1
|
Akiyama M, Kamei K, Nishi K, Kaneda T, Inoki Y, Osaka K, Sato M, Ogura M, Ito S. Frequency and prognosis of peritoneal dialysis-associated peritonitis in children. Clin Exp Nephrol 2024; 28:692-700. [PMID: 38472543 DOI: 10.1007/s10157-024-02482-x] [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: 05/08/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Peritonitis is the leading cause of peritoneal dialysis (PD) discontinuation. However, few data concern risk factors of peritonitis development and catheter removal caused by treatment failure in pediatric patients. METHODS This single-center, retrospective study analyzed data from pediatric patients who underwent chronic PD between March 2002 and June 2022. The incidence rates of peritonitis by the person-year method were calculated, and they were stratified by patient age groups. Risk factors for peritonitis development and catheter removal were also analyzed by multivariate analysis using logistic regression model. RESULTS Ninety patients were enrolled, and 62 peritonitis episodes were observed in 41 (46%) patients. The incidence rate of peritonitis was 0.21 episodes per patient-year, which was the highest in children aged under 2 years old (0.26 episodes per patient-year). Moreover, 44 (71%) cases were successfully cured by antibiotics alone, although 17 (27%) cases required catheter removal, and 4 (6%) cases transitioned to chronic hemodialysis because of peritoneal dysfunction. One patient died. The risk factor for peritonitis development and catheter removal caused by treatment failure was PD insertion at under 2 years old (odds ratio = 2.5; P = 0.04) and Pseudomonas aeruginosa (odds ratio = 11.0; P = 0.04) in the multivariate analysis. P. aeruginosa was also a risk factor for difficulty in re-initiating PD (P = 0.004). CONCLUSIONS The incidence rate of peritonitis was the highest in children under 2 years old. P. aeruginosa peritonitis is a risk factor for catheter removal and peritoneal dysfunction.
Collapse
Affiliation(s)
- Misaki Akiyama
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Tomoya Kaneda
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kei Osaka
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| |
Collapse
|
2
|
Francisco D, Carnevale A, Ávila G, Calça AR, Matias P, Branco P. Transitioning to peritoneal dialysis: it does not matter where you come from. J Bras Nefrol 2024; 46:e20230139. [PMID: 38717919 DOI: 10.1590/2175-8239-jbn-2023-0139en] [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: 09/08/2023] [Accepted: 03/01/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Patients with end-stage renal disease (ESRD) frequently change renal replacement (RRT) therapy modality due to medical or social reasons. We aimed to evaluate the outcomes of patients under peritoneal dialysis (PD) according to the preceding RRT modality. METHODS We conducted a retrospective observational single-center study in prevalent PD patients from January 1, 2010, to December 31, 2017, who were followed for 60 months or until they dropped out of PD. Patients were divided into three groups according to the preceding RRT: prior hemodialysis (HD), failed kidney transplant (KT), and PD-first. RESULTS Among 152 patients, 115 were PD-first, 22 transitioned from HD, and 15 from a failing KT. There was a tendency for ultrafiltration failure to occur more in patients transitioning from HD (27.3% vs. 9.6% vs. 6.7%, p = 0.07). Residual renal function was better preserved in the group with no prior RRT (p < 0.001). A tendency towards a higher annual rate of peritonitis was observed in the prior KT group (0.70 peritonitis/year per patient vs. 0.10 vs. 0.21, p = 0.065). Thirteen patients (8.6%) had a major cardiovascular event, 5 of those had been transferred from a failing KT (p = 0.004). There were no differences between PD-first, prior KT, and prior HD in terms of death and technique survival (p = 0.195 and p = 0.917, respectively) and PD efficacy was adequate in all groups. CONCLUSIONS PD is a suitable option for ESRD patients regardless of the previous RRT and should be offered to patients according to their clinical and social status and preferences.
Collapse
Affiliation(s)
- Diogo Francisco
- Centro Hospitalar Lisboa Ocidental, Serviço de Nefrologia, Lisboa, Portugal
| | - Andreia Carnevale
- Centro Hospitalar Lisboa Ocidental, Serviço de Nefrologia, Lisboa, Portugal
| | - Gonçalo Ávila
- Centro Hospitalar Lisboa Ocidental, Serviço de Nefrologia, Lisboa, Portugal
| | - Ana Rita Calça
- Centro Hospitalar Lisboa Ocidental, Serviço de Nefrologia, Lisboa, Portugal
| | - Patrícia Matias
- Centro Hospitalar Lisboa Ocidental, Serviço de Nefrologia, Lisboa, Portugal
| | - Patrícia Branco
- Centro Hospitalar Lisboa Ocidental, Serviço de Nefrologia, Lisboa, Portugal
| |
Collapse
|
3
|
Blanchard F, Henry B, Vijayaratnam S, Canouï E, Moura A, Thouvenot P, Bracq-Dieye H, Tessaud-Rita N, Valès G, Diakité A, Leclercq A, Lecuit M, Charlier C. Listeria monocytogenes-associated spontaneous bacterial peritonitis in France: a nationwide observational study of 208 cases. THE LANCET. INFECTIOUS DISEASES 2024; 24:783-792. [PMID: 38608698 DOI: 10.1016/s1473-3099(24)00151-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Listeriosis is a foodborne infection caused by Listeria monocytogenes. Three main forms of listeriosis are well characterised, but little is known about L monocytogenes-associated spontaneous bacterial peritonitis. We used data from the French national surveillance of listeriosis to perform a nationwide retrospective study. METHODS All patients with L monocytogenes isolated by culture from a peritoneal fluid sample in France between April 1, 1993, and Dec 31, 2022, were included. Individuals for whom bacterial peritonitis was not confirmed and those who also had another type of invasive listeriosis were excluded. A standardised checklist was used to collect demographic, clinical, and biological data as well as antibiotic treatment and follow-up data. The primary outcome was to determine the characteristics of L monocytogenes-associated spontaneous bacterial peritonitis. We did descriptive analyses and assessed risk factors for 1-month mortality using an exploratory multivariable Cox model analysis. FINDINGS Among the 8768 L monocytogenes cases reported, 208 (2%) were patients with L monocytogenes-associated spontaneous bacterial peritonitis. Mean age was 65 years (SD 13), 50 (24%) of 208 patients were female, and 158 (76%) were male (no data on race or ethnicity were available). 200 (98%) of 205 patients with L monocytogenes-associated spontaneous bacterial peritonitis with available data had immunosuppressive comorbidities, including cirrhosis (148 [74%] of 201 with available data), ongoing alcoholism (58 [62%] of 94), and ongoing neoplasia (60 [31%] of 195). Causes of ascites included cirrhosis (146 [70%] of 208), ongoing neoplasia (26 [13%]), end-stage heart failure (13 [6%]), and peritoneal dialysis (11 [5%]). Among those with available data, presentation was pauci-symptomatic and non-specific; only 67 (50%) of 135 patients presented with fever, 49 (37%) of 132 with abdominal pain, and 27 (21%) of 129 with diarrhoea. 61 (29%) of 208 patients were dead at 1 month, 92 (44%) were dead at 3 months, and 109 (52%) were dead at 6 months after diagnosis. Ongoing neoplasia (hazard ratio 2·42 [95% CI 1·05-5·56]; p=0·039), septic shock (8·03 [2·66-24·02]; p=0·0021), and high blood leukocyte count (1·05 [1·00-1·09]; p=0·045) were independently associated with 1-month mortality. INTERPRETATION Despite the non-specific and mild presentation of L monocytogenes-associated spontaneous bacterial peritonitis, the outcome is poor and similar to that of neurolisteriosis, and so identification of L monocytogenes in ascitic fluid samples requires urgent parenteral amoxicillin-based treatment to avoid a fatal outcome. FUNDING Institut Pasteur, Inserm, and French Public Health Agency. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Florian Blanchard
- Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France; Antibiotic stewardship team, Department of Infectious Diseases and Tropical Medicine, Cochin Port-Royal University Hospital, APHP, Paris, France; Department of Anesthesiology and Critical Care Sorbonne University, GRC 29, AP-HP, DMU DREAM, Pitié-Salpêtrière Hospital, Paris, France
| | - Benoît Henry
- Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France; Division of Infectious Diseases and Tropical Medicine, Bicêtre University Hospital, APHP, Le Kremlin-Bicêtre, France
| | - Sofieya Vijayaratnam
- Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France
| | - Etienne Canouï
- Antibiotic stewardship team, Department of Infectious Diseases and Tropical Medicine, Cochin Port-Royal University Hospital, APHP, Paris, France
| | - Alexandra Moura
- Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France; Biology of Infection Unit, Institut Pasteur, Université Paris Cité, Inserm U1117, Paris, France
| | - Pierre Thouvenot
- Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France
| | - Hélène Bracq-Dieye
- Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France
| | - Nathalie Tessaud-Rita
- Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France
| | - Guillaume Valès
- Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France
| | - Andrée Diakité
- Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France
| | - Alexandre Leclercq
- Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France
| | - Marc Lecuit
- Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France; Biology of Infection Unit, Institut Pasteur, Université Paris Cité, Inserm U1117, Paris, France; Université Paris Cité, Paris, France; Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, APHP, Institut Imagine, Paris, France.
| | - Caroline Charlier
- Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France; Antibiotic stewardship team, Department of Infectious Diseases and Tropical Medicine, Cochin Port-Royal University Hospital, APHP, Paris, France; Biology of Infection Unit, Institut Pasteur, Université Paris Cité, Inserm U1117, Paris, France; Université Paris Cité, Paris, France.
| |
Collapse
|
4
|
Sakurada T, Miyazaki M, Nakayama M, Ito Y. Peritoneal dialysis-related infections in elderly patients. Clin Exp Nephrol 2024:10.1007/s10157-024-02531-5. [PMID: 38914913 DOI: 10.1007/s10157-024-02531-5] [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: 05/22/2024] [Accepted: 06/16/2024] [Indexed: 06/26/2024]
Abstract
This review outlines the epidemiology, characteristics, risk factors, and prognosis of peritoneal dialysis (PD)-related peritonitis, PD catheter-related infections, and the effects of assisted PD in elderly patients from the Japanese perspective. Based on the literature, the incidence of peritonitis is likely to be higher in elderly patients than in younger patients. The most frequent causative bacteria in elderly patients are Gram-positive bacteria, as in adult PD patients, most commonly due to transcatheter infection. However, elderly patients may have difficulty recognizing cloudy drainage fluid due to decreased visual acuity. Hypokalemia, the use of gastric acid suppressants, prophylactic antibiotic use before endoscopy, biocompatible fluids and hypoalbuminemia considered modifiable risk factors for peritonitis. However, the mechanism by which treatment of hypokalemia prevents peritonitis is unknown. Currently, the relationship between gastric acid suppression therapy and peritonitis in elderly patients is debatable, with no evidence to strongly recommend uniform discontinuation of gastric acid suppression therapy. Exit-site infection (ESI) is a major risk factor for the development of peritonitis, and appropriate prevention and management of ESI may reduce infection-related hospitalizations in PD patients. Currently, no randomized, controlled trials have verified the effectiveness of antibiotic application for ESI in Japan, but results from other countries are awaited. In assisted PD, it is extremely important that family members, caregivers, and nurses who support the procedure receive sufficient education and training from medical professionals familiar with PD. Early detection and treatment of PD-related infections are required because the risk of death increases in elderly patients.
Collapse
Affiliation(s)
- Tsutomu Sakurada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, 216-8511, Japan.
| | | | - Masaaki Nakayama
- St Luke's International University, Visiting Researcher, Tokyo, Japan
| | | |
Collapse
|
5
|
Dong X, Xie C, Yi C, Ye P, Ye H, Guo Q, Huang F, Kong YZ, Yang X. Clinical characteristics and antibiotic treatment of peritoneal dialysis-associated peritonitis caused by Pseudomonas species: a review of 15 years' experience from southern China. Microbiol Spectr 2024; 12:e0009624. [PMID: 38695572 DOI: 10.1128/spectrum.00096-24] [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: 01/11/2024] [Accepted: 03/25/2024] [Indexed: 06/06/2024] Open
Abstract
Pseudomonas can lead to peritoneal dialysis-associated peritonitis, which is characterized by a poor prognosis, such as a substantial failure rate and a high death rate. This study aimed to provide an overview of Pseudomonas peritonitis's clinical features, the regimens of antibiotic, antibiotic resistance, and outcomes in peritoneal dialysis (PD) patients. This study observed patients with Pseudomonas peritonitis in two large PD centers in South China from January 2008 to December 2022. The demographics, symptomatology, antibiotics regimens, resistance to common antibiotics, and clinical outcomes of all included patients were reviewed. A total of 3,459 PD patients were included, among them 57 cases of peritonitis caused by Pseudomonas, including 48 cases (84.2%) of Pseudomonas aeruginosa. The incidence rate of Pseudomonas peritonitis was 0.0041 episode per patient-year. Of them, 28.1% (16 cases) of the patients were accompanied by exit site infection (ESI), and all had abdominal pain and turbid ascites at the time of onset. The most commonly used antibiotic combination was ceftazidime combined with amikacin. Approximately 89% of Pseudomonas species were sensitive to ceftazidime, and 88% were sensitive to amikacin. The overall primary response rate was 28.1% (16 patients), and the complete cure rate was 40.4% (23 patients). There was no significant difference in the complete cure rate of peritonitis using three and other antibiotic treatment regimens (44.8% vs 46.4%; P = 0.9). The successful treatment group had higher baseline albumin level (35.9 ± 6.2; P = 0.008) and residual urine volume (650.7 ± 375.5; P = 0.04). Although the incidence of peritonitis caused by Pseudomonas was low, the symptoms were serious, and prognosis was very poor. Pseudomonas was still highly susceptible to first-line antibiotics currently in use against Gram-negative bacteria. Patients with successful treatment had higher albumin levels and higher urine output. IMPORTANCE Although the incidence of peritoneal dialysis-associated peritonitis caused by Pseudomonas is very low, it seriously affects the technique survival of peritoneal dialysis patients. However, there are few studies and reports on Pseudomonas peritonitis in the Chinese mainland area. Therefore, the purpose of this study is to describe the clinical characteristics, the regimens of antibiotic, drug resistance, and outcome of peritoneal dialysis patients in southern China in the past 15 years and summarize the clinical experience in the treatment of Pseudomonas peritonitis.
Collapse
Affiliation(s)
- Xiao Dong
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
- Department of Nephrology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Chao Xie
- Department of Nephrology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
| | - Peiyi Ye
- Department of Nephrology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
| | - Qunying Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
| | - Yao-Zhong Kong
- Department of Nephrology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
| |
Collapse
|
6
|
Osaki Y, Maeoka Y, Sami M, Takahashi A, Ishiuchi N, Sasaki K, Masaki T. Peritoneal dialysis-associated peritonitis, caused by superior mesenteric artery thrombosis with intestinal necrosis: a case report. CEN Case Rep 2024:10.1007/s13730-024-00894-y. [PMID: 38825653 DOI: 10.1007/s13730-024-00894-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/14/2024] [Indexed: 06/04/2024] Open
Abstract
Peritoneal dialysis (PD)-associated peritonitis is a common complication of PD. Enteric peritonitis is defined as peritonitis arising from an intestinal or intra-abdominal organ source. The delay in the diagnosis or treatment of enteric peritonitis has been reported to increase mortality. Therefore, the early consideration of enteric peritonitis, particularly in cases of culture-negative peritonitis, is imperative. A 67-year-old Japanese man who had been undergoing PD for 3 years, was admitted to our hospital with a diagnosis of PD-associated peritonitis. A month previously, he experienced a bleeding gastric ulcer, which led to severe anemia (hemoglobin 6.3 mg/dL), followed by thrombocytosis. On admission, peritoneal fluid analysis showed a high white blood cell count (WBC: 8,570 /µL), with neutrophils predominating (74.5%). Cultures of both his dialysis effluent and blood were negative. After admission, the WBC count of the dialysis effluent gradually decreased alongside antibiotic therapy, but the patient's abdominal pain did not improve. After 4 days, enhanced computed tomography showed superior mesenteric artery (SMA) thrombosis and intestinal necrosis. Therefore, emergency intestinal resection and PD catheter removal were performed, and then antithrombosis therapy was initiated. Because the patient's abdominal pain was improved and platelet count and D-dimer concentration were reduced by these treatments, he was discharged from the hospital after 47 days. Thus, we report a rare case of culture-negative PD-associated peritonitis, which was caused by SMA thrombosis and intestinal necrosis. It is likely that combination of severe calcification of SMA and prolonged thrombocytosis secondary to the severe anemia contributed to the thrombosis.
Collapse
Affiliation(s)
- Yosuke Osaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yujiro Maeoka
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Mai Sami
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Akira Takahashi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Naoki Ishiuchi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Kensuke Sasaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| |
Collapse
|
7
|
Raguž F, Tomić M, Stojčić A, Tipurić M, Volarić M, Bevanda S. Peritoneal dialysis in Herzegovina, Federation of Bosnia and Herzegovina: 18 years of experience from our center. Ther Apher Dial 2024; 28:409-416. [PMID: 38115783 DOI: 10.1111/1744-9987.14097] [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: 09/13/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Due to treatment of end-stage-renal-disease (ESRD), continuous peritoneal dialysis (CAPD) is used in 11% of cases and is associated with several PD-associated infections. METHODS Clinical data on 71 patients with CAPD were evaluated in addition to exit site infections and episodes of acute peritonitis (AP). RESULTS There were 39 men and 32 women. Average age was 61 years when we began CAPD and average time spent on CAPD program was 3.35 years. Illness that dominantly caused ESRD was diabetes (23 patients). Exit site infection was mostly caused by S epidermidis-MRSE and AP was most commonly caused by Staphylococcus sp. group. Most common cause of death was cardiovascular disease. At the end of this study, 9 patients were alive and still on CAPD, 10 were transplanted, 15 switched to HD and 36 died. CONCLUSION Optimal prevention measures and treatment of infectious complications in CAPD is necessary for better treatment possibilities.
Collapse
Affiliation(s)
- Fila Raguž
- Department of Nephrology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Monika Tomić
- Department of Nephrology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Andrea Stojčić
- Department of Nephrology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Manuel Tipurić
- Department of Urology, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Mile Volarić
- Department of Gastroenterology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Sanja Bevanda
- Department of Endocrinology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| |
Collapse
|
8
|
Chieochanthanakij R, Wattanasatja V, Passorn P, Wannigama DL, Kanjanabuch T. Caregiver skin infection causing peritoneal dialysis-associated peritonitis. Med Mycol Case Rep 2024; 44:100653. [PMID: 38884003 PMCID: PMC11176955 DOI: 10.1016/j.mmcr.2024.100653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/08/2024] [Accepted: 05/23/2024] [Indexed: 06/18/2024] Open
Abstract
We present the first case report of peritoneal dialysis (PD)-associated peritonitis due to Gibellulopsis nigrescens, with the same pathogen detected in her caregiver's tinea capitis. This confirms that touch contamination from the caregiver's infection was the primary source of this rare organism. The species of pathogen causing peritonitis and her caregiver's scalp lesions were identified by DNA barcoding. The patient responded well to timely PD catheter removal and a 2-week course of systemic amphotericin B deoxycholate. Preventive strategies should prioritize hygiene practices, including maintaining adequate personal hygiene and practicing thorough hand washing, to mitigate the risk of touch contamination and subsequent infection with fungal pathogens.
Collapse
Affiliation(s)
| | - Veerapat Wattanasatja
- Department of Internal Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Panthira Passorn
- Department of Internal Medicine, Sawanpracharak Hospital, Nakhon Sawan, 60000, Thailand
| | - Dhammika Leshan Wannigama
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence in Antimicrobial Resistance and Stewardship, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Infectious Diseases and Infection Control, Yamagata Prefectural Central Hospital, Yamagata, Japan
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia
- Biofilms and Antimicrobial Resistance Consortium of ODA Receiving Countries, The University of Sheffield, Sheffield, United Kingdom
- Pathogen Hunter's Research Collaborative Team, Department of Infectious Diseases and Infection Control, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Talerngsak Kanjanabuch
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- CAPD Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| |
Collapse
|
9
|
Borzych-Dużałka D, Same R, Neu A, Yap HK, Verrina E, Bakkaloglu SA, Cano F, Patel H, Szczepańska M, Obrycki Ł, Spizzirri AP, Sartz L, Vondrak K, Rebori A, Milosevski-Lomic G, Chan EYH, Basu B, Pezo AL, Zaloszyc A, Chadha V, Schaefer F, Warady BA. Best Practice of Peritoneal Dialysis-Associated Gram-Negative Peritonitis in Children: Insights From the International Pediatric Peritoneal Dialysis Network Registry. Kidney Int Rep 2024; 9:1654-1663. [PMID: 38899186 PMCID: PMC11184244 DOI: 10.1016/j.ekir.2024.03.031] [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: 01/31/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction Gram-negative peritonitis (GNP) is associated with significant morbidity in children receiving long-term peritoneal dialysis (PD) and current treatment recommendations are based on limited data. Methods Analysis of 379 GNP episodes in 308 children (median age 6.9 years, interquartile range [IQR]: 3.0-13.6) from 45 centers in 28 countries reported to the International Pediatric Peritoneal Dialysis Network registry between 2011 and 2023. Results Overall, 74% of episodes responded well to empiric therapy and full functional recovery (FFR) was achieved in 82% of cases. In vitro bacterial susceptibility to empiric antibiotics and lack of severe abdominal pain at onset were associated with a good initial response. Risk factors for failure to achieve FFR included severe abdominal pain at onset and at 60 to 72 hours from treatment initiation (odds ratio [OR]: 3.81, 95% confidence interval [CI]: 2.01-7.2 and OR: 3.94, 95% CI: 1.06-14.67, respectively), Pseudomonas spp. etiology (OR: 1.73, 95% CI: 1.71-4.21]) and in vitro bacterial resistance to empiric antibiotics (OR: 2.40, 95% CI: 1.21-4.79); the risk was lower with the use of monotherapy as definitive treatment (OR: 0.40, 95% CI: 0.21-0.77). Multivariate analysis showed no benefit of dual antibiotic therapy for treatment of Pseudomonas peritonitis after adjustment for age, presenting symptomatology, 60 to 72-hour treatment response, and treatment duration. Monotherapy with cefazolin in susceptible Enterobacterales peritonitis resulted in a similar FFR rate (91% vs. 93%) as treatment with ceftazidime or cefepime monotherapy. Conclusion Detailed microbiological assessment, consisting of patient-specific and center-specific antimicrobial susceptibility data, should guide empiric treatment. Treatment "deescalation" with the use of monotherapy and narrow spectrum antibiotics according to susceptibility data is not associated with inferior outcomes and should be advocated in the context of emerging bacterial resistance.
Collapse
Affiliation(s)
- Dagmara Borzych-Dużałka
- Department for Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland
- University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Rebeca Same
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alicia Neu
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hui Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - Francisco Cano
- Division of Pediatric Nephrology, Hospital Dr. Luis Calvo Mackenna, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Hiren Patel
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Maria Szczepańska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | - Ana Paula Spizzirri
- Division of Pediatric Nephrology, Hospital for Maria Ludovica, La Plata, Argentina
| | - Lisa Sartz
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | | | | | - Eugene Yu-hin Chan
- Pediatric Nephrology Centre, Hong Kong Children’s Hospital, Kowloon Bay, Hong Kong SAR
| | | | | | - Ariane Zaloszyc
- Pediatric Nephrology, Pédiatrie 1, Centre Hospitalier Universitaire de Strasbourg, France
| | - Vimal Chadha
- Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Franz Schaefer
- University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | | |
Collapse
|
10
|
Baillie J, Gill P, Courtenay M. Perceptions of peritonitis risk, prevention, diagnosis and stigma: Findings from a mixed methods study with patients and relatives using peritoneal dialysis. J Ren Care 2024; 50:138-150. [PMID: 36946307 DOI: 10.1111/jorc.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/27/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Peritonitis is the main treatment-related complication of peritoneal dialysis and a primary concern for patients and their relatives. Therefore, understanding their perceptions of peritonitis is important. OBJECTIVES To explore patients' and relatives' perceptions of peritoneal dialysis-associated peritonitis risk, prevention measures and experiences of diagnosis, and experience of perceived stigma. DESIGN A sequential mixed methods study design was used, including a questionnaire and semi-structured interviews. PARTICIPANTS Patients using peritoneal dialysis and relatives (n = 75) from six National Health Service organisations from the United Kingdom. MEASUREMENTS A structured questionnaire was administered with patients and relatives (n = 75) using peritoneal dialysis; data were analysed using descriptive statistics. Thirty questionnaire respondents were then purposively sampled and interviewed in-depth; data were analysed thematically. Data were collected 2017-2018. Ethical and governance approvals were gained. RESULTS Qualitative and quantitative analyses were integrated and three themes presented: • Perceptions of risk: participants assessed their risk of developing peritonitis and possible implications on their health and relatives. Participants felt greatly responsible for preventing infection. • Preventing peritonitis: participants reported similar and some differing measures to minimise their risk of developing peritonitis. Participants wanted to be seen as "clean". • Diagnosis of peritonitis: peritonitis diagnosis was embarrassing and stigmatising for many individuals. This was influenced by the response of healthcare professionals and the cause of peritonitis. CONCLUSIONS It is important that healthcare professionals are aware of how responsible patients and relatives feel about preventing peritonitis, the emotional effect of this responsibility and crucially the impact this may have on seeking help.
Collapse
Affiliation(s)
- Jessica Baillie
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Paul Gill
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| |
Collapse
|
11
|
Sapsitthikul T, Pongpirul K, Kanjanabuch T, Chuengsaman P, Punyabukkana P, Pratanwanich PN, Sawetpiyakul P, Wannigama DL, Susantitaphong P, Townamchai N, Avihingsanon Y, Perl J, Johnson DW, Pecoits-Filho R, Eiam-Ong S, Tungsanga K, Sriratanaban J. Optimizing home visits through machine learning for preventing peritoneal dialysis-associated peritonitis: a proof of concept study and results from PDOPPS. Clin Kidney J 2024; 17:sfae136. [PMID: 38912223 PMCID: PMC11191826 DOI: 10.1093/ckj/sfae136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Indexed: 06/25/2024] Open
Affiliation(s)
- Tossaporn Sapsitthikul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Krit Pongpirul
- Center of Excellence in Preventive and Integrative Medicine and Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Infection Biology & Microbiomes, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Piyatida Chuengsaman
- Banphaeo-Charoenkrung Peritoneal Dialysis Center, Banphaeo Dialysis Group, Banphaeo Hospital, Bangkok, Thailand
| | - Proadpran Punyabukkana
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Ploy N Pratanwanich
- Department of Mathematics and Computer Science, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
- Chula Intelligent and Complex Systems Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Panus Sawetpiyakul
- International School of Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Dhammika Leshan Wannigama
- Department of Infectious Diseases and Infection Control, Yamagata Prefectural Central Hospital, Yamagata, Japan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence in Antimicrobial Resistance and Stewardship, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia
- Biofilms and Antimicrobial Resistance Consortium of ODA Receiving Countries, The University of Sheffield, Sheffield, UK
- Pathogen Hunter's Research Collaborative Team, Department of Infectious Diseases and Infection Control, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Natavudh Townamchai
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yingyos Avihingsanon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - David W Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | | | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Jiruth Sriratanaban
- Center of Excellence in Preventive and Integrative Medicine and Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
12
|
Xie R, Ling Y, Huang Y, Qin L, Bao K, Qin X. A rare case of successful treatment of peritoneal dialysis patient with Serratia marcescens peritonitis without catheter removal: case report and literature review. Front Cell Infect Microbiol 2024; 14:1373036. [PMID: 38873095 PMCID: PMC11169698 DOI: 10.3389/fcimb.2024.1373036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Serratia marcescens, as a Gram-negative opportunistic pathogen, is a rare cause of peritonitis and has worse clinical outcomes than Gram-positive peritonitis. In this case report, we describe a case of Serratia marcescens associated peritonitis that was successfully cured without catheter removal. A 40-year-old male patient with peritoneal dialysis who worked in the catering industry was admitted to the hospital for 16 hours after the discovery of cloudy peritoneal dialysate and abdominal pain. Ceftazidime and cefazolin sodium were immediately given intravenously as an empirical antibiotic regimen. After detecting Serratia marcescens in the peritoneal diasate culture, the treatment was switched to ceftazidime and levofloxacin. The routine examination of peritoneal dialysate showed a significant decrease in white blood cells, the peritoneal dialysate became clear, and the peritoneal dialysis catheter was retained. The patient was treated for 2 weeks and treated with oral antibiotics for 1 week. It is necessary to further strengthen the hygiene of work environment to prevent Serratia marcescens infection in peritoneal dialysis patients. We recommend that patients with Serratia marcescens associated peritonitis should be treated with a combination of antibiotics as early as possible empirically, and at the same time, the peritoneal dialysis fluid culture should be improved, and the antibiotic regimen should be timely adjusted according to the drug sensitivity results. For patients with clinical symptoms for more than 3 days, considering the strong virulence of Serratia marcescens, whether to use meropenem directly or not can provide a reference for clinical decision-making. Further clinical studies are needed to achieve more precise anti-infective treatment.
Collapse
Affiliation(s)
- Ruizhi Xie
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ying Ling
- The Sixth Clinical Medical College, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Yaru Huang
- The College of Basic Medical Sciences of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lulu Qin
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kun Bao
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Nephrology Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases, Guangzhou, China
| | - Xindong Qin
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Nephrology Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases, Guangzhou, China
| |
Collapse
|
13
|
Shah AD, Vashisth S, Raker CA, Hu SL. Trends, Outcomes, and Economic Implications of Peritoneal Dialysis-Associated Peritonitis Hospitalizations: A National Cohort Study. Am J Nephrol 2024:1-5. [PMID: 38815553 DOI: 10.1159/000539452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Peritoneal dialysis-associated peritonitis (PDAP) is a serious complication of peritoneal dialysis, associated with significant morbidity, modality transition, and mortality. Here, we provide an update on the national burden of this significant complication, highlighting trends in demographics, treatment practices, and in-hospital outcomes of PDAP from 2016 to 2020. METHODS Utilizing a national all-payer dataset of hospitalizations in the USA, we conducted a retrospective cohort study of adult hospitalizations with a primary diagnosis of PDAP from 2016 to 2020. We analyzed demographic, clinical, and hospital-level data, focusing on in-hospital mortality, PD catheter removal, length of stay, and healthcare expenses. Multivariable logistic regression adjusted for demographic and clinical covariates was employed to identify risk factors associated with adverse outcomes. RESULTS There was a stable burden of annual PDAP admissions from 2016 to 2020. Healthcare expenditures associated with PDAP were high, totaling over USD 75,000 per admission. Additionally, our data suggest geographic inconsistencies in treatment patterns, with treatment at western and teaching hospitals associated with increased rates of catheter removal relative to northeastern and non-teaching centers and a mean cost of nearly USD 55,000 more in Western states compared to Midwest states. 23.2% of episodes resulted in the removal of the PD catheter. Risk factors associated with adverse outcomes included older age, higher Charlson comorbidity index scores, peripheral vascular disease, and the need for vasopressors. CONCLUSION PDAP is a major cause of mortality among PD patients, and there is a vital need for future studies to examine the impact of hospital location and teaching status on PDAP outcomes, which can inform treatment practices and resource allocation.
Collapse
Affiliation(s)
- Ankur D Shah
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Division of Kidney Disease and Hypertension, Department of Medicine at Rhode Island Hospital, Providence, Rhode Island, USA
| | - Shagun Vashisth
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA,
| | - Christina A Raker
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Biostatistics, Epidemiology, Research Design, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Susie L Hu
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Division of Kidney Disease and Hypertension, Department of Medicine at Rhode Island Hospital, Providence, Rhode Island, USA
| |
Collapse
|
14
|
Tsai SF, Chen CH, Wu MJ, Hsieh M. Dialysate cyclophilin A as a predictive marker for historical peritonitis in patients undergoing peritoneal dialysis. Heliyon 2024; 10:e31021. [PMID: 38813216 PMCID: PMC11133656 DOI: 10.1016/j.heliyon.2024.e31021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction No markers have been used to diagnose historical peritoneal dialysis (PD)-related peritonitis. Cyclophilin A (CypA) is associated with glucose toxicity and inflammation. We hypothesize that dialysate CypA can be a marker for historical peritonitis (at least 3 months free from peritonitis). Method An enzyme-linked immunosorbent assay kit was used to measure the concentration of dialysate CypA. Clinical and laboratory data were collected to correlate with historical peritonitis. Mann-Whitney U test and Chi-square test were used for analysis. Receiver operating characteristic (ROC) analysis was used to evaluate predictive power. Results Out of a total of 31 patients who had undergone PD for at least 2 years, 18 had no history of PD-related peritonitis, while 13 had experienced PD-related peritonitis at least once. Overall, the patients in this population were in good health (normal white blood cell count, no anemia, normal electrolyte and serum albumin levels). There were no significant differences between patients with and without a history of peritonitis, except for blood white blood cell count (5650.6 ± 1848.4 vs. 7154.6 ± 2056.8, p = 0.032) and dialysate CypA value (24.27 ± 22.715 vs. 54.41 ± 45.63, p = 0.020). In the univariate analysis, only the dialysate CypA level showed a statistically significant association with historical peritonitis (HR = 1.030, 95 % CI = 1.010-1.062, p = 0.046). The AUC for dialysate CypA (>34.83 ng/mL) was 0.748, with a sensitivity of 0.615 and specificity of 0.833. Conclusion PD peritonitis poses a significant threat to the long-term use of peritoneal dialysis. Based on our study, even in the absence of concurrent infection, dialysate CypA can serve as a predictive marker for historical peritonitis, demonstrating high predictive power along with fair sensitivity and good specificity.
Collapse
Affiliation(s)
- Shang-Feng Tsai
- Department of Life Science, Tunghai University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Hsu Chen
- Department of Life Science, Tunghai University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Program in Tissue Engineering and Regenerative Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ming-Ju Wu
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Mingli Hsieh
- Department of Life Science, Tunghai University, Taichung, Taiwan
| |
Collapse
|
15
|
Wen YK. Empyema associated with peritoneal dialysis peritonitis. Perit Dial Int 2024:8968608241241180. [PMID: 38807441 DOI: 10.1177/08968608241241180] [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: 05/30/2024] Open
Abstract
A 65-year-old woman on peritoneal dialysis (PD) was admitted due to abdominal pain with cloudy PD effluent. The white blood cell count in PD effluent was 5860/µL with 85% polymorphonuclear neutrophils. Therefore, she was clinically diagnosed with peritonitis. The cultures of PD effluent were negative. Initial abdominal computed tomography did not find suggest any intraabdominal pathology. The patient was treated with empirical intraperitoneal antibiotics. Because abdominal pain with cloudy PD effluent persisted, the PD catheter was removed eventually. The culture of the removed PD catheter grew Klebsiella pneumoniae. However, intermittent fever was noted over the following days and empyema developed approximately 2 weeks after PD catheter removal. The culture of pleural fluid also grew K. pneumoniae. Another computed tomography revealed multiple intraabdominal abscesses that was assumed to come from a complication of PD-associated peritonitis. We postulate that the empyema might be caused by transdiaphragmatic extension of the intraabdominal abscesses into the pleural space.
Collapse
Affiliation(s)
- Yao-Ko Wen
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Taiwan
| |
Collapse
|
16
|
Ibrahim R, Hijazi MM, AlAli F, Hamad A, Bushra A, Mirow L, Siepmann T. Diagnostic Accuracy of MMP-8 and IL-6-Based Point-of-Care Testing to Detect Peritoneal Dialysis-Related Peritonitis: A Single-Center Experience. Diagnostics (Basel) 2024; 14:1113. [PMID: 38893639 PMCID: PMC11171716 DOI: 10.3390/diagnostics14111113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Peritoneal dialysis-related peritonitis (PDRP) is the most common complication of peritoneal dialysis (PD), which can lead to poor outcomes if not diagnosed and treated early. We aimed to investigate the diagnostic accuracy of MMP-8 and IL-6-based point-of-care tests (POCTs) in diagnosing PDRP in PD patients. METHODS This retrospective chart review study was conducted at a comprehensive kidney center in Qatar. It involved all adult PD patients who underwent PDRP from July 2018 to October 2019 and for whom MMP-8 and IL-6-based POCTs were used to diagnose presumptive peritonitis. Measures of diagnostic accuracy were computed. Peritoneal fluid effluent analysis was the reference standard. RESULTS We included 120 patients (68 [56.7%] females, ages 55.6 ± 15.6 years, treatment duration 39.5 ± 30.4 months [range: 5-142 months]). In this population, MMP-8 and IL-6-based POCTs yielded 100% in all dimensions of diagnostic accuracy (sensitivity, specificity, positive and negative predictive values). CONCLUSIONS MMP-8 and IL-6-based POCTs might be helpful in the early detection of PDRP. This monocentric observation requires further confirmation in a prospective multicentric setting.
Collapse
Affiliation(s)
- Rania Ibrahim
- Department of Nephrology, Dialysis Division, Fahad Bin Jassim Kidney Center, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.I.); (F.A.); (A.H.); (A.B.)
- Division of Health Care Sciences, Dresden International University, Freiberger Str. 37, 01067 Dresden, Germany
| | - Mido Max Hijazi
- Department of Neurosurgery, Division of Spine Surgery, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany;
| | - Fadwa AlAli
- Department of Nephrology, Dialysis Division, Fahad Bin Jassim Kidney Center, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.I.); (F.A.); (A.H.); (A.B.)
| | - Abdullah Hamad
- Department of Nephrology, Dialysis Division, Fahad Bin Jassim Kidney Center, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.I.); (F.A.); (A.H.); (A.B.)
| | - Ahlam Bushra
- Department of Nephrology, Dialysis Division, Fahad Bin Jassim Kidney Center, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.I.); (F.A.); (A.H.); (A.B.)
| | - Lutz Mirow
- Department of Surgery, Klinikum Chemnitz gGmbH, Medical Faculty and University Hospital Carl Gustav Carus, Medical Campus Chemnitz, Technische Universität Dresden, Flemmingstraße 2, 09116 Chemnitz, Germany;
| | - Timo Siepmann
- Division of Health Care Sciences, Dresden International University, Freiberger Str. 37, 01067 Dresden, Germany
- Department of Neurology, Technische Universität Dresden, Medical Faculty and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany
| |
Collapse
|
17
|
Greer N, Hudson JQ, Jacobs A, Wells DA. The Use of Intraperitoneal Ampicillin in a Patient With Enterococcus faecalis Peritonitis. J Pharm Pract 2024:8971900241256726. [PMID: 38780407 DOI: 10.1177/08971900241256726] [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: 05/25/2024]
Abstract
INTRODUCTION Peritoneal dialysis (PD) - associated peritonitis is a serious complication of peritoneal dialysis (PD). The 2022 International Society of Peritoneal Dialysis (ISPD) guidelines do not recommend intraperitoneal (IP) ampicillin for treatment of Enterococcal PD - associated peritonitis. To date, there is no in vivo data to support use of IP ampicillin for the treatment of Enterococcus faecalis. CASE DESCRIPTION A 69-year-old man with a past medical history of end stage kidney disease (ESKD) requiring continuous cycling peritoneal dialysis (CCPD) was admitted to the hospital and treated for peritonitis with E. faecalis. The patient's CCPD prescription was 2.5% Dianeal with 5 total exchanges. IP ampicillin was added to the first 4 exchanges and additional ampicillin was added to the last fill. The patient successfully completed the treatment course with clinical cure. DISCUSSION The use of IP ampicillin for E. faecalis peritonitis is controversial and previously lacked compelling clinical evidence for or against its use. This case demonstrates treatment of peritonitis using a modified dosing strategy with ampicillin added to each CCPD exchange and last fill. The loss of ampicillin antimicrobial activity reported in vitro with E. faecalis was not supported by this case.
Collapse
Affiliation(s)
- Natalie Greer
- Department of Pharmacy, Union University College of Pharmacy, Jackson, TN, USA
| | - Joanna Q Hudson
- Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
- Division of Nephrology, The University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
- Department of Pharmacy, Methodist Le Bonheur Healthcare, University Hospital, Memphis, TN, USA
| | - Anna Jacobs
- Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
- Department of Pharmacy, Methodist Le Bonheur Healthcare, University Hospital, Memphis, TN, USA
| | - Drew A Wells
- Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
- Department of Pharmacy, Methodist Le Bonheur Healthcare, University Hospital, Memphis, TN, USA
| |
Collapse
|
18
|
Yeter HH, Altunok M, Cankaya E, Yildirim S, Akturk S, Bakirdogen S, Akoğlu H, Bulut M, Sahutoglu T, Erdut A, Ozkahya M, Koc Y, Tunca O, Kara E, Erek M, Polat M, Akagun T, Guz G. Effects of incremental peritoneal dialysis with low glucose-degradation product neutral pH solution on clinical outcomes. Int Urol Nephrol 2024:10.1007/s11255-024-04077-7. [PMID: 38740705 DOI: 10.1007/s11255-024-04077-7] [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: 03/06/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Incremental peritoneal dialysis (IPD) could decrease unfavorable glucose exposure results and preserve (RKF). However, there is no standardization of dialysis prescriptions for patients undergoing IPD. We designed a prospective observational multi-center study with a standardized IPD prescription to evaluate the effect of IPD on RKF, metabolic alterations, blood pressure control, and adverse outcomes. METHODS All patients used low GDP product (GDP) neutral pH solutions in both the incremental continuous ambulatory peritoneal dialysis (ICAPD) group and the retrospective standard PD (sPD) group. IPD patients started treatment with three daily exchanges five days a week. Control-group patients performed four changes per day, seven days a week. RESULTS A total of 94 patients (47 IPD and 47 sPD) were included in this study. The small-solute clearance and mean blood pressures were similar between both groups during follow-up. The weekly mean glucose exposure was significantly higher in sPD group than IPD during the follow-up (p < 0.001). The patients with sPD required more phosphate-binding medications compared to the IPD group (p = 0.05). The rates of peritonitis, tunnel infection, and hospitalization frequencies were similar between groups. Patients in the sPD group experienced more episodes of hypervolemia compared to the IPD group (p = 0.007). The slope in RKF in the 6th month was significantly higher in the sPD group compared to the IPD group (65% vs. 95%, p = 0.001). CONCLUSION IPD could be a rational dialysis method and provide non-inferior dialysis adequacy compared to full-dose PD. This regimen may contribute to preserving RKF for a longer period.
Collapse
Affiliation(s)
- Hasan Haci Yeter
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Hacettepe University, TR-06560, Ankara, Turkey.
| | - Murat Altunok
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Erdem Cankaya
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Saliha Yildirim
- Department of Nephrology, Sincan State Hospital, Ankara, Turkey
| | - Serkan Akturk
- Department of Nephrology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Serkan Bakirdogen
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, 18 Mart University, Canakkale, Turkey
| | - Hadim Akoğlu
- Department of Nephrology, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Mesudiye Bulut
- Department of Nephrology, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Tuncay Sahutoglu
- Department of Nephrology, Mehmet Akif Ersoy Education and Research Hospital, Sanliurfa, Turkey
| | - Arda Erdut
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Hacettepe University, TR-06560, Ankara, Turkey
| | - Mehmet Ozkahya
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Yener Koc
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Onur Tunca
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Afyonkarahisar Health Science University, Afyon, Turkey
| | - Ekrem Kara
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Müge Erek
- Department of Nephrology, Harakani State Hospital, Kars, Turkey
| | - Mehmet Polat
- Department of Nephrology, Nevsehir State Hospital, Nevsehir, Turkey
| | - Tulin Akagun
- Department of Nephrology, Giresun Education and Research Hospital, Giresun, Turkey
| | - Galip Guz
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Gazi University, Ankara, Turkey
| |
Collapse
|
19
|
Kim JH, Kim SM, Kang M, Kang E, Park SH, Kim YL, Pecoits-Filho R, Bieber B, Pisoni RL, Oh KH. Characteristics of patients and facility of peritoneal dialysis in Korea: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) Korea. Perit Dial Int 2024:8968608241252015. [PMID: 38738926 DOI: 10.1177/08968608241252015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Varying peritoneal dialysis (PD)-related clinical outcomes have been reported in different countries. As a participant of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), this study investigated the characteristics of Korean PD patients, PD facilities and the incidence rates of clinical outcomes including mortality and PD-related outcomes. METHODS From July 2019 to December 2021, a total of 766 Korean PD patients were included for analysis. Poisson regression analysis was used to explore the incidence rates of various clinical events including mortality, modality transfer, exit site or catheter tunnel infection and peritonitis. RESULTS Among the 766 patients (median age 55.5 years, males 59.5%), 276 were incident and 490 were prevalent PD patients. The incidence rates of events were as follows: all-cause mortality (0.048), modality transfer (0.051), exit site or catheter tunnel infection (0.054) and peritonitis (0.136) events per person year. The most common causative organism for exit site or tunnel infection was staphylococcus species (47%) and that for peritonitis was streptococcus (28%) followed by staphylococcus (27%) species. CONCLUSIONS Up to now, PDOPPS Korea has recruited 766 Korean PD patients and started documentation of major PD-related outcomes which occurred during the follow-up period. The overall incidence rates of clinical outcomes in Korean PD patients were relatively favourable. There was no statistically significant difference in the incidence rates of clinical outcomes according to both facility and patient factors.
Collapse
Affiliation(s)
- Ji Hye Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Seon-Mi Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Minjung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun-Hee Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | | | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| |
Collapse
|
20
|
Nardelli L, Scalamogna A, Ponzano F, Sikharulidze A, Tripodi F, Vettoretti S, Alfieri C, Castellano G. Peritoneal dialysis related peritonitis: insights from a long-term analysis of an Italian center. BMC Nephrol 2024; 25:163. [PMID: 38734613 PMCID: PMC11088076 DOI: 10.1186/s12882-024-03594-y] [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: 11/07/2023] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Peritonitis is a common and severe complication of peritoneal dialysis (PD). For comparative analysis standardized definitions as well as measurements and outcomes are crucial. However, most PD-related peritonitis studies have been using heterogenous definitions and variable methods to measure outcomes. The ISPD 2022 guidelines have revised and clarified numerous definitions and proposed new peritonitis categories and outcomes. METHODS Between 1st January 2009 and 31st May 2023, 267 patients who started PD at our institution were included in the study. All PD-related peritonitis episodes that occurred in our unit during the study period were collected. The new definitions and outcomes of ISPD 2022 recommendations were employed. RESULTS The overall peritonitis rate was 0.25 episode/patient year. Patient cumulative probability of remaining peritonitis-free at one year was 84.2%. The medical cure and refractory peritonitis rates were equal to 70.3 and 22.4%, respectively. Culture-negative peritonitis accounted for 25.6% of all specimens. The rates of peritonitis associated death, hemodialysis transfer, catheter removal and hospitalization were 6.8%, 18.3%, 18.7% and 64.4%, respectively. Relapsing, repeat, recurrent and enteric peritonitis accounted for 7.8%, 6.8%, 4.1% and 2.7% of all episodes, respectively. Catheter insertion, catheter related and pre-PD peritonitis were 4.2, 2.1 and 0.5%. CONCLUSIONS The implementation of PD-related peritonitis reports using standardized definitions and outcome measurements is of paramount importance to enhance clinical practice and to allow comparative studies.
Collapse
Affiliation(s)
- Luca Nardelli
- Division of Nephrology, Dialysis and Kidney Transplantation, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico 1, Via della Commenda 15, Milano, 20122, Italia.
- Department of Clinical Sciences and Community Health, Università degli studi di Milano, Milan, Italy.
| | - Antonio Scalamogna
- Division of Nephrology, Dialysis and Kidney Transplantation, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico 1, Via della Commenda 15, Milano, 20122, Italia
| | - Federico Ponzano
- Division of Nephrology, Dialysis and Kidney Transplantation, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico 1, Via della Commenda 15, Milano, 20122, Italia
| | - Anna Sikharulidze
- Division of Nephrology, Dialysis and Kidney Transplantation, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico 1, Via della Commenda 15, Milano, 20122, Italia
| | - Federica Tripodi
- Division of Nephrology, Dialysis and Kidney Transplantation, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico 1, Via della Commenda 15, Milano, 20122, Italia
| | - Simone Vettoretti
- Division of Nephrology, Dialysis and Kidney Transplantation, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico 1, Via della Commenda 15, Milano, 20122, Italia
| | - Carlo Alfieri
- Division of Nephrology, Dialysis and Kidney Transplantation, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico 1, Via della Commenda 15, Milano, 20122, Italia
- Department of Clinical Sciences and Community Health, Università degli studi di Milano, Milan, Italy
| | - Giuseppe Castellano
- Division of Nephrology, Dialysis and Kidney Transplantation, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico 1, Via della Commenda 15, Milano, 20122, Italia
- Department of Clinical Sciences and Community Health, Università degli studi di Milano, Milan, Italy
| |
Collapse
|
21
|
Desbiens LC, Bargman JM, Chan CT, Nadeau-Fredette AC. Integrated home dialysis model: facilitating home-to-home transition. Clin Kidney J 2024; 17:i21-i33. [PMID: 38846416 PMCID: PMC11151120 DOI: 10.1093/ckj/sfae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Indexed: 06/09/2024] Open
Abstract
Peritoneal dialysis (PD) and home hemodialysis (HHD) are the two home dialysis modalities offered to patients. They promote patient autonomy, enhance independence, and are generally associated with better quality of life compared to facility hemodialysis. PD offers some advantages (enhanced flexibility, ability to travel, preservation of residual kidney function, and vascular access sites) but few patients remain on PD indefinitely due to peritonitis and other complications. By contrast, HHD incurs longer and more intensive training combined with increased upfront health costs compared to PD, but is easier to sustain in the long term. As a result, the integrated home dialysis model was proposed to combine the advantages of both home-based dialysis modalities. In this paradigm, patients are encouraged to initiate dialysis on PD and transfer to HHD after PD termination. Available evidence demonstrates the feasibility and safety of this approach and some observational studies have shown that patients who undergo the PD-to-HHD transition have clinical outcomes comparable to patients who initiate dialysis directly on HHD. Nevertheless, the prevalence of PD-to-HHD transfers remains low, reflecting the multiple barriers that prevent the full uptake of home-to-home transitions, notably a lack of awareness about the model, home-care "burnout," clinical inertia after a transfer to facility HD, suboptimal integration of PD and HHD centers, and insufficient funding for home dialysis programs. In this review, we will examine the conceptual advantages and disadvantages of integrated home dialysis, present the evidence that underlies it, identify challenges that prevent its success and finally, propose solutions to increase its adoption.
Collapse
Affiliation(s)
- Louis-Charles Desbiens
- Department of Medicine, Université de Montréal, Montreal, Canada
- Department of Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | - Joanne M Bargman
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Annie-Claire Nadeau-Fredette
- Department of Medicine, Université de Montréal, Montreal, Canada
- Department of Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Canada
| |
Collapse
|
22
|
Al Sahlawi M, AlRukhaimi M, Al-Ghamdi SM, Al Salmi I, Al-Aradi AH, Hamad A, AlSahow A. Peritoneal dialysis in the Arabian Gulf countries: Challenges and opportunities. Perit Dial Int 2024; 44:171-176. [PMID: 37846093 DOI: 10.1177/08968608231204107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
The Gulf Cooperation Council (GCC) is a regional organisation, consisting of six Arab countries that share common objectives and cultural identities, with a total population of 57.3 million. The prevalence of patients requiring dialysis in GCC countries is increasing, with a current mean prevalence of 551 per million population. Despite the several patient-level and healthcare system benefits of peritoneal dialysis (PD) compared to in-centre haemodialysis, the growth in PD utilisation has been limited. This is related to several factors, including deficiencies in modality education for chronic kidney disease patients, nephrology training and governmental policies advocating for this dialysis modality. Establishing a detailed PD registry in GCC countries is an important step towards understanding our patients' characteristics, outcomes, current PD practices and challenges in order to increase the use of PD and to facilitate future initiatives aimed at optimising the management of PD patients in this part of the world. This article reviews common challenges around PD practices and utilisation in GCC countries and provides possible solutions to overcome these challenges. It should be noted that the literature on PD patients, outcomes and treatment practices in GCC countries is limited, and as a result, many of our recommendations and discussion are based on clinical observations, experience and data when available.
Collapse
Affiliation(s)
- Muthana Al Sahlawi
- Department of Internal Medicine, College of Medicine, King Faisal University, Al-Hasa, Saudi Arabia
| | | | - Saeed Mg Al-Ghamdi
- Department of Medicine, College of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Ali H Al-Aradi
- Department of Nephrology, Salmaniya Medical Complex, Manama, Bahrain
| | - Abdullah Hamad
- Division of Nephrology, Hamad General Hospital, Doha, Qatar
| | - Ali AlSahow
- Division of Nephrology, Jahra Hospital, Jahra, Kuwait
| |
Collapse
|
23
|
Nel H, Debbie F, Narelle H, Sean R, Aron C. A retrospective clinical and economic analysis of an assisted automated peritoneal dialysis programme in Western Australia . Perit Dial Int 2024; 44:203-210. [PMID: 37635394 DOI: 10.1177/08968608231190772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Assisted peritoneal dialysis (aPD) represents an alternative kidney replacement therapy for dialysis-dependent patients whose only other options are prolonged hospitalisations or transfer to in-centre haemodialysis (HD). Most programmes have not examined the role of temporary aPD, and there is limited data surrounding the economic implications of temporary aPD programmes. The main aim of this study was to describe the cost-effectiveness of an assisted automated peritoneal dialysis (aAPD) programme, for patients whose only reason to stay in hospital was the temporary inability to independently perform PD at home. METHODS Retrospective, single-centre analysis of 45 referrals for aAPD from November 2015 to May 2021. Two groups of patients were enrolled in the study: respite patients already established on PD (to facilitate discharge or prevent admission) and new patients who were not yet trained (to facilitate discharge). To calculate the cost differential, patients were allocated to either staying in hospital or transferring to centre-based HD with comparison to costs on aAPD. Costs were calculated using a healthcare system perspective over the duration of aAPD assistance. Clinical outcomes including peritonitis rate, hospitalisation and mortality were also assessed. RESULTS Overall, 1349 episodes of aAPD care were delivered. One thousand forty-two episodes (77%) were for respite patients and 307 episodes (23%) were for new patients awaiting training. The mean duration of assistance was 18 days for pretraining patients and 37 days for respite patients. Overall, the mean length of stay on the programme was 30 days with a range of 1-263 days (SD 43) and 73% of patients graduated to self-care PD. The cost of the aAPD programme was $242 per visit, with an average cost $7260 per patient-episode. The aAPD programme was significantly cheaper than the alternatives, with average hospitalization costs $46,170 per episode, and in-centre HD costs of $9667. $1.497 million was saved over the course of the study. Eleven hospitalisations occurred and the peritonitis rate was 0.8 episodes per patient-year. Two patients died while on aAPD. CONCLUSION This study provides the first detailed description of an aAPD respite programme in Australia. We conclude that the implementation of a temporary aAPD programme could lead to a significant reduction in healthcare costs, however peritonitis rates were high.
Collapse
Affiliation(s)
- Henco Nel
- Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- HomeLink Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Fortnum Debbie
- Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Hawkins Narelle
- HomeLink Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Randall Sean
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Chakera Aron
- Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| |
Collapse
|
24
|
Cho Y, Chow KM, Kam-Tao Li P, Runnegar N, Johnson DW. Peritoneal Dialysis-Related Infections. Clin J Am Soc Nephrol 2024; 19:641-649. [PMID: 37574658 PMCID: PMC11108252 DOI: 10.2215/cjn.0000000000000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
Peritoneal dialysis (PD) represents an important treatment choice for patients with kidney failure. It allows them to dialyze outside the hospital setting, facilitating enhanced opportunities to participate in life-related activities, flexibility in schedules, time and cost savings from reduced travel to dialysis centers, and improved quality of life. Despite its numerous advantages, PD utilization has been static or diminishing in parts of the world. PD-related infection, such as peritonitis, exit-site infection, or tunnel infection, is a major concern for patients, caregivers, and health professionals-which may result in hesitation to consider this as treatment or to cease therapy when these complications take place. In this review, the definition, epidemiology, risk factors, prevention, and treatment of PD-related infection on the basis of the contemporary evidence will be described.
Collapse
Affiliation(s)
- Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Kai-Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - David W. Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
25
|
Hayat A, Cho Y, Pascoe E, Krishnasamy R, Borlace M, Chen J, Boudville N, Sud K, Varnfield M, Francis R, Pitt R, Hughes JT, Johnson DW. Uptake and Outcomes of Peritoneal Dialysis among Aboriginal and Torres Strait Islander People: Analysis of Registry Data. Kidney Int Rep 2024; 9:1484-1495. [PMID: 38707791 PMCID: PMC11068974 DOI: 10.1016/j.ekir.2024.01.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Peritoneal dialysis (PD) enables people to use kidney replacement therapy (KRT) outside of healthcare-dependent settings, a strong priority of Aboriginal and Torres Strait Islander people. Methods We undertook an observational study analyzing registry data to describe access to PD and its outcome as the first KRT among Aboriginal and Torres Strait Islander people between January 1, 2004 and December 31 2020. Results Out of 4604 Aboriginal and Torres Strait Islander people, reflecting 10.4% of all Australians commencing KRT, PD was the first KRT modality among 665 (14.4%). PD utilization was 17.2% in 2004 to 2009 and 12.7% in 2016 to 2020 (P = 0.002); 1105 episodes of peritonitis were observed in 413 individuals, median of 3 (interquartile range [IQR], 2-5) episodes/patient. The crude peritonitis rate was 0.53 (95% confidence interval [CI], 0.50-0.56) episodes/patient-years without any significant changes over time. The median time to first peritonitis was 1.1 years. A decrease in the peritonitis incidence rate ratio (IRR) was observed in 2016 to 2020 (IRR, 0.63 [95% CI, 0.52-0.77], P < 0.001) compared to earlier eras (2010-2015: IRR, 0.90 [95% CI, 0.76-1.07], P = 0.23; Ref: 2004-2009). The cure rates decreased from 80.0% (n = 435) in 2004 to 2009, to 70.8% (n = 131) in 2016 to 2020 (P < 0.001). Conclusion Aboriginal and Torres Strait Islander people who utilized PD as their first KRT during 2004 to 2020 recorded a higher peritonitis rate than the current benchmark of 0.4 episodes/patient-years. The cure rates have worsened recently, which should be a big concern. There is an exigent need to address these gaps in kidney care for Aboriginal and Torres Strait Islander people.
Collapse
Affiliation(s)
- Ashik Hayat
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Yeoungjee Cho
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - E.M. Pascoe
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Rathika Krishnasamy
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Sunshine Coast University Hospital, Queensland, Australia
| | - Monique Borlace
- Department of Nephrology, Royal Adelaide Hospital, Adelaide, Australia
| | - Jenny Chen
- Department of Renal Medicine, Wollongong Hospital, Wollongong, Australia
- School of Medicine, University of Wollongong, Wollongong, Australia
| | - Neil Boudville
- Medical School, University of Western Australia, Perth, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kamal Sud
- Nepean KIdney Research Centre, Department of Renal Medicine, Nepean Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - M. Varnfield
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Australian e-Health Research Centre; CSIRO, Brisbane, Australia
| | - Ross Francis
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Rochelle Pitt
- Inala Indigenous Health Services, Queensland, Australia
| | - Jaquelyne T. Hughes
- Royal Darwin Hospital, Northern Territory, Darwin, Australia
- Rural and Remote Health, College of Medicine and Public Health, Flinders University Northern Territory, Nhulunbuy, Australia
- Wagadagam tribe of near west Torres Strait
| | - David Wayne Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| |
Collapse
|
26
|
Obermueller M, Traby L, Weiss-Tessbach M, Kriz R, Spettel K, Schneider L, Hohl L, Burgmann H, Kussmann M. Staphylococcus aureus small colony variants: A potentially underestimated microbiological challenge in peritoneal dialysis. Int J Antimicrob Agents 2024; 63:107135. [PMID: 38458357 DOI: 10.1016/j.ijantimicag.2024.107135] [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: 07/06/2023] [Revised: 02/03/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Peritonitis remains the major infectious complication in the setting of peritoneal dialysis (PD). Despite known only moderate pathogenicity, the most frequently detected pathogens in PD-related peritonitis are surprisingly coagulase-negative staphylococci. However, this could be explained, at least in part, by Staphylococcus aureus small colony variants (SCVs) induced by PD fluids (PDFs) and misidentified by routinely used microbiological methods. MATERIAL AND METHODS Bacteria were exposed to commonly used PDFs in various regimens designed to simulate daily use as closely as possible. Wild-type isolates and SCVs were subsequently used to determine minimum inhibitory concentrations (MICs), in vitro biofilm formation capacities, and auxotrophies. Underlying genetic alterations were investigated using whole-genome sequencing, and various microbial identification methods were tested to determine their performance for wild-types and SCVs. RESULTS Stable SCVs could be isolated most successfully after exposure to glucose-containing PDFs alone. The reading of MICs was significantly affected by the reduced growth of SCVs, resulting in lower MIC values in 44% of all tests. Nonsynonymous mutations were found in all but one SCV, while only two isolates showed typical auxotrophic responses. While MALDI-TOF, PCR and Pastorex Staph-Plus correctly identified all S. aureus SCVs, API-Staph and VITEK-2 yielded identification rates of only 40% and 10%, respectively. CONCLUSIONS Overall, the present study has shown that commercially available PDFs induce S. aureus SCVs in vitro, which are difficult to identify and test for antimicrobial susceptibility and can potentially lead to recurrent or persistent infections. Thus, they represent a potentially underappreciated challenge not only for microbiologists, but also for clinicians.
Collapse
Affiliation(s)
- Markus Obermueller
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Ludwig Traby
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Matthias Weiss-Tessbach
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria; Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Richard Kriz
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Kathrin Spettel
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Lisa Schneider
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Lena Hohl
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Heinz Burgmann
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
| | - Manuel Kussmann
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria.
| |
Collapse
|
27
|
Mehta A, Yung T, Davis W, Choi J, Singh S. Peritoneal dialysis-associated peritonitis: A case first for Aquamicrobium. Nephrology (Carlton) 2024; 29:297-299. [PMID: 38164820 DOI: 10.1111/nep.14268] [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: 11/04/2023] [Revised: 12/17/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
Aquamicrobium is an aerobic gram-negative rod which until recently had only been isolated from wastewater and contaminated soil. In 2021, two cases of Aquamicrobium infection in humans were reported. Both were cases of endophthalmitis following cataract surgery. In this manuscript, we describe the presentation and treatment of a 56-year-old immunocompetent male who has peritoneal dialysis-associated peritonitis caused by Aquamicrobium lusatiense. To our knowledge, this is the third reported case of Aquamicrobium infection in humans and the first example of this agent causing peritonitis.
Collapse
Affiliation(s)
- Ashin Mehta
- Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Timothy Yung
- Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Whitt Davis
- Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Jennifer Choi
- Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Sanjay Singh
- Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| |
Collapse
|
28
|
Greenberg D, Rosenblum ND, Tonelli M. The multifaceted links between hearing loss and chronic kidney disease. Nat Rev Nephrol 2024; 20:295-312. [PMID: 38287134 DOI: 10.1038/s41581-024-00808-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/31/2024]
Abstract
Hearing loss affects nearly 1.6 billion people and is the third-leading cause of disability worldwide. Chronic kidney disease (CKD) is also a common condition that is associated with adverse clinical outcomes and high health-care costs. From a developmental perspective, the structures responsible for hearing have a common morphogenetic origin with the kidney, and genetic abnormalities that cause familial forms of hearing loss can also lead to kidney disease. On a cellular level, normal kidney and cochlea function both depend on cilial activities at the apical surface, and kidney tubular cells and sensory epithelial cells of the inner ear use similar transport mechanisms to modify luminal fluid. The two organs also share the same collagen IV basement membrane network. Thus, strong developmental and physiological links exist between hearing and kidney function. These theoretical considerations are supported by epidemiological data demonstrating that CKD is associated with a graded and independent excess risk of sensorineural hearing loss. In addition to developmental and physiological links between kidney and cochlear function, hearing loss in patients with CKD may be driven by specific medications or treatments, including haemodialysis. The associations between these two common conditions are not commonly appreciated, yet have important implications for research and clinical practice.
Collapse
Affiliation(s)
- Dina Greenberg
- Program in Developmental and Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Norman D Rosenblum
- Program in Developmental and Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
29
|
Al Sahlawi M, Bieber B, Bansal S, Block G, Masud T, Piraino B, Schreiber M, Srivatana V, Teitelbaum I, Khan S, El Shamy O, Watnick S, Garcia L, Pisoni RL, Perl J. Standardized Peritonitis Reporting: A Quality Improvement Initiative of the Optimizing Prevention of Peritoneal Dialysis-Associated Peritonitis in the United States (OPPUS) Study. Am J Kidney Dis 2024; 83:692-694. [PMID: 37879528 DOI: 10.1053/j.ajkd.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Muthana Al Sahlawi
- Department of Internal Medicine, College of Medicine, King Faisal University, Al-Hasa, Saudi Arabia
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Shweta Bansal
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | | | - Beth Piraino
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Vesh Srivatana
- The Rogosin Institute, New York, New York; Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York
| | - Isaac Teitelbaum
- Division of Hypertension and Renal Diseases, University of Colorado-Denver, Aurora, Colorado
| | - Sana Khan
- University of Virginia, Charlottesville, Virginia
| | - Osama El Shamy
- Department of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Leslie Garcia
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
| |
Collapse
|
30
|
Fung WW, SZE RKH, Szeto CC, Chow KM. Staphylococcus lugdunensis Peritoneal Dialysis-Related Peritonitis: A Matched Comparative Analysis. Kidney Med 2024; 6:100811. [PMID: 38650953 PMCID: PMC11033185 DOI: 10.1016/j.xkme.2024.100811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Rationale & Objective Staphylococcus lugdunensis (S lugdunensis) is a coagulase-negative staphylococcus species that has been increasingly recognized to cause serious infections with virulence resembling Staphylococcus aureus (S aureus). No studies have evaluated the characteristics and outcomes of patients with S lugdunensis peritoneal dialysis-related peritonitis compared with those with S aureus peritonitis. We aim to evaluate the clinical course of peritonitis as caused by these organisms. Study Design A retrospective matched comparative analysis involving a single tertiary center from July 2000 to July 2020. Setting & Participants Forty-eight episodes of S aureus peritonitis were matched to 19 cases of S lugdunensis peritonitis. Analytical Approach The cases were individually matched for year of peritonitis, sex, age (±10 years), and Charlson Comorbidity Index (±3). A comparative analysis was performed between the 2 organisms. The outcome includes responses at day 5 of peritonitis and the rate of complete response. Results There is a higher predilection of diabetes in those with S aureus peritonitis than in those with S lugdunensis (64.6% vs 31.6%; P = 0.03). Patients with S aureus peritonitis also have a much higher total cell count at presentation (4,463.9 ± 5,479.5 vs 1,807.9 ± 3,322.7; P = 0.05); a higher prevalence of poor response at day 5 (50.0% vs 15.8%; P = 0.03); a lower rate of complete response (64.6% vs 94.7%; P = 0.01) and are more prone to relapse with the same organism (29.2% vs 0%, respectively; P = 0.01) as compared to those with S lugdunensis. Limitations The result of this small retrospective study involving a single center may not be generalizable to other centers. There is also no data for comparative analysis on other coagulase-negative staphylococci such as Staphylococcus epidermidis, which belongs to the same family as S lugdunensis. Conclusions Although S aureus peritonitis is more virulent with significant morbidity, S lugdunensis can cause similarly serious peritonitis. This largest case series of S lugdunensis peritonitis enabled better characterization of clinical features and outcomes of patients with S lugdunensis peritonitis.
Collapse
Affiliation(s)
- Winston W.S. Fung
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Ryan K.-H. SZE
- Department of Microbiology, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
- Li Ka Shing Institute of Health Sciences (LiHS), The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kai-Ming Chow
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| |
Collapse
|
31
|
Morisi N, Virzì GM, Ferrarini M, Alfano G, Zanella M, Ronco C, Donati G. Exploring the Role of Cell-Free Nucleic Acids and Peritoneal Dialysis: A Narrative Review. Genes (Basel) 2024; 15:553. [PMID: 38790182 PMCID: PMC11121405 DOI: 10.3390/genes15050553] [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: 03/30/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Cell-free nucleic acids (cf-NAs) represent a promising biomarker of various pathological and physiological conditions. Since its discovery in 1948, cf-NAs gained prognostic value in oncology, immunology, and other relevant fields. In peritoneal dialysis (PD), blood purification is performed by exposing the peritoneal membrane. Relevant sections: Complications of PD such as acute peritonitis and peritoneal membrane aging are often critical in PD patient management. In this review, we focused on bacterial DNA, cell-free DNA, mitochondrial DNA (mtDNA), microRNA (miRNA), and their potential uses as biomarkers for monitoring PD and its complications. For instance, the isolation of bacterial DNA in early acute peritonitis allows bacterial identification and subsequent therapy implementation. Cell-free DNA in peritoneal dialysis effluent (PDE) represents a marker of stress of the peritoneal membrane in both acute and chronic PD complications. Moreover, miRNA are promising hallmarks of peritoneal membrane remodeling and aging, even before its manifestation. In this scenario, with multiple cytokines involved, mtDNA could be considered equally meaningful to determine tissue inflammation. CONCLUSIONS This review explores the relevance of cf-NAs in PD, demonstrating its promising role for both diagnosis and treatment. Further studies are necessary to implement the use of cf-NAs in PD clinical practice.
Collapse
Affiliation(s)
- Niccolò Morisi
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, 41124 Modena, Italy; (N.M.)
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St. Bortolo Hospital, 36100 Vicenza, Italy
- IRRIV-International Renal Research Institute Vicenza-Foundation, 36100 Vicenza, Italy
| | - Marco Ferrarini
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, 41124 Modena, Italy; (N.M.)
| | - Gaetano Alfano
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41124 Modena, Italy
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, St. Bortolo Hospital, 36100 Vicenza, Italy
- IRRIV-International Renal Research Institute Vicenza-Foundation, 36100 Vicenza, Italy
| | - Claudio Ronco
- IRRIV-International Renal Research Institute Vicenza-Foundation, 36100 Vicenza, Italy
| | - Gabriele Donati
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, 41124 Modena, Italy; (N.M.)
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, 41124 Modena, Italy
| |
Collapse
|
32
|
You L, Zhang B, Zhang F, Wang J. Pathogenic spectrum and risk factors of peritoneal dialysis-associated peritonitis: a single-center retrospective study. BMC Infect Dis 2024; 24:440. [PMID: 38658811 PMCID: PMC11044422 DOI: 10.1186/s12879-024-09334-9] [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: 01/20/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
The present study aimed to explore the pathogenic spectrum and risk factors of peritoneal dialysis-associated peritonitis (Peritoneal dialysis associated peritonitis, PDAP) in Yongzhou, Hunan, China. The clinical and epidemiological data on regular peritoneal dialysis (Peritoneal dialysis, PD) between January 2016 and December 2020 in Yongzhou were collected for retrospective analysis. The related factors of peritonitis were evaluated by single-factor analysis, while risk factors of refractory PDAP were evaluated by multivariate logistic regression analysis.172/331 172 (51.9%) patients developed peritonitis. The risk factors of PDAP in PD patients included high C-reactive protein (C-reactive protein, CRP), low albumin(Albumin, ALB), low hemoglobin (Hemoglobin, Hb), low educational level (junior high school or lower), preference of spicy food, irregular diet, low annual household income, unfavorable fluid exchange conditions, unstable employment (including working as a farmer), and unfavorable humidity conditions (P < 0.05). 63/172 (36.6%) PDAP patients were intractable cases with a pathogenic bacteria positive rate of 74.60% in the peritoneal dialysate cultures, and 109/172 patients were non-intractable cases with a pathogenic bacteria positive rate of 53.21%. Gram-positive bacteria (G+) were detected in most of the dialysate cultures, with Staphylococcus epidermidis (S. epidermidis) as the most common type, while Escherichia coli (E. coli) was the most common Gram-negative bacteria (G-). Gram-positive bacteria were sensitive to vancomycin and linezolid, while G- bacteria were sensitive to imipenem and amikacin. Lifestyle, educational level, and environmental factors are the major contributors to PDAP in PD patients. Fungal and multi-bacterial infections are the major causes of death; PD is stopped for such patients.
Collapse
Affiliation(s)
- Linshuang You
- Department of Nephropathy, The Central Hospital of Yongzhou, Yongzhou, China
| | - Baoguo Zhang
- Department of Nephropathy, The Central Hospital of Yongzhou, Yongzhou, China
| | - Fan Zhang
- Department of Nephropathy, The Central Hospital of Yongzhou, Yongzhou, China
| | - Jianwen Wang
- Department of Nephropathy, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, 410013, China.
- Department of Critical Kidney Disease Research Center, Third Xiangya Hospital of Central South University, Changsha, China.
| |
Collapse
|
33
|
Virtanen J, Heiro M, Koivuviita N, Löyttyniemi E, Järvisalo MJ, Tertti R, Metsärinne K, Hellman T. Survival, cumulative hospital days and infectious complications in urgent-start PD compared with urgent-start HD. Perit Dial Int 2024:8968608241244939. [PMID: 38661183 DOI: 10.1177/08968608241244939] [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: 04/26/2024] Open
Abstract
BACKGROUND Urgent-start peritoneal dialysis (PD) carries a similar efficacy and safety profile compared to urgent-start haemodialysis (HD) but is only sparsely applied due to resource issues and concerns of complication risks. Furthermore, few data exist on adverse outcomes associated with central venous catheter (CVC) insertions in urgent-start HD patients. Thus, we sought to compare patient and dialysis-related outcomes in patients undergoing urgent-start PD or HD. METHODS All patients initiating urgent-start PD in a tertiary research hospital in 2005-2018 were included in this retrospective, single-centre, comparative study and matched with urgent-start HD patients of similar age and chronic kidney disease aetiology. All urgent-start PDs were initiated within 72 h after catheter insertion, and urgent-start HDs were performed via a CVC. All analyses were performed at 3 months and at 1 year of follow-up, respectively. RESULTS Thirty-three patients who commenced urgent-start PD and 58 matched urgent-start HD control patients were included. Altogether, 26 patients (29%; PD: 36%, HD 24%) died within the 1-year follow-up, and patient survival was similar at 3 months (hazard ratio (HR): 1.15, 95% confidence interval (CI): 0.35-3.81, p = 0.82) and at 1 year of follow-up (HR: 0.64, 95% CI: 0.30-1.39, p = 0.26) between the study groups. There were no differences in the total kidney replacement therapy (KRT)-related infection rate (p = 0.66) or cumulative first-year hospital care days (p = 0.43) between the treatment groups. Altogether, 139 CVCs were inserted during the 1-year follow-up. The number of CVCs per patient was associated with the emergence of blood culture-positive bacteraemia and increased cumulative first-year hospital care days. CONCLUSIONS Patient survival, cumulative first-year hospital care days and total KRT-related infection rate at 3 months and 1-year follow-up are similar between urgent-start PD and urgent-start HD patients. Furthermore, CVC insertion rate is associated with incident blood culture-positive bacteraemia and increased cumulative first-year hospital care days.
Collapse
Affiliation(s)
- Jonna Virtanen
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
| | - Maija Heiro
- Department of Internal Medicine, Vaasa Central Hospital and University of Turku, Vaasa, Finland
| | - Niina Koivuviita
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku and Turku University Hospital, Finland
| | - Mikko J Järvisalo
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
- Department of Internal Medicine, Satakunta Central Hospital, Pori, Finland
| | - Risto Tertti
- Department of Internal Medicine, Vaasa Central Hospital and University of Turku, Vaasa, Finland
| | - Kaj Metsärinne
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
| | - Tapio Hellman
- Kidney Center, Department of Internal Medicine, Turku University Hospital and University of Turku, Finland
| |
Collapse
|
34
|
Okubo N, Suwabe T, Yamanouchi M, Ikuma D, Mizuno H, Oba Y, Miki K, Yokoyama T, Ishii Y, Sawa N, Nakamura Y, Takaya H, Ubara Y. Early diagnosis of tuberculous peritonitis in peritoneal dialysis patients using the T-SPOT test. CEN Case Rep 2024:10.1007/s13730-024-00882-2. [PMID: 38643328 DOI: 10.1007/s13730-024-00882-2] [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: 10/05/2023] [Accepted: 04/12/2024] [Indexed: 04/22/2024] Open
Abstract
A 49-year-old man was admitted with peritonitis nine months after starting continuous ambulatory peritoneal dialysis (CAPD) for kidney failure. Ceftazidime and cefazolin were started. Peritoneal dialysate culture was negative for bacteria, but antibiotic treatment was continued because peritonitis improved. Twenty days later, the patient was discharged with no signs of peritonitis. However, 40-day culture of the original peritoneal dialysate detected Mycobacterium tuberculosis, and peritonitis recurred, leading to readmission. A T-SPOT test was performed and was positive in 4 days. Anti-tuberculosis therapy was started, which cured the peritonitis. The T-SPOT test may enable early diagnosis of tuberculosis.
Collapse
Affiliation(s)
- Naoto Okubo
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
| | - Tatsuya Suwabe
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Daisuke Ikuma
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Hiroki Mizuno
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Yuki Oba
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Katsuyuki Miki
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Takayoshi Yokoyama
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Yasuo Ishii
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Naoki Sawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Yuki Nakamura
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Hisashi Takaya
- Department of Respiratory Medicine, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
| |
Collapse
|
35
|
Lim RS, See YP. Pyogenic liver abscesses in peritoneal dialysis patients: A single-centre retrospective case series. Perit Dial Int 2024:8968608241239798. [PMID: 38644580 DOI: 10.1177/08968608241239798] [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: 04/23/2024] Open
Abstract
Peritoneal dialysis (PD)-related infection rates have improved, but serious complications such as liver abscesses remain an issue, posing unique management challenges including safety of continuing PD versus early PD catheter removal. Current literature describing this is unfortunately limited. This study aims to describe the characteristics, management and outcomes of liver abscesses in PD patients from a retrospective review of prevalent PD patients on follow-up at Tan Tock Seng Hospital between 1st January 2016 and 30th June 2021. A total of 11/383 PD patients (2.9%) were treated for liver abscesses. Most were diabetic (n =10, 90.9%), with a median PD vintage of 541 days (interquartile range: 310-931 days). Fever (n = 7, 63.6%), bacteraemia (n = 7, 63.6%) and concomitant PD peritonitis (n = 7, 63.6%) were the most common presenting symptoms. Majority of patients underwent radiological aspiration of abscess in addition to antibiotics (n = 7, 63.6%). PD catheter was removed in eight patients (72.7%), with the most common indications being empirical removal due to intra-abdominal abscess (n = 5, 62.5%) followed by septic shock (n = 2, 25%) and refractory PD peritonitis (n = 1, 12.5%). Only three patients (37.5%) remained on PD, as they did not develop PD peritonitis during their course of treatment. The overall mortality remains high with three patients (27.3%) passing away within 6 months of presentation. Liver abscesses in PD patients is associated with poor technique and overall survival. Absence of PD peritonitis appears to be a good prognostic factor, but larger studies are required to guide the optimal management of liver abscesses in PD patients.
Collapse
Affiliation(s)
| | - Yong Pey See
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| |
Collapse
|
36
|
Lanot A, Boyer A, Lobbedez T, Béchade C. Exploring clinical practice guidelines in PD: When to guide and when to draw the line. Perit Dial Int 2024:8968608241245900. [PMID: 38644579 DOI: 10.1177/08968608241245900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Affiliation(s)
- Antoine Lanot
- Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- ANTICIPE U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Annabel Boyer
- Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
| | - Thierry Lobbedez
- Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- ANTICIPE U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| | - Clémence Béchade
- Normandie Université, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- ANTICIPE U1086 INSERM-UCN, Centre François Baclesse, Caen, France
| |
Collapse
|
37
|
Virzì GM, Morisi N, Marturano D, Milan Manani S, Tantillo I, Ronco C, Zanella M. Peritoneal Inflammation in PD-Related Peritonitis Induces Systemic Eryptosis: In Vitro and In Vivo Assessments. Int J Mol Sci 2024; 25:4284. [PMID: 38673869 PMCID: PMC11049828 DOI: 10.3390/ijms25084284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Erythrocytes (RBCs) have a highly specialized and organized membrane structure and undergo programmed cell death, known as eryptosis. Our preliminary data show a significant increase in the eryptosis during peritoneal dialysis (PD)-associated peritonitis. The objectives of the present study were assessment of the incrementation of eryptosis in PD patients with peritonitis, evaluation of the relationship between systemic eryptosis in peritonitis and specific peritonitis biomarkers in PD effluent (PDE), and confirmation of the induction of eryptosis by peritonitis in a vitro setting. We enrolled 22 PD patients with peritonitis and 17 healthy subjects (control group, CTR). For the in vivo study, eryptosis was measured in freshly isolated RBCs. For the in vitro study, healthy RBCs were exposed to the plasma of 22 PD patients with peritonitis and the plasma of the CTR group for 2, 4, and 24 h. Eryptosis was evaluated by flow cytometric analyses in vivo and in vitro. PDE samples were collected for biomarkers analysis.The percentage of eryptotic RBCs was significantly higher in PD patients with peritonitis than in CTR (PD patients with peritonitis: 7.7; IQR 4.3-14.2, versus CTR: 0.8; IQR 0.7-1.3; p < 0.001). We confirmed these in vivo results by in vitro experiments: healthy RBCs incubated with plasma from PD patients with peritonitis demonstrated a significant increase in eryptosis compared to healthy RBCs exposed to plasma from the control group at all times. Furthermore, significant positive correlations were observed between eryptosis level and all analyzed peritoneal biomarkers of peritonitis. We investigated a potential connection between systemic eryptosis and peritoneal biomarkers of peritonitis. Up-regulation of inflammatory markers could explain the increased rate of systemic eryptosis during PD-related peritonitis.
Collapse
Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Niccolò Morisi
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
- Nephrology Dialysis and Renal Transplantation Unit, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Davide Marturano
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Claudio Ronco
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| |
Collapse
|
38
|
Takata K, Omae T, Hamano Y, Ishikawa T, Nogami K. Peritoneal dialysis-associated infection caused by Mycobacterium abscessus in a pediatric patient on continuous peritoneal dialysis without switching to hemodialysis. CEN Case Rep 2024:10.1007/s13730-024-00875-1. [PMID: 38581567 DOI: 10.1007/s13730-024-00875-1] [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: 12/04/2023] [Accepted: 03/31/2024] [Indexed: 04/08/2024] Open
Abstract
Most peritoneal dialysis (PD)-associated infections caused by Mycobacterium abscessus (M. abscessus) require a transfer from PD to hemodialysis (HD). Here, we report a pediatric case of exit-site and tunnel infections caused by M. abscessus, for whom PD was continued with catheter replacement, debridement of the infected site, and the administration of multiple antibacterial agents. A 10-year-old boy with end-stage kidney disease secondary to juvenile nephronophthisis with NPHP1 deletion, for whom PD was initiated at the age of 9 years, was admitted to the hospital with complaints of fever, pus at the exit-site of the PD catheter, and poor PD drainage. The dialysis effluent culture results were negative; however, M. abscessus was detected in the pus at the exit-site of the PD catheter. The management of HD was expected to be challenging owing to the presence of developmental disorders. Therefore, PD was continued with the simultaneous removal of the PD catheter, reinsertion of a new catheter at a new site, and debridement of the infected site. Multiple antibacterial therapies were administered for 2 months, and the patient was eventually discharged without switching to HD. To the best of our knowledge, this is the first pediatric case of a PD-associated infection caused by M. abscessus, for whom PD was continued without switching to HD. This treatment strategy is not generally recommended but may be an option for patients without peritonitis who have difficulty switching to HD.
Collapse
Affiliation(s)
- Koji Takata
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
- Department of Pediatrics, Minami-Nara General Medical Center, 8-1 Hukugami, Oyodo-cho, Yosino, Nara, 638-8551, Japan
| | - Takashi Omae
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yuri Hamano
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tomoaki Ishikawa
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| |
Collapse
|
39
|
Liang Q, Zhao H, Wu B, Niu Q, Lu L, Qiao J, Men C, He Y, Chu X, Zuo L, Wang M. Risk Factors of the Occurrence and Treatment Failure of Refractory Peritoneal Dialysis-Associated Peritonitis: A Single-Center Retrospective Study From China. Semin Dial 2024. [PMID: 38566455 DOI: 10.1111/sdi.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/17/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND This study aimed to investigate the clinical characteristics and prognosis of refractory peritoneal dialysis (PD)-associated peritonitis as well as the risk factors of its occurrence and treatment failure. METHODS A single-center retrospective cohort study was conducted among 519 patients undergoing PD from January 2007 to October 2021. According to the International Society for Peritoneal Dialysis guidelines, all episodes occurred in our center were divided into two groups: refractory and nonrefractory. Demographic, biochemical, and pathogenic bacteria and treatment outcome data were collected. RESULTS During the 15-year period, 282 episodes of peritonitis occurred in 166 patients undergoing PD. The refractory rate was 34.0% (96/282). Gram-positive organisms were the leading cause of peritonitis (47.9%); however, gram-negative organisms were predominant in refractory peritonitis (34.4%, p = 0.002). Multiple logistic regression revealed that gram-negative organism-based peritonitis, longer PD duration, and female sex were the significant independent predictors of refractory peritonitis. Among 96 refractory episodes, white blood cell (WBC) count, dialysate WBC on Day 3, and PD duration ≥5 years were the independent risk factors of treatment failure. CONCLUSIONS Gram-negative organism-based peritonitis, longer PD duration, and female sex were the independent risk factors of refractory peritonitis. Refractory peritonitis with higher WBC count, higher dialysate WBC on Day 3, and PD duration ≥5 years increased treatment failure risk and required immediate PD catheter removal. The timely identification of refractory peritonitis with high risk of treatment failure as well as timely PD catheter removal is important.
Collapse
Affiliation(s)
- Qichen Liang
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Huiping Zhao
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Bei Wu
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Qingyu Niu
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Lixia Lu
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Jie Qiao
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Chuncui Men
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Yuting He
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Xinxin Chu
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Mei Wang
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| |
Collapse
|
40
|
Mehrotra R, Williamson DE, Betts CR, Greco BA, Yu E, El-Badry A, Fisher B, Mehoudar PD, Briggs B, Chertow GM. A Prospective Clinical Study to EvaluAte the AbiliTy of the CloudCath System to Detect Peritonitis During In-Home Peritoneal Dialysis (CATCH). Kidney Int Rep 2024; 9:929-940. [PMID: 38765568 PMCID: PMC11101817 DOI: 10.1016/j.ekir.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/15/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Peritonitis is the leading complication of peritoneal dialysis (PD). Patients are instructed to seek care promptly for signs (cloudy effluent) or symptoms (abdominal pain), and earlier treatment improves outcomes. The CloudCath Peritoneal Dialysis Drain Set Monitoring (CloudCath) system monitors turbidity in dialysis effluent and sends notifications of changes signaling possible peritonitis. Methods We conducted this single-arm, open-label, multicenter study of CloudCath system use during PD. We deactivated system notifications to participants and investigators, who followed standard-of-care for peritonitis signs and symptoms. Effectiveness endpoints measured time between CloudCath system notifications and peritonitis events using International Society of Peritoneal Dialysis (ISPD) criteria. Results Two hundred forty-three participants used the CloudCath system for 178.8 patient-years. Of 71 potential peritonitis events, 51 events (0.29 per patient-year) met ISPD white blood cell (WBC) count criteria. The system triggered notifications for 41 of 51 events (80.4%), with a median lead time of 2.6 days (10%-90% range, -1.0 to 15.7; P < 0.0001). Excluding 6 peritonitis events that occurred when the system was not in use, the system triggered notifications for 41 of 45 events (91.1%), with a median lead time of 3.0 days (10%-90% range, -0.5 to 18.8; P < 0.0001). Of the 0.78 notifications per patient-year, the majority were peritonitis events or nonperitonitis events such as exit site and tunnel infections or catheter/cycler issues. Conclusion The CloudCath system detected peritonitis events during PD several days earlier than the current standard-of-care and has the capacity to send notifications that could expedite peritonitis diagnosis and treatment.
Collapse
Affiliation(s)
- Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - C. Ross Betts
- Coordinated Kidney Care Group and American Renal Associates, Butler, Pennsylvania, USA
| | - Barbara A. Greco
- Renal and Transplant Associates of New England, Springfield, Massachusetts, USA
| | - Eric Yu
- CloudCath, Inc., San Francisco, California, USA
| | | | | | | | - Benjamin Briggs
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Rochester, Rochester, New York, USA
- CosmosID, Germantown, Maryland, USA
| | - Glenn M. Chertow
- Division of Nephrology, Departments of Medicine, Epidemiology and Population Health, and Health Policy, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
41
|
Dogan I, Ucar E, Odabas M, Kaya NU, Sadioglu RE, Celik G, Acikgoz E, Sayarlioglu H, Turkmen E, Delibalta B, Aktas N, Cakir SK, Kaya EA, Alsancak S, Ayar Y, Ustunel N, Inan Z, Yildirim T, Sen F, Oruc A, Korkmaz R, Kayadibi H, Ates K. The effect of hand fine motor skills on peritoneal dialysis-related peritonitis. Ther Apher Dial 2024; 28:284-296. [PMID: 37932586 DOI: 10.1111/1744-9987.14079] [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: 06/16/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION We aimed to evaluate the relationship between the hand fine motor skills of peritoneal dialysis (PD) practitioners and PD-related peritonitis. METHODS This multicenter prospective observational study was conducted with 120 incident PD patients. Patients were divided into two groups who had PD-related peritonitis within the first year as Group 1, and those who did not as Group 2. Hand fine motor skills were evaluated by Nine-Hole Peg Test (NHPT) and Nut Screwing Test (NST). RESULTS Initial NHPT (28.5 ± 6.0 s vs. 25.8 ± 5.0 s, p = 0.011) and NST (82.3 (61.5-102.8) s versus 65.3 (52.3-88.5) s p = 0.023) scores were significantly higher in Group 1 than Group 2. In multivariate logistic regression analysis, NHPT, Body Mass Index, Mini-Mental Test, self PD practitioner, and catheter complications were found to be independent variables in predicting PD-related peritonitis. CONCLUSION Decreased hand fine motor skills of PD patients is a risk factor for peritonitis.
Collapse
Affiliation(s)
- Ibrahim Dogan
- Department of Nephrology, Hitit University, Faculty of Medicine, Corum, Turkey
| | - Emel Ucar
- Department of Peritonael Dialysis, Baxter, Baxter International Inc, Ankara, Turkey
| | - Mehtap Odabas
- Department of Nephrology, Hitit University, Faculty of Medicine, Corum, Turkey
| | - Nur Unal Kaya
- Department of Nephrology, Hitit University, Faculty of Medicine, Corum, Turkey
| | | | - Gulden Celik
- Department of Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elif Acikgoz
- Department of Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hayriye Sayarlioglu
- Department of Nephrology, 19 Mayis University Faculty of Medicine, Samsun, Turkey
| | - Ercan Turkmen
- Department of Nephrology, 19 Mayis University Faculty of Medicine, Samsun, Turkey
| | - Bulbul Delibalta
- Department of Nephrology, 19 Mayis University Faculty of Medicine, Samsun, Turkey
| | - Nimet Aktas
- Department of Nephrology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Selma Kuran Cakir
- Department of Nephrology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Emel Acar Kaya
- Department of Nephrology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Serap Alsancak
- Department of Nephrology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Yavuz Ayar
- Department of Nephrology, Bursa City Hospital, Bursa, Turkey
| | - Narin Ustunel
- Department of Nephrology, Bursa City Hospital, Bursa, Turkey
| | - Zuhal Inan
- Department of Nephrology, Bursa City Hospital, Bursa, Turkey
| | - Tolga Yildirim
- Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatma Sen
- Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aysegul Oruc
- Department of Nephrology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Rahime Korkmaz
- Department of Nephrology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Huseyin Kayadibi
- Department of Medical Biochemistry, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Kenan Ates
- Department of Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
42
|
Shah N, Bennett PN, Cho Y, Leibowitz S, Abra G, Kanjanabuch T, Baharani J. Exploring Preconceptions as Barriers to Peritoneal Dialysis Eligibility: A Global Scenario-Based Survey of Kidney Care Physicians. Kidney Int Rep 2024; 9:941-950. [PMID: 38765569 PMCID: PMC11101779 DOI: 10.1016/j.ekir.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Despite the growing number of patients requiring kidney replacement therapy (KRT), peritoneal dialysis (PD) is underutilized globally. A contributory factor may be clinician myths about its use. The aim of this study was to explore perceptions about PD initiation by clinicians according to various physical, social, and clinical characteristics of patients. Methods An online global survey (in English and Thai) was administered to ascertain nephrologists' and nephrology trainees' decisions on recommending PD as a treatment modality. Results A total of 645 participants (522 nephrologists and 123 trainees; 56% male) from 54 countries (66% from high-income countries [HICs], 22% from upper middle-income countries [UMICs], 12% from lower middle-income countries, and 1% from low-income countries [LICs]) completed the survey. Of the respondents, 81% identified as attending physicians or consultants, and 19% identified as trainees or other. PD was recommended for most scenarios, including repeated exposures to heavy lifting, swimming (especially in a private pool and ocean), among patients with cirrhosis or cognitive impairment with available support, and those living with a pet if a physical separation can be achieved during PD. Certain abdominal surgeries were more acceptable to proceed with PD (hysterectomy, 90%) compared to others (hemicolectomy, 45%). Similar variation was noted for different types of stomas (nephrostomies, 74%; suprapubic catheters, 53%; and ileostomies, 27%). Conclusion The probability of recommending PD in various scenarios was greater among clinicians from HICs, larger units, and consultants with more clinical experience. There is a disparity in recommending PD across various clinical scenarios driven by experience, unit-level characteristics, and region of practice. Globally, evidence-informed education is warranted to rectify misconceptions to enable greater PD uptake.
Collapse
Affiliation(s)
- Nikhil Shah
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Paul N. Bennett
- Renal Nursing (Clinical & Health Sciences), University of South Australia, Adelaide, Australia
| | | | | | - Graham Abra
- Satellite Healthcare and Department of Medicine, Division of Nephrology, Stanford University School of Medicine, California, USA
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | |
Collapse
|
43
|
Bandi PS, Brar A, Al-Handola R, Navari Y, Osterholzer D. A Rare Case of Peritoneal Dialysis-Associated Peritonitis Caused by Neisseria sicca. Cureus 2024; 16:e59358. [PMID: 38817497 PMCID: PMC11138232 DOI: 10.7759/cureus.59358] [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] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Peritonitis is a critical complication in peritoneal dialysis, often leading to peritoneal dialysis (PD) treatment failure. We present a rare case of Neisseria sicca (NS)-related peritonitis in a 47-year-old male with multiple comorbidities. Despite NS's infrequent association with infections, prompt diagnosis and antibiotic therapy based on International Society for Peritoneal Dialysis (ISPD) guidelines led to a favorable outcome. This case emphasizes identifying uncommon pathogens in immunocompromised individuals and highlights the importance of prompt treatment to prevent morbidity.
Collapse
Affiliation(s)
- Pushyami Satya Bandi
- Internal Medicine/Pediatrics, Hurley Medical Center/Michigan State University, Flint, USA
| | - Ajit Brar
- Internal Medicine, Hurley Medical Center/Michigan State University, Flint, USA
| | - Rami Al-Handola
- Internal Medicine, Hurley Medical Center/Michigan State University, Flint, USA
| | - Yasaman Navari
- Internal Medicine, Hurley Medical Center/Michigan State University, Flint, USA
| | | |
Collapse
|
44
|
Lambie M, Wilkie M. Realtime Remote Detection of Evolving Peritonitis in Peritoneal Dialysis. Kidney Int Rep 2024; 9:749-751. [PMID: 38765579 PMCID: PMC11101765 DOI: 10.1016/j.ekir.2024.02.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
- Mark Lambie
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| |
Collapse
|
45
|
Wang IK, Chan CI, Lin AHF, Yu TM, Yen TH, Lai PC, Li CY, Sung FC. The impact of icodextrin on the outcomes of incident peritoneal dialysis patients. PLoS One 2024; 19:e0297688. [PMID: 38551920 PMCID: PMC10980222 DOI: 10.1371/journal.pone.0297688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/09/2024] [Indexed: 04/01/2024] Open
Abstract
OBJECTIVE The aim of the study is to investigate the effects of icodextrin on the risks of death, technique failure and the first episode of peritonitis in peritoneal dialysis (PD) patients. METHODS From medical records of a medical center in Taiwan, a total of 725 newly diagnosed end-stage kidney disease patients receiving PD for at least 90 days from January 1, 2007 to December 31, 2018 were identified. These patients were grouped as 190 icodextrin users and 535 non-users. Users were defined as utilization of icodextrin for ≥ 50% of their PD duration. The use of icodextrin was considered a time-varying exposure in the Cox proportional hazard model. The risks of death, technique failure and the first episode of peritonitis were compared between two cohorts by the end of 2018. RESULTS Compared to the non-users, the icodextrin users had significant lower risks of mortality (6.5 vs.7.2 per 100 person-years; adjusted HR = 0.62, 95% CI = 0.42-0.91) and technique failure (12.7 vs. 15.2 per 100 person-years; adjusted HR = 0.61, 95% CI = 0.47-0.81), and the first peritonitis episode (5.0 vs. 17.0 per 100 person-years; adjusted HR = 0.22, 95% CI = 0.14-0.35). The risk of peritonitis reduced further in icodextrin users with diabetes and with cardiovascular disease. CONCLUSION Icodextrin was associated with lower risks of mortality, technique failure, and the first episode of peritonitis.
Collapse
Affiliation(s)
- I-Kuan Wang
- Divisions of Nephrology, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chan Ip Chan
- Baxter Healthcare Ltd., Taipei, Taiwan
- Graduate Institute of Management, National Taiwan University of Science and Technology, Taipei, Taiwan
| | | | - Tung-Min Yu
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tzung-Hai Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ping-Chin Lai
- Divisions of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Yuan Li
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University College of Public Health, Taichung, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
| |
Collapse
|
46
|
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.
Collapse
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
| |
Collapse
|
47
|
Htay H, Choo JCJ, Huang DH, Jayaballa M, Johnson DW, Koniman R, Oei EL, Suai TC, Wu SY, Foo MWY. Rapid point-of-care test for diagnosis of peritonitis in peritoneal dialysis patients. Perit Dial Int 2024:8968608241234728. [PMID: 38453893 DOI: 10.1177/08968608241234728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Periplex® is a rapid point-of-care test based on the detection of interleukin-6 (IL-6) or matrix metalloproteinase-8 (MMP-8) to diagnose peritonitis in peritoneal dialysis (PD) patients. METHODS This single-centre study was conducted in Singapore General Hospital from 2019 to 2022. The study recruited PD patients suspected of having peritonitis. Periplex was performed at the presentation and recovery of peritonitis. Primary outcomes were sensitivity and specificity of Periplex at presentation. The positive and negative predictive values of tests were also performed. RESULTS A total of 120 patients were included in the study. The mean age was 60.9 ± 14.9 years, 53% were male, 79% were Chinese and 47.5% had diabetes mellitus. Periplex was positive in all patients with peritonitis (n = 114); sensitivity of 100%; 95% confidence interval (CI): 100-100%. Periplex was falsely positive in three patients with non-infective eosinophilic peritonitis, resulting in a low specificity of 50%; 95% CI: 41.1-59.0%. Periplex had a positive predictive value of 97.4% and a negative predictive value of 100%. During recovery from peritonitis, Periplex had high specificity (93.6%) and negative predictive value (98.7%) to indicate the resolution of infection. MMP-8 was more sensitive than IL-6 in detecting peritonitis. Periplex was positive in all patients with peritonitis regardless of the types of PD solutions used. CONCLUSIONS Periplex had high sensitivity, and positive and negative predictive values in the diagnosis of peritonitis can be considered as a screening tool for peritonitis. Given its high specificity and negative predictive value, it may also be used to document the resolution of peritonitis.
Collapse
Affiliation(s)
- Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
| | - Jason Chon Jun Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
| | | | - Mathini Jayaballa
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Kidney Disease Research, University of Queensland, Brisbane, QLD, Australia
| | - Riece Koniman
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
| | - Elizabeth Ley Oei
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
| | - Tan Chieh Suai
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
| | - Sin Yan Wu
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Marjorie Wai Yin Foo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- DUKE-NUS Medical School, Singapore, Singapore
| |
Collapse
|
48
|
Nakamura T, Yamauchi M, Sonoda S, Aharen D, Ikemura M, Kohagura K, Kusunose K. Green Nails, Red Alert: An Unusual Exit site infection Presentation. Perit Dial Int 2024:8968608241234529. [PMID: 38445494 DOI: 10.1177/08968608241234529] [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: 03/07/2024] Open
Abstract
Green nail syndrome is an infectious nail disorder caused most commonly by Pseudomonas aeruginosa. We report a rare case of peritoneal dialysis (PD) exit site infection (ESI) accompanied by P. aeruginosa-associated green nail syndrome. The patient was treated with oral and topical antibiotics without the need for PD catheter removal. We aim to emphasise the importance of nail assessment for ESI in patients undergoing PD.
Collapse
Affiliation(s)
- Takuto Nakamura
- Department of Internal Medicine, Nishizaki Hospital, Okinawa, Japan
| | - Marino Yamauchi
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shinichiro Sonoda
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Daigo Aharen
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Masaki Ikemura
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kentaro Kohagura
- Department of Nephrology, Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| |
Collapse
|
49
|
Motta Guimarães MG, Pinheiro Martin Tapioca F, Costa Neves F, Nunes Freitas Teixeira S, Santana Passos LC. The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysis. Nefrologia 2024; 44:173-179. [PMID: 38697695 DOI: 10.1016/j.nefroe.2024.04.002] [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: 04/26/2023] [Accepted: 07/24/2023] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES The efficacy of fluconazole as a prophylactic strategy in patients with chronic kidney disease (CKD) on peritoneal dialysis (PD) with prior antibiotic exposure is controversial in the current literature. This study aimed to compare a strategy of fluconazole prophylaxis versus no-prophylaxis for patients in PD on antibiotics for previous episodes of peritonitis. MATERIALS AND METHODS We performed a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) comparing fluconazole prophylaxis with no prophylaxis for PD-related peritonitis. The search was conducted on PubMed, EMBASE, and Cochrane Central in January 23, 2023. The outcome of interest was the occurrence of fungal peritonitis (FP). RESULTS We included six studies (1 RCT, 5 observational) with 4515 occurrences of peritonitis, of which 1098 (24.8%) received fluconazole prophylaxis in variable doses, whereas 3417 (75.6%) did not receive prophylaxis during peritonitis episodes. Overall, fluconazole prophylaxis was associated with a lower incidence of FP (OR 0.22; 95% CI 0.12-0.41; p<0.001; I2=0%). Subgroup analysis of studies that administered daily doses of fluconazole also demonstrated a reduced incidence of FP in patients who received antifungal prophylaxis (OR 0.31; CI 0.14-0.69; p=0.004; I2=0%). CONCLUSIONS In this meta-analysis of 4515 episodes of PD-related peritonitis, prophylaxis with fluconazole significantly reduced episodes of FP as compared with no antifungal prophylaxis.
Collapse
Affiliation(s)
| | - Fernanda Pinheiro Martin Tapioca
- Division of Nephrology, Ana Nery Hospital, Salvador, Bahia, Brazil; Bahiana School of Medicine, Salvador, Bahia, Brazil; Medicine and Health Program, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Felipe Costa Neves
- Division of Nephrology, Ana Nery Hospital, Salvador, Bahia, Brazil; Bahiana School of Medicine, Salvador, Bahia, Brazil
| | | | - Luiz Carlos Santana Passos
- Medicine and Health Program, Federal University of Bahia, Salvador, Bahia, Brazil; Division of Cardiology, Ana Nery Hospital, Salvador, Bahia, Brazil
| |
Collapse
|
50
|
Möhlmann JE, Daza Zabaleta AM, van Luin M, Abrahams AC. Vancomycin flushing reaction after intraperitoneal vancomycin: A case report. Perit Dial Int 2024; 44:145-148. [PMID: 37743776 DOI: 10.1177/08968608231199735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Vancomycin has been reported to cause vancomycin flushing reaction (VFR), a hypersensitivity reaction that mostly occurs after intravenous administration. The incidence of VFR in a patient receiving intraperitoneal vancomycin is rare. We report a case of a female peritoneal dialysis (PD) patient with a PD-related peritonitis who developed VFR after intraperitoneal administration of 2000 mg vancomycin. Seventy-five minutes after instillation, she developed flushing, a pruritic erythema on the upper body and swelling of the lips. Blood results revealed a vancomycin plasma concentration of 54.8 mg/L and a normal tryptase level. During a relapse of her PD-related peritonitis, vancomycin was successfully reintroduced in a 50% reduced dose. No symptoms of VFR developed, and the corresponding vancomycin plasma concentration was 33.6 mg/L. Intraperitoneal treatment was continued with 500 mg vancomycin every 2-3 days with frequently measured, adequate trough levels ranging from 15-22 mg/L. This case illustrates the risk factors for the development of VFR after intraperitoneal administration of vancomycin, namely a high and concentrated loading dose together with a low body weight, a fast peritoneal transport state and peritonitis. Reintroduction of vancomycin after occurrence of VFR is safe, but a lower loading dose or a slower instillation rate is recommended.
Collapse
Affiliation(s)
- Julia E Möhlmann
- Department of Clinical Pharmacy, University Medical Centre Utrecht, University Utrecht, The Netherlands
| | - Amely Mk Daza Zabaleta
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, University Utrecht, The Netherlands
| | - Matthijs van Luin
- Department of Clinical Pharmacy, University Medical Centre Utrecht, University Utrecht, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, University Utrecht, The Netherlands
| |
Collapse
|