Low Peritonitis Rate Leads to High Patient Survival and Technique Success: The First Five Years of a Peritoneal Dialysis Program

Mastrosimone, Stefania; Virga, Giovambattista; Stanic, L; Gastaldon, Fiorella; Porto, Armando; Bonadonna, A

doi:10.1177/089686080202200119

Cited by 7 publications

(4 citation statements)

References 5 publications

(11 reference statements)

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“…Preventing dialysis related infectious complications, especially peritonitis, is imperative for improving long‐term outcomes 18,55,56 . ISPD 28 and British Renal Association guidelines 57 target a peritonitis rate of less than 1 episode in 18 patient months, which is conservative when compared with rates of 1 episode per 45 patient months or better achieved in many Asian countries (Table 1).…”

Section: Improving Patient Outcomesmentioning

confidence: 99%

Peritoneal dialysis practice in Australia and New Zealand: A call to action

et al. 2010

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Peritoneal dialysis technique survival in Australia and New Zealand is lower than in other parts of the world. More than two-thirds of technique failures are related to infective complications (predominantly peritonitis) and 'social reasons'. Practice patterns vary widely and more than one-third of peritoneal dialysis units do not meet the International Society of Peritoneal Dialysis minimum accepted peritonitis rate. In many cases, poor peritonitis outcomes reflect significant deviations from international guidelines. In this paper we propose a series of practical recommendations to improve outcomes in peritoneal dialysis patients through appropriate patient selection, prophylaxis and treatment of infectious complications, investigation of social causes of technique failure and a greater focus on patient education and clinical governance.

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Section: Improving Patient Outcomesmentioning

confidence: 99%

Peritoneal dialysis practice in Australia and New Zealand: A call to action

et al. 2010

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“…Peritonitis not only is the leading cause of technique failure but also contributes to mortality. [3][4][5][6][7][8][9][10][11][12][13][14][15] In a single center study of a PD cohort of 516 adults, the rate of death from all infections or sepsis was 30 per 1000 dialysis years at risk. 8 Ninety-two percent of these deaths due to infection were related to peritonitis.…”

mentioning

confidence: 99%

“…Peritonitis risk is not evenly spread across the PD population as some patients never get peritonitis, while others have frequent episodes. [3][4][5][6] Modifiable risk factors are not well studied. Hypoalbuminemia at the start of dialysis is an important risk factor for the subsequent development of peritonitis in PD patients.…”

mentioning

confidence: 99%

Prevention of infectious complications in peritoneal dialysis: best demonstrated practices

Bender

Bernardini

Piraino

2006

Kidney International

134

125

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Peritoneal dialysis (PD) related infections continue to be a serious complication for PD patients. Peritonitis can be associated with pain, hospitalization and catheter loss as well as a risk of death. Peritonitis risk is not evenly spread across the PD population or programs. Very low rates of peritonitis in a program are possible if close attention is paid to the causes of peritonitis and protocols implemented to reduce the risk of infection. Protocols to decrease infection risk in PD patients include proper catheter placement, exit-site care that includes Staphylococcus aureus prophylaxis, careful training of patients with periodic retraining, treatment of contamination, and prevention of procedure-related and fungal peritonitis. Extensive data have been published on the use of antibiotic prophylaxis to prevent exit site infections. There are fewer data on training methods of patients to prevent infection risk. Quality improvement programs with continuous monitoring of infections, both of the catheter exit site and peritonitis, are important to decrease the PD related infections in PD programs. Continuous review of every episode of infection to determine the root cause of the event should be routine in PD programs. Further research is needed examining approaches to decrease infection risk.

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“…19 Most of these studies provide conjectural evidence that biocompatible fluid with neutral pH and low GDP may improve longevity on PD, but this is limited by the fact that these fluids have not been around long enough to determine an impact on long-term technique survival. Certainly, infection 26 plays an important role in any PD program. Although our findings show a significant benefit in the reduction of peritonitis rate in patients on Physioneal, there is no difference in outcome after an episode.…”

Section: Discussionmentioning

confidence: 99%

Impact of new dialysis solutions on peritonitis rates

Ahmad

Sehmi

Ahmad-Zakhi

et al. 2006

Kidney International

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Peritonitis remains a major cause of morbidity among patients on peritoneal dialysis (PD), yet there is little information about the effect of new biocompatible dialysis solutions on peritonitis rates and treatment. In our unit, information on each peritonitis episode is prospectively collected. Since 2003, bicarbonate/lactate dialysate has been gradually introduced for new patients and for patients experiencing abdominal pain with conventional lactate solutions. From 2002 to 2005, data from 121 episodes of peritonitis (71 automated PD and 50 continuous ambulatory PD) were analyzed; 107 episodes occurred in patients using standard lactate dialysate and 14 episodes in patients using bicarbonate/lactate solution. Patients using bicarbonate/lactate had a significantly lower peritonitis rate of 1 per 52.5 patient-months compared to those using standard lactate dialysate (1 per 26.9 patient-months) (P=0.0179). Response to treatment, however, was not affected by the type of dialysate; cure rates (71.4 and 69.1%, respectively) and recurrence rates (21.4 and 15.8%, respectively) were not significantly different. Catheter removal was required in three (21.4%) patients using bicarbonate/lactate and 23 (22.4%) patients using lactate solution. Use of biocompatible dialysate appears to reduce the peritonitis rate by 50%, although this has to be confirmed in a randomized study. The type of dialysate, on the other hand, does not affect response to treatment.

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Low Peritonitis Rate Leads to High Patient Survival and Technique Success: The First Five Years of a Peritoneal Dialysis Program

Cited by 7 publications

References 5 publications

Peritoneal dialysis practice in Australia and New Zealand: A call to action

Peritoneal dialysis practice in Australia and New Zealand: A call to action

Prevention of infectious complications in peritoneal dialysis: best demonstrated practices

Impact of new dialysis solutions on peritonitis rates

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