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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.
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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
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Ponce D, Nitsch D, Ikizler TA. Strategies to Prevent Infections in Dialysis Patients. Semin Nephrol 2023; 43:151467. [PMID: 38199826 DOI: 10.1016/j.semnephrol.2023.151467] [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: 01/12/2024]
Abstract
Infections are the second leading cause of death among patients with end-stage kidney disease, behind only cardiovascular disease. In addition, patients on chronic dialysis are at a higher risk for acquiring infection caused by multidrug-resistant organisms and for death resulting from infection owing to their likelihood of requiring treatment that involves invasive devices, their frequent exposure to antibiotics, and their impaired immunity. Vascular access is a major risk factor for bacteremia, hospitalization, and mortality among hemodialysis (HD) patients. Catheter-related bacteremia is the most severe central venous catheter (CVC)-related infection and increases linearly with the duration of catheter use. Given the high prevalence of CVC use and its direct association with catheter-related bacteremia, which adversely impacts morbidity and mortality rates among HD patients, several prevention measures aimed at reducing the rates of CVC-related infection have been proposed and implemented. As a result, a large number of clinical trials, systematic reviews, and meta-analyses have been conducted to assess the effectiveness, clinical applicability, and long-term adverse effects of such measures. Peritoneal dialysis chronic treatment without the occurence of peritonitis is rare. Although most cases of peritonitis can be treated adequately with antibiotics, some cases are complicated by hospitalization or a temporary or permanent need to abstain from using the peritoneal dialysis catheter. Severe and long-lasting peritonitis can lead to peritoneal membrane failure, requiring the treatment method to be switched to HD. Some measures as patients training, early diagnosis, and choice of antibiotics can contribute to the successful treatment of peritonitis. Finally, medical directors are key leaders in infection prevention and are an important resource to implement programs to monitor and improve infection prevention practices at all levels within the dialysis clinic.
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Affiliation(s)
- Daniela Ponce
- Division of Internal Medicine, Botucatu School of Medicine, University of São Paulo State (UNESP). Botucatu, Sao paulo, Brazil.
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK
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Bitar W, Helve J, Kanerva M, Honkanen E, Rauta V, Haapio M, Finne P. Severe infections in peritoneal dialysis and home hemodialysis patients: An inception cohort study. PLoS One 2023; 18:e0286579. [PMID: 37314998 DOI: 10.1371/journal.pone.0286579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/19/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Infections are the most common non-cardiovascular cause of death among dialysis patients. Earlier studies have shown similar or higher risk of infectious complications in peritoneal dialysis (PD) compared to hemodialysis (HD) patients, but comparisons to home HD patients have been rare. We investigated the risk of severe infections after start of continuous ambulatory PD (CAPD) and automated PD (APD) as compared to home HD. METHODS All adult patients (n = 536), who were on home dialysis at day 90 from starting kidney replacement therapy (KRT) between 2004 and 2017 in Helsinki healthcare district, were included. We defined severe infection as an infection with C-reactive protein of 100 mg/l or higher. Cumulative incidence of first severe infection was assessed considering death as a competing risk. Hazard ratios were estimated using Cox regression with propensity score adjustment. RESULTS The risk of getting a severe infection during the first year of dialysis was 35% for CAPD, 25% for APD and 11% for home HD patients. During five years of follow-up, the hazard ratio of severe infection was 2.8 [95% CI 1.6-4.8] for CAPD and 2.2 [95% CI 1.4-3.5] for APD in comparison to home HD. Incidence rate of severe infections per 1000 patient-years was 537 for CAPD, 371 for APD, and 197 for home HD patients. When excluding peritonitis, the incidence rate was not higher among PD than home HD patients. CONCLUSIONS CAPD and APD patients had higher risk of severe infections than home HD patients. This was explained by PD-associated peritonitis.
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Affiliation(s)
- Wisam Bitar
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Jaakko Helve
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Finnish Kidney and Liver Association, Helsinki, Finland
| | - Mari Kanerva
- Department of Infectious Diseases, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Eero Honkanen
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Virpi Rauta
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- IT Management, Helsinki and Uusimaa Hospital District, Helsinki, Finland
| | - Mikko Haapio
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Patrik Finne
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Finnish Kidney and Liver Association, Helsinki, Finland
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Tong Y, Wang H, Cao X, Cai G, Chen X, Zhou J. Research hotspots and emerging trends of automated peritoneal dialysis: A bibliometric analysis from 2000 to 2020. Semin Dial 2023; 36:117-130. [PMID: 35352408 DOI: 10.1111/sdi.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The implementation of automated peritoneal dialysis (APD) has considerably increased in many countries. We conducted a bibliometric analysis to evaluate the accumulating studies on APD in the last two decades quantitatively and qualitatively. METHODS Publications regarding APD research between 2000 and 2020 were retrieved from the Web of Science Core Collection database by using the index term "automated peritoneal dialysis." CiteSpace, VOSviewer, and an online platform were employed to analyze the number of publications and the collaboration relationships between countries, institutions, authors, and co-cited journals. Cluster analysis and burst keywords detection were performed on co-cited references and keywords, respectively. RESULTS We obtained a record of 545 publications related to APD in total. The United States was the country that contributes most, and Baxter Healthcare Corporation was the leading institution. Peritoneal Dialysis International was the most active journals in this field. Claudio Ranco was the most productive author, and Simon J Davies ranked the first in the cited authors. Co-cited reference cluster analysis and high frequency keywords showed that survival, ultrafiltration and peritonitis are continuous hot topics. While remote monitoring (RM) and telemedicine may be APD research frontiers according to burst keywords detection. CONCLUSION This bibliometric study provides comprehensive overview on the publications of APD over the past two decades. These findings help to identify the hotspots and explore new directions for future research. RM has become an emerging trend in APD field.
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Affiliation(s)
- Yan Tong
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Hong Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xueying Cao
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Jianhui Zhou
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
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Guía clínica de la Sociedad Española de Nefrología para la prevención y tratamiento de la infección peritoneal en diálisis peritoneal. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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6
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Domenici A, Giuliani A. Automated Peritoneal Dialysis: Patient Perspectives and Outcomes. Int J Nephrol Renovasc Dis 2021; 14:385-392. [PMID: 34675604 PMCID: PMC8504469 DOI: 10.2147/ijnrd.s236553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/15/2021] [Indexed: 12/03/2022] Open
Abstract
A steadily increasing number of end stage kidney disease (ESKD) patients are maintained on automated peritoneal dialysis (APD) worldwide, in long-standing as well as in more recently established peritoneal dialysis (PD) programs. A better understanding of the technique, paralleled by progress in involved technology, sustained this growth to the point that APD has become the prevalent mode of PD delivery in most high-income countries. While APD is now regarded to be at least as efficient as continuous ambulatory peritoneal dialysis (CAPD) with regard to major biomedical outcomes, its impact on patient-reported outcomes has been less investigated. This paper reviews the main outcomes of APD from a clinical point of view and from the person on dialysis perspective.
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Affiliation(s)
- Alessandro Domenici
- Department of Clinical and Molecular Medicine, "Sapienza" University, Sant'Andrea Hospital, Nephrology and Dialysis Unit, Rome, Italy
| | - Anna Giuliani
- Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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7
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Hasegawa T, Noma H, Hamano T, Abe M, Wada A, Honda H, Ito Y, Masakane I, Nitta K. Association between the use of exchange devices for peritoneal dialysis fluids and peritonitis incidence: A nationwide cohort study. Perit Dial Int 2021; 42:177-184. [PMID: 34663130 DOI: 10.1177/08968608211051591] [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: 11/15/2022] Open
Abstract
BACKGROUND The use of exchange devices for peritoneal dialysis (PD) fluids is a common practice in Japan. Evidence on the effectiveness of exchange devices in preventing PD-related peritonitis is scarce. We evaluated the association between the use of exchange devices for PD fluids and peritonitis incidence. METHODS We retrospectively enrolled 3845 patients, aged ≥20 years, receiving PD for ≥3 months, with available data on the exchange procedure for PD fluids and peritonitis incidence that was obtained from the Japan Renal Data Registry, a nationwide annual survey. The patients were grouped according to whether the manual or device PD fluid exchange method was used. The onset of peritonitis was defined as a leukocyte count of >100/µL (neutrophils ≥50%) in PD effluents. We applied quasi-Poisson regression analyses to estimate the incidence rate ratio (IRR). Age, sex, PD vintage, body mass index, automated PD use, residual kidney function, comorbidities, haemoglobin and serum albumin were adjusted as potential confounders. RESULTS Older age, automated PD use, diabetes as comorbidity and lower haemoglobin levels were associated with the use of exchange devices for PD fluids. Patients using devices for PD fluid exchange (69.2%) had an increased risk of peritonitis of 37% (IRR: 1.37, 95% confidence interval (CI): 1.07-1.75) and 28% (IRR: 1.28, 95% CI: 1.00-1.63) in the crude and multivariate adjustment models, respectively. CONCLUSIONS The use of exchange devices for PD fluids and peritonitis incidence showed no favourable association. There may remain possible residual confounding by indication.
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Affiliation(s)
- Takeshi Hasegawa
- Showa University Research Administration Center (SURAC), Showa University, Tokyo, Japan
- Division of Nephrology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
- Department of Hygiene, Public Health and Preventive Medicine, Graduate School of Medicine, Showa University, Tokyo, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Japan
| | - Hisashi Noma
- Department of Statistical Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Takayuki Hamano
- Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | | | - Hirokazu Honda
- Division of Nephrology, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Yasuhiko Ito
- Division of Nephrology and Rheumatology, Aichi Medical University, Japan
| | - Ikuto Masakane
- Division of Nephrology, Motomachi Yabuki Clinic, Yamagata, Japan
| | - Kosaku Nitta
- Kidney Center, Department of Medicine, Tokyo Women's Medical University, Japan
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8
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Nataatmadja M, Zhao J, McCullough K, Fuller DS, Cho Y, Krishnasamy R, Boudville N, Figueiredo AE, Ito Y, Kanjanabuch T, Perl J, Piraino BM, Pisoni RL, Szeto CC, Teitelbaum I, Woodrow G, Johnson DW. International peritoneal dialysis training practices and the risk of peritonitis. Nephrol Dial Transplant 2021; 37:937-949. [PMID: 34634100 DOI: 10.1093/ndt/gfab298] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The effects of training practices on outcomes of patients receiving peritoneal dialysis (PD) are poorly understood and there is a lack of evidence informing best training practices. This prospective cohort study aims to describe and compare international PD training practices and their association with peritonitis. METHODS Adult patients on PD < 3 months participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) were included. Training characteristics (including duration, location, nurse affiliation, modality, training of family members, use of individual/group training, and use of written/oral competency assessments) were reported at patient and facility levels. Hazard ratio for time to first peritonitis was estimated using Cox models, adjusted for selected patient and facility case-mix variables. RESULTS 1376 PD patients from 120 facilities across 7 countries were included. Training was most commonly performed at the facility (81%), by facility-affiliated nurses (87%) in a 1:1 setting (79%). In the UK, being trained by both facility and third-party nurses was associated with reduced peritonitis risk (aHR 0.31, 95% CI 0.15-0.62, vs facility nurses only). However, this training practice was utilized in only 5 of 14 UK facilities. No other training characteristics were convincingly associated with peritonitis risk. CONCLUSIONS There was no evidence to support that peritonitis risk was associated with when, where, how, or how long PD patients are trained.
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Affiliation(s)
- Melissa Nataatmadja
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia.,Sunshine Coast Health Institute, Birtinya, Australia
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, USA
| | | | | | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Neil Boudville
- Department of Nephrology, Sir Charles Gairdner Hospital, Perth, Australia.,Medical School, University of Western Australia, Perth, Australia
| | - Ana E Figueiredo
- School of Health Sciences and Life, Nursing School, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jeffrey Perl
- Arbor Research Collaborative for Health, Ann Arbor, USA.,St Michael's Hospital, Toronto, Canada
| | | | | | - Cheuk C Szeto
- The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | | | - Graham Woodrow
- Renal Unit, St James's University Hospital, Leeds, United Kingdom
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
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Al Sahlawi M, Zhao J, McCullough K, Fuller DS, Boudville N, Ito Y, Kanjanabuch T, Nessim SJ, Piraino BM, Pisoni RL, Teitelbaum I, Woodrow G, Kawanishi H, Johnson DW, Perl J. Variation in Peritoneal Dialysis-Related Peritonitis Outcomes in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Am J Kidney Dis 2021; 79:45-55.e1. [PMID: 34052357 DOI: 10.1053/j.ajkd.2021.03.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/09/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Peritoneal dialysis (PD)-associated peritonitis is a significant PD-related complication. We describe the likelihood of cure after a peritonitis episode, exploring its association with various patient, peritonitis, and treatment characteristics. STUDY DESIGN Observational prospective cohort study. SETTING & PARTICIPANTS 1,631 peritonitis episodes (1,190 patients, 126 facilities) in Australia, New Zealand, Canada, Japan, Thailand, the United Kingdom, and the United States. EXPOSURE Patient characteristics (demographics, patient history, laboratory values), peritonitis characteristics (organism category, concomitant exit-site infection), dialysis center characteristics (use of icodextrin and low glucose degradation product solutions, policies regarding antibiotic self-administration), and peritonitis treatment characteristics (antibiotic used). OUTCOME Cure, defined as absence of death, transfer to hemodialysis (HD), PD catheter removal, relapse, or recurrent peritonitis within 50 days of a peritonitis episode. ANALYTICAL APPROACH Mixed-effects logistic models. RESULTS Overall, 65% of episodes resulted in a cure. Adjusted odds ratios (AOR) for cure were similar across countries (range, 54%-68%), by age, sex, dialysis vintage, and diabetes status. Compared with Gram-positive peritonitis, the odds of cure were lower for Gram-negative (AOR, 0.41 [95% CI, 0.30-0.57]), polymicrobial (AOR, 0.30 [95% CI, 0.20-0.47]), and fungal (AOR, 0.01 [95% CI, 0.00-0.07]) peritonitis. Odds of cure were higher with automated PD versus continuous ambulatory PD (AOR, 1.36 [95% CI, 1.02-1.82]), facility icodextrin use (AOR per 10% greater icodextrin use, 1.06 [95% CI, 1.01-1.12]), empirical aminoglycoside use (AOR, 3.95 [95% CI, 1.23-12.68]), and ciprofloxacin use versus ceftazidime use for Gram-negative peritonitis (AOR, 5.73 [95% CI, 1.07-30.61]). Prior peritonitis episodes (AOR, 0.85 [95% CI, 0.74-0.99]) and concomitant exit-site infection (AOR, 0.41 [95% CI, 0.26-0.64]) were associated with a lower odds of cure. LIMITATIONS Sample selection may be biased and generalizability may be limited. Residual confounding and confounding by indication limit inferences. Use of facility-level treatment variables may not capture patient-level treatments. CONCLUSIONS Outcomes after peritonitis vary by patient characteristics, peritonitis characteristics, and modifiable peritonitis treatment practices. Differences in the odds of cure across infecting organisms and antibiotic regimens suggest that organism-specific treatment considerations warrant further investigation.
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Affiliation(s)
- Muthana Al Sahlawi
- Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Internal Medicine, College of Medicine, King Faisal University, Al-Hasa, Saudi Arabia
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | | | | | - Neil Boudville
- Medical School, University of Western Australia, Perth, Australia
| | | | - Talerngsak Kanjanabuch
- Center of Excellence in Kidney Metabolic Disorders and Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sharon J Nessim
- Division of Nephrology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | | | | | - Graham Woodrow
- Renal Unit, St. James's University Hospital, Leeds, United Kingdom
| | - Hideki Kawanishi
- Akane Foundation, Tsuchiya General Hospital, Nakaku, Hiroshima, Japan
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - 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, University of Toronto, Toronto, ON, Canada.
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10
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Ling CW, Sud K, Van C, Zaidi STR, Patel RP, Peterson GM, Castelino RL. Pharmacokinetics of culture-directed antibiotics for the treatment of peritonitis in automated peritoneal dialysis: A systematic narrative review. Perit Dial Int 2021; 41:261-272. [PMID: 33559525 DOI: 10.1177/0896860821990528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objectives of this study were to provide a summary of the pharmacokinetic data of some intraperitoneal (IP) antibiotics that could be used for both empirical and culture-directed therapy, as per the ISPD recommendations, and examine factors to consider when using IP antibiotics for the management of automated peritoneal dialysis (APD)-associated peritonitis. A literature search of PubMed, EMBASE, Scopus, MEDLINE and Google Scholar for articles published between 1998 and 2020 was conducted. To be eligible, articles had to describe the use of antibiotics via the IP route in adult patients ≥18 years old on APD in the context of pharmacokinetic studies or case reports/series. Articles describing the use of IP antibiotics that had been recently reviewed (cefazolin, vancomycin, gentamicin and ceftazidime) or administered for non-APD-associated peritonitis were excluded. A total of 1119 articles were identified, of which 983 abstracts were screened. Seventy-three full-text articles were assessed for eligibility. Eight records were included in the final study. Three reports had pharmacokinetic data in patients on APD without peritonitis. Each of cefepime 15 mg/kg IP, meropenem 0.5 g IP and fosfomycin 4 g IP given in single doses achieved drug plasma concentrations above the minimum inhibitory concentration for treating the susceptible organisms. The remaining five records were case series or reports in patients on APD with peritonitis. While pharmacokinetic data support intermittent cefepime 15 mg/kg IP daily, only meropenem 0.5 g IP and fosfomycin 4 g IP are likely to be effective if given in APD exchanges with dwell times of 15 h. Higher doses may be required in APD with shorter dwell times. Information on therapeutic efficacy was derived from case reports/series in individual patients and without therapeutic drug monitoring. Until more pharmacokinetic data are available on these antibiotics, it would be prudent to shift patients who develop peritonitis on APD to continuous ambulatory peritoneal dialysis, where pharmacokinetic information is more readily available.
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Affiliation(s)
- Chau Wei Ling
- 522555Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Kamal Sud
- 522555Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia.,Departments of Renal Medicine, Nepean and Westmead Hospitals, Sydney, New South Wales, Australia.,Peritoneal Dialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Connie Van
- 522555Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | | | - Rahul P Patel
- School of Pharmacy and Pharmacology, 3925University of Tasmania, Hobart, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, 3925University of Tasmania, Hobart, Australia.,Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Ronald L Castelino
- 522555Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia.,Department of Pharmacy, Blacktown Hospital, New South Wales, Australia
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Kokubu M, Matsui M, Uemura T, Morimoto K, Eriguchi M, Samejima K, Akai Y, Tsuruya K. Relationship between initial peritoneal dialysis modality and risk of peritonitis. Sci Rep 2020; 10:18763. [PMID: 33127929 PMCID: PMC7599327 DOI: 10.1038/s41598-020-75918-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/02/2020] [Indexed: 01/31/2023] Open
Abstract
Peritonitis is a critical complication of peritoneal dialysis (PD). Investigators have reported the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) versus automated peritoneal dialysis (APD), but the available evidence is predominantly based on observational studies which failed to report on the connection type. Our understanding of the relationship between peritonitis risk and PD modality thus remained insufficient. We studied 285 participants who began PD treatment between 1997 and 2014 at three hospitals in Nara Prefecture in Japan. We matched 106 APD patients with 106 CAPD patients based on their propensity scores. The primary outcome was time to first episode of peritonitis within 3 years after PD commencement. In total, PD peritonitis occurred in 64 patients during the study period. Patients initiated on APD had a lower risk of peritonitis than did those initiated on CAPD in both the unadjusted and adjusted models. The hazard ratio (HR) and 95% confidence interval (CI) for the primary endpoint were 0.30 (0.17–0.53) in the fully adjusted model including connection type. In the matched cohort, APD patients had a significantly lower risk of peritonitis than did CAPD patients (log-rank: p < 0.001, HR 0.32, 95% CI 0.16–0.59). The weighting-adjusted analysis of the inverse probability of treatment yielded a similar result (HR 0.35, 95% CI 0.18–0.67). In conclusion, patients initiated on APD at PD commencement had a reduced risk of peritonitis compared with those initiated on CAPD, suggesting APD may be preferable for prevention of peritonitis among PD patients.
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Affiliation(s)
- Maiko Kokubu
- Department of Nephrology, Nara Prefecture General Medical Center, 2-897-5 Shichijo-nishimachi, Nara, 630-8581, Japan
| | - Masaru Matsui
- Department of Nephrology, Nara Prefecture General Medical Center, 2-897-5 Shichijo-nishimachi, Nara, 630-8581, Japan.
| | - Takayuki Uemura
- Department of Nephrology, Nara Prefecture General Medical Center, 2-897-5 Shichijo-nishimachi, Nara, 630-8581, Japan
| | - Katsuhiko Morimoto
- Department of Nephrology, Nara Prefecture Seiwa Medical Center, Nara, 636-0802, Japan
| | - Masahiro Eriguchi
- Department of Nephrology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Kenichi Samejima
- Department of Nephrology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Yasuhiro Akai
- Department of Nephrology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
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12
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Roumeliotis A, Roumeliotis S, Leivaditis K, Salmas M, Eleftheriadis T, Liakopoulos V. APD or CAPD: one glove does not fit all. Int Urol Nephrol 2020; 53:1149-1160. [PMID: 33051854 PMCID: PMC7553382 DOI: 10.1007/s11255-020-02678-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/03/2020] [Indexed: 12/16/2022]
Abstract
The use of Automated Peritoneal Dialysis (APD) in its various forms has increased over the past few years mainly in developed countries. This could be attributed to improved cycler design, apparent lifestyle benefits and the ability to achieve adequacy and ultrafiltration targets. However, the dilemma of choosing the superior modality between APD and Continuous Ambulatory Peritoneal Dialysis (CAPD) has not yet been resolved. When it comes to fast transporters and assisted PD, APD is certainly considered the most suitable Peritoneal Dialysis (PD) modality. Improved patients’ compliance, lower intraperitoneal pressure and possibly lower incidence of peritonitis have been also associated with APD. However, concerns regarding increased cost, a more rapid decline in residual renal function, inadequate sodium removal and disturbed sleep are APD’s setbacks. Besides APD superiority over CAPD in fast transporters, the other medical advantages of APD still remain controversial. In any case, APD should be readily available for all patients starting PD and the most important indication for its implementation remains patient’s choice.
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Affiliation(s)
- Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Konstantinos Leivaditis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece.
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13
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Alanyl-Glutamine Restores Tight Junction Organization after Disruption by a Conventional Peritoneal Dialysis Fluid. Biomolecules 2020; 10:biom10081178. [PMID: 32823646 PMCID: PMC7464725 DOI: 10.3390/biom10081178] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022] Open
Abstract
Understanding and targeting the molecular basis of peritoneal solute and protein transport is essential to improve peritoneal dialysis (PD) efficacy and patient outcome. Supplementation of PD fluids (PDF) with alanyl-glutamine (AlaGln) increased small solute transport and reduced peritoneal protein loss in a recent clinical trial. Transepithelial resistance and 10 kDa and 70 kDa dextran transport were measured in primary human endothelial cells (HUVEC) exposed to conventional acidic, glucose degradation products (GDP) containing PDF (CPDF) and to low GDP containing PDF (LPDF) with and without AlaGln. Zonula occludens-1 (ZO-1) and claudin-5 were quantified by Western blot and immunofluorescence and in mice exposed to saline and CPDF for 7 weeks by digital imaging analyses. Spatial clustering of ZO-1 molecules was assessed by single molecule localization microscopy. AlaGln increased transepithelial resistance, and in CPDF exposed HUVEC decreased dextran transport rates and preserved claudin-5 and ZO-1 abundance. Endothelial clustering of membrane bound ZO-1 was higher in CPDF supplemented with AlaGln. In mice, arteriolar endothelial claudin-5 was reduced in CPDF, but restored with AlaGln, while mesothelial claudin-5 abundance was unchanged. AlaGln supplementation seals the peritoneal endothelial barrier, and when supplemented to conventional PD fluid increases claudin-5 and ZO-1 abundance and clustering of ZO-1 in the endothelial cell membrane.
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14
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Wang IK, Yu TM, Yen TH, Lin SY, Chang CL, Lai PC, Li CY, Sung FC. Comparison of patient survival and technique survival between continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. Perit Dial Int 2020; 40:563-572. [PMID: 32735162 DOI: 10.1177/0896860820942987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: This retrospective cohort study compared patient survival and technique survival between patients on continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) using recent data at a single tertiary medical center in Taiwan. Methods: From medical records, we identified incident 459 CAPD patients and 266 APD patients on dialysis for at least 90 days and aged more than 18 years to estimate mortality and technique failure rates, and related hazard ratio (HR) and 95% confidence interval (CI) from 2007 to 2018. Results: There were more women (52.3%) in the CAPD group, whereas patients in the APD group were younger. Compared to CAPD patients, APD patients had a lower mortality rate (2.83 vs. 5.79 per 100 person-years) with an adjusted HR of 0.69 (95% CI = 0.47–1.02), and a lower technique failure rate (9.70 vs. 17.52 per 100 person-years) with an adjusted HR of 0.65 (95% CI = 0.51–0.83). Further subgroup analyses revealed that, compared to CAPD, APD was associated with a significant lower risk of technique failure in male patients, patients aged 50–65 years, diabetic patients, patients without cardiovascular disease (CVD), patients with higher peritoneal permeability, or patients initiating PD in an earlier era. Conclusions: The mortality risk was not significant between CAPD and APD patients. APD is associated with a lower risk of technique failure than CAPD, particularly for male patients, and patients aged 50–65 years, with diabetes, without CVD, with high or high average peritoneal permeability, or initiating PD in an earlier era.
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Affiliation(s)
- I-Kuan Wang
- Graduate Institute of Biological Sciences, College of Medicine, China Medical University, Taichung
- Division of Nephrology, China Medical University Hospital, Taichung
- Department of Medicine, College of Medicine, China Medical University, Taichung
| | - Tung-Min Yu
- Division of Nephrology, Taichung Veterans General Hospital, Taichung
- Biostatistics Center and School of Public Health, China Medical University, Taichung
| | - Tzung-Hai Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei
- School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Shih-Yi Lin
- Division of Nephrology, China Medical University Hospital, Taichung
| | - Chia-Ling Chang
- Management Office for Health Data, China Medical University Hospital, Taichung
| | - Ping-Chin Lai
- Division of Nephrology, China Medical University Hospital, Taichung
| | - Chi-Yuan Li
- Graduate Institute of Biological Sciences, College of Medicine, China Medical University, Taichung
- Department of Anesthesiology, China Medical University Hospital, Taichung
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung
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15
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Chen JH, Johnson DW, Wong G, Boudville N, Borlace M, Walker R, Hawley C, McDonald S, Lim WH. Associations between diabetes and sex with peritoneal dialysis technique and patient survival: Results from the Australia and New Zealand Dialysis and Transplant Registry cohort study. Perit Dial Int 2020; 41:57-68. [PMID: 32319873 DOI: 10.1177/0896860820918708] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A differential association between mortality and cause of end-stage kidney disease in patients with type 2 diabetes mellitus (T2DM) has been shown. Sex-specific differences in diabetes-related complications have been described. It is unclear whether sex affects the associations between diabetes and peritoneal dialysis (PD) technique and patient survival. METHODS Using the Australia and New Zealand Dialysis and Transplant Registry, we examined a two-way interaction between sex and diabetes status (no diabetes, T2DM and non-diabetic nephropathy [T2DM + non-DN] and T2DM and diabetic nephropathy [T2DM + DN]) for PD technique failure (including death), all-cause mortality and cause-specific mortality in incident adult PD patients between 1996 and 2016 using adjusted Cox regression. Mediation analysis was conducted to determine whether peritonitis was a mediator in these associations. RESULTS In 8279 PD patients, those with T2DM + DN had the greatest risks in technique failure, all-cause mortality and cause-specific mortality followed by patients with T2DM + non-DN, then patients without diabetes. Sex modified the association with diabetes status in technique failure (p interaction = 0.001) and cardiac mortality (p interaction = 0.008). In women with T2DM + DN, the adjusted hazard ratio (HR) for technique failure was 1.45 (1.30-1.62) and was higher than men with T2DM + DN (1.17 [1.08-1.28]; referent: no diabetes). In women with T2DM + DN, the adjusted HR for cardiac mortality was 2.12 (1.73-2.61) and was also higher than men with T2DM + DN (1.66 [1.43-1.95]). Less than 10 % of the effect between diabetes and PD technique failure or mortality was mediated by peritonitis. CONCLUSIONS PD patients with diabetic nephropathy had increased risk of PD technique failure and mortality, with the magnitude of these risks greater in women.
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Affiliation(s)
- Jenny Hc Chen
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Renal Medicine, 60122Wollongong Hospital, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - David W Johnson
- Department of Nephrology, 1966Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Health Services Research, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, Brisbane, Queensland, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia
| | - Neil Boudville
- Department of Renal Medicine, 5728Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Medical School, 2720University of Western Australia, Perth, Australia
| | - Monique Borlace
- Central Northern Adelaide Renal and Transplantation Service, 1062Royal Adelaide Hospital, South Australia, Australia
| | - Rachael Walker
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.,63590Eastern Institute of Technology, Napier, New Zealand
| | - Carmel Hawley
- Department of Nephrology, 1966Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Health Services Research, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, Brisbane, Queensland, Australia
| | - Stephen McDonald
- Central and Northern Adelaide Renal and Transplantation Services, South Australia, Australia.,Adelaide Medical School, The University of Adelaide, South Australia, Australia.,Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Wai H Lim
- Department of Renal Medicine, 5728Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Medical School, 2720University of Western Australia, Perth, Australia
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16
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Ong LM, Ch'ng CC, Wee HC, Supramaniam P, Zainal H, Goh BL, Bavanandan S, Mushahar L, Hooi LS, Ahmad G. Risk of Peritoneal Dialysis-Related Peritonitis in a Multi-Racial Asian Population. Perit Dial Int 2020; 37:35-43. [DOI: 10.3747/pdi.2015.00141] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/27/2016] [Indexed: 11/15/2022] Open
Abstract
BackgroundPeritonitis is one of the most common complications of peritoneal dialysis (PD). Understanding the risk factors of peritonitis in a multi-racial Asian population may help to improve outcomes on PD.MethodsWe conducted a prospective observational study to identify risk factors for PD-related peritonitis over a 1-year period in 15 adult PD centers. All peritonitis episodes were independently adjudicated.ResultsA total of 1,603 participants with a mean age of 51.6 years comprising 52.7% females, 62.6% ethnic Malays, 27.0% Chinese, and 8.1% Indians were recruited. The overall peritonitis rate was 1 episode per 44.0 patient-months with 354 episodes recorded in 282 (17.6%) patients over 15,588 patient-months. Significant risk factors of peritonitis were severe obesity (incidence-rate ratio [IRR] 3.32, 95% confidence interval [CI]: 1.30, 8.45), hypoalbuminemia (IRR 1.61, 95% CI: 1.06, 2.46), Staphylococcus aureus nasal carriage (IRR 2.26, 95% CI: 1.46, 3.50), and use of Fresenius system (Fresenius Medical Care North America, Waltham, MA, USA) (IRR 2.49, 95% CI: 1.27, 4.89). The risk of peritonitis was lower in those on automated PD compared with standard PD (IRR 0.43, 95% CI: 0.25, 0.74), and in centers with a patient-staff ratio of 15 to 29.9 (IRR 0.67, 95% CI: 0.49, 0.90) and ≥ 30 (IRR 0.52, 95% CI: 0.34, 0.80). Prevalent patients and exit-site care with topical antibiotics were also protective against peritonitis. Peritonitis rates varied between racial groups. The IRRs of overall peritonitis and gram-positive peritonitis in Chinese versus other racial groups were 0.65 (95% CI: 0.46, 0.90) and 0.47 (95% CI: 0.24, 0.91), respectively.ConclusionsMultiple patient, center, and PD-system factors influence the risk of peritonitis. In the Asian population, there are racial differences in the risk of peritonitis.
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Affiliation(s)
- Loke Meng Ong
- Clinical Research Centre, Sultanah Aminah Hospital, Johor, Malaysia
| | - Chin Chin Ch'ng
- Clinical Research Centre, Sultanah Aminah Hospital, Johor, Malaysia
| | - Hong Chin Wee
- Clinical Research Centre, Sultanah Aminah Hospital, Johor, Malaysia
| | - Premaa Supramaniam
- Penang Hospital, Penang, Malaysia; Clinical Research Centre, Sultanah Aminah Hospital, Johor, Malaysia
| | - Hadzlinda Zainal
- Clinical Research Centre, Sultanah Aminah Hospital, Johor, Malaysia
| | - Bak Leong Goh
- Sultanah Aminah Hospital, Johor, Malaysia; Department of Nephrology, Sultanah Aminah Hospital, Johor, Malaysia
| | - Sunita Bavanandan
- Serdang Hospital, Selangor, Malaysia; Department of Nephrology, Sultanah Aminah Hospital, Johor, Malaysia
| | - Lily Mushahar
- Kuala Lumpur Hospital, Kuala Lumpur, Malaysia; Department of Nephrology, Sultanah Aminah Hospital, Johor, Malaysia
| | - Lai Seong Hooi
- Tuanku Jaafar Hospital, Negeri Sembilan, Malaysia; and Department of Nephrology, Sultanah Aminah Hospital, Johor, Malaysia
| | - Ghazali Ahmad
- Serdang Hospital, Selangor, Malaysia; Department of Nephrology, Sultanah Aminah Hospital, Johor, Malaysia
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17
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Perl J, Fuller DS, Bieber BA, Boudville N, Kanjanabuch T, Ito Y, Nessim SJ, Piraino BM, Pisoni RL, Robinson BM, Schaubel DE, Schreiber MJ, Teitelbaum I, Woodrow G, Zhao J, Johnson DW. Peritoneal Dialysis-Related Infection Rates and Outcomes: Results From the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Am J Kidney Dis 2020; 76:42-53. [PMID: 31932094 DOI: 10.1053/j.ajkd.2019.09.016] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/24/2019] [Indexed: 01/29/2023]
Abstract
RATIONALE & OBJECTIVE Peritoneal dialysis (PD)-related peritonitis carries high morbidity for PD patients. Understanding the characteristics and risk factors for peritonitis can guide regional development of prevention strategies. We describe peritonitis rates and the associations of selected facility practices with peritonitis risk among countries participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). STUDY DESIGN Observational prospective cohort study. SETTING & PARTICIPANTS 7,051 adult PD patients in 209 facilities across 7 countries (Australia, New Zealand, Canada, Japan, Thailand, United Kingdom, United States). EXPOSURES Facility characteristics (census count, facility age, nurse to patient ratio) and selected facility practices (use of automated PD, use of icodextrin or biocompatible PD solutions, antibiotic prophylaxis strategies, duration of PD training). OUTCOMES Peritonitis rate (by country, overall and variation across facilities), microbiology patterns. ANALYTICAL APPROACH Poisson rate estimation, proportional rate models adjusted for selected patient case-mix variables. RESULTS 2,272 peritonitis episodes were identified in 7,051 patients (crude rate, 0.28 episodes/patient-year). Facility peritonitis rates were variable within each country and exceeded 0.50/patient-year in 10% of facilities. Overall peritonitis rates, in episodes per patient-year, were 0.40 (95% CI, 0.36-0.46) in Thailand, 0.38 (95% CI, 0.32-0.46) in the United Kingdom, 0.35 (95% CI, 0.30-0.40) in Australia/New Zealand, 0.29 (95% CI, 0.26-0.32) in Canada, 0.27 (95% CI, 0.25-0.30) in Japan, and 0.26 (95% CI, 0.24-0.27) in the United States. The microbiology of peritonitis was similar across countries, except in Thailand, where Gram-negative infections and culture-negative peritonitis were more common. Facility size was positively associated with risk for peritonitis in Japan (rate ratio [RR] per 10 patients, 1.07; 95% CI, 1.04-1.09). Lower peritonitis risk was observed in facilities that had higher automated PD use (RR per 10 percentage points greater, 0.95; 95% CI, 0.91-1.00), facilities that used antibiotics at catheter insertion (RR, 0.83; 95% CI, 0.69-0.99), and facilities with PD training duration of 6 or more (vs <6) days (RR, 0.81; 95% CI, 0.68-0.96). Lower peritonitis risk was seen in facilities that used topical exit-site mupirocin or aminoglycoside ointment, but this association did not achieve conventional levels of statistical significance (RR, 0.79; 95% CI, 0.62-1.01). LIMITATIONS Sampling variation, selection bias (rate estimates), and residual confounding (associations). CONCLUSIONS Important international differences exist in the risk for peritonitis that may result from varied and potentially modifiable treatment practices. These findings may inform future guidelines in potentially setting lower maximally acceptable peritonitis rates.
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Affiliation(s)
- Jeffrey Perl
- Arbor Research Collaborative for Health, Ann Arbor, MI; St Michael's Hospital, Toronto, Canada.
| | | | | | - Neil Boudville
- Medical School, University of Western Australia, Perth, Australia
| | - Talerngsak Kanjanabuch
- Center of Excellence in Kidney Metabolic Disorders and Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Sharon J Nessim
- Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Canada
| | | | | | | | | | | | | | - Graham Woodrow
- Renal Unit, St James's University Hospital, Leeds, United Kingdom
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
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18
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Abstract
Peritonitis is a common and severe complication in peritoneal dialysis (PD). Detailed recommendations on the prevention and treatment of PD-associated peritonitis have been published by the International Society for Peritoneal Dialysis (ISPD), but there is a substantial variation in clinical practice among dialysis units. Prophylactic antibiotics administered before PD catheter insertion, colonoscopy, or invasive gynecologic procedures, daily topical application of antibiotic cream or ointment to the catheter exit site, and prompt treatment of exit site or catheter infection are key measures to prevent PD-associated peritonitis. When a patient on PD presents with clinical features compatible with PD-associated peritonitis, empirical antibiotic therapy, with coverage of both Gram-positive and Gram-negative organisms (including Pseudomonas species), should be started once the appropriate microbiologic specimens have been obtained. Intraperitoneal is the preferred route of administration. Antifungal prophylaxis, preferably oral nystatin, should be added to prevent secondary fungal peritonitis. Once the PD effluent Gram stain or culture and sensitivity results are available, antibiotic therapy can be adjusted accordingly. A detailed description on the dosage of individual antibiotic can be found in the latest recommendations by the ISPD. The duration of antibiotics is usually 2-3 weeks, depending on the specific organisms identified. Catheter removal and temporary hemodialysis support is recommended for refractory, relapsing, or fungal peritonitis. In some patients, a new PD catheter could be inserted after complete resolution of the peritonitis. PD catheter removal should also be considered for refractory exit site or tunnel infections. After the improvement in clinical practice, there is a worldwide trend of reduction in PD-associated peritonitis rate, supporting the use of PD as a first-line dialysis modality.
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Affiliation(s)
- Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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19
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Li X, Xu H, Chen N, Ni Z, Chen M, Chen L, Dong J, Fang W, Yu Y, Yang X, Chen J, Yu X, Yao Q, Sloand JA, Marshall MR. The Effect of Automated versus Continuous Ambulatory Peritoneal Dialysis on Mortality Risk in China. Perit Dial Int 2018; 38:S25-S35. [PMID: 30315042 DOI: 10.3747/pdi.2017.00235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/15/2018] [Indexed: 12/12/2022] Open
Abstract
Background There is an emerging practice pattern of automated peritoneal dialysis (APD) in China. We report on outcomes compared to continuous ambulatory peritoneal dialysis (CAPD) in a Chinese cohort. Methods Data were sourced from the Baxter Healthcare (China) Investment Co. Ltd Patient Support Program database, comprising an inception cohort commencing PD between 1 January 2005 and 13 August 2015. We used time-dependent cause-specific Cox proportional hazards and Fine-Gray competing risks (kidney transplantation, change to hemodialysis) models to estimate relative mortality risk between APD and CAPD. We adjusted or matched for age, gender, employment, insurance, primary renal disease, size of PD program, and year of dialysis inception. We used cluster robust regression to account for center effect. Results We modeled 100,351 subjects from 1,178 centers over 240,803 patient-years. Of these, 368 received APD at some time. Compared with patients on CAPD, those on APD were significantly younger, more likely to be male, employed, self-paying, and from larger programs. Overall, APD was associated with a hazard ratio (HR) for death of 0.79 (95% confidence interval [CI] 0.64 – 0.97) compared with CAPD in Cox proportional hazards models, and 0.76 (0.62 – 0.95) in Fine-Gray competing risks regression models. There was prominent effect modification by follow-up time: benefit was observed only up to 4 years follow-up, after which risk of death was similar. Conclusion Automated peritoneal dialysis is associated with an overall lower adjusted risk of death compared with CAPD in China. Analyses are limited by the likelihood of important selection bias arising from group imbalance, and residual confounding from unavailability of important clinical covariates such as comorbidity and Kt/V.
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Affiliation(s)
- Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Nan Chen
- Department of Nephrology, Ruijin Hospital, the Medical School affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Zhaohui Ni
- Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Menghua Chen
- Department of Nephrology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, PR China
- Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People's Republic of China, Beijing, PR China
| | - Wei Fang
- Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Yusheng Yu
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xueqing Yu
- Institute of Nephrology, Guangdong Medical University, Dongguan, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | | | - Mark R. Marshall
- Baxter Healthcare (Asia) Pte Ltd, Singapore
- and Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Htay H, Cho Y, Pascoe EM, Hawley C, Clayton PA, Borlace M, Badve SV, Sud K, Boudville N, McDonald SP, Johnson DW. Outcomes of Acinetobacter Peritonitis in Peritoneal Dialysis Patients: A Multicenter Registry Analysis. Perit Dial Int 2018; 38:257-265. [DOI: 10.3747/pdi.2017.00199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/29/2017] [Indexed: 11/15/2022] Open
Abstract
Background Acinetobacter is a rare but important cause of peritonitis in peritoneal dialysis (PD) patients. As the complication has not been comprehensively evaluated previously, the present study examined the outcomes of Acinetobacter peritonitis in a large, national cohort of PD patients. Methods The study included all episodes of peritonitis in Australia from January 2004 to December 2014 using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. The primary outcome was peritonitis cure and secondary outcomes were catheter removal, hemodialysis transfer, recurrent/relapsing peritonitis, peritonitis-related hospitalization, and death. Outcomes were compared using multivariable logistic regression. Results Overall, 5,367 patients experienced 11,122 episodes of peritonitis across 51 centers in Australia. Of these, 228 (4.2%) patients experienced 253 (2.3%) episodes of Acinetobacter peritonitis (176 episodes were due to Acinetobacter alone and 77 involved co-infection with other organisms). Of the 176 solitary Acinetobacter episodes, 131(74%) achieved cure with antibiotics alone. Compared with Acinetobacter, significantly lower odds of peritonitis cure were observed for Pseudomonas (adjusted odds ratio [AOR] 0.24, 95% confidence interval [CI]: 0.16 – 0.36), other gram-negative organisms (AOR 0.54, 95% CI 0.37 – 0.77), fungi (AOR 0.02, 95% CI 0.01 – 0.03), and polymicrobial organisms (AOR 0.36, 95% CI 0.25 – 0.51), whilst similar odds of cure were observed for Staphylococcus (AOR 0.73, 95% CI 0.50 – 1.06), other gram-positive organisms (AOR 1.32,95% CI 0.93 – 1.89), culture-negative (AOR 1.19, 95% CI 0.82 –1.71), and other organisms (AOR 0.72, 95% CI 0.49 – 1.07). The odds of catheter removal and hemodialysis transfer were higher with Pseudomonas, other gram-negative, fungal, and polymicrobial peritonitis than with Acinetobacter peritonitis. The odds of death were also higher with Pseudomonas and fungal peritonitis than with Acinetobacter peritonitis. Treatment of Acinetobacter peritonitis with gentamicin, ciprofloxacin, or ceftazidime achieved comparable outcomes. Conclusions Outcomes of Acinetobacter peritonitis were favorable compared with most other forms of organism-specific peritonitis. Commonly used antibiotics covering gram-negative bacteria achieved comparable outcomes in Acinetobacter peritonitis.
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Affiliation(s)
- Htay Htay
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yeoungjee Cho
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Elaine M. Pascoe
- Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Carmel Hawley
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Philip A. Clayton
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Monique Borlace
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Sunil V. Badve
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Department of Nephrology, St George Hospital, Sydney, Australia
| | - Kamal Sud
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Departments of Renal Medicine, Nepean and Westmead Hospitals, Sydney, Australia
- University of Sydney Medical School, Sydney, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, University of Western Australia, Australia
| | - Stephen P. McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - David W. Johnson
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
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Htay H, Cho Y, Pascoe EM, Darssan D, Nadeau-Fredette AC, Hawley C, Clayton PA, Borlace M, Badve SV, Sud K, Boudville N, McDonald SP, Johnson DW. Center Effects and Peritoneal Dialysis Peritonitis Outcomes: Analysis of a National Registry. Am J Kidney Dis 2017; 71:814-821. [PMID: 29289475 DOI: 10.1053/j.ajkd.2017.10.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/11/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Peritonitis is a common cause of technique failure in peritoneal dialysis (PD). Dialysis center-level characteristics may influence PD peritonitis outcomes independent of patient-level characteristics. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data, all incident Australian PD patients who had peritonitis from 2004 through 2014 were included. PREDICTORS Patient- (including demographic data, causal organisms, and comorbid conditions) and center- (including center size, proportion of patients treated with PD, and summary measures related to type, cause, and outcome of peritonitis episodes) level predictors. OUTCOMES & MEASUREMENT The primary outcome was cure of peritonitis with antibiotics. Secondary outcomes were peritonitis-related catheter removal, hemodialysis therapy transfer, peritonitis relapse/recurrence, hospitalization, and mortality. Outcomes were analyzed using multilevel mixed logistic regression. RESULTS The study included 9,100 episodes of peritonitis among 4,428 patients across 51 centers. Cure with antibiotics was achieved in 6,285 (69%) peritonitis episodes and varied between 38% and 86% across centers. Centers with higher proportions of dialysis patients treated with PD (>29%) had significantly higher odds of peritonitis cure (adjusted OR, 1.21; 95% CI, 1.04-1.40) and lower odds of catheter removal (OR, 0.78; 95% CI, 0.62-0.97), hemodialysis therapy transfer (OR, 0.78; 95% CI, 0.62-0.97), and peritonitis relapse/recurrence (OR, 0.68; 95% CI, 0.48-0.98). Centers with higher proportions of peritonitis episodes receiving empirical antibiotics covering both Gram-positive and Gram-negative organisms had higher odds of cure with antibiotics (OR, 1.22; 95% CI, 1.06-1.42). Patient-level characteristics associated with higher odds of cure were younger age and less virulent causative organisms (coagulase-negative staphylococci, streptococci, and culture negative). The variation in odds of cure across centers was 9% higher after adjustment for patient-level characteristics, but 66% lower after adjustment for center-level characteristics. LIMITATIONS Retrospective study design using registry data. CONCLUSIONS These results suggest that center effects contribute substantially to the appreciable variation in PD peritonitis outcomes that exist across PD centers within Australia.
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Affiliation(s)
- Htay Htay
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia; Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yeoungjee Cho
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Darsy Darssan
- Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | | | - Carmel Hawley
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Central Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital, Adelaide, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Monique Borlace
- Central Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital, Adelaide, Australia
| | - Sunil V Badve
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, St George Hospital, Sydney, Australia
| | - Kamal Sud
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Renal Medicine, Nepean Hospital, Sydney, Australia; Department of Renal Medicine, Westmead Hospital, Sydney, Australia; University of Sydney Medical School, Sydney, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Central Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital, Adelaide, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - David W Johnson
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia.
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Htay H, Cho Y, Pascoe EM, Darssan D, Hawley C, Clayton PA, Borlace M, Badve SV, Sud K, Boudville N, McDonald SP, Johnson DW. Outcomes of Corynebacterium Peritonitis: A Multicenter Registry Analysis. Perit Dial Int 2017; 37:619-626. [DOI: 10.3747/pdi.2017.00028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/09/2017] [Indexed: 01/26/2023] Open
Abstract
Background Corynebacterium is a rare cause of peritonitis that is increasingly being recognized in peritoneal dialysis (PD) patients. The aims of this study were to compare Corynebacterium peritonitis outcomes with those of peritonitis caused by other organisms and to examine the effects of type and duration of antibiotic therapy on outcomes of Corynebacterium peritonitis. Methods Using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data, we included all PD patients who developed peritonitis in Australia between 2004 and 2014. The primary outcome was peritonitis cure by antibiotic therapy, defined as resolution of a peritonitis episode with antibiotics alone and without being complicated by recurrence, relapse, catheter removal, hemodialysis transfer, or death. Peritonitis outcomes were analyzed using multivariable logistic regression. Results A total of 11,122 episodes of peritonitis in 5,367 patients were included. Of these, 162 episodes (1.5%) were due to Corynebacterium. Compared with Corynebacterium peritonitis, the odds of cure were lower in peritonitis due to Staphylococcus aureus (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.45 – 0.97), Pseudomonas (OR 0.22, 95% CI 0.14 – 0.33), other gram-negative organisms (OR 0.52, 95% CI 0.35 – 0.75), fungi (OR 0.02, 95% CI 0.01 – 0.03), polymicrobial organisms (OR 0.32, 95% CI 0.22 – 0.47), and other organisms (OR 0.66, 95% CI 0.44 – 0.99) but similar for culture-negative and other gram-positive peritonitis. Similar results were observed for hemodialysis transfer and death. The outcomes of Corynebacterium peritonitis were not associated with the type of initial antibiotic selected (vancomycin vs cefazolin) or the duration of antibiotic therapy (≤ 14 days vs > 14 days). Conclusions Outcomes for Corynebacterium peritonitis are generally favorable compared with other forms of peritonitis. Cure rates did not appear to differ if peritonitis was treated initially with vancomycin or cefazolin or if treatment duration was prolonged beyond 14 days.
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Affiliation(s)
- Htay Htay
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Princess Alexandra Hospital, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yeoungjee Cho
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Princess Alexandra Hospital, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Elaine M. Pascoe
- Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Darsy Darssan
- Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Carmel Hawley
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Princess Alexandra Hospital, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Philip A. Clayton
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Princess Alexandra Hospital, Brisbane, Australia
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Monique Borlace
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Sunil V. Badve
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Princess Alexandra Hospital, Brisbane, Australia
- Department of Nephrology, St George Hospital, Sydney, Australia
| | - Kamal Sud
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Princess Alexandra Hospital, Brisbane, Australia
- Departments of Renal Medicine, Nepean and Westmead Hospitals, Sydney, Australia
- University of Sydney Medical School, Sydney, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, University of Western Australia, Australia
| | - Stephen P. McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Princess Alexandra Hospital, Brisbane, Australia
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - David W. Johnson
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Princess Alexandra Hospital, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
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Yacoub R, Nugent M, Cai W, Nadkarni GN, Chaves LD, Abyad S, Honan AM, Thomas SA, Zheng W, Valiyaparambil SA, Bryniarski MA, Sun Y, Buck M, Genco RJ, Quigg RJ, He JC, Uribarri J. Advanced glycation end products dietary restriction effects on bacterial gut microbiota in peritoneal dialysis patients; a randomized open label controlled trial. PLoS One 2017; 12:e0184789. [PMID: 28931089 PMCID: PMC5607175 DOI: 10.1371/journal.pone.0184789] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/28/2017] [Indexed: 12/12/2022] Open
Abstract
The modern Western diet is rich in advanced glycation end products (AGEs). We have previously shown an association between dietary AGEs and markers of inflammation and oxidative stress in a population of end stage renal disease (ESRD) patients undergoing peritoneal dialysis (PD). In the current pilot study we explored the effects of dietary AGEs on the gut bacterial microbiota composition in similar patients. AGEs play an important role in the development and progression of cardiovascular (CVD) disease. Plasma concentrations of different bacterial products have been shown to predict the risk of incident major adverse CVD events independently of traditional CVD risk factors, and experimental animal models indicates a possible role AGEs might have on the gut microbiota population. In this pilot randomized open label controlled trial, twenty PD patients habitually consuming a high AGE diet were recruited and randomized into either continuing the same diet (HAGE, n = 10) or a one-month dietary AGE restriction (LAGE, n = 10). Blood and stool samples were collected at baseline and after intervention. Variable regions V3-V4 of 16s rDNA were sequenced and taxa was identified on the phyla, genus, and species levels. Dietary AGE restriction resulted in a significant decrease in serum Nε-(carboxymethyl) lysine (CML) and methylglyoxal-derivatives (MG). At baseline, our total cohort exhibited a lower relative abundance of Bacteroides and Alistipes genus and a higher abundance of Prevotella genus when compared to the published data of healthy population. Dietary AGE restriction altered the bacterial gut microbiota with a significant reduction in Prevotella copri and Bifidobacterium animalis relative abundance and increased Alistipes indistinctus, Clostridium citroniae, Clostridium hathewayi, and Ruminococcus gauvreauii relative abundance. We show in this pilot study significant microbiota differences in peritoneal dialysis patients’ population, as well as the effects of dietary AGEs on gut microbiota, which might play a role in the increased cardiovascular events in this population and warrants further studies.
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Affiliation(s)
- Rabi Yacoub
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- * E-mail:
| | - Melinda Nugent
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Weijin Cai
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Girish N. Nadkarni
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Lee D. Chaves
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Sham Abyad
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Amanda M. Honan
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Shruthi A. Thomas
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Wei Zheng
- Department of Computer Science and Engineering, University at Buffalo, Buffalo, New York, United States of America
| | - Sujith A. Valiyaparambil
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Mark A. Bryniarski
- Department of Phamaceutical Sciences, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, United States of America
| | - Yijun Sun
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Michael Buck
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Robert J. Genco
- Department of Oral Biology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Richard J. Quigg
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - John C. He
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Jaime Uribarri
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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Guest S, Leypoldt JK, Cassin M, Schreiber M. Kinetic Modeling of Incremental Ambulatory Peritoneal Dialysis Exchanges. Perit Dial Int 2017; 37:205-211. [DOI: 10.3747/pdi.2016.00055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/25/2016] [Indexed: 11/15/2022] Open
Abstract
Background Incremental peritoneal dialysis (PD), the gradual introduction of dialysate exchanges at less than full-dose therapy, has been infrequently described in clinical reports. One concern with less than full-dose dialysis is whether urea clearance targets are achievable with an incremental regimen. In this report, we used a large database of PD patients, across all membrane transport types, and performed urea kinetic modeling determinations of possible incremental regimens for an individual membrane type. Methods Using a modified 3-pore model of peritoneal transport, various incremental manual continuous ambulatory PD (CAPD) exchanges employing glucose and/or icodextrin were evaluated. Peritoneal urea clearances from those simulations were added to residual kidney urea clearance for patients with various glomerular filtration rates (GFRs), and the total weekly urea clearance was then compared to the total weekly urea Kt/V target of 1.7. All 4 peritoneal membrane types were modeled. For each simulated prescription, net ultrafiltration and carbohydrate absorption were also calculated. Results Incremental CAPD regimens of 2 exchanges a day met adequacy targets if the GFR was 6 mL/min/1.73 m2 in all membrane types. For regimens employing 3 exchanges a day, Kt/V targets were achieved at GFR levels of 4 to 5 mL/min/1.73 m2 in high transporters to low transporters but higher tonicity 2.5% glucose solutions or icodextrin were required in some regimens. Conclusions This work demonstrates that with incremental CAPD regimens, urea kinetic targets are achievable in most new starts to PD with residual kidney function. Incremental PD may be a less intrusive, better accepted initial treatment regime and a cost-effective way to initiate chronic dialysis in the incident patient. The key role of intrinsic kidney function in incremental regimens is highlighted in this analysis and would warrant conscientious monitoring.
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Ding L, Shao X, Cao L, Fang W, Yan H, Huang J, Gu A, Yu Z, Qi C, Chang X, Ni Z. Possible role of IL-6 and TIE2 gene polymorphisms in predicting the initial high transport status in patients with peritoneal dialysis: an observational study. BMJ Open 2016; 6:e012967. [PMID: 27798027 PMCID: PMC5093628 DOI: 10.1136/bmjopen-2016-012967] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the effect of interleukin (IL)-6 and TIE2 gene polymorphisms on baseline peritoneal transport property. DESIGN An observational study. SETTING Renji Hospital in Shanghai, China. PARTICIPANTS This study included 220 patients with continuous ambulatory peritoneal dialysis (PD). OUTCOME MEASURES Patients were divided into 2 groups based on the results of an initial peritoneal equilibration test performed within 3 months of starting PD therapy: group 1 consisted of low/low average transporters (n=123), and group 2 consisted of high/high average transporters (n=97). We genotyped TIE2 and IL-6 polymorphisms and analysed their effects on baseline transport status. RESULTS The genotype AT in IL-6 Rs13306435 and the genotype CC in TIE2 Rs639225 were both negatively associated with a higher initial peritoneal transport status (IL-6 Rs13306435: OR=0.408, 95% CI 0.227 to 0.736; TIE2 Rs639225: OR=0.188, 95% CI 0.044 to 0.806). CONCLUSIONS IL-6 and TIE2 polymorphisms are associated with baseline peritoneal transport property.
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Affiliation(s)
- Li Ding
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinghua Shao
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liou Cao
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Fang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Yan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiaying Huang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Aiping Gu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zanzhe Yu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chaojun Qi
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinbei Chang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Mizuno M, Suzuki Y, Sakata F, Ito Y. Which clinical conditions are most suitable for induction of automated peritoneal dialysis? RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0057-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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El-Reshaid W, Al-Disawy H, Nassef H, Alhelaly U. Comparison of peritonitis rates and patient survival in automated and continuous ambulatory peritoneal dialysis: a 10-year single center experience. Ren Fail 2016; 38:1187-92. [PMID: 27435043 DOI: 10.1080/0886022x.2016.1209025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In this retrospective study, peritonitis rates and patient survival of 180 patients on CAPD and 128 patients on APD were compared in the period from January 2005 to December 2014 at Al-Nafisi Center in Kuwait. All patients had prophylactic topical mupirocin at catheter exit site. Patients on CAPD had twin bag system with Y transfer set. The peritonitis rates were 1 in 29 months in CAPD and 1 in 38 months in APD (p < 0.05). Percentage of peritonitis free patients over 10-year period in CAPD and APD were 49 and 60%, respectively (p < 0.05). Time to develop peritonitis was 10.25 ± 3.1 months in CAPD compared to 16.1 ± 4 months in APD (p < 0.001). Relapse and recurrence rates were similar in both groups. Median patient survival in CAPD and APD groups with peritonitis was 13.1 ± 1 and 14 ± 1.4 months respectively (p = 0.3) whereas in peritonitis free patients it was 15 ± 1.4 months in CAPD and 23 ± 3.1 months in APD (p = 0.025). APD had lower incidence rate of peritonitis than CAPD. Patient survival was better in APD than CAPD in peritonitis free patients but was similar in patients who had peritonitis.
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Affiliation(s)
- Wael El-Reshaid
- a Department of Medicine, Faculty of Medicine , Kuwait University , Kuwait , Kuwait
| | - Hanan Al-Disawy
- b Division of Nephrology , Al-Nafisi Renal Centre , Kuwait, Kuwait
| | | | - Usama Alhelaly
- b Division of Nephrology , Al-Nafisi Renal Centre , Kuwait, Kuwait
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Deciphering the Contribution of Biofilm to the Pathogenesis of Peritoneal Dialysis Infections: Characterization and Microbial Behaviour on Dialysis Fluids. PLoS One 2016; 11:e0157870. [PMID: 27336367 PMCID: PMC4918928 DOI: 10.1371/journal.pone.0157870] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/06/2016] [Indexed: 12/20/2022] Open
Abstract
Infections are major complications in peritoneal dialysis (PD) with a multifactorial etiology that comprises patient, microbial and dialytic factors. This study aimed at investigating the contribution of microbial biofilms on PD catheters to recalcitrant infections and their interplay with PD related-factors. A prospective observational study was performed on 47 patients attending Centro Hospitalar of Porto and Vila Nova de Gaia/Espinho to whom the catheter was removed due to infectious (n = 16) and non-infectious causes (n = 31). Microbial density on the catheter was assessed by culture methods and the isolated microorganisms identified by matrix-assisted laser desorption/ionization time-of-flight intact cell mass spectrometry. The effect of conventional and three biocompatible PD solutions on 16 Coagulase Negative Staphylococci (CNS) and 10 Pseudomonas aeruginosa strains planktonic growth and biofilm formation was evaluated. Cultures were positive in 87.5% of the catheters removed due infectious and 90.3% removed due to non-infectious causes. However, microbial yields were higher on the cuffs of catheters removed due to infection vs. non-infection. Staphylococci (CNS and Staphylococcus aureus) and P. aeruginosa were the predominant species: 32% and 20% in the infection and 43.3% and 22.7% in the non-infection group, respectively. In general, PD solutions had a detrimental effect on planktonic CNS and P. aeruginosa strains growth. All strains formed biofilms in the presence of PD solutions. The solutions had a more detrimental effect on P. aeruginosa than CNS strains. No major differences were observed between conventional and biocompatible solutions, although in icodextrin solution biofilm biomass was lower than in bicarbonate/lactate solution. Overall, we show that microbial biofilm is universal in PD catheters with the subclinical menace of Staphylococci and P. aeruginosa. Cuffs colonization may significantly contribute to infection. PD solutions differentially impact microbial species. This knowledge is important for the development of infection diagnosis, treatment and preventive strategies.
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Li PKT, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, Fish DN, Goffin E, Kim YL, Salzer W, Struijk DG, Teitelbaum I, Johnson DW. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int 2016; 36:481-508. [PMID: 27282851 PMCID: PMC5033625 DOI: 10.3747/pdi.2016.00078] [Citation(s) in RCA: 612] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Beth Piraino
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Javier de Arteaga
- Department of Nephrology, Hospital Privado and Catholic University, Cordoba, Argentina
| | - Stanley Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | - Ana E Figueiredo
- Nursing School-FAENFI, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas N Fish
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Eric Goffin
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Belgium
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - William Salzer
- University of Missouri-Columbia School of Medicine, Department of Internal Medicine, Section of Infectious Disease, MI, USA
| | - Dirk G Struijk
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
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Benabed A, Bechade C, Ficheux M, Verger C, Lobbedez T. Effect of assistance on peritonitis risk in diabetic patients treated by peritoneal dialysis: report from the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant 2016; 31:656-62. [DOI: 10.1093/ndt/gfw011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/07/2016] [Indexed: 01/06/2023] Open
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Nadeau-Fredette AC, Johnson DW, Hawley CM, Pascoe EM, Cho Y, Clayton PA, Borlace M, Badve SV, Sud K, Boudville N, McDonald SP. Center-Specific Factors Associated with Peritonitis Risk-A Multi-Center Registry Analysis. Perit Dial Int 2016; 36:509-18. [PMID: 26764341 DOI: 10.3747/pdi.2015.00146] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/20/2015] [Indexed: 01/08/2023] Open
Abstract
UNLABELLED ♦ BACKGROUND Previous studies have reported significant variation in peritonitis rates across dialysis centers. Limited evidence is available to explain this variability. The aim of this study was to assess center-level predictors of peritonitis and their relationship with peritonitis rate variations. ♦ METHODS All incident peritoneal dialysis (PD) patients treated in Australia between October 2003 and December 2013 were included. Data were accessed through the Australia and New Zealand Dialysis and Transplant Registry. The primary outcome was peritonitis rate, evaluated in a mixed effects negative binomial regression model. Peritonitis-free survival was assessed as a secondary outcome in a Cox proportional hazards model. ♦ RESULTS Overall, 8,711 incident PD patients from 51 dialysis centers were included in the study. Center-level predictors of lower peritonitis rates included smaller center size, high proportion of PD, low peritoneal equilibration test use at PD start, and low proportion of hospitalization for peritonitis. In contrast, a low proportion of automated PD exposure, high icodextrin exposure and low or high use of antifungal prophylaxis at the time of peritonitis were associated with a higher peritonitis rate. Similar results were obtained for peritonitis-free survival. Overall, accounting for center-level characteristics appreciably decreased peritonitis variability among dialysis centers (p = 0.02). ♦ CONCLUSION This study identified specific center-level characteristics associated with the variation in peritonitis risk. Whether these factors are directly related to peritonitis risk or surrogate markers for other center characteristics is uncertain and should be validated in further studies.
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Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada
| | - David W Johnson
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Carmel M Hawley
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Yeoungjee Cho
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Nephrology, Prince of Wales Hospital, Sydney, Australia Faculty of Medicine, University of Sydney, Nepean Clinical School, Kingswood, Australia
| | - Monique Borlace
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Sunil V Badve
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
| | - Kamal Sud
- Faculty of Medicine, University of Sydney, Nepean Clinical School, Kingswood, Australia Departments of Renal Medicine, Nepean and Westmead Hospitals, Sydney, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, University of Western Australia, Australia
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
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Duquennoy S, Béchade C, Verger C, Ficheux M, Ryckelynck JP, Lobbedez T. Is Peritonitis Risk Increased in Elderly Patients on Peritoneal Dialysis? Report from the French Language Peritoneal Dialysis Registry (RDPLF). Perit Dial Int 2015; 36:291-6. [PMID: 26634564 DOI: 10.3747/pdi.2014.00154] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 01/01/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ INTRODUCTION This study was carried out to examine whether or not elderly patients on peritoneal dialysis (PD) had an increased risk of peritonitis. ♦ METHODS This was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analyzed 8,396 incident patients starting PD between January 2003 and December 2010. The end of the observation period was 31 December 2012. Patients were separated into 2 age groups: up to 75 and over of 75 years old. ♦ RESULTS Among 8,396 patients starting dialysis there were 3,173 patients older than 75. When using a Cox model, no association was found between age greater than 75 years and increased risk of peritonitis (hazard ratio [HR]: 0.97 [0.88 - 1.07]). Diabetes (HR: 1.14 [1.01 - 1.28] and continuous ambulatory PD (HR: 1.13 [1.04 - 1.23]) were significantly associated with a higher risk of peritoneal infection whereas nurse-assisted PD was associated with a lower risk of peritonitis (HR: 0.85 [0.78 - 0.94]. In the analysis restricted to the 3,840 self-care PD patients, there was no association between age older than 75 years and risk of peritonitis. ♦ CONCLUSION The risk of peritonitis is not increased in elderly patients on PD in a country where assisted PD is available.
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Affiliation(s)
| | | | - Christian Verger
- Registre de dialyse péritonéale de langue Française, Pontoise, France
| | | | - Jean-Philippe Ryckelynck
- Néphrologie, CHU Clemenceau, Caen CEDEX, France Registre de dialyse péritonéale de langue Française, Pontoise, France
| | - Thierry Lobbedez
- Néphrologie, CHU Clemenceau, Caen CEDEX, France Registre de dialyse péritonéale de langue Française, Pontoise, France
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Nadeau-Fredette AC, Hawley CM, Pascoe EM, Chan CT, Clayton PA, Polkinghorne KR, Boudville N, Leblanc M, Johnson DW. An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry). Clin J Am Soc Nephrol 2015; 10:1397-407. [PMID: 26068181 PMCID: PMC4527016 DOI: 10.2215/cjn.00840115] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/20/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Home dialysis is often recognized as a first-choice therapy for patients initiating dialysis. However, studies comparing clinical outcomes between peritoneal dialysis and home hemodialysis have been very limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This Australia and New Zealand Dialysis and Transplantation Registry study assessed all Australian and New Zealand adult patients receiving home dialysis on day 90 after initiation of RRT between 2000 and 2012. The primary outcome was overall survival. The secondary outcomes were on-treatment survival, patient and technique survival, and death-censored technique survival. All results were adjusted with three prespecified models: multivariable Cox proportional hazards model (main model), propensity score quintile-stratified model, and propensity score-matched model. RESULTS The study included 10,710 patients on incident peritoneal dialysis and 706 patients on incident home hemodialysis. Treatment with home hemodialysis was associated with better patient survival than treatment with peritoneal dialysis (5-year survival: 85% versus 44%, respectively; log-rank P<0.001). Using multivariable Cox proportional hazards analysis, home hemodialysis was associated with superior patient survival (hazard ratio for overall death, 0.47; 95% confidence interval, 0.38 to 0.59) as well as better on-treatment survival (hazard ratio for on-treatment death, 0.34; 95% confidence interval, 0.26 to 0.45), composite patient and technique survival (hazard ratio for death or technique failure, 0.34; 95% confidence interval, 0.29 to 0.40), and death-censored technique survival (hazard ratio for technique failure, 0.34; 95% confidence interval, 0.28 to 0.41). Similar results were obtained with the propensity score models as well as sensitivity analyses using competing risks models and different definitions for technique failure and lag period after modality switch, during which events were attributed to the initial modality. CONCLUSIONS Home hemodialysis was associated with superior patient and technique survival compared with peritoneal dialysis.
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Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Medicine, Université de Montreal, Montreal, Canada
| | - Carmel M Hawley
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kevan R Polkinghorne
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Department of Nephrology, Monash Medical Centre, Monash Health, Clayton, Australia; Departments of Medicine, Epidemiology, and Preventative Medicine, Monash University, Melbourne, Australia; and
| | - Neil Boudville
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Martine Leblanc
- Department of Medicine, Université de Montreal, Montreal, Canada
| | - David W Johnson
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia;
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Beduschi GDC, Figueiredo AE, Olandoski M, Pecoits-Filho R, Barretti P, de Moraes TP. Automated Peritoneal Dialysis Is Associated with Better Survival Rates Compared to Continuous Ambulatory Peritoneal Dialysis: A Propensity Score Matching Analysis. PLoS One 2015. [PMID: 26214801 PMCID: PMC4516259 DOI: 10.1371/journal.pone.0134047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction The impact of peritoneal dialysis modality on patient survival and peritonitis rates is not fully understood, and no large-scale randomized clinical trial (RCT) is available. In the absence of a RCT, the use of an advanced matching procedure to reduce selection bias in large cohort studies may be the best approach. The aim of this study is to compare automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) according to peritonitis risk, technique failure and patient survival in a large nation-wide PD cohort Methods This is a prospective cohort study that included all incident PD patients with at least 90 days of PD recruited in the BRAZPD study. All patients who were treated exclusively with either APD or CAPD were matched for 15 different covariates using a propensity score calculated with the nearest neighbor method. Clinical outcomes analyzed were overall mortality, technique failure and time to first peritonitis. For all analysis we also adjusted the curves for the presence of competing risks with the Fine and Gray analysis. Results After the matching procedure, 2,890 patients were included in the analysis (1,445 in each group). Baseline characteristics were similar for all covariates including: age, diabetes, BMI, Center-experience, coronary artery disease, cancer, literacy, hypertension, race, previous HD, gender, pre-dialysis care, family income, peripheral artery disease and year of starting PD. Mortality rate was higher in CAPD patients (SHR1.44 CI95%1.21-1.71) compared to APD, but no difference was observed for technique failure (SHR0.83 CI95%0.69-1.02) nor for time till the first peritonitis episode (SHR0.96 CI95%0.93-1.11). Conclusion In the first large PD cohort study with groups balanced for several covariates using propensity score matching, PD modality was not associated with differences in neither time to first peritonitis nor in technique failure. Nevertheless, patient survival was significantly better in APD patients.
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Affiliation(s)
| | - Ana Elizabeth Figueiredo
- Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | | | - Pasqual Barretti
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
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Sherman RA. Briefly Noted. Semin Dial 2015. [DOI: 10.1111/sdi.12297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen JL, Mehrotra R, Kalantar-Zadeh K. Surviving the First Year of Peritoneal Dialysis: Enduring Hard Times. Am J Kidney Dis 2014; 64:673-6. [DOI: 10.1053/j.ajkd.2014.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 07/07/2014] [Indexed: 11/11/2022]
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