Retraining for prevention of peritonitis in peritoneal dialysis patients: A randomized controlled trial

Abstract

Background: Peritonitis is more common in peritoneal dialysis (PD) patients nonadherent to the PD exchange protocol procedures than in compliant patients. We therefore investigated whether regular testing of PD knowledge with focus on infection prophylaxis could increase the time to first peritonitis (primary outcome) and reduce the peritonitis rate in new PD patients. Methods: This physician-initiated, open-label, parallel group trial took place at 57 centers in Sweden, Denmark, Norway, Finland, Estonia, Latvia, the Netherlands, and the United Kingdom from 2010 to 2015. New peritonitis-free PD patients were randomized using computer-generated numbers 1 month after the start of PD either to a control group ( n = 331) treated according to center routines or to a retraining group ( n = 340), which underwent testing of PD knowledge and skills at 1, 3, 6, 12, 18, 24, 30, and 36 months after PD start, followed by retraining if the goals were not achieved. Results: In all, 74% of the controls and 80% of the retraining patients discontinued the study. The groups did not differ significantly regarding cumulative incidence of first peritonitis adjusted for competing risks (kidney transplantation, transfer to hemodialysis and death; hazard ratio 0.84; 95% confidence interval (CI) 0.65–1.09) nor regarding peritonitis rate per patient year (relative risk 0.93; 95% CI 0.75–1.16). Conclusions: In this randomized controlled trial, we were unable to demonstrate that regular, targeted testing and retraining of new PD patients increased the time to first peritonitis or reduced the rate of peritonitis, as the study comprised patients with a low risk of peritonitis, was underpowered, open to type 1 statistical error, and contamination between groups.

S. aureus Colonization, Biofilm Production, and Phage Susceptibility in Peritoneal Dialysis Patients

“…Interestingly, we did not detect higher peritonitis or S. aureus -caused peritonitis rate in the carrier group that could be explained by our relatively small study group. Nevertheless, the overall peritonitis rate was 0.35 per patient year, similar to data from other studies having larger cohorts in Northern Europe [ 40 ].…”

Ochrobactrum Peritonitis: Case Report and Literature Review

“…This is particularly pertinent in those with Ochrobactrum peritonitis, as this pathogen is more likely more likely to occur from lapse in technique rather than from gastrointestinal translocation. Evidence on the efficacy of retraining is lacking as well as standardization of content and timing, with one randomized controlled trial limited by discontinuation in 77%-80% of subjects; however, this remains a best practice [11].…”

Time until treatment initiation is associated with catheter survival in peritoneal dialysis-related peritonitis

“…Opportunities for re-education about initial actions to be taken at the onset of peritonitis should be provided for PD patients. Although re-training programs reportedly are unable to prevent the onset of peritonitis 13 , continuous education might contribute to reduction of PD catheter loss after peritonitis.…”