Recent advances in novel diagnostic testing for peritoneal dialysis-related peritonitis

Fung, Winston Wing‐Shing; Li, Philip Kam-Tao

doi:10.23876/j.krcp.21.204

Cited by 8 publications

(10 citation statements)

References 58 publications

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“…Pathogen-specific immune fingerprints are promising clinical applications, 154,155,392 although machine learning application remains underutilised in nephrology research. 393,394…”

Section: Future Researchmentioning

confidence: 99%

“…Pathogen-specific immune fingerprints are promising clinical applications, 154,155,392 although machine learning application remains underutilised in nephrology research. 393,394 There is a paucity of research on IP drug dosing for APD, as opposed to CAPD. Further pharmacokinetic data are needed for managing peritonitis in patients on APD because it is not always feasible to convert such patients 234,235 Pyridoxine Oral 50-100 mg daily 375,382 BW: body weight.…”

Section: Non-tuberculous Mycobacterial Peritonitismentioning

confidence: 99%

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ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

et al. 2022

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Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.

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“…Pathogen-specific immune fingerprints are promising clinical applications, 154,155,392 although machine learning application remains underutilised in nephrology research. 393,394…”

Section: Future Researchmentioning

confidence: 99%

Section: Non-tuberculous Mycobacterial Peritonitismentioning

confidence: 99%

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

et al. 2022

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“…Several markers of inflammation have been used in clinical practice for chronic inflammation such as CRP, interleukin-6, etc. [18,91] CRP is one of the most common indicators of inflammatory status. It is a protein produced by human hepatocytes in response to infection, inflammation, or tissue damage and play several mechanistic roles in the innate immune response.…”

Section: Animal Studymentioning

confidence: 99%

X‐Ray Visualized Sensors for Peritoneal Dialysis Catheter Infection

Kiridena

Wijayaratna

Levon

et al. 2023

Adv Funct Materials

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Peritonitis is a common complication for patients with end-stage renal disease undergoing peritoneal dialysis (PD) and is a direct cause or contributor in >15% deaths in PD patients. Since early detection is key to treatment, patients and their care teams need rapid, on-site diagnostics. A hydrogelbased peritoneal fluid pH sensor attached to a peritoneal dialysis catheter is developed to measure local acidosis indicative of peritoneal infections for early detection and monitoring of infections using X-ray imaging. The sensor comprises a polyacrylic acid hydrogel with embedded radiopaque markers enclosed in a polymer casing; contraction of the hydrogel in response to acidic pH is evident from the radiographically measured marker position. The sensor has a pH 4-8 response range; between pH 6.5 and 7.5 it responds linearly with a slope of 14% pH 7 length per pH unit, and about 1% length precision. The sensor is attached to a catheter and implanted in a rat peritoneum. Results in awake rats show a rapid pH drop during infection not observed in systemic C-reactive proteins (CRP) levels nor in the uninfected control animal, with negligible drift over 2 weeks. To our knowledge, this is the first report of an in vivo chemically responsive hydrogel sensor.

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“…The development of point-of-care devices to detect changes in PD effluent for infection whilst a patient is on PD is an area of interest and early developments have begun in this area (19,20).…”

Section: Q: Is There a Guideline On How Patients On Automated Periton...mentioning

confidence: 99%

PD effluent specimen collection: Your questions answered

et al. 2022

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When a patient on peritoneal dialysis (PD) presents with suspected PD-related peritonitis (e.g. cloudy PD fluid and abdominal pain), one of the most important initial aspects of management is for the nephrology nurse/home dialysis nurse to collect PD effluent specimens for white blood cells count, Gram stain, culture and sensitivity for inspection and to send for laboratory testing before antibiotics are started. A review by seven members of the International Society for Peritoneal Dialysis (ISPD) Nursing Committee of all 133 questions posted to the ISPD website ‘Questions about PD’ over the last 4 years (January 2018–December 2021), revealed 97 posted by nephrology nurses from around the world. Of these 97 questions, 10 were noted to be related to best practices for PD effluent specimen collection. For our review, we focused on these 10 questions along with their responses by the members of the ISPD ‘Ask The Experts Team’, whereby existing best practice recommendations were considered, if available, relevant literature was cited and differences in international practice discussed. We revised the original responses for clarity and updated the references. We found that these 10 questions were quite varied but could be organised into four categories: how to collect PD effluent safely; how to proceed with PD effluent collection; how to collect PD effluent for assessment; and how to proceed with follow-up PD effluent collection after intraperitoneal antibiotics have been started. In general, we found that there was limited evidence in the PD literature to answer several of these 10 questions posted to the ISPD website ‘Questions about PD’ by nephrology nurses from around the world on this important clinical topic of best practices for PD effluent specimen collection. Some of these questions were also not addressed in the latest ISPD Peritonitis Guidelines. Moreover, when polling members of our ISPD Nursing Committee we found when answering a few of these questions, nursing practice varied within and among countries. We encourage PD nurses to conduct their own research on this important topic, focusing on areas where research evidence is lacking.

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Recent advances in novel diagnostic testing for peritoneal dialysis-related peritonitis

Cited by 8 publications

References 58 publications

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

X‐Ray Visualized Sensors for Peritoneal Dialysis Catheter Infection

PD effluent specimen collection: Your questions answered

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