The Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD): Characterization of the cohort

Abstract

The Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD) was launched in December 2004 aiming to collect data monthly and continuously from a representative cohort, allowing for a continuous snapshot of the peritoneal dialysis (PD) reality in the country. This is an observational study of PD patients comprising follow-up from December 2004 to February 2007 (mean follow-up of 13.6 months-ranging from 1 to 26 months) in 114 Brazilian centers. All centers report data through a central web-based database. After an initial baseline retrospective data collection, all patients are followed prospectively every month until they drop out from the PD program. Total number of patients recruited until February 2007 was 3226 (2094 incident patients). Mean age was 54+/-19 years (37% above 65 years old), with 55% females and 64% Caucasians. The more frequent causes of renal failure were diabetic nephropathy (34%), renal vascular disease associated with hypertension (26%), and glomerulopathies (13%). The most common comorbidities were hypertension (76%), diabetes (36%), and ischemic heart disease (23%). Automated PD (APD) was the modality utilized in 53%. The estimated overall peritonitis rate was 1 episode per 30 patient-months (most frequently due to Staphylococcus aureus). The total dropout rate was 33%, mainly due to deaths, whereas 20% of dropouts were due to renal transplant. The gross mortality was 17.6% and the main causes of mortality were cardiovascular diseases (40%) and infections (15%). The initial results of this first Brazilian PD registry provide a unique opportunity to develop future clinical studies addressing specific PD questions in the Brazilian reality and context.

Novel Predictors of Peritonitis-Related Outcomes in the BRAZPD Cohort

“…The study included all incident patients 18 years or older, who remained at least 90 days on PD and presented their first peritonitis episode (n = 474) during the follow-up, from 114 PD centers reporting monthly to the BRAZPD, a multicenter Brazilian cohort study, from December 2004 through October 2007 (7). Data were obtained using software specifically designed to collect data in each participating clinic (PDNet), which were transferred to a central database.…”

Hand Hygiene in Peritoneal Dialysis Patients: A Comparison of Two Techniques

“…Worldwide, gram-positive cocci have been the main agents of bacterial peritonitis, CNS being the more frequently identified micro-organism (3)(4)(5)(6)(7)19,(29)(30)(31)(32). Despite being responsible for only a small proportion of peritonitis episodes in many countries, S. aureus has been the main agent of PD peritonitis in some Latin American countries, particularly Brazil (6,32).…”

“…In a Brazilian multicenter survey, death from cardiovascular causes was the main reason for PD discontinuation, followed by peritonitis (4). In the same study, the prevalence of peritonitis was 1 episode in 30 patient-months, mostly caused by Staphylococcus aureus and coagulase-negative Staphylococcus (CNS), although large regional differences were found.…”

“…Both tests were conducted in the Microbiology Laboratory of the Hospital São Lucas da PUCRS. Before counting started, we decided to consider only the CFUs of S. aureus and CNS, the germs most frequently associated with bacterial peritonitis (4,6,21,22).…”

“…In the same study, the prevalence of peritonitis was 1 episode in 30 patient-months, mostly caused by Staphylococcus aureus and coagulase-negative Staphylococcus (CNS), although large regional differences were found. The prevalence of exit-site infection was 1 episode in 54 patient-months, with negative cultures in almost 40% of cases (4)(5)(6). Preventing such complications, largely associated with skin-resident microbes such as S. aureus and CNS, requires special attention (7).…”