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Rivera AS, Vesga JI, Páez S, Astudillo K, Aldana A, Alba Y, Niño LE, Castillo JC, Sanabria M, Lindholm B, Rutherford P. Early outcomes of peritoneal dialysis in a middle-income country: A retrospective cohort study of a large dialysis network in Colombia. Perit Dial Int 2023; 43:467-474. [PMID: 37723995 DOI: 10.1177/08968608231198977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The first year of dialysis is critical given the significant risk for complications following dialysis initiation. We analysed complications during the first year among incident peritoneal dialysis (PD) patients. METHODS This retrospective cohort study comprised adult kidney failure patients starting PD in Baxter Renal Care Services in Colombia, receiving their first PD catheter between 1 January 2017 and 31 December 2020 and were followed up for up to 1 year. We analysed incidence, causes and factors associated with complications using logistic regression and transfer to haemodialysis (HD) using the Fine-Gray regression model. RESULTS Among 4743 patients receiving their first PD catheter: 4628 (97.6%) of catheter implantations were successful; 377 (7.9%) patients experienced early complications. The incidence rate of complications during the year was 0.51 events per patient-year (95% CI: 0.48-0.54). Age, obesity and urgent start were associated with higher probability of complications after catheter implantation. The cumulative incidence of transfer to HD within 1 year of PD initiation was 10.1% [95% CI: 9.2-11.1%]. The hazard function for transfer to HD showed an accelerating pattern during the first month followed by progressive decrease during the first year. CONCLUSIONS In this large population of incident PD patients, there is a high primary catheter placement success rate. Urgent start, age ≥65 years, obesity, centre size ≥150 PD patients and diabetes were risk factors associated with early complications. The follow-up of the cohort from day 1 of PD treatment showed that the risk for transfer to HD was higher during the first month.
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Affiliation(s)
| | | | - Sergio Páez
- Departamento de Estadística, Facultad de Ciencias, Universidad Nacional de Colombia, Bogotá, DC, Colombia
| | | | - Andrea Aldana
- Baxter Renal Care Services Colombia, Bogotá, DC, Colombia
| | - Yolima Alba
- Baxter Renal Care Services Colombia, Bogotá, DC, Colombia
| | - Luz E Niño
- Baxter Renal Care Services, Bucaramanga, Colombia
| | | | | | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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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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Guo Q, Chen Y, Yang L, Zhu X, Zhang X, Zhao Q, Zhuang X, Wu Y, Luo P, Cui W. Influence of Early-Onset Peritonitis on Mortality and Clinical Outcomes in ESRD Patients with Diabetes Mellitus on Peritoneal Dialysis: A Retrospective Multicenter Study. Blood Purif 2021; 51:280-287. [PMID: 34638121 DOI: 10.1159/000514938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The impact of early-onset peritonitis (EOP) on patients with diabetes undergoing peritoneal dialysis (PD) has not been adequately addressed. We therefore sought to investigate the effects of EOP on the therapeutic response to management and long-term prognostic outcomes in patients with diabetes undergoing PD. METHODS For this retrospective cohort study, we analyzed the data for patients with end-stage renal disease, who were also suffering from diabetes mellitus and had undergone PD between January 1, 2013, and December 31, 2018. EOP was defined as the first episode of peritoneal dialysis-related peritonitis (PDAP) occurring within 12 months of PD initiation. All patients were divided into an EOP group and a later-onset peritonitis (LOP) group. Clinical data, treatment results, and outcomes were compared between groups. RESULTS Ultimately, 202 patients were enrolled for the analysis. Compared to the EOP group, the LOP group had more Streptococcus (p = 0.033) and Pseudomonas (p = 0.048). Patients with diabetes in the EOP group were less likely to have PDAP-related death (OR 0.13, CI: 0.02-0.82, p = 0.030). Patients with diabetes in the EOP group were more likely to have multiple episodes of PDAP and had higher rates of technical failure and poorer patient survival than those in the LOP group, as indicated by Kaplan-Meier analysis (p = 0.019, p = 0.004, and p < 0.001). In the multivariate Cox proportional hazards model, EOP was a significant predictor for multiple PDAP (HR 4.20, CI: 1.48-11.96, p = 0.007), technical failure (HR 6.37, CI: 2.21-18.38, p = 0.001), and poorer patient survival (HR 3.09, CI: 1.45-6.58, p = 0.003). CONCLUSIONS The occurrence of EOP is significantly associated with lower rates of PDAP-related death and poorer clinical outcomes in patients with diabetes undergoing PD.
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Affiliation(s)
- Qiaoyan Guo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Yangyang Chen
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Liming Yang
- Department of Nephrology, Second Part of the First Hospital of Jilin University, Changchun, China
| | - Xueyan Zhu
- Department of Nephrology, Jilin Central Hospital, Jilin, China
| | - Xiaoxuan Zhang
- Department of Nephrology, Jilin FAW General Hospital, Changchun, China
| | - Qiao Zhao
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Xiaohua Zhuang
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Yanfeng Wu
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Ping Luo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Wenpeng Cui
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
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Vesga JI, Rodriguez N, Sanabria RM. Peritoneal Dialysis Modality Failure in a Middle-Income Country: A Retrospective Cohort Study. Kidney Med 2021; 3:335-342.e1. [PMID: 34136779 PMCID: PMC8178469 DOI: 10.1016/j.xkme.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Rationale & Objective Technique failure in peritoneal dialysis (PD) remains one of the most critical challenges of this therapy and is associated with a significant increase in costs and morbidity. Our objective was to estimate the frequency of PD technique failure and identify factors associated with technique failure. Study Design A retrospective multicenter observational cohort study. Setting & Participants All adult patients initiating PD between January 1, 2010, and December 31, 2015, with follow-up until December 31, 2018, at the Renal Therapy Services network in Colombia. Exposure & Predictors PD modality (continuous ambulatory PD and automated PD) and demographic and clinical characteristics. Outcomes Technique failure, defined as a switch to hemodialysis lasting at least 30 days. Analytical Approach Sociodemographic and clinical characteristics of all patients were summarized descriptively according to modality. We estimated the cumulative incidence of technique failure, and a flexible parametric survival model with competing risks was used to evaluate factors associated with this outcome. Results Among 6,452 patients meeting inclusion criteria, 67% were treated with continuous ambulatory PD. The cumulative incidence of technique failure within 1 year of PD initiation adjusting for competing risks was 6.9% (95% CI, 6.3%-7.6%); within 2 years, technique failure was 13.5% (95% CI, 12.6%-14.4%); and within 3 years, 19.6% (95% CI, 18.5%-20.7%). Female sex, larger center size, and higher Kt/V were associated with lower risk for modality change, whereas diabetes, history of major abdominal surgery, catheter implant technique (laparotomy and percutaneous techniques), obesity, and peritonitis were associated with a higher likelihood of technique failure. Limitations Variables of distance to the center, use of icodextrin, and measures of outcomes reported by patients were not included. Conclusions Technique failure is relatively uncommon in Colombia; catheter-related problems are the most frequent cause of technique failure. Best practices in catheter insertion could minimize the risk for this outcome.
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Affiliation(s)
- Jasmin I. Vesga
- Renal Therapy Services-Colombia, Bogotá, DC, Colombia
- Address for Correspondence: Jasmin I. Vesga, NR, MSc, Renal Care Services-Colombia, Transversal 23 # 97-73, 6th Floor, Bogotá, Colombia 110221002.
| | - Nelcy Rodriguez
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontifical Javeriana University, Bogotá, DC, Colombia
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Corzo L, Wilkie M, Vesga JI, Lindholm B, Buitrago G, Rivera AS, Sanabria RM. Technique failure in remote patient monitoring program in patients undergoing automated peritoneal dialysis: A retrospective cohort study. Perit Dial Int 2020; 42:288-296. [PMID: 33380265 DOI: 10.1177/0896860820982223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Remote patient monitoring (RPM) programs in automated peritoneal dialysis (APD) allow clinical teams to be aware of many aspects and events of the therapy that occur in the home. The present study evaluated the association between RPM use and APD technique failure. METHODS A retrospective, multicentre, observational cohort study of 558 prevalent adult APD patients included between 1 October 2016 and 30 June 2017 with follow-up until 30 June 2018 at Renal Therapy Services network in Colombia. Patients were divided into two cohorts based on the RPM use: APD-RPM (n = 148) and APD-without RPM (n = 410). Sociodemographic and clinical characteristics of all patients were summarized descriptively. A propensity score was used to create a pseudo-population in which the baseline covariates were well balanced. The association of RPM with technique failure was estimated adjusting for the competing events death and kidney transplant. RESULTS Five hundred fifty-eight patients were analyzed. 26.5% had APD-RPM. In the matched sample comprising 148 APD-RPM and 148 APD-without RPM patients, we observed a lower technique failure rate of 0.08 [0.05-0.15] episodes per patient-year in APD-RPM versus 0.18 [0.12-0.26] in APD-without RPM cohort; incidence rate ratio = 0.45 95% confidence interval: [0.22-0.91], p-value = 0.03. CONCLUSIONS The use of an RPM program in APD patients may be associated with a lower technique failure rate. More extensive and interventional studies are needed to confirm its potential benefits and to measure other patient-centered outcomes.
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Affiliation(s)
- Leyder Corzo
- Renal Therapy Services, Instituto Nacional del Riñón, Bogotá, Colombia
| | - Martin Wilkie
- Sheffield Teaching Hospital, NHS Foundation Trust, Sheffield, UK
| | | | - Bengt Lindholm
- Division of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Giancarlo Buitrago
- Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia, Bogota, DC, Colombia
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Franco J, Vizcaya D. Availability of secondary healthcare data for conducting pharmacoepidemiology studies in Colombia: A systematic review. Pharmacol Res Perspect 2020; 8:e00661. [PMID: 32965783 PMCID: PMC7510335 DOI: 10.1002/prp2.661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022] Open
Abstract
Real-world evidence (RWE) is emerging as a fundamental component of the post-marketing evaluation of medicinal products. Even though the focus on RWE studies has increased in Colombia, the availability of secondary data sources to perform this type of research is not well documented. Thus, we aimed at identifying and characterizing secondary data sources available in Colombia. We performed a systematic literature review on PubMed, EMBASE, and VHL using a combination of controlled vocabulary and keywords for the concepts of electronic health records, epidemiologic studies and Colombia. A total of 323 publications were included. These comprised 123 identified secondary data sources including pharmacy dispensing databases, government datasets, disease registries, insurance databases, and electronic heath records, among others. These data sources were mostly used for cross-sectional studies focused on disease epidemiology in a specific population. Almost all databases (95%) contained demographic information, followed by pharmacological treatment (44%) and diagnostic tests (39%). Even though the database owner was identifiable in 94%, access information was only available in 44% of the articles. Only a pharmacy-dispensing database, local cancer registries, and government databases included a description regarding the quality of the information available. The diversity of databases identified shows that Colombia has a high potential to continue enhancing its RWE strategy. Greater efforts are required to improve data quality and accessibility. The linkage between databases will expand data pooling and integration to boost the translational potential of RWE.
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7
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Ma S, Cai Y, Wang Z, Zhao Z, Xiao J, Yu D. Derivation and validation of a risk score predicting risk of early-onset peritonitis among patients initializing peritoneal dialysis: A cohort study. Int J Infect Dis 2020; 99:301-306. [PMID: 32781164 DOI: 10.1016/j.ijid.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/17/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Early onset peritonitis (EOP) increases the risk of clinical complications in patients initializing peritoneal dialysis (PD). This study aimed to develop and validate a risk prediction model for EOP among patients initializing PD. METHODS 3772 patients registered with the Henan Peritoneal Dialysis Registry (HPDR) between 2007 and 2015 were included. The main outcome, EOP, was defined as incident peritonitis occurring within 6 months of the initialization of PD. Multivariable logistic regression modeling was applied to derive the risk score. All accessible clinical measurements were screened as potential predictors. Assessment of the developed model in terms of model discrimination and calibration was performed using C statistics and a calibration slope, respectively, and validated internally through a bootstrapping (1000-fold) method to adjust for over-fitting. RESULTS The absolute risk of EOP was 14.5%. Age, cardiac function measurements, serum electrolyte test items, lipid profiles, liver function test items, blood urea nitrogen, and white cell count were significant predictors of EOP in the final risk score. Good model discrimination, with C statistics above 0.70, and calibration of agreed observed and predicted risks were identified in the model. CONCLUSION A prediction model that quantifies risks of EOP has been developed and validated. It is based on a small number of clinical metabolic measurements that are available for patients initializing PD in many developing countries, and could serve as a tool to screen the population at high risk of EOP.
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Affiliation(s)
- Shuang Ma
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Yamei Cai
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Zheng Wang
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Jing Xiao
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
| | - Dahai Yu
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China; Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele ST5 5BG, UK.
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8
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Chow JS, Adams K, Cho Y, Choi P, Equinox KL, Figueiredo AE, Hawley CM, Howard K, Johnson DW, Jose MD, Lee A, Longergan M, Manera KE, Moodie JA, Paul-Brent PA, Pascoe EM, Reidlinger D, Steiner GZ, Tomlins M, Tong A, Voss D, Boudville NC. Targeted Education ApproaCH to improve Peritoneal Dialysis Outcomes (TEACH-PD): A feasibility study. Perit Dial Int 2020; 40:153-163. [PMID: 32063194 DOI: 10.1177/0896860819887283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is substantial variation in peritonitis rates across peritoneal dialysis (PD) units globally. This may, in part, be related to the wide variability in the content and delivery of training for PD nurse trainers and patients. AIM The aim of this study was to test the feasibility of implementing the Targeted Education ApproaCH to improve Peritoneal Dialysis Outcomes (TEACH-PD) curriculum in real clinical practice settings. METHODS This study used mixed methods including questionnaires and semi-structured interviews (pretraining and post-training) with nurse trainers and patients to test the acceptability and usability of the PD training modules implemented in two PD units over 6 months. Quantitative data from the questionnaires were analysed descriptively. Interviews were analysed using thematic analysis. RESULTS Ten PD trainers and 14 incident PD patients were included. Mean training duration to complete the modules were 10.9 h (range 6-17) and 24.9 h (range 15-35), for PD trainers and patients, respectively. None of the PD patients experienced PD-related complications at 30 days follow-up. Three (21%) patients were transferred to haemodialysis due to non-PD-related complications. Ten trainers and 14 PD patients participated in the interviews. Four themes were identified including use of adult learning principles (trainers), comprehension of online modules (trainers), time to complete the modules (trainers) and patient usability of the manuals (patient). CONCLUSION This TEACH-PD study has demonstrated feasibility of implementation in a real clinical setting. The outcomes of this study have informed refinement of the TEACH-PD modules prior to rigorous evaluation of its efficacy and cost-effectiveness in a large-scale study.
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Affiliation(s)
- Josephine Sf Chow
- Clinical Innovation and Business Unit, South Western Sydney Local Health District, Liverpool Hospital, NSW, Australia.,Faculty of Nursing, The University of Sydney, NSW, Australia.,School of Health Science, University of Tasmania, Hobart, Australia
| | - Kelly Adams
- Department of Renal Medicine, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Yeoungjee Cho
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Peter Choi
- Department of Renal Medicine, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Keri-Lu Equinox
- Department of Renal Medicine, Cairns Hospital, QLD, Australia
| | - Ana E Figueiredo
- Faculty of Nursing, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carmel M Hawley
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - David W Johnson
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Matthew D Jose
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Anna Lee
- Department of Renal Medicine, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Maureen Longergan
- Department of Renal Medicine, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Karine E Manera
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, NSW, Australia
| | - Jo-Anne Moodie
- Department of Nephrology, The Royal Melbourne Hospital, VIC, Australia
| | - Peta-Anne Paul-Brent
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Elaine M Pascoe
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Donna Reidlinger
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Genevieve Z Steiner
- NICM Health Research Institute and Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Melinda Tomlins
- Department of Renal Medicine, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, NSW, Australia
| | - David Voss
- Department of Renal Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Neil C Boudville
- Medical School, University of Western Australia, Perth, Australia
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Lanot A, Bechade C, Verger C, Fabre E, Vernier I, Lobbedez T. Patterns of peritoneal dialysis catheter practices and technique failure in peritoneal dialysis: A nationwide cohort study. PLoS One 2019; 14:e0218677. [PMID: 31220171 PMCID: PMC6586404 DOI: 10.1371/journal.pone.0218677] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/06/2019] [Indexed: 11/27/2022] Open
Abstract
Introduction Our objective was to assess whether clusters of centers with similar peritoneal dialysis (PD) catheter related practices were associated with differences in the risk of technique failure. Methods Patients on incident PD in French centers contributing to the French Language PD Registry from 2012 to 2016 were included in a retrospective analysis of prospectively collected data. Centers with similar catheter cares practices were gathered in clusters in a hierarchical analysis. Clusters of centers associated with technique failure were evaluated using Cox and Fine and Gray models. A mixed effect Cox model was used to assess the influence of a center effect, as explained by the clusters. Results Data from 2727 catheters placed in 64 centers in France were analyzed. Five clusters of centers were identified. After adjustment for patient-level characteristics, the fourth cluster was associated with a lower risk of technique failure (cause specific-HR 0.70, 95%CI 0.54–0.90. The variance of the center effect decreased by 5% after adjusting for patient characteristics and by 26% after adjusting for patient characteristics and clusters of centers in the mixed effect Cox model. Favorable outcomes were observed in clusters with a greater proportion of community hospitals, where catheters were placed via open surgery, first dressing done 6 to 15 days after catheter placement, and local prophylactic antibiotics was applied on exit-site. Conclusion Several patterns of PD catheter related practices have been identified in France, associated with differences in the risk of technique failure. Combinations of favorable practices are suggested in this study.
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Affiliation(s)
- Antoine Lanot
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie université, Unicaen, UFR de médecine, Caen, France
- * E-mail:
| | - Clemence Bechade
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
| | | | | | - Isabelle Vernier
- RDPLF, Pontoise, France
- Néphrologie, polyclinique le Languedoc, Narbonne, France
| | - Thierry Lobbedez
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie université, Unicaen, UFR de médecine, Caen, France
- RDPLF, Pontoise, France
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Balzer MS, Claus R, Haller H, Hiss M. Are ISPD Guidelines on Peritonitis Diagnosis Too Narrow? A 15-Year Retrospective Single-Center Cohort Study on PD-Associated Peritonitis Accounting for Untrained Patients. Perit Dial Int 2019; 39:220-228. [DOI: 10.3747/pdi.2018.00179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/10/2018] [Indexed: 12/23/2022] Open
Abstract
Background Peritoneal dialysis (PD)-associated peritonitis remains by far the most important complication requiring patients to transfer to hemodialysis and has a major impact on patient morbidity and mortality. Current International Society for Peritoneal Dialysis (ISPD) guidelines on peritonitis recommend analysis of peritonitis episodes only in trained patients. In a large tertiary care center, we analyzed peritonitis episodes accounting for different groups of untrained patients and compared these with episodes in the trained patient population. Methods We analyzed data collected prospectively over a 15-year time span regarding differences between peritonitis episodes in trained patients and episodes in untrained patients post-catheter insertion but prior to training completion as well as on in-center intermittent PD with respect to incidence rates, pathogenic organisms, outcome, and peritonitis predictors. Results In 275 patients, a total of 160 peritonitis episodes in trained patients were counted. A total of 27 additional episodes in untrained patients were recorded. When accounting for these episodes, the peritonitis incidence significantly increased and the percentage of peritonitis-free patients decreased. Peritonitis episodes in untrained patients were most often culture-negative and the pathogen spectrum differed significantly compared with episodes counted as per ISPD recommendations, while outcome of peritonitis episodes did not differ. Predictors of peritonitis after multivariate logistic regression analysis included glomerulonephritis as primary kidney disease, being on home PD rather than being on in-center intermittent PD, and higher dialysis vintage. Conclusions Depending on local practice patterns, we argue that centers should additionally monitor peritonitis episodes in untrained patients because computation of statistics as per ISPD recommendations could underestimate peritonitis incidence and may depict a distorted pathogen spectrum.
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Affiliation(s)
- Michael S. Balzer
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Robert Claus
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Hermann Haller
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Marcus Hiss
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
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