Renal Association Clinical Practice Guideline on peritoneal dialysis in adults and children

Abstract

These guidelines cover all aspects of the care of patients who are treated with peritoneal dialysis. This includes equipment and resources, preparation for peritoneal dialysis, and adequacy of dialysis (both in terms of removing waste products and fluid), preventing and treating infections. There is also a section on diagnosis and treatment of encapsulating peritoneal sclerosis, a rare but serious complication of peritoneal dialysis where fibrotic (scar) tissue forms around the intestine. The guidelines include recommendations for infants and children, for whom peritoneal dialysis is recommended over haemodialysis.Immediately after the introduction there is a statement of all the recommendations. These recommendations are written in a language that we think should be understandable by many patients, relatives, carers and other interested people. Consequently we have not reworded or restated them in this lay summary. They are graded 1 or 2 depending on the strength of the recommendation by the authors, and A-D depending on the quality of the evidence that the recommendation is based on.

Current guidelines in peritoneal dialysis – Part I

“…In Portugal, in 2016, infection was the primary reason for PD patients dropout, accounting for 37% of technique failure (1). All PD units should have strategies for monitoring their ESi incidence (ISPD Evidence 1C; UK Renal Association Evidence 1B) at least on a yearly basis 55,56 , and PD units should report ESi as number of episodes per year. No minimum target is recommended for ESi and/or tunnel infection.…”

“…The most important approach is the administration of prophylactic perioperative intravenous antibiotics at the time of the catheter placement (ISPD: Evidence 1A; Renal Association: Evidence 1B) 55,56 , covering Gram positive agents. This attitude is particularly relevant in the reduction of early peritonitis, but has no evidence in the reduction of the rate of ESi, as demonstrated in a recent systematic review 62 .…”

“…Daily topical antibiotic cream or ointment administration at the exit site is a recommendation with the level of evidence 1A 55,56 . It should be noted that the application of the topical antibiotic must be on the skin and not the catheter material.…”

“…If interruptions are necessary, they shouldn't be superior to 2 days. A large cohort study revealed that the utmost peritonitis rates were in those patients trained within the 10 days after PD catheter insertion when comparing with those trained before catheter inser tion 71 , despite that commencement of training is recommended between 10 days and 6 weeks and before RRT in order to enable correction of early catheter related problems without the need for temporary hemodialysis (Renal Association Evidence 1C) 55,56 .…”

“…Patients (and/or carers) should undergo regular revision of their technique at least annually or more frequently if indicated, such as after an episode of PD related infection or a significant interruption to the patient performing PD (Renal Association Evidence 1C, ISPD recommendation) 56,69 . More frequent retraining should be considered in patients who needed more training sessions at the start of PD 72 .…”