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Sakurada T, Kojima S, Yamada S, Koitabashi K, Taki Y, Matsui K, Murasawa M, Kawarazaki H, Shimizu S, Kobayashi H, Asai T, Hashimoto K, Hoshino T, Sugitani S, Maoka T, Nagase A, Sato H, Fukuoka K, Sofue T, Koibuchi K, Nagayama K, Washida N, Koide S, Okamoto T, Ishii D, Furukata S, Uchiyama K, Takahashi S, Nishizawa Y, Naito S, Toda N, Naganuma T, Kikuchi H, Suzuki T, Komukai D, Kimura T, Io H, Yoshikawa K, Naganuma T, Morishita M, Oshikawa J, Tamagaki K, Fujisawa H, Ueda A, Kanaoka T, Nakamura H, Yanagi M, Udagawa T, Yoneda T, Sakai M, Gunji M, Osaki S, Saito H, Yoshioka Y, Kaneshiro N. A multi-institutional, observational study of outcomes after catheter placement for peritoneal dialysis in Japan. Perit Dial Int 2023; 43:457-466. [PMID: 37632293 DOI: 10.1177/08968608231193240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This multi-institutional, observational study examined whether the outcomes after peritoneal dialysis (PD) catheter placement in Japan meet the audit criteria of the International Society for Peritoneal Dialysis (ISPD) guideline and identified factors affecting technique survival and perioperative complications. METHODS Adult patients who underwent first PD catheter placement for end-stage kidney disease between April 2019 and March 2021 were followed until PD withdrawal, kidney transplantation, transfer to other facilities, death, 1 year after PD start or March 2022, whichever came first. Primary outcomes were time to catheter patency failure and technique failure, and perioperative infectious complications within 30 days of catheter placement. Secondary outcomes were perioperative complications. Appropriate statistical analyses were performed to identify factors associated with the outcomes of interest. RESULTS Of the total 409 patients, 8 who underwent the embedded catheter technique did not have externalised catheters. Of the 401 remaining patients, catheter patency failure occurred in 25 (6.2%). Technical failure at 12 months after PD catheter placement calculated from cumulative incidence function was 15.3%. On Cox proportional hazards model analysis, serum albumin (hazard ratio (HR) 0.44; 95% confidence interval (CI) 0.27-0.70) and straight type catheter (HR 2.14; 95% CI 1.24-3.69) were the independent risk factors for technique failure. On logistic regression analysis, diabetes mellitus was the only independent risk factor for perioperative infectious complications (odds ratio 2.70, 95% CI 1.30-5.58). The occurrence rate of perioperative complications generally met the audit criteria of the ISPD guidelines. CONCLUSION PD catheter placement in Japan was proven to be safe and appropriate.
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Affiliation(s)
- Tsutomu Sakurada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Shigeki Kojima
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Shohei Yamada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | | | - Yasuhiro Taki
- Department of Nephrology, Inagi Municipal Hospital, Tokyo, Japan
| | - Katsuomi Matsui
- Division of Nephrology and Hypertension, St Marianna University School of Medicine Yokohama City Seibu Hospital, Kanagawa, Japan
| | - Masaru Murasawa
- Department of Nephrology, Gyotoku General Hospital, Chiba, Japan
| | - Hiroo Kawarazaki
- Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Sayaka Shimizu
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto University, Japan
| | - Hironori Kobayashi
- Department of Nephrology, Japanese Red Cross Asahikawa Hospital, Hokkaido, Japan
| | - Toshihiro Asai
- Department of Urology, Osaka City General Hospital, Japan
| | - Koji Hashimoto
- Department of Nephrology, Shinshu University School of Medicine, Nagano, Japan
| | - Taro Hoshino
- Department of Nephrology, Japanese Red Cross Saitama Hospital, Japan
| | - Seita Sugitani
- Department of Nephrology, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Tomochika Maoka
- Department of Nephrology, NTT Medical Center Sapporo, Hokkaido, Japan
| | - Akihiko Nagase
- Department of Nephrology and Hypertension, Dokkyo Medical University, Tochigi, Japan
| | - Hirotaka Sato
- Department of Nephrology, Shimane Prefectural Central Hospital, Japan
| | - Kosuke Fukuoka
- Department of Nephrology, Kurashiki Central Hospital, Okayama, Japan
| | - Tadashi Sofue
- Department of CardioRenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Japan
| | - Kiyoto Koibuchi
- Department of Nephrology and Dialysis, Saiseikai Yokohamashi Tobu Hospital, Japan
| | | | - Naoki Washida
- Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Shigehisa Koide
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | - Takayuki Okamoto
- Department of Nephrology, Kyowakai Medical Corporation Kyoritsu Hospital, Hyogo, Japan
| | - Daisuke Ishii
- Department of Urology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Satoshi Furukata
- Department of Nephrology, Fukaya Red Cross Hospital, Saitama, Japan
| | - Kiyotaka Uchiyama
- Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Takahashi
- Department of Nephrology, National Hospital Organization Kure Medical Center, Hiroshima, Japan
| | - Yoshiko Nishizawa
- Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
| | - Shotaro Naito
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Naohiro Toda
- Department of Nephrology, Kansai Electric Power Hospital, Osaka, Japan
| | - Tsukasa Naganuma
- Department of Nephrology, Yamanashi Prefectural Central Hospital, Japan
| | - Hidetoshi Kikuchi
- Department of Nephrology, National Hospital Organization Beppu Medical Center, Oita, Japan
| | - Tomo Suzuki
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Daisuke Komukai
- Department of Nephrology, Kawasaki-Saiwai Hospital, Kanagawa, Japan
| | - Takahide Kimura
- Department of Nephrology, International University of Health and Welfare Atami Hospital, Shizuoka, Japan
| | - Hiroaki Io
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kazuhiro Yoshikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, Iwate Medical University School of Medicine, Japan
| | | | | | - Jin Oshikawa
- Department of Nephrology, Yokohama Sakae Kyosai Hospital, Kanagawa, Japan
| | - Keiichi Tamagaki
- Division of Nephrology, Department of Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Hajime Fujisawa
- Department of Nephrology, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan
| | - Atsushi Ueda
- Department of Nephrology, Hitachi General Hospital, Ibaraki, Japan
| | - Tomohiko Kanaoka
- Department of Medical Science and Cardiorenal Medicine, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | | | - Mai Yanagi
- Department of Nephrology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Takashi Udagawa
- Department of Nephrology, Nippon Koukan Hospital, Kanagawa, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Japan
| | - Masashi Sakai
- Department of Nephrology, Fujisawa City Hospital, Kanagawa, Japan
| | - Masanobu Gunji
- Department of Nephrology, Mito Saiseikai General Hospital, Ibaraki, Japan
| | - Shinichi Osaki
- Department of Surgery, Gengendo Kimitsu Hospital, Chiba, Japan
| | - Hisako Saito
- Department of Nephrology, Showa General Hospital, Tokyo, Japan
| | - Yuuki Yoshioka
- Department of Nephrology, Tachikawa General Hospital, Niigata, Japan
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Thomas KL, Davies M. Survival outcomes of HIV-positive adults on peritoneal dialysis at Helen Joseph renal unit. South Afr J HIV Med 2023; 24:1471. [PMID: 37293605 PMCID: PMC10244927 DOI: 10.4102/sajhivmed.v24i1.1471] [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: 11/16/2022] [Accepted: 03/10/2023] [Indexed: 06/10/2023] Open
Abstract
Background HIV is a risk factor for the development of chronic kidney disease. People with chronic kidney disease in the state sector are likely to be prescribed continuous ambulatory peritoneal dialysis (CAPD). Previous studies have raised concern about the safety of CAPD in people living with HIV (PLWH) compared to HIV-negative patients. Objectives To compare the risk of peritonitis, and modality and patient survival by HIV status in patients receiving CAPD at Helen Joseph Hospital. Method A retrospective study of patients receiving CAPD between 01 January 2007 and 31 December 2017 was undertaken. Five-year patient and modality survival were modelled for PLWH and HIV-negative subgroups and analysed using the log-rank test; the effect of CD4 count, HIV viral load, and duration of antiretroviral therapy on these parameters in PLWH were additionally modelled using the Cox Proportional Hazards technique. Results Eighty-four patients, comprising of 21 PLWH and 63 HIV-negative patients, were analysed. No difference was observed in the proportion of patients who had at least one episode of peritonitis between PLWH (61.2%) and HIV-negative patients (63.5%) (P = 0.547). A trend towards increased risk of peritonitis due to Gram-negative organisms in PLWH was noted (odds ratio: 3.20, 95% confidence interval: 0.86-11.9, P = 0.083). No difference was observed in 5-year patient or modality survival on CAPD between PLWH (log-rank P = 0.161) and HIV-negative patients (log-rank P = 0.240). Conclusion People living with HIV should not be excluded from CAPD as a mode of kidney replacement therapy (KRT).
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Affiliation(s)
- Kagisho L Thomas
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Malcolm Davies
- Renal Department, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Sunnyraj MM, Davies M, Cassimjee Z. Peritoneal dialysis outcomes in a tertiary-level state hospital in Johannesburg, South Africa: Ethnicity and HIV co-infection do not increase risk of peritonitis or discontinuation. S Afr Med J 2023; 113:98-103. [PMID: 36757076 DOI: 10.7196/samj.2023.v113i2.16629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is a valuable means to increase access to kidney replacement therapy in South Africa (SA). An increased rate of modality discontinuation related to an increased risk of peritonitis in patients of black African ethnicity, in those with diabetes and in those living with HIV has previously been suggested, which may lead to hesitancy in adoption of 'PD first' programmes. OBJECTIVES To analyse the safety of a PD-first programme in terms of 5-year peritonitis risk and patient and modality survival at the outpatient PD unit at Helen Joseph Hospital, Johannesburg. METHODS After exclusions, clinical data from 120 patients were extracted for analysis. The effects of patient age at PD initiation, ethnicity, gender, diabetes mellitus and HIV infection on patient and modality survival and peritonitis risk were analysed using Cox proportional hazards modelling and logistic regression analysis. Five-year technique and patient Kaplan-Meier survival curves for peritonitis and comorbidity groups were compared using the Cox-Mantel test. The Mann-Whitney U-test and Fisher's exact test were used to compare continuous and categorical variables where appropriate. RESULTS Five-year patient survival was 49.9%. Black African ethnicity was associated with reduced mortality hazard (hazard ratio (HR) 0.33; 95% confidence interval (CI) 0.15 - 0.71; p=0.004), and patients with diabetes had poorer 5-year survival (19.1%; p=0.097). Modality survival at 5 years was 48.1%. Neither Black African ethnicity nor HIV infection increased the risk of PD discontinuation. Peritonitis was associated with increased modality failure (HR 2.99; 95% CI 1.31 - 6.87; p=0.009). Black African ethnicity did not increase the risk of peritonitis. HIV was not independently associated with an increased risk of peritonitis. Patient and PD survival were generally similar to other contemporaneous cohorts, and the peritonitis rate in this study was within the International Society for Peritoneal Dialysis acceptable range. CONCLUSION PD is a safe and appropriate therapy in a low socioeconomic setting with a high prevalence of HIV infection. Consideration of home circumstances and training in sterile technique reduce peritonitis risk and improve PD modality survival. Patients with diabetes may be at risk of poorer outcomes on PD.
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Affiliation(s)
- M M Sunnyraj
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - M Davies
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Nephrology, Helen Joseph Hospital, Johannesburg, South Africa.
| | - Z Cassimjee
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Nephrology, Helen Joseph Hospital, Johannesburg, South Africa.
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Teo S, Yuen TW, Cheong CWS, Rahman MA, Bhandari N, Hussain NH, Mistam H, Geng J, Goh CYP, Than M, Chan YH, Yap HK, Ng KH. Structured re-training to reduce peritonitis in a pediatric peritoneal dialysis program: a quality improvement intervention. Pediatr Nephrol 2021; 36:3191-3200. [PMID: 33797581 DOI: 10.1007/s00467-021-05039-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Decline in skills and knowledge among patients and/or caregivers contributes to peritoneal-dialysis (PD)-related peritonitis. Re-training is important, but no guidelines exist. We describe the implementation of a structured re-training program to decrease peritonitis rates. METHODS This is a prospective quality improvement study involving pediatric patients on long-term home automated PD at National University Hospital, Singapore, between 2012 and 2018. With increasing peritonitis rates, systematic root cause analysis was performed, and based on the contributory factors identified, a structured re-training program was implemented from 2015. This was conducted in 5 cycles, each consisting of 4 modules (hand hygiene, exit site care, peritonitis, and PD troubleshooting). RESULTS Peritonitis rates were analyzed in 2 phases: Phase 1 (2012-2014) when no re-training was performed and Phase 2 (2016-2018) after re-training was instituted. Fifty-nine patients were included. Of these, 45 patients were in Phase 1, 32 in Phase 2, and 18 in both phases. Peritonitis rates decreased from 0.37 ± 0.67 episodes per patient-year in Phase 1 to 0.13 ± 0.32 episodes per patient-year in Phase 2. After adjusting for age at kidney failure onset, PD vintage, years of nursing experience, and the average patient-to-nurse ratio over the study period for each patient, the adjusted peritonitis rates decreased by 0.38 episodes per patient-year (95% CI, 0.09 to 0.67, p = 0.011) from Phase 1 to Phase 2. CONCLUSION Despite an improvement in staffing ratio, peritonitis rates only improved significantly after intensive structured re-training was instituted.
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Affiliation(s)
- Sharon Teo
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Tin Wei Yuen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Md Azizur Rahman
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Neha Bhandari
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Noor-Haziah Hussain
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Hamidah Mistam
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Jing Geng
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Charmaine Yan-Pin Goh
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Mya Than
- Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong-Huak Chan
- Biostatistics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui-Kim Yap
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kar-Hui Ng
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Kong X, Zhu X, Zhang Y, Wu J. The application of plan, do, check, act (PDCA) quality management in reducing nosocomial infections in endoscopy rooms: It does work. Int J Clin Pract 2021; 75:e14351. [PMID: 33973325 DOI: 10.1111/ijcp.14351] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/07/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The role of plan, do, check, act (PDCA) cycle quality management in reducing nosocomial infections in endoscopy rooms remains unclear; we aimed to evaluate the effects of PDCA in the nosocomial infections control of endoscopy rooms. METHODS This present study was a before and after design. The patients treated in our endoscopy room from 1 January 2019 to 31 December 2019 were included in the control group, which were managed according to current department practice. The patients from 1 January 2020 to 31 December 2020 were included in the PDCA group, which were managed according to PDCA cycle quality management including formulation of cleaning and disinfection process, establishment of an infection control team and improvement of inspection standards. The nosocomial infections of patients, the pass rate of medical staff's knowledge on the nosocomial infection and hand hygiene, the pass rate of disinfection of endoscope cavity and surface, the incidence of sharp injury and biological pollution were compared between two groups. RESULTS A total of 1020 patients were included, with 512 patients in PDCA group and 508 patients in the control group. The incidence of nosocomial infections in PDCA group was significantly lower than that of control group (0.98% vs. 2.76%, P = .002). The pass rate of medical staff's knowledge on the nosocomial infection and hand hygiene was significantly higher than that of control group (all P < .05). The pass rate of disinfection of endoscope cavity in PDCA group was significantly higher than that of control group (P = .037). The incidence of sharp injury and biological pollution in PDCA group were significantly lower than that of control group (all P < .05). CONCLUSIONS PDCA cycle management is beneficial to reduce the risk of nosocomial infection, enhance the awareness of infection control and reduce the risk of occupational exposure of medical staff in the endoscopy room.
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Affiliation(s)
- Xiaoming Kong
- Department of Infection Management, People's Hospital of Liyang, Changzhou, China
| | - Xiaolu Zhu
- Department of Infection Management, People's Hospital of Liyang, Changzhou, China
| | - Yidan Zhang
- Department of Infection Management, People's Hospital of Liyang, Changzhou, China
| | - Jie Wu
- Department of Infection Management, People's Hospital of Liyang, Changzhou, China
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Nataatmadja M, Cho Y, Johnson DW. Continuous Quality Improvement Initiatives to Sustainably Reduce Peritoneal Dialysis-Related Infections in Australia and New Zealand. Perit Dial Int 2017; 36:472-7. [PMID: 27659926 DOI: 10.3747/pdi.2016.00114] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Translational Research Institute, Brisbane, Australia Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Translational Research Institute, Brisbane, Australia Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
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Wallace EL, Fissell RB, Golper TA, Blake PG, Lewin AM, Oliver MJ, Quinn RR. Catheter Insertion and Perioperative Practices Within the ISPD North American Research Consortium. Perit Dial Int 2015; 36:382-6. [PMID: 26493754 DOI: 10.3747/pdi.2015.00089] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/19/2015] [Indexed: 12/21/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND In general, efforts to standardize care based on group consensus practice guidelines have resulted in lower morbidity and mortality. Although there are published guidelines regarding insertion and perioperative management of peritoneal dialysis (PD) catheters, variation in practice patterns between centers may exist. The objective of this study is to understand variation in PD catheter insertion practices in preparation for conducting future studies. ♦ METHODS An electronic survey was developed by the research committee of the International Society for Peritoneal Dialysis - North American Research Consortium (ISPD-NARC) to be completed by physicians and nurses involved in PD programs across North America. It consisted of 45 questions related to 1) organizational characteristics; 2) PD catheter insertion practices; 3) current quality-improvement initiatives; and 4) interest in participation in PD studies. Invitation to participate in the survey was given to nephrologists and nurses in centers across Canada and the United States (US) identified by participation in the inaugural meeting of the ISPD-NARC. Descriptive statistics were applied to analyze the data. ♦ RESULTS Fifty-one ISPD-NARC sites were identified (45% in Canada and 55% in the US) of which 42 responded (82%). Center size varied significantly, with prevalent PD population ranging from 6 - 300 (median: 60) and incident PD patients in the year prior to survey administration ranging from 3 - 180 (median: 20). The majority of centers placed fewer than 19 PD catheters/year, with a range of 0 - 50. Availability of insertion techniques varied significantly, with 83% of centers employing more than 1 insertion technique. Seventy-one percent performed laparoscopic insertion with advanced techniques (omentectomy, omentopexy, and lysis of adhesions), 62% of sites performed open surgical dissection, 10% performed blind insertion via trocar, and 29% performed blind placement with the Seldinger technique. Use of double-cuff catheters was nearly universal, with a near even distribution of catheters with pre-formed bend versus straight inter-cuff segments. There was also variation in the choice of perioperative antibiotics and perioperative flushing practices. Although 86% of centers had quality-improvement initiatives, there was little consensus as to appropriate targets. ♦ CONCLUSIONS There is marked variability in PD catheter insertion techniques and perioperative management. Large multicenter studies are needed to determine associations between these practices and catheter and patient outcomes. This research could inform future trials and guidelines and improve practice. The ISPD-NARC is a network of PD units that has been formed to conduct multicenter studies in PD.
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Affiliation(s)
- Eric L Wallace
- University of Alabama at Birmingham, Department of Medicine, Division of Nephrology, Birmingham, AL, USA
| | - Rachel B Fissell
- Vanderbilt University, Department of Medicine, Division of Nephrology, Nashville, TN, USA
| | - Thomas A Golper
- Vanderbilt University, Department of Medicine, Division of Nephrology, Nashville, TN, USA
| | - Peter G Blake
- University of Western Ontario, Department of Medicine, Division of Nephrology, London, ON, Canada
| | - Adriane M Lewin
- University of Calgary, Departments of Medicine & Community Health Sciences, Calgary, AB, Canada
| | | | - Rob R Quinn
- University of Calgary, Departments of Medicine & Community Health Sciences, Calgary, AB, Canada
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8
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Yu Y, Zhou Y, Wang H, Zhou T, Li Q, Li T, Wu Y, Liu Z. Impact of continuous quality improvement initiatives on clinical outcomes in peritoneal dialysis. Perit Dial Int 2015; 34 Suppl 2:S43-8. [PMID: 24962962 DOI: 10.3747/pdi.2013.00123] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We evaluated the role of a quality improvement initiative in improving clinical outcomes in peritoneal dialysis (PD). METHODS In a retrospective analysis of 6 years of data from a hospital registry, the period between 1 July 2005 and 30 June 2008 (control group) provided baseline data from before implementation of systemic outcomes monitoring, and the period between 1 July 2008 and 30 June 2011 [continuous quality improvement (CQI) group] represented the time when a CQI program was in place. Peritonitis incidence, patient and technique survival, cardiovascular status, causes of death, and drop-out were compared between the groups. RESULTS In the 370 patients of the CQI group and the 249 patients of the control group, the predominant underlying kidney diseases were chronic glomerulonephritis and diabetic nephropathy. After implementation of the CQI initiative, the peritonitis rate declined to 1 episode in 77.25 patient-months from 1 episode in 22.86 patient-months. Ultrasound parameters of cardiac structure were generally unchanged in the CQI group, but significant increases in cardiothoracic ratio and interventricular septal thickness were observed in the control group (both p < 0.05). Patient survival at 1, 2, and 3 years was significantly higher in the CQI group (97.3%, 96.3%, and 96.3% respectively) than in the control group (92.6%, 82.4%, and 67.3% respectively, p < 0.001). Implementation of the CQI initiative also appeared to significantly improve technique survival rates: 95.6%, 92.6%, and 92.6% in the CQI group compared with 89.6%, 79.2%, and 76.8% in the control group (p < 0.001) after 1, 2, and 3 years respectively. CONCLUSION Integration of a CQI process into a PD program can significantly improve the quality of therapy and its outcomes.
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Affiliation(s)
- Yusheng Yu
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Yan Zhou
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Han Wang
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Tingting Zhou
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Qing Li
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Taoyu Li
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Yan Wu
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
| | - Zhihong Liu
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China
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Zhang L, Hawley CM, Johnson DW. Focus on peritoneal dialysis training: working to decrease peritonitis rates. Nephrol Dial Transplant 2015; 31:214-22. [PMID: 26908816 DOI: 10.1093/ndt/gfu403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/02/2014] [Indexed: 11/12/2022] Open
Abstract
Patient training has widely been considered to be one of the most critical factors for achieving optimal peritoneal dialysis clinical outcomes, including avoidance of peritonitis. However, research in this important area has been remarkably scant to date. This article will critically review the clinical evidence underpinning PD patient training and will specifically focus on four key areas: who should provide training and how, when and where should it be performed to obtain the best results. Evidence gaps and future research directions will also be discussed.
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Affiliation(s)
- Lei Zhang
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
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Cho Y, Johnson DW. Peritoneal dialysis-related peritonitis: towards improving evidence, practices, and outcomes. Am J Kidney Dis 2014; 64:278-89. [PMID: 24751170 DOI: 10.1053/j.ajkd.2014.02.025] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/20/2014] [Indexed: 11/11/2022]
Abstract
Peritonitis is a common serious complication of peritoneal dialysis that results in considerable morbidity, mortality, and health care costs. It also significantly limits the use of this important dialysis modality. Despite its importance as a patient safety issue, peritonitis practices and outcomes vary markedly and unacceptably among different centers, regions, and countries. This article reviews peritonitis risk factors, diagnosis, treatment, and prevention, particularly focusing on potential drivers of variable practices and outcomes, controversial or unresolved areas, and promising avenues warranting further research. Potential strategies for augmenting the existing limited evidence base and reducing the gap between evidence-based best practice and actual practice also are discussed.
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Affiliation(s)
- Yeoungjee Cho
- Centre for Kidney Disease Research, Translational Research Institute at University of Queensland, Brisbane, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Centre for Kidney Disease Research, Translational Research Institute at University of Queensland, Brisbane, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
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Turkmen K, Guney I, Yazici R, Arslan S, Altintepe L, Yeksan M. Health-related quality of life, depression and mortality in peritoneal dialysis patients in Turkey: seven-year experience of a center. Ren Fail 2014; 36:859-64. [DOI: 10.3109/0886022x.2014.899874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Preliminary Experience of a PDCA-Cycle and Quality Management Based Training Curriculum for Rat Liver Transplantation. J Surg Res 2012; 176:409-22. [DOI: 10.1016/j.jss.2011.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 09/11/2011] [Accepted: 10/12/2011] [Indexed: 11/22/2022]
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13
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Gadola L, Poggi C, Poggio M, Sáez L, Ferrari A, Romero J, Fumero S, Ghelfi G, Chifflet L, Borges PL. Using a multidisciplinary training program to reduce peritonitis in peritoneal dialysis patients. Perit Dial Int 2012; 33:38-45. [PMID: 22753455 DOI: 10.3747/pdi.2011.00109] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The present study evaluated the tool used to assess patients' skills and the impact on peritonitis rates of a new multidisciplinary peritoneal dialysis (PD) education program (PDEP). METHODS After the University Hospital Ethics Committee approved the study, the educational and clinical records of PD patients were retrospectively analyzed in two phases. In phase I, an Objective Structured Assessment (OSA) was used during August 2008 to evaluate the practical skills of 25 patients with adequate Kt/V and no mental disabilities who had been on PD for more than 1 month. Test results were correlated with the prior year's peritonitis rate. In phase II, the new PDEP, consisting of individual lessons, a retraining schedule, and group meetings, was introduced starting 1 September 2008. Age, sex, years of education, time on PD, number of training sessions, and peritonitis episodes were recorded. Statistical analyses used t-tests, chi-square tests, and Poisson distributions; a p value of less than 0.05 was considered significant. RESULTS In phase I, 25 patients [16 men, 9 women; mean age: 54 ± 15 years (range: 22 - 84 years); mean time on PD: 35 ± 30 months (range: 1 - 107 months)] were studied. The OSA results correlated with peritonitis rates: patients who passed the test had experienced significantly lower peritonitis rates during the prior year (p < 0.05). In phase II, after the new PDEP was introduced, overall peritonitis rates significantly declined (to 0.28 episodes/patient-year from 0.55 episodes/patient-year, p < 0.05); the Staphylococcus peritonitis rate also declined (to 0.09 episodes/patient-year from 0.24 episodes/patient-year, p < 0.05). CONCLUSIONS The OSA is a reliable tool for assessing patients' skills, and it correlates with peritonitis rates. The multidisciplinary PDEP significantly improved outcomes by further lowering peritonitis rates.
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Affiliation(s)
- Liliana Gadola
- Centro de Nefrología, Hospital de Clínicas, Universidad de la República, Uruguay.
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Yung S, Chan TM. Tissue remodeling and inflammation during peritoneal dialysis: catheter versus fluid. Perit Dial Int 2010; 30:274-6. [PMID: 20424196 DOI: 10.3747/pdi.2010.00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Susan Yung
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
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