hunan, China
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20
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Kawanishi H, Moriishi M, Ide K, Dohi K. Recommendation of the Surgical Option for Treatment of Encapsulating Peritoneal Sclerosis. Perit Dial Int 2020. [DOI: 10.1177/089686080802803s38] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is an intestinal obstruction syndrome in which peritoneal deterioration and intraperitoneal inflammation result in intestinal adhesions, which are covered with a fibrin capsule and cause bowel obstruction. The widespread use of peritoneal dialysis (PD) has been associated with an increase in the number of patients with this life-threatening complication. For this reason, some negative comments have been made about PD therapy. However, recent clinical studies have elucidated the pathogenesis of EPS and proposed therapeutic strategies. Currently, these facts are known: • EPS occurs in 2.5% of all patients (3.18/1000 patient-years). • A longer duration of PD is associated with a higher incidence of EPS and a poorer prognosis, indicating the involvement of peritoneal deterioration in the development of EPS. • Development of EPS involves some kind of infection. • Development of EPS frequently occurs after PD withdrawal and catheter removal. • Peritoneal lavage after PD withdrawal delays, but cannot prevent the development of EPS. • Timely administration of steroids is effective. • Surgical adhesiolysis is the optimal treatment to relieve bowel obstructions, but does not exclude the potential for re-adhesions, requiring various ingenious gastrointestinal surgical techniques.
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21
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Li PK, Cheng YL. Therapeutic Options for Preservation of Residual Renal Function in Patients on Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080702702s27] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dialysis is not the ideal renal replacement therapy because it does not fully restore all kidney functions. Increasing evidence suggests that preservation of residual renal function is associated with a survival benefit, a decrease in morbidity, better nutrition, a lower level of inflammatory markers, an improved quality of life, and cost savings by obviating the need for more peritoneal dialysis exchanges and possibly by reducing the requirement for antihypertensive agents, phosphate binders, and erythropoietin. In the present article, we review the impact of residual renal function on patient outcomes and the renoprotective strategies available in patients on peritoneal dialysis.
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Affiliation(s)
- Philip KamTao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong PR China
| | - Yuk Lun Cheng
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, PR China
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22
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Abstract
With its ambulatory nature and freedom from complicated and expensive technology, chronic peritoneal dialysis (PD) is the ideal renal replacement therapy for resource-poor India. Despite being available for more than 15 years, PD has been limited in its growth because of economic factors, inadequate government policies, nephrologist bias, and lack of adequate pre-dialysis care. The number of patients initiated on therapy has increased in recent years, but the number of early dropouts remains high. Single-center studies suggest that contributors to poor outcome include gram-negative peritonitis, malnutrition, and failure to increase the dialysis dose as residual renal function declines. Development of a national PD registry and increased educational activities to position PD as part of integrated therapy for end-stage kidney disease would improve utilization of the PD modality.
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Affiliation(s)
- Vivekanand Jha
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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23
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Chiu MC, Tong PC, Lai WM, Lau SC. Peritonitis and Exit-Site Infection in Pediatric Automated Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080802803s33] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We reviewed 30 patients in an automated peritoneal dialysis (APD) program from 2002 to 2006 for peritonitis. Patients were 11.6 ± 5.5 years old at initiation of peritoneal dialysis (PD) and had a total of 976 PD months. The overall peritonitis rate was 1 episode in 54.2 patient– months, for a rate of 0.22 episode annually. The rate was considered low, which other than being an APD program, may be attributed to adherence to guidelines and in-charge nurse policy. A total of 17 episodes of peritonitis were identified in 9 patients, and the distribution of patient-specific peritonitis incidence appeared bimodal: 87% patients had no or only 1 episode of peritonitis, and 4 patients accounted for 12 episodes, with an average peritonitis rate of 1.0 annually. Causative organisms included Staphylococcus aureus, coagulase-negative Staphylococcus, methicillin-resistant S. aureus (MRSA), Pseudomonas aeruginosa, enterococci, alpha-hemolytic Streptococcus. Five episodes had concurrent exit-site infection with the same organism. During the same period in these 30 patients, 40 episodes of exit-site infection (ESI) were recorded in 23 patients. The overall ESI rate was 1 episode in 24.4 PD months. S. aureus and Pseudomonas aeruginosa were the two most common pathogens, accounting for 70% of the infections. Nasal carriage of MRSA was found in 4 patients, and MRSA ESIs in 2. The ESI rate was not low as that observed in peritonitis, which may be attributed to the humid climate.
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Affiliation(s)
- Man-Chun Chiu
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR, PR China
| | - Pak-Chiu Tong
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR, PR China
| | - Wai-Ming Lai
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR, PR China
| | - Shing-Chi Lau
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR, PR China
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24
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Abstract
A review is given of 30 years of development in peritoneal dialysis (PD). After a short description of the first 20 years, the main emphasis is put on the last 10 years. Subjects discussed are the increasing use of PD in high-risk populations, peritonitis and other catheter-related problems, adequacy of dialysis and nutrition, patient outcomes in comparison with hemodialysis, and peritoneal membrane changes with time on PD. Topics that have emerged during the last decade and the challenges for the next decennium are discussed. The great importance of quality assurance in fast-growing PD populations and of prevention of long-term membrane alterations are emphasized.
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Affiliation(s)
- Raymond T. Krediet
- Division of Nephrology, Department of Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
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25
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Nayak K, Sinoj K, Subhramanyam S, Mary B, Rao N. Our Experience of Home Visits in City and Rural Areas. Perit Dial Int 2020. [DOI: 10.1177/089686080702702s04] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In a peritoneal dialysis (PD) program, an efficient and well-structured home visit schedule is imperative for ensuring patient compliance, adherence to proper exchange technique, nutrition status monitoring and intervention, and early detection of evolving medical co-morbid problems so as to prevent further complications. Regular home-visit follow-up of the PD patient directly affects technique survival and quality of life. The clinical coordinator is ideally placed to be the direct link between the PD center and patients in their domiciliary surroundings. This professional plays a crucial role in the success of a PD program.
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Affiliation(s)
- K.S. Nayak
- PD Center, Department of Nephrology, Global Hospitals, Hyderabad, Andhra Pradesh, India
| | - K.A. Sinoj
- PD Center, Department of Nephrology, Global Hospitals, Hyderabad, Andhra Pradesh, India
| | - S.V. Subhramanyam
- PD Center, Department of Nephrology, Global Hospitals, Hyderabad, Andhra Pradesh, India
| | - B. Mary
- PD Center, Department of Nephrology, Global Hospitals, Hyderabad, Andhra Pradesh, India
| | - N.V.V. Rao
- PD Center, Department of Nephrology, Global Hospitals, Hyderabad, Andhra Pradesh, India
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Abstract
Peritonitis caused by gram-negative bacteria is a serious complication of peritoneal dialysis. Antibiotic resistance is common, and response to medical treatment is often poor. In the present article, we review recent advances in the understanding of the pathogenesis and treatment of this serious condition.
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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
| | - Kai-Ming Chow
- 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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Incidence and characteristics of methicillin-resistant coagulase-negative Staphylococcus aureus in peritoneal dialysis-associated peritonitis in a single center using molecular methods. Int Urol Nephrol 2020; 53:373-380. [PMID: 32804344 DOI: 10.1007/s11255-020-02605-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Peritonitis is a serious complication of peritoneal dialysis and coagulase-negative Staphylococcus (CNS) is the most frequent cause of peritoneal dialysis (PD)-infections in many centers. This study aimed to investigate the molecular epidemiology of CNS isolated from PD-peritonitis in a Brazilian single center, focusing on the genetic determinants conferring methicillin resistance. METHODS Bacterial strains were isolated from peritoneal fluid of patients presenting PD-peritonitis, identified by phenotypic and molecular methods, and those identified as CNS were submitted to mecA detection, SCCmec, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). RESULTS Over the 18-year period of this study (1995-2011), a total of 878 peritonitis episodes were diagnosed in this unit, 115 were caused by coagulase-negative staphylococci of which 72 by Staphylococcus epidermidis. mecA gene was detected in 55 CNS (47.8%), more frequently on the more recent years. SCCmec type III was the most frequent cassette, followed by SCCmec type IV and SCCmec type II. A diverstity of pulsotypes was observed among the S. epidermidis isolates, but five clusters (based on the 80% cutoff) were identified. Diversified sequence types (ST02, ST05, ST06, ST09, ST23, ST59 and ST371) were detected. CONCLUSIONS Detection of SCCmec type III among coagulase-negative Staphylococcus underscores the role of hospital environments as potential source of methicillin-resistant Staphylococcus causing peritonitis in PD patients.
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Clarke WT, Satyam VR, Fudman DI, Zullow S, Goyal KG, Byanova KL, Huang C, Feuerstein JD. Antibiotic prophylaxis and infectious complications in patients on peritoneal dialysis undergoing lower gastrointestinal endoscopy. Gastroenterol Rep (Oxf) 2020; 8:407-409. [PMID: 33163197 PMCID: PMC7603873 DOI: 10.1093/gastro/goaa017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/12/2019] [Accepted: 01/08/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- William T Clarke
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Venkata R Satyam
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - David I Fudman
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samantha Zullow
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Kashika G Goyal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Katerina L Byanova
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christopher Huang
- Section of Gastroenterology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Alonso JDM, Rosa GDS, Santos B, Guerra S, Ribeiro M, Watanabe MJ, Alves A, Rodrigues C, Takahira RK, Hussni CA. Adjuvant intraperitoneal ceftriaxone in the treatment of septic peritonitis in horses. Vet Rec 2020; 187:e29. [PMID: 32234866 DOI: 10.1136/vr.105570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 03/10/2020] [Accepted: 03/15/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intraperitoneal administration of ceftriaxone maintains therapeutic abdominal concentrations for 24 hours in healthy horses. Therefore, it is a possible treatment for septic peritonitis. The aim of this study was to evaluate the efficacy of ceftriaxone as an adjuvant treatment in horses with septic peritonitis. METHODS Twenty-six horses with clinical signs, sonography and/or laboratory findings of septic peritonitis were included. Peritoneal fluid was collected for microbiological culture and in vitro microbial sensitivity profile assessment. Daily intraperitoneal administration of ceftriaxone (25 mg/kg) was initiated with supportive and systemic antimicrobial treatment. The animals were divided into three groups: group 1-gastrointestinal tract injuries and abdominal surgery (excluding perforations/ruptures); group 2-not related to changes in the gastrointestinal tract; group 3-secondary to intestinal rupture and/or faeces contamination. RESULTS The mean success rate of the treatment was 77 per cent (20/26 animals), with success rates of 84.6 per cent in group 1; 87.5 per cent, group 2; and 40 per cent, group 3. CONCLUSIONS This is the first study to report adjuvant intraperitoneal treatment ceftriaxone for septic peritonitis in horses and indicates that this treatment can successfully treat septic peritonitis in horses.
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Affiliation(s)
- Juliana de Moura Alonso
- Department of Veterinary Surgery and Anaesthesiology, Univ Estadual Paulista (UNESP)-School of Veterinary Medicine and Animal Science (FMVZ), Botucatu, Brazil
| | - Gustavo Dos Santos Rosa
- Department of Veterinary Surgery and Anaesthesiology, Univ Estadual Paulista (UNESP)-School of Veterinary Medicine and Animal Science (FMVZ), Botucatu, Brazil
| | - Bruna Santos
- Department of Veterinary Clinics, Univ Estadual Paulista (UNESP)-School of Veterinary Medicine and Animal Science (FMVZ), Botucatu, Brazil
| | - Simony Guerra
- Department of Veterinary Hygiene and Public Health, Univ Estadual Paulista (UNESP)-School of Veterinary Medicine and Animal Science (FMVZ), Botucatu, Brazil
| | - Márcio Ribeiro
- Department of Veterinary Hygiene and Public Health, Univ Estadual Paulista (UNESP)-School of Veterinary Medicine and Animal Science (FMVZ), Botucatu, Brazil
| | - Marcos Jun Watanabe
- Department of Veterinary Surgery and Anaesthesiology, Univ Estadual Paulista (UNESP)-School of Veterinary Medicine and Animal Science (FMVZ), Botucatu, Brazil
| | - A Alves
- Department of Veterinary Surgery and Anaesthesiology, Univ Estadual Paulista (UNESP)-School of Veterinary Medicine and Animal Science (FMVZ), Botucatu, Brazil
| | - Celso Rodrigues
- Department of Veterinary Surgery and Anaesthesiology, Univ Estadual Paulista (UNESP)-School of Veterinary Medicine and Animal Science (FMVZ), Botucatu, Brazil
| | - Regina Kiomi Takahira
- Department of Veterinary Clinics, Univ Estadual Paulista (UNESP)-School of Veterinary Medicine and Animal Science (FMVZ), Botucatu, Brazil
| | - Carlos Alberto Hussni
- Department of Veterinary Surgery and Anaesthesiology, Univ Estadual Paulista (UNESP)-School of Veterinary Medicine and Animal Science (FMVZ), Botucatu, Brazil
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Aguilera-Flórez AI, Sastre-López A, Linares-Fano B, Guerra-Ordoñez JR, Alonso-Rojo AC, Prieto-Velasco M. Análisis del tiempo de entrenamiento y su relación con los episodios de peritonitis. ENFERMERÍA NEFROLÓGICA 2020. [DOI: 10.37551/s2254-28842020006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: El entrenamiento es fundamental para garantizar el éxito de la Diálisis Peritoneal. Objetivo: Valorar la relación entre el tiempo de apren-dizaje y la aparición del primer episodio de peritonitis, comparando entre pacientes jóvenes y ancianos.Material y Método: Estudio observacional, retrospec-tivo. Se incluyó a los pacientes entrenados entre el 1 enero 2014 a 31 diciembre 2018, en el Complejo Asis-tencial Universitario de León. Se estudiaron variables demográficas, nivel de autonomía, tiempo de entrena-miento, primera peritonitis y germen causante. El punto de corte para diferenciar entre jóvenes y ancianos fue 70 años. Los datos se obtuvieron de la base de datos existente en nuestra unidad. Resultados: Se estudiaron 112 pacientes, 68% hombres, edad media 62,68 ±15,69 años, 40% ma-yores de 70 años, el 82% eran autónomos para rea-lizar la diálisis. La media de horas de entrenamiento fue 14,82±6,55; ancianos 18,13±7,93 horas, jóvenes 12,73±4,27, (p=0,004). El 25% tuvieron peritonitis, 64% por gérmenes Gram+. La media al primer episo-dio fue 266±283 días. Los ancianos tardan 84 días me-nos de media en tener peritonitis. Análisis del tiempo de entrenamiento y su relación con los episodios de peritonitisAna Isabel Aguilera-Flórez, Aránzazu Sastre-López, Blanca Linares-Fano, Juan Ramón Guerra-Ordoñez, Ana Cristina Alonso-Rojo, Mario Prieto-Velasco Servicio de Nefrología. Complejo Asistencial Universitario de León. León. EspañaComo citar este artículo:Aguilera-Flórez AI, Sastre-López A, Linares-Fano B, Guerra-Ordoñez JR, Alonso-Rojo AC, Prieto-Velasco M. Análisis del tiempo de entrenamiento y su relación con los episodios de peritonitis. Enferm Nefrol. 2020 Ene-Mar;23(1):54-59Conclusiones: Aunque aparecieron más peritonitis en los pacientes que necesitaron más horas de entre-namiento, no se pudo establecer relación estadística alguna entre ambas variables; si bien los ancianos ne-cesitan más tiempo para completar el entrenamiento y el primer episodio de peritonitis aparece más pre-cozmente.
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Affiliation(s)
| | | | - Blanca Linares-Fano
- Servicio de Nefrología. Complejo Asistencial Universitario de León. León. España
| | | | | | - Mario Prieto-Velasco
- Servicio de Nefrología. Complejo Asistencial Universitario de León. León. España
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Obata Y, Murashima M, Toda N, Yamamoto S, Tsujimoto Y, Tsujimoto Y, Tsujimoto H, Yuasa H, Ryuzaki M, Ito Y, Tomo T, Nakamoto H. Topical application of mupirocin to exit sites in patients on peritoneal dialysis: a systematic review and meta-analysis of randomized controlled trials. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00261-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The International Society for Peritoneal Dialysis guidelines recommends the topical application of antibiotics on the exit site for the prevention of peritoneal dialysis (PD)-related infections. However, the recommendation is based on meta-analyses on applying nasal mupirocin ointment or observational or retrospective studies. Here, we evaluated the efficacy of topical application of mupirocin on the exit site for the prevention of PD-related infections.
Methods
We searched the databases, MEDLINE and CENTRAL, documenting the topical application of antibiotics on the exit site in PD patients in April 2017. We included only randomized controlled trials (RCTs) with adult patients wherein the effects of mupirocin were examined. Exit site infection (ESI), peritonitis, and technical failure were assessed as the main outcomes.
Results
Overall, six RCTs were included in this study. It was uncertain whether the application of mupirocin ointment prevents ESI (rate ratio (RR), 0.36; 95% CI, 0.13–1.05), peritonitis (RR 0.78, 95% CI 0.50–1.21), and technical failure (RR, 1.35; 95% CI, 0.25–7.21). Moreover, a comparison between mupirocin and gentamicin showed no difference in the incidence of ESI (RR, 1.14; 95% CI, 0.27–4.81), peritonitis (RR, 0.85; 95% CI, 0.32–2.26), and technical failure (RR, 0.58; 95% CI, 0.28–1.20).
Conclusions
It remains unclear whether topical application of mupirocin on the exit site has any significant effects on PD-related infection or technical failure. Large-scale RCTs with high methodological quality are required to confirm the efficacy of topical application of antibiotics on the exit site.
Trial registration
UMINR000039267
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Abstract
Peritonitis is a serious and common problem in the peritoneal dialysis (PD) population. Abdominal pain, fever, and cloudy PD fluid usually heralds the onset of infective peritonitis. However, in up to 20% of cases, no organism is identified. In these situations, diagnosis can be made only by excluding a microbiological cause and performing a cytological examination of the PD fluid to determine the cellular or noncellular constituents. This review examines the differential diagnosis of sterile peritonitis and uses cytological examination to facilitate the appropriate diagnosis.
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Affiliation(s)
- Declan G. de Freitas
- Department of Renal Medicine, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ram Gokal
- Department of Renal Medicine, Manchester Royal Infirmary, Manchester, United Kingdom
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Affiliation(s)
- Richard Amerling
- Division of Nephrology Beth Israel Medical Center New York, NY, USA
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Friedman O, Jassal SV, Bargman JM. Acinetobacter Peritoneal Dialysis Peritonitis: Description and Relation to the spice Family of Organisms. Perit Dial Int 2020. [DOI: 10.1177/089686080802800217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Oded Friedman
- Division of Nephrology University of Toronto Toronto, Ontario, Canada
| | - Sarbjit V. Jassal
- Division of Nephrology University of Toronto Toronto, Ontario, Canada
| | - Joanne M. Bargman
- Division of Nephrology University of Toronto Toronto, Ontario, Canada
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Wong PN, Lo KY, Tong GM, Chan SF, Lo MW, Mak SK, Wong AK. Treatment of Fungal Peritonitis with a Combination of Intravenous Amphotericin B and Oral Flucytosine, and Delayed Catheter Replacement in Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080802800211] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BackgroundFungal peritonitis (FP) is associated with significant mortality and high risk of peritoneal failure. The optimum treatment for peritoneal dialysis (PD)-associated FP remains unclear. Since January 2000 we have been treating FP with a combination of intravenous amphotericin B and oral flucytosine, together with deferred catheter replacement. We examined the clinical course and outcome of the FP patients treated with this approach (study group). An outcome comparison was also made to an alternatively treated historic cohort (control group).MethodsThis was a single-center retrospective study. The clinical course and outcome of 13 consecutive episodes of FP occurring in 13 patients treated between January 2000 and April 2005 with the study approach were examined. The patients were treated with an incremental dose of intravenous amphotericin B to a target dose of 0.75 – 1 mg/kg body weight/day, and oral flucytosine 1 g/day upon a diagnosis of FP at 3.77 ± 0.93 days from presentation. Replacement of the peritoneal catheter was intended after complete clearing of effluent, after which, antifungal chemotherapy was continued for another 1 – 2 weeks. Their outcome was compared with 14 historic controls that were treated between April 1995 and December 1999.ResultsMean age of the study group was 58.7 ± 13.2 years; male-to-female ratio was 2:11; 6 (46.1%) were diabetic. All FP were caused by Candida species ( C. albicans, 2; C. parapsilosis, 8; C. glabrata, 3). Two (15.4%) patients died before resolution of the peritonitis. The dialysate effluent cleared in 11 patients (84.6%) after 13.2 ± 3.3 days of treatment, but 2 patients died of acute myocardial infarction before catheter replacement. Nine patients had their catheters replaced at day 26.7 ± 7.7 of treatment; all 9 returned to PD after a total of 31 ± 12.2 days of antifungal chemotherapy. Reversible liver dysfunction was common with this regimen. When compared with the 14 cases in the historic control group ( Candida species, 13; Trichosporon, 1), who were treated with amphotericin B, fluconazole, or a combination of the two, and the majority (78.6%) of whose catheters were removed before day 10 of presentation, the study group appeared to have a lower technique failure rate (30.8% vs 78.6%, p = 0.013) and similar all-cause mortality (30.7% vs 28.5%, p = NS), FP-related mortality (15.4% vs 28.5%, p = NS), and length of hospitalization (48.5 ± 30.2 vs 57.0 ± 37.7 days, p = NS). However, a significantly earlier commencement of antifungal treatment in the study group (3.8 ± 0.9 vs 5.8 ± 2.4 days, p = 0.012) could be an important confounder of outcome.ConclusionsCombination of intravenous amphotericin B and oral flucytosine with deferred catheter replacement appears to be associated with a relatively low incidence of PD technique failure, without affecting mortality in patients suffering from FP due to yeasts in this preliminary study. Nonetheless, drug-induced hepatic dysfunction was common; close monitoring during treatment is of paramount importance. The reasons accounting for the observed distinctive outcome remain unclear and further study is required to confirm the results and to investigate for the underlying mechanism.
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Affiliation(s)
- Ping-Nam Wong
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Kin-Yee Lo
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Gensy M.W. Tong
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Shuk-Fan Chan
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Man-Wai Lo
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Siu-Ka Mak
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Andrew K.M. Wong
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
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Junejo K, Jeboda F, Chawdhery MZ, Stoby-Field M, Fan SLS. Use of Embedded Peritoneal Dialysis Catheters — a UK Perspective and a Single Center's Experience. Perit Dial Int 2020. [DOI: 10.1177/089686080802800318] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kulsoom Junejo
- Department of Renal Medicine and Transplantation Barts and The London NHS Trust London, United Kingdom
| | - Femikemi Jeboda
- Department of Renal Medicine and Transplantation Barts and The London NHS Trust London, United Kingdom
| | - Muhammed Z. Chawdhery
- Department of Renal Medicine and Transplantation Barts and The London NHS Trust London, United Kingdom
| | - Megan Stoby-Field
- Department of Renal Medicine and Transplantation Barts and The London NHS Trust London, United Kingdom
| | - Stanley L.-S. Fan
- Department of Renal Medicine and Transplantation Barts and The London NHS Trust London, United Kingdom
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Cox SD, Walsh SB, Yaqoob MM, Fan SLS. Predictors of Survival and Technique Success after Reinsertion of Peritoneal Dialysis Catheter following Severe Peritonitis. Perit Dial Int 2020. [DOI: 10.1177/089686080702700115] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BackgroundPeritonitis remains the most important complication of peritoneal dialysis (PD). The success rate of restarting PD after severe peritonitis (peritonitis unresolved despite treatment with appropriate antibiotics for 3 days, or fungal or pseudomonas infections) is unclear. We wished to determine PD technique survival and overall mortality when PD is offered to these patients and to identify predictors of successful reinitiation.MethodWe conducted a retrospective single-center study of 556 patients undergoing PD between January 2000 and December 2001. We collected demographic information from the 106 patients who had their PD catheter removed for peritonitis, details about their dialysis history and peritonitis, and whether they successfully restarted PD and if not, the reason.ResultsWe divided patients into groups as follows: group 1 ( n = 42) underwent catheter reinsertion, group 2 ( n = 16) had no medical contraindication to restarting PD but the patients elected to remain on hemodialysis, group 3 ( n = 35) were deemed medically unsuitable to return to PD, and group 4 ( n = 13) were those that died within 4 weeks of presenting with peritonitis. If there were no medical contraindications, Indo-Asians were more likely to retry PD. In group 1, after a mean follow-up of 20 ± 7.3 months, 23 of 42 patients restarted PD successfully. Technique survival for group 1 as a whole was 69% at 3 months and 55% at the end of follow-up. Patients of greater dialysis vintage were more likely to develop PD technique failure after restarting. Of those judged suitable for PD, there was no statistically significant difference in the mortality of patients who wished to either restart PD or remain on hemodialysis (group 1 vs group 2). Significant numbers of patients returned successfully to PD after pseudomonas and fungal peritonitis.ConclusionRestarting PD after severe peritonitis was possible and safe. Ethnicity was an important predictor for wanting to retry PD, but not for technique failure: given the choice, Indo-Asians preferred PD and had a higher failure rate after restarting, but this did not reach statistical significance. Only dialysis vintage predicted technique failure. We conclude that, after severe peritonitis, patients should be given the choice to return to PD but risk stratification based on dialysis vintage is important. Patient retraining and creating a backup arteriovenous fistula might minimize morbidity in these high-risk patients.
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Affiliation(s)
- Sue D. Cox
- Department of Renal Medicine and Transplantation, Barts and The Royal London Hospital, Whitechapel, London, United Kingdom
| | - Stephen B. Walsh
- Department of Renal Medicine and Transplantation, Barts and The Royal London Hospital, Whitechapel, London, United Kingdom
| | - Muhammad M. Yaqoob
- Department of Renal Medicine and Transplantation, Barts and The Royal London Hospital, Whitechapel, London, United Kingdom
| | - Stanley L.-S. Fan
- Department of Renal Medicine and Transplantation, Barts and The Royal London Hospital, Whitechapel, London, United Kingdom
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Prowant BF. Determining if Characteristics of Peritoneal Dialysis Home Training Programs Affect Clinical Outcomes: Not an Easy Task. Perit Dial Int 2020. [DOI: 10.1177/089686080602600605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lew SQ. Hemoperitoneum: Bloody Peritoneal Dialysate in Esrd Patients Receiving Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080702700303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Hemoperitoneum is seen in patients receiving peritoneal dialysis (PD) because the PD catheter provides a window to the peritoneum. Gynecological associated phenomena account for the majority of cases. Intra-abdominal pathology of solid organs such as the kidney, liver, and spleen as well as the gastrointestinal tract is recognized. Unique to PD patients, hemoperitoneum may be associated with the catheter itself, uremic bleeding, or peritonitis. A successful PD program requires nephrologists, PD nurses, and patients assess and manage hemoperitoneum in a systematic fashion. This paper reviews hemoperitoneum in adult PD patients.
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Affiliation(s)
- Susie Q. Lew
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, Washington, DC, USA
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Nessim SJ, Tomlinson G, Bargman JM, Jassal SV. Gastric Acid Suppression and the Risk of Enteric Peritonitis in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080802800310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectivePeritonitis caused by enteric organisms in peritoneal dialysis (PD) patients is associated with greater morbidity and mortality than peritonitis with non-enteric organisms. One reported risk factor for enteric peritonitis (EP) is gastric acid suppression, with two small studies providing conflicting results. The objective of this study was to determine, using a larger patient population, whether gastric acid suppressants are associated with an increased risk of EP.Patients and MethodsUsing a single-center case-control design, information on episodes of EP occurring between 2003 and 2006 was collected. Control episodes were all non-enteric episodes of peritonitis that occurred during the same time interval. Proton pump inhibitor (PPI) or H2-blocker (H2B) use prior to development of peritonitis was documented.ResultsA total of 228 peritonitis episodes among 137 patients met inclusion criteria. In 32% of episodes, the causative organism was enteric. Gastric acid suppressant use was documented in 46% of episodes, with the majority on PPIs. Overall, gastric acid suppression was not associated with a higher EP risk ( p = 0.17). In a post hoc analysis, PPIs were not associated with EP [odds ratio (OR) 1.3, 95% confidence interval (CI) 0.7 – 2.4; p = 0.42], whereas H2Bs were associated with a higher risk of EP (OR 2.9, 95% CI 1.1 – 7.7; p = 0.04), although the number of patients on H2Bs was small.ConclusionOverall, gastric acid suppression was not associated with an increased risk of peritonitis with enteric organisms. While PPI use appears to be safe for PD patients with appropriate indications, the potential risk of EP with H2Bs requires further investigation.
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Affiliation(s)
- Sharon J. Nessim
- Division of Nephrology, Toronto General Research Institute, Toronto, Ontario, Canada
- University Health Network; Institute of Medical Sciences, Toronto General Research Institute, Toronto, Ontario, Canada
| | - George Tomlinson
- University of Toronto; Division of Clinical Decision-Making & Health Care, Toronto General Research Institute, Toronto, Ontario, Canada
| | - Joanne M. Bargman
- Division of Nephrology, Toronto General Research Institute, Toronto, Ontario, Canada
| | - Sarbjit Vanita Jassal
- Division of Nephrology, Toronto General Research Institute, Toronto, Ontario, Canada
- University Health Network; Institute of Medical Sciences, Toronto General Research Institute, Toronto, Ontario, Canada
- University of Toronto; Division of Clinical Decision-Making & Health Care, Toronto General Research Institute, Toronto, Ontario, Canada
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Crabtree JH. Hernia Repair without Delay in Initiating or Continuing Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080602600209] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- John H. Crabtree
- Department of Surgery Southern California Permanente Medical Group Kaiser Permanente Bellflower Medical Center Bellflower, California, USA
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Lam MF, Tang BSF, Tse KC, Chan TM, Lai KN. Ampicillin–Sulbactam and Amikacin Used as Second-Line Antibiotics for Patients with Culture-Negative Peritonitis. Perit Dial Int 2020. [DOI: 10.1177/089686080802800520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Man Fai Lam
- Nephrology Division Queen Mary Hospital University of Hong Kong Hong Kong
| | - Bone Siu Fai Tang
- Department of Medicine Department of Microbiology Queen Mary Hospital University of Hong Kong Hong Kong
| | - Kai Chung Tse
- Nephrology Division Queen Mary Hospital University of Hong Kong Hong Kong
| | - Tak Mao Chan
- Nephrology Division Queen Mary Hospital University of Hong Kong Hong Kong
| | - Kar Neng Lai
- Nephrology Division Queen Mary Hospital University of Hong Kong Hong Kong
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Rozenberg R, Magen E, Weissgarten J, Korzets Z. Icodextrin-Induced Sterile Peritonitis: The Israeli Experience. Perit Dial Int 2020. [DOI: 10.1177/089686080602600319] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Roza Rozenberg
- Division of Nephrology and Hypertension University of Tel-Aviv, Tel-Aviv
- Assaf-Harofe Medical Center, Zerifin Sackler Faculty of Medicine University of Tel-Aviv, Tel-Aviv
| | - Eva Magen
- Assaf-Harofe Medical Center, Zerifin Sackler Faculty of Medicine University of Tel-Aviv, Tel-Aviv
- Nephrology and Hypertension Sapir Medical Center, Kfar-Saba Israel
| | - Joshua Weissgarten
- Division of Nephrology and Hypertension University of Tel-Aviv, Tel-Aviv
- Assaf-Harofe Medical Center, Zerifin Sackler Faculty of Medicine University of Tel-Aviv, Tel-Aviv
| | - Ze'ev Korzets
- Assaf-Harofe Medical Center, Zerifin Sackler Faculty of Medicine University of Tel-Aviv, Tel-Aviv
- Nephrology and Hypertension Sapir Medical Center, Kfar-Saba Israel
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Chu KH, Choy WY, Cheung CCW, Fung KS, Tang HL, Lee W, Cheuk A, Yim KF, Chan WHH, Tong KLM. A Prospective Study of the Efficacy of Local Application of Gentamicin versus Mupirocin in the Prevention of Peritoneal Dialysis Catheter-Related Infections. Perit Dial Int 2020. [DOI: 10.1177/089686080802800514] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BackgroundPeritoneal dialysis (PD)-related infections are the major cause of technique failure. Exit-site infections (ESI) can be prevented by local application of antibiotics. Mupirocin (M) is the most extensively studied drug for this application. Long-term use can result in the development of resistance. Gentamicin (G) is an attractive alternative, with both gram-positive and gram-negative activities. We studied the comparative efficacy of G cream versus M ointment in the prevention of PD-related infections in a Chinese cohort.MethodsThis was a prospective study of adult PD patients of the Princess Margaret Hospital, Hong Kong. Patients were excluded if they had active infection, recent ESI or peritonitis, history of allergy to either drug, or were unable to apply the drug or give consent. Patients were taught to apply the drug daily to the exit site after routine exit-site care. Records were tracked prospectively during hospital admissions and clinic follow-ups.Results95 patients were recruited; 14 discontinued the study. The ESI rates were 0.38 and 0.20 episodes/patient-year for the G group and the M group respectively ( p = 0.36). Gram-positive ESI rates were 0.18 and 0 episodes/patient-year for the G group and the M group respectively. Gram-negative ESI rates were 0.20 episodes/patient-year for both groups ( p = 0.62). The overall peritonitis rates were similar in the two groups ( p = 0.91).DiscussionIn addition to good perioperative care and strict exit-site care, local antibiotic application can prevent ESI. Mupirocin has been extensively studied and shown to be effective. Similar if not superior effects of G cream have been demonstrated. In this study, neither antibiotic gave significantly better results in the prevention of either ESI or peritonitis.ConclusionsBoth gentamicin and mupirocin were effective as prophylaxis for ESI. Longer study is required to determine the long-term efficacy and the potential beneficial effect on the prevention of peritonitis.
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Affiliation(s)
- Kwok Hong Chu
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Wai Yee Choy
- Department of Pharmacy, Princess Margaret Hospital, Hong Kong, China
| | | | - Ka Shun Fung
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Hon Lok Tang
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - William Lee
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Au Cheuk
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Ka Fai Yim
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Wai Han Hilda Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
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Pérez-Fontán M, Rodríguez-Carmona A. Peritoneal Catheter Removal for Severe Peritonitis: Landscape after a Lost Battle. Perit Dial Int 2020. [DOI: 10.1177/089686080702700210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Elhassan EA, Kaballo B, Fedail H, Abdelraheem MB, Ali T, Medani S, Tammam L, Basheir I, Taha A, Mandour M, Awad KE, Abu-Aisha H. Peritoneal Dialysis in the Sudan. Perit Dial Int 2020. [DOI: 10.1177/089686080702700505] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background End-stage renal disease is a significant social and economic burden on the Sudan. Continuous ambulatory peritoneal dialysis (CAPD) was recently introduced as a national service and is provided free of charge by the Federal State. We present here an overview of our experience and outcomes after the first 20 months of operation of the National Program, displaying its organization and patient and technique survival, peritonitis rates, and adequacy parameters of the first patients to undergo CAPD. Methods As a national experiment, the program was sequentially launched in 5 adult and 2 pediatric centers in Khartoum, the capital city of the country. The data include the entire 111 patients who underwent CAPD from June 2005 to January 2007. All data were reported to, and analyzed at, the head office of the Sudan National Peritoneal Dialysis Program. Results CAPD is the modality exclusively utilized thus far. Automated PD will be added to the program this year. By 30 January 2007, the total number of patients enrolled was 111. Their age range was 1 – 75 (median 56) years. 20 patients (18%) were shifted to hemodialysis and 5 patients received living related kidney transplants. Two died of severe septicemia due to peritonitis; 16 (14%) others died of non-PD-related causes. There were 60 cases of peritonitis in 839 patient-months, which equates to an overall peritonitis rate of 1 episode every 14 months (0.87 episodes per year at risk). The individual center rates varied. A critical review of cases at the end of the first year showed a statistically significant age difference, with peritonitis being more common in the younger patients. Mean age of patients that developed peritonitis was 30.53 years, whereas that for peritonitis-free patients was 44.09 years ( p = 0.025). All patients that had peritonitis presented with abdominal pain and had a cloudy effluent; none had exit-site or tunnel infection. The culture-negative peritonitis rate was 53%. Pseudomonas species were responsible for 13.3% and Staphylococcus aureus for 6.7%. Touch contamination was the likely mechanism behind 46.7% of the episodes. There were 3 cases of refractory peritonitis and a single case of relapsing peritonitis. Concerning PD adequacy, average Kt/V urea was 1.74; weekly creatinine clearance was 62.5 L/1.73 m2. Average normalized protein catabolic rate, as a measure of dietary protein intake in patients in a steady state, was 1.17 g/kg. These measures indicate that the overall program adequacy was satisfactory and the values fall within the recommended ranges. Conclusion The first 20 months of operation of the Sudan's National Peritoneal Dialysis Program have proven that it is a promising project with multifaceted success. The adequacy indicators are acceptable but the cumulative peritonitis incidence is above that recommended, indicating several areas for potential improvement. Although CAPD is highly cost-effective, ongoing difficulties, including the cost of medications and laboratory tests, are being sorted out with official support and public involvement.
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Affiliation(s)
| | | | | | | | - Tigani Ali
- Soba University Hospital Khartoum, Sudan
| | - Safaa Medani
- Jaafar Ibn Auf Pediatric Hospital Khartoum, Sudan
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Boer WH, van Ampting JM, Vos P. Successful Treatment of Eight Episodes of Candida Peritonitis without Catheter Removal Using Intracatheter Administration of Amphotericin B. Perit Dial Int 2020. [DOI: 10.1177/089686080702700221] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Pieter Vos
- Dianet Dialysis Centers, Utrecht The Netherlands
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48
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Affiliation(s)
- T.L. Bonadio
- Fresenius Medical Care Charlotte, North Carolina, USA
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Jassal SV, Lok CE. A Randomized Controlled Trial Comparing Mupirocin versus Polysporin Triple for the Prevention of Catheter-Related Infections in Peritoneal Dialysis Patients (The MP3 Study). Perit Dial Int 2020. [DOI: 10.1177/089686080802800112] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BackgroundPeritonitis remains the most serious complication of peritoneal dialysis (PD). Gram-positive organisms are among the most common causes of PD peritonitis; however, recent trends show increasing rates of gram-negative and fungal infections. Strategies to prevent peritonitis include the use of prophylactic topical mupirocin at the site where the PD catheter exits from the abdominal wall; however, mupirocin does not afford protection against gram-negative or fungal infections. The aim of this study is to determine if the incidence of catheter-related infections (exit-site infection, tunnel infection, or peritonitis) is significantly reduced by the routine application of Polysporin Triple antibiotic ointment (Pfizer Canada, Markham, Ontario, Canada) in comparison to mupirocin ointment.Methods and DesignThe Mupirocin Versus Polysporin Triple Study (MP3) is a multicenter, randomized, double-blinded controlled study comparing Polysporin Triple (P3) against the current standard of care. The aim of the study is to recruit 200 patients being treated with or starting on PD and randomize them to receive either mupirocin or P3 at the catheter exit site. Patients will be followed for 18 months or until death or transfer from PD to an alternate treatment modality. The primary outcome will be the time to first catheter-related infection. Catheter-related infections will be strictly defined using current guidelines and categorized into exit-site infections, infective peritonitis, or tunnel infections. The primary analysis will be an intention-to-treat analysis.DiscussionThe results of this study will help determine if the use of P3 is superior to mupirocin ointment in the prevention of catheter-related infections and will help guide evidence-based best practices.
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Affiliation(s)
- Sarbjit V. Jassal
- Department of Medicine, University of Toronto, and Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Charmaine E. Lok
- Department of Medicine, University of Toronto, and Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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Wong PN, Lo KY, Tong GM, Chan SF, Lo MW, Mak SK, Wong AK. Prevention of Fungal Peritonitis with Nystatin Prophylaxis in Patients Receiving CAPD. Perit Dial Int 2020. [DOI: 10.1177/089686080702700512] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Fungal peritonitis (FP) is a serious complication of continuous ambulatory peritoneal dialysis (CAPD), being associated with significant morbidity and mortality. The role of nystatin prophylaxis during antibiotic therapy in the prevention of FP remains controversial, especially in programs with a modest or low baseline FP rate. The aim of the present study was to evaluate the effect of nystatin prophylaxis on the occurrence of FP in programs with a relatively modest baseline FP rate. Patients and Methods Incident and prevalent patients receiving CAPD between April 1995 and April 2005 at our center were included and divided into 2 groups. The control group included 320 patients (total follow-up 8875 patient-months) being treated without nystatin before October 1999; the nystatin group included 481 patients (total follow-up 13725 patient-months) being treated after October 1999. Nystatin tablets (500000 units, 4 times per day) were given orally during whatever use of antibiotics to cover the whole course of antibiotic therapy. Occurrence of FP and antibiotic-related FP (AR-FP) in patients with and without nystatin prophylaxis was compared. Results The two groups were of similar age but the nystatin group had a significantly higher percentage of diabetics. In addition, the nystatin group had a higher proportion of patients using disconnecting twin-bag exchange systems and had a significantly lower peritonitis rate compared with the control. There were 13 and 14 episodes of FP in the nystatin and control groups respectively. The fungal peritonitis rate of the nystatin group was slightly lower than that of the control group (0.011 vs 0.019 per patient-year) but it did not reach statistical significance. There was, however, a significant decrease in the incidence and proportion of AR-FP in the nystatin group compared with the control group, which persisted even after adjustment for the peritonitis rate. Kaplan–Meier analysis further demonstrated significantly better AR-FP-free survival in the nystatin group compared with the control group. No significant side effects were observed for nystatin. Subgroup analyses in patients of the 2 different connecting systems revealed a similar but nonsignificant trend toward reduction of AR-FP in patients given nystatin prophylaxis. Conclusion Oral nystatin prophylaxis might prevent the occurrence of AR-FP in CAPD patients, resulting in a trend toward reduction in the incidence of FP even in programs with a modest baseline FP rate. A large scale, prospective, randomized controlled trial is needed to further examine this issue.
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Affiliation(s)
- Ping-Nam Wong
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Kin-Yee Lo
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Gensy M.W. Tong
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Shuk-Fan Chan
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Man-Wai Lo
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Siu-Ka Mak
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Andrew K.M. Wong
- Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
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