Incidence Of Peritonitis Research Articles

A predictive model of treatment effectiveness of refractory peritoneal dialysis-related peritonitis in patients with peritoneal dialysis: a single-center observational study in South China

Abstract Background To prevent loss of peritoneal function caused by persistent abdominal inflammation, the guidelines recommend early extubation in patients with refractory peritoneal dialysis-associated peritonitis (rPDAP). In attempt to pinpoint high-risk patient cohorts that did not respond to treatment for refractory peritonitis, we created a model to predict the effectiveness of peritonitis treatment. Methods This observational cohort study included peritoneal dialysis (PD) patients from January 1, 2011 to December 31, 2020. Multivariate logistic regression analysis was used to explore the factors affecting the occurrence and prognosis of rPDAP, and to construct a predictive model for the success of rPDAP treatment. Receiver operator characteristic (ROC) curve, calibration and decision curve were drawn to evaluate the predictive performance of the model. Results A total of 1, 397 cases of peritoneal dialysis-associated peritonitis (PDAP) occurred in our center during the study period, of which 558 cases were diagnosed as rPDAP. The incidence of refractory peritonitis was 0.047 cases/patient-year. In the study, 440 cases with rPDAP were included. Among them 304 cases (69.1%) had been successfully cured, while 136 cases (30.9%) were treatment failure, of which 19 cases (4.3%) died, 85 (19.3%) cases transferred to hemodialysis and 32 cases (7.2%) were relapse/recurrent peritonitis. Dialysate culture results showed 132 (30.0%) cases were infected with gram positive bacteria, 161 (36.6%) gram negative bacteria. Multivariate Logistic regression analysis showed that episodes of peritonitis previously ≤ 3 times were correlated with the better prognosis of rPDAP, but white blood cell (WBC) counts in peritoneal dialysate on the 3rd day of peritonitis or WBC counts on the 5th day ≥ 300 × 106/L, the pathogenic microorganism with gram-negative bacteria, as well as longer duration of PD were associated with poor outcomes. The C-statistical value of the training data set was 0.870 (95%CI: 0.821–0.918). The calibration curve and clinical decision-making curve also proved that this nomogram could accurately predict the success of treatment in patients with refractory peritonitis. Conclusion The nomogram model created through internal verification indicated a strong clinical application value and a high prognostic prediction accuracy for rPDAP.

Unveiling the Intricacies: Exploring Stepwise Initiation of Peritoneal Dialysis in a Single-Center Setting

Background and Objectives: Chronic kidney disease (CKD) poses a significant global health challenge, necessitating effective renal replacement therapies. Peritoneal dialysis (PD) offers a patient-friendly, home-based alternative to hemodialysis. The Stepwise Initiation of Peritoneal Dialysis (SIPD) method, used in the SPD group and involving a gradual introduction of PD, presents a potential advantage over traditional protocols, yet the scientific literature on its efficacy and safety is limited. Materials and Methods: We conducted a retrospective analysis of 39 end-stage renal disease patients undergoing SIPD and 78 patients receiving conventional PD (CPD) at a single center from 1 January 2010 to 31 December 2023. Patients were matched for age and sex. Surgical techniques, early and late complications, infection rates, and catheter survival were evaluated. Data were analyzed using statistical methods, including the chi-square test, t-test, and negative binomial regression. Results: The mean break-in period was significantly more extended for the SPD group (176.05 ± 154.39 days) compared to the CPD group (26.87 ± 58.45 days). Early complications were similar between groups, but late complications, including peritonitis, were significantly higher in the CPD group. The SPD group experienced fewer infection events (28 vs. 80, p = 0.043). Median catheter survival times were 1486 days for SPD and 1774 days for CPD, with no statistical difference. Age was a significant factor in peritonitis incidence, increasing with age in both groups. Conclusions: Our study suggests that SPD may reduce the incidence of catheter-related infections and peritonitis compared to CPD. The extended break-in period in SPD could enhance tissue healing and reduce biofilm formation, thereby contributing to fewer infectious complications. Despite these findings, no significant difference in overall catheter survival was observed. Further multi-center studies with larger sample sizes are recommended to confirm these results and explore the economic impact of SPD vs. CPD.

S1875 The Incidence of Spontaneous Bacterial Peritonitis in Decompensated Cirrhotics With Gastric Antral Vascular Ectasia and Associated Risk Factors

S1875 The Incidence of Spontaneous Bacterial Peritonitis in Decompensated Cirrhotics With Gastric Antral Vascular Ectasia and Associated Risk Factors

Association between serum potassium, risk and prognosis of peritonitis in peritoneal dialysis patients-results from the Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study.

Hypokalemia has been associatedwith an increased risk of peritoneal dialysis (PD)-associated peritonitis. However, hypokalemia is commonly associated with malnutrition, inflammation, and severe coexisting comorbidities, which thus are suspected of being potential confounders. This study was aimed at testingwhether hypokalemia was independently associated with the occurrence and prognosis of PD-associated peritonitis. A national-level dataset from the Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study was used to explore the independent association of serum potassium with PD-associated peritonitis. Unmatched and propensity score-adjusted multivariate competing risk models, as well as univariate competing risk models following 1:1 propensity score matching, were conducted to balance potential biases between patients with and without hypokalemia. The association between potassium levels prior to peritonitis and treatment failure due to peritonitis was also investigated. During a median follow-up of 25.7months in 7220 PD patients, there was a higher incidence of peritonitis in patients with serum potassium below 4.0mmol/L compared to those withhigher serum levels (677 [0.114/patient-year] vs. 914 [0.096/patient-year], P = 0.001). After adjusting for demographics, laboratory tests, residual renal function, and medication use, baseline potassium levels below 4.0mmol/L were not linked to an increased risk of peritonitis, with a hazard ratio of 0.983 (95% CI 0.855-1.130, P = 0.810). This result remained consistent in both the propensity score adjusted multivariate competing risk regression (HR = 0.974, 95% CI 0.829-1.145, P = 0.750) and the univariate competing risk regression after 1:1 propensity score matching (Fine-Gray test, P = 0.218). The results were similar when analyzing patients with serum potassium level above or below 3.5mmol/L. Lastly, hypokalemia before the occurrence of peritonitis was not independently associated with treatment failure. Hypokalemia was not found to be an independent risk factor for PD-associated peritonitis or treatment failure of peritonitis in China.

Automated peritoneal dialysis versus continuous ambulatory peritoneal dialysis for people with kidney failure.

Peritoneal dialysis (PD) is a home-based kidney replacement therapy (KRT) performed in people with kidney failure. PD can be performed by manual filling and draining of the abdominal cavity, i.e. continuous ambulatory PD (CAPD), or using a device connected to the PD catheter that is programmed to perform PD exchanges, i.e. automated PD (APD). APD is considered to have several advantages over CAPD, such as a lower incidence of peritonitis, fewer mechanical complications, and greater psychosocial acceptability. Acknowledging the increasing uptake of APD in incident and prevalent patients undergoing PD, it is important to re-evaluate the evidence on the comparative clinical and patient-reported outcomes of APD compared to CAPD. This is an update of a Cochrane review published in 2007. To compare clinical and patient-reported outcomes of APD to CAPD in people with kidney failure. In this update, we searched the Cochrane Kidney and Transplant Register of Studies until 29 August 2024. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. Randomised controlled trials (RCTs) comparing APD with CAPD in adults (≥ 18 years) with kidney failure. Two authors independently screened the search results and extracted data. Data synthesis was performed using random-effects meta-analyses, expressing effect estimates as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data and mean differences (MD) with 95% CIs for continuous data. Certainty in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Two RCTs (131 randomised people) comparing APD with CAPD were included in this update. One RCT had a follow-up of six months, and one RCT had a follow-up of 24 months. The risk of bias in the included studies was mostly low, except for the high risk of performance bias for subjective outcomes. The evidence is very uncertain about the effect of APD compared to CAPD on death, hospitalisations, PD-related peritonitis, change of dialysis modality, residual kidney function, health-related quality of life (HRQoL), overhydration, blood pressure, exit-site infections, tunnel infections, mechanical complications, PD catheter removal, or dialysis adequacy measures. These results were largely based on low to very low certainty evidence; hence, caution is warranted when drawing conclusions. Insufficient evidence exists to decide between APD and CAPD in kidney failure patients with regard to clinical and patient-reported outcomes. Therefore, current evidence is insufficient as a guide for clinical practice. Given that the sample sizes of existing studies are generally small with insufficient follow-up, there is a need for large-scale, multicentre studies. Future research should focus on possible differences between APD and CAPD in residual kidney function, euvolaemia, and patient-reported outcomes such as HRQoL, symptoms, patient satisfaction and life participation.

Clinical effects of a home care program for patients with peritoneal dialysis in a tertiary care hospital.

Digital health technologies have been rapidly adopted during the coronavirus disease 2019 pandemic. In Korea, a home care program, including face-to-face educational consultation and remote patient monitoring, was initiated to improve patients' quality of life. This study focused on patients with end-stage renal disease undergoing peritoneal dialysis to verify the long-term clinical effectiveness of this home care program. This retrospective cohort study was designed as a pre-post study to analyze the clinical impact of a home care program for patients undergoing peritoneal dialysis in a single tertiary care hospital. A total of 186 patients were selected from June 2017 to May 2022 to identify clinical changes after program implementation by analyzing changes in peritonitis incidence and laboratory test results. Interrupted time series analyses with ordinary least squares linear regression and chi-square tests were used. At baseline, the incidence of peritonitis continuously increased by 0.480 cases per 1,000 patient-months (p = 0.02). After program initiation, the trend significantly decreased by 0.886 cases per 1,000 patient-months (p = 0.02). In addition, the proportion of individuals reaching the clinical target range had increased calcium levels (4.9%p, p = 0.003), stable hemoglobin (1.2%p, p = 0.477), phosphorus (2.8%p, p = 0.09), potassium (-1.6%p, p = 0.22), while parathyroid hormone levels decreased (-6.6%p, p = 0.005). With a reduction in peritonitis incidence and overall improvement in laboratory test results, our study suggests that conducting a home care program for patients undergoing peritoneal dialysis is clinically effective.

Decreased incidence of peritoneal dialysis-associated peritonitis in young children.

Peritonitis is the most common complication of peritoneal dialysis (PD). This study aimed to investigate changes in the incidence, risk factors, microbiology, and clinical outcomes of PD-associated peritonitis in the past decades. This was a retrospective study that included children who initiated chronic PD at our institution between 2000 and 2017. The patients were divided into two groups according to the year of initiation: those who initiated PD between 2000 and 2008 and those who initiated PD between 2009 and 2017. The incidence and characteristics of peritonitis were compared between the groups. A total of 184 patients with a median age of 10.2 years were included in this study. Of the patients, 92 experienced 210 episodes of peritonitis. The incidence rate of peritonitis decreased from 0.35 to 0.21 episodes/patient year during the study period (P = 0.001). During the 2000-2008 period, the 2-year peritonitis-free survival rate was significantly lower for patients under 2 years of age than for the other age groups (P = 0.004), whereas this was not observed during the 2009-2017 period. The multivariable Cox proportional hazard model showed that the <2 years age group had a significantly higher risk of developing peritonitis in the 2000-2008 period. However, this was not evident in the 2009-2017 period. The incidence of PD-associated peritonitis decreased, particularly in children under 2 years of age. Thus, younger age may not be a risk factor for PD-associated peritonitis.

Peritoneal dialysis-related infections in elderly patients.

This review outlines the epidemiology, characteristics, risk factors, and prognosis of peritoneal dialysis (PD)-related peritonitis, PD catheter-related infections, and the effects of assisted PD in elderly patients from the Japanese perspective. Based on the literature, the incidence of peritonitis is likely to be higher in elderly patients than in younger patients. The most frequent causative bacteria in elderly patients are Gram-positive bacteria, as in adult PD patients, most commonly due to transcatheter infection. However, elderly patients may have difficulty recognizing cloudy drainage fluid due to decreased visual acuity. Hypokalemia, the use of gastric acid suppressants, prophylactic antibiotic use before endoscopy, biocompatible fluids and hypoalbuminemia considered modifiable risk factors for peritonitis. However, the mechanism by which treatment of hypokalemia prevents peritonitis is unknown. Currently, the relationship between gastric acid suppression therapy and peritonitis in elderly patients is debatable, with no evidence to strongly recommend uniform discontinuation of gastric acid suppression therapy. Exit-site infection (ESI) is a major risk factor for the development of peritonitis, and appropriate prevention and management of ESI may reduce infection-related hospitalizations in PD patients. Currently, no randomized, controlled trials have verified the effectiveness of antibiotic application for ESI in Japan, but results from other countries are awaited. In assisted PD, it is extremely important that family members, caregivers, and nurses who support the procedure receive sufficient education and training from medical professionals familiar with PD. Early detection and treatment of PD-related infections are required because the risk of death increases in elderly patients.

Effect of a Management Algorithm for Wet Contamination of Peritoneal Dialysis System on the Prevention of Peritonitis: A Prospective Observational Study

Introduction: Wet contamination was a common problem of peritoneal dialysis (PD) system. We developed a management algorithm for wet contamination of PD system (wet contamination) on the basis of the related research literature and clinical practice experience. The purpose of this study was to observe clinical effect of the management algorithm on the prevention of peritonitis. Methods: Patients treated wet contamination in a single PD center between October 2017 and September 2022 were included. A management algorithm was established to treat wet contamination. It comprised identification of the contamination type, addressing contaminated or aging catheters, prophylactic antibiotics, and retraining. Demographic data and clinical data about wet contamination were collected and compared. Results: One hundred and forty-one cases of wet contamination were included in this study. The mean age was 51.7 ± 14.1 years, and 49.6% were female. The proportion of diabetic nephropathy was 9.9%. The median PD duration was 27.0 (1.7–79.7) months. Eighteen episodes (12.8%) of wet contamination-associated peritonitis developed after wet contamination. The main pathogenic bacteria of peritonitis were Gram-positive bacteria (33.3%) and Gram-negative bacteria (27.8%). The incidence of wet contamination-associated peritonitis in the compliance with the management algorithm group was significantly lower than that in the non-compliance with the management algorithm group (0.9 vs. 48.6%; p < 0.001). Non-compliance with management algorithm (OR = 185.861, p < 0.001) together with advance age (OR = 1.116, p < 0.001) and longer distance from home to hospital (OR = 1.007, p < 0.001) were independent risk factors for wet contamination-associated peritonitis. Conclusion: The management algorithm for wet contamination of PD system could reduce the risk of peritonitis.

Impacts of rifaximin and midodrine on morbidity, mortality, and quality of life in patients with decompensated liver cirrhosis.

Vasodilatation and bacterial dislocation are the main contributors to the catastrophic events in patients with decompensated liver cirrhosis (DLC). The aim of this study was to evaluate the impacts of adding midodrine and rifaximin on morbidity, mortality, and quality of life in patients with DLC. This interventional clinical study included 100 consecutively enrolled DLC patients randomized 1 : 1 into two groups. Group A received oral midodrine (5 mg/8 h) and rifaximin (550 mg/12 h) with standard diuretic therapy, while group B received only standard diuretic therapy. Clinical and laboratory data, including the McGill Quality of Life Questionnaire, were evaluated over a 3-month treatment period. In the study group, there was a significant reduction in Child-Pugh and Model for End-Stage Liver Disease scores, international normalized ratio, and mean arterial blood pressure at 2, 6, and 12 weeks (P < 0.05). Ascites, spontaneous bacterial peritonitis incidence, hematemesis, paracentesis need, and hepatic encephalopathy showed improvement after 12 weeks compared with the control group. McGill Quality of Life Questionnaire significantly improved after 6 and 12 weeks (P < 0.05). Survival rates demonstrated a noteworthy improvement (P = 0.014), substantiated by evidence in both univariate and multivariate regression analyses. Combined midodrine with rifaximin represents an endowment to patients with DLC with spectacular improvements in synthetic liver functions, along with improved quality of life, and survival.

#1262 Risk factors of peritoneal dialysis associated peritonitis caused by gram-negative bacteria: a single-center retrospective study over 16 years

Abstract Background and Aims To analyse the clinical characteristics, pathogen distribution, and treatment outcomes of peritoneal dialysis associated peritonitis (PDAP) caused by gram-negative bacteria, and explore the risk factors for the occurrence and treatment failure of gram-negative bacterial peritonitis. Method We performed a single-center retrospective study included 544 PD patients who underwent regular follow-up between January 1, 2007, and December 31, 2022. After excluding culture-negative peritonitis, fungal peritonitis, and tuberculous peritonitis, based on the pathogens, all episodes were divided into the gram-negative peritonitis group (GNP) and the non-gram-negative peritonitis group (non-GNP). Demographic characteristics, laboratory examinations, pathogenic bacteria, and treatment outcomes were collected and compared between the two groups of peritonitis. Results Over the course of 16 years, 297 episodes of peritonitis occurred in 179 patients. Although the overall incidence of peritonitis is showing a year-on-year downward trend, the incidence of GNP has not changed significantly. However, the percentage of GNP cases among all peritonitis cases is on the rise. After excluding episodes of culture-negative peritonitis, fungal peritonitis, and tuberculous peritonitis, a total of 226 cases of peritonitis were included in the study. Among them, females accounted for 50.0%, with an average age of 63.04 ± 11.58 years and a median PD duration of 42 (21, 73) months. Escherichia coli was the main pathogen responsible for gram-negative bacterial peritonitis in our center (37/80, 46.3%), followed by Klebsiella pneumoniae (9/80, 11.3%). The GNP group had significantly higher white blood cell counts in peritoneal effluent on day 0, day 3, and day 5 after peritonitis onset compared to the non-GNP group (p &amp;lt; 0.001 for all). In terms of treatment outcomes, the GNP group had significantly higher rates of developing refractory peritonitis, treatment failure, and peritonitis-associated death compared to the non-GNP group (p &amp;lt; 0.001 for all). Multivariate logistic regression analysis revealed that enteric infection was an independent risk factor for GNP occurrence (OR = 6.315, 95% CI 3.364-11.854, p &amp;lt; 0.001). White blood cell counts on day 3 of peritoneal effluent (OR = 2.666, 95% CI 1.099-6.469, p = 0.030) and post-PDAP blood white blood cell counts (OR = 1.389, 95% CI 1.060-1.820, p = 0.017) were independent risk factors for treatment failure in GNP. Conclusion Over the past 16 years, the incidence rate of GNP in our center has shown no significant decrease, and the proportion of GNP cases has been increasing year by year. Escherichia coli is the main pathogen responsible for GNP in our center. GNP cases are more difficult to treat and have a poorer prognosis compared to non-GNP cases. Therefore, it is important to strengthen preventive measures for peritoneal dialysis patients, reduce the risk of enteric infection, and actively treat patients who have already developed gram-negative bacterial peritonitis to avoid adverse outcomes.

#2805 The effect of the COVID-19 pandemic on personal hygiene behaviours and the frequency of peritonitis in patients with peritoneal dialysis

Abstract Background and Aims Peritonitis is the most important complication encountered in patients with Peritoneal Dialysis (PD). It is very important to follow the rules of personal hygiene to prevent peritonitis. The COVID-19 (Coronavirus Disease 2019) epidemic has led to the improvement of personal hygiene behaviours. In this study, we aimed to show the awareness created by the COVID-19 pandemic on personal hygiene behaviours in PD patients and to investigate the effect on the incidence of peritonitis. Method Fifty-two PD patients were included in our study. The personal hygiene behaviours of the patients were evaluated with a questionnaire consisting of 15 questions. The medical history, chronic diseases, height, weight and educational status of each patient were questioned. In addition, the averages of complete blood count and biochemical values of the patients before and after COVID-19 were noted and compared. The culture results of the patients who had peritonitis and the microorganisms grown were noted. Results Demographic characteristics of patients are summarized in Table 1. A significant difference was found in 11 personal hygiene behaviours, especially in the frequency of hand washing after the COVID-19 pandemic (p &amp;lt; 0.05). After the pandemic, there was a decrease in the rates of peritonitis, but no significant difference could be reached (22 (42.9%) vs. 7 (13.5%) peritonitis rates, p &amp;lt; 0.05). A decrease was also observed in gram (+) peritonitis case rates (Table 2). After the pandemic, the frequency of hand washing before attaching the transfer set (p = 0.014) and the frequency of daily/every other day dressing of the exit site (p = 0.026) were found to be higher in those who did not have peritonitis. Conclusion Due to a significant improvement in personal hygiene behaviours after the COVID-19 pandemic, a decrease in the rates of peritonitis and infection with gram (+) microorganisms was observed. In our study, it has been shown that the frequency of hand washing before attaching the transfer set and daily/every other day dressing of the exit site reduce the risk of peritonitis. Trainings for improving personal hygiene behaviours in PD patients should be expanded.

#1513 Update on the peritonitis trend in central Spain

Abstract Background and Aims Peritonitis is one of the most common and severe complications associated with peritoneal dialysis (PD) traditionally cited as the primary cause of catheter loss and discontinuation of the dialysis technique. Nevertheless, the incidence and severity of peritonitis has been significantly reduced over time. Therefore, we aimed to update the current impact of peritonitis in PD patients. Method We performed an observational, multi-centre, prospective cohort including 3,037 patients who started PD between 2003-2020 followed for a median of 1.6 [0.8-2.9] years. Results We observed 2 941 episodes of peritonitis, with a peritonitis rate (PR) of 0.46 episodes per patient year and a mean of 2.6 years CI 95% [2.4-2.8] to first peritonitis episode. As expected, gram-positive organism was identified in the 69.3% of the cases, followed by gram-negative (19.6%) and sterile culture (15.6%). The usual course of the peritonitis is favourable, with complete recovery in the 76.4% of the cases, whereas just the 37.6% require admission during a median of 5 [3-9] days, with a peritonitis recurrence of 11.2%. A fatal peritonitis (resulted in PD cessation) was observed in 11.7% of the patients with an overall mortality of 0.7% (considering all the deaths within the 90 days after peritonitis). Factors associated with a 90-days mortality rate related to PD rate were age &amp;gt; 65 years (OR 2.99 [1.84-4.85]), Charlson index (OR 1.19 [1.07-1.33]), and the type of microorganism: fungus (OR 9.8 [4.16-23.43], multi-bacterial (OR 7.97 [0.91-69.88] and gram- negative OR (2.41 [1.45, 3.99]). Comparing patients who developed peritonitis (P) (N = 1230) vs patients who not developed peritonitis (NP) (N = 1807), P patients were older (P 59 ± 15.5 years vs NP 55 ± 15.5 years, p &amp;lt; 0.001) and associated higher comorbidity (such as Charlson index, cardiovascular and diabetes mellitus history) than NP patients. P patients more commonly had a prior history of renal replacement therapy (kidney transplant P 9.2% vs NP 6.9% and hemodialysis 18.8% vs 17.1%) compared with NP patients. PR has significantly decreased over three consecutive 5-year periods: from 0.51 [0.48-0.54] peritonitis cases per year during 2003-2008 to 0.45 [0.43-0.48] during 2009-2014 (p 0.03), and further dropping to 0.41 [0.38-0.44] for the period 2015-2020 (p &amp;lt; 0.001). Conclusion Over the past 17 years, the incidence and severity of peritonitis have significantly reduced, despite PD patients becoming older and associated high comorbidities.

#2189 Percutaneous peritoneal dialysis catheter implantation

Abstract Background and Aims There are three main techniques to implant a peritoneal dialysis catheter (PDC): percutaneously, laparoscopically or through open surgery; and current guidelines recommend individualising according to previous abdominal surgeries and anaesthetic risk. Recent metanalysis show the percutaneous technique to be safe, non-inferior in catheter survival, and with an equal incidence in mechanic complications (within &amp;lt;3 months after implantation) and infectious complications (within &amp;lt;1 month after implantation) to laparoscopic technique. On the other side, as the percutaneous PDC implantation is a minimal intervention that requires neither surgery room nor over 24h hospitalisation, it allows for a lower waiting time to PDC implantation, a shorter period until usage, and it's economically efficient. Considering these benefits and its non-inferiority described in the literature, our centre started using this technique since 2018. In this study we analyse our results. Method This is an observational retrospective unicentric study, which included the first PDC implantation in adult patients between January 2019 and August 2023, were we analysed the mechanical and infectious complications associated with the implantation technique. All PDC were double-cuff straight Tenckhoff, placed using Seldinger technique with radioscopy. A single dose of prophylactic antibiotic was used. We considered as mechanic complication all those non-infectious incidences that required repositioning or replacement of the PDC within 3 months of implantation (excluding those patients whose catheter was removed because of kidney transplantation, death by other reasons non related to the procedure, or trespass to haemodialysis); and we considered as infectious complications all those peritonitis diagnosed the first month after implantation. Results We analysed a total of 147 patients, 71.4% were male, mean age was 61 years old, and mean kidney function at implantation time was 11.5 ml/min/1.73 m2. We found a total of 8.1% of mechanical complications (33% required repositioning and 66% required replacement) and 5.4% infectious complications. There were no deaths related to percutaneous PDC technique. Conclusion In this study we observe that mechanic or infectious complications associated with percutaneous PDC technique are similar to those published in the literature: ISPD guidelines recommend the incidence of peritonitis associated to catheter implantation to be less than 5%. And though there is no clear percentage of mechanical complications that are considered acceptable or unavoidable, many studies report a survival of 76-86% PDC at 90 days of implantation in percutaneous and laparoscopic procedures, without significant differences between them.

Clinical characteristics and antibiotic treatment of peritoneal dialysis-associated peritonitis caused by Pseudomonas species: a review of 15 years' experience from southern China.

Although the incidence of peritoneal dialysis-associated peritonitis caused by Pseudomonas is very low, it seriously affects the technique survival of peritoneal dialysis patients. However, there are few studies and reports on Pseudomonas peritonitis in the Chinese mainland area. Therefore, the purpose of this study is to describe the clinical characteristics, the regimens of antibiotic, drug resistance, and outcome of peritoneal dialysis patients in southern China in the past 15 years and summarize the clinical experience in the treatment of Pseudomonas peritonitis.

Effect of two different peritoneal dialysis modalities on wound infection in peritoneal dialysis patients: A meta-analysis.

Peritoneal dialysis(PD) is one of the most efficient methods in end-stage kidney disease, and it is very important for PD to perform well. No research has been conducted to evaluate the effect of various types of PD catheters on the prognosis of post-operative wound complications. While recent meta-analyses are in favour of straight tubing, there is still uncertainty as to whether direct or coiled PD is beneficial. The purpose of this meta-analysis was to compare the efficacy of direct and coiled PD catheters on the incidence of post-operative wound infection, bleeding and peritonitis. A comprehensive search was carried out on three databases, including PubMed and Embase, and a manual search was carried out on the links in the paper. The results showed that the incidence rate of bleeding after operation and the degree of infection among the straight and coiled pipes were compared. The results showed that there were no statistically significant differences in the incidence of post-operative wound infection among straight PD patients with coiled PD (OR, 0.79; 95% CI, 0.58-1.08 p = 0.13). No statistical significance was found in the case of PD with coiled tubing compared with that of straight PD group in wound leakage (OR, 1.17; 95% CI, 0.71-1.93 p = 0.55). No statistically significantly different rates of post-operative peritonitis were observed for coiled tubing compared with straight ones in PD patients (OR, 1.06; 95% CI, 0.78-1.45 p = 0.7). There is no statistical significance on the rate of wound infection, wound leakage and peritonitis among coiled and straight tube in PD.

Palliative long-term abdominal drains vs large volume paracenteses for the management of refractory ascites in end-stage liver disease.

Long-term abdominal drains (LTAD) are a cost-effective palliative measure to manage malignant ascites in the community, but their use in patients with end-stage chronic liver disease and refractory ascites is not routine practice. The safety and cost-effectiveness of LTAD are currently being studied in this setting, with preliminary positive results. We hypothesised that palliative LTAD are as effective and safe as repeat palliative large volume paracentesis (LVP) in patients with cirrhosis and refractory ascites and may offer advantages in patients' quality of life. To compare the effectiveness and safety of palliative LTAD and LVP in refractory ascites secondary to end-stage chronic liver disease. A retrospective, observational cohort study comparing the effectiveness and safety outcomes of palliative LTAD and regular palliative LVP as a treatment for refractory ascites in consecutive patients with end-stage chronic liver disease followed-up at our United Kingdom tertiary centre between 2018 and 2022 was conducted. Fisher's exact tests and the Mann-Whitney U test were used to compare qualitative and quantitative variables, respectively. Kaplan-Meier survival estimates were generated to stratify time-related outcomes according to the type of drain. Thirty patients had a total of 35 indwelling abdominal drains and nineteen patients underwent regular LVP. The baseline characteristics were similar between the groups. Prophylactic antibiotics were more frequently prescribed in patients with LTAD (P = 0.012), while the incidence of peritonitis did not differ between the two groups (P = 0.46). The incidence of acute kidney injury (P = 0.014) and ascites/drain-related hospital admissions (P = 0.004) were significantly higher in the LVP group. The overall survival was similar in the two groups (log-rank P = 0.26), but the endpoint-free survival was significantly shorter in the LVP group (P = 0.003, P < 0.001, P = 0.018 for first ascites/drain-related admission, acute kidney injury and drain-related complications, respectively). The use of LTAD in the management of refractory ascites in palliated end-stage liver disease is effective, safe, and may reduce hospital admissions and utilisation of healthcare resources compared to LVP.

L-fucose and fucoidan alleviate high-salt diet-promoted acute inflammation.

Excessive salt intake is a widespread health issue observed in almost every country around the world. A high salt diet (HSD) has a strong correlation with numerous diseases, including hypertension, chronic kidney disease, and autoimmune disorders. However, the mechanisms underlying HSD-promotion of inflammation and exacerbation of these diseases are not fully understood. In this study, we observed that HSD consumption reduced the abundance of the gut microbial metabolite L-fucose, leading to a more substantial inflammatory response in mice. A HSD led to increased peritonitis incidence in mice, as evidenced by the increased accumulation of inflammatory cells and elevated levels of inflammatory cytokines, such as tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), and monocyte chemotactic protein-1 (MCP-1, also known as C-C motif chemokine ligand 2 or CCL2), in peritoneal lavage fluid. Following the administration of broad-spectrum antibiotics, HSD-induced inflammation was abolished, indicating that the proinflammatory effects of HSD were not due to the direct effect of sodium, but rather to HSD-induced alterations in the composition of the gut microbiota. By using untargeted metabolomics techniques, we determined that the levels of the gut microbial metabolite L-fucose were reduced by a HSD. Moreover, the administration of L-fucose or fucoidan, a compound derived from brown that is rich in L-fucose, normalized the level of inflammation in mice following HSD induction. In addition, both L-fucose and fucoidan inhibited LPS-induced macrophage activation in vitro. In summary, our research showed that reduced L-fucose levels in the gut contributed to HSD-exacerbated acute inflammation in mice; these results indicate that L-fucose and fucoidan could interfere with HSD-promotion of the inflammatory response.

The association between albumin levels, platelet-to-albumin ratio, and the likelihood of peritonitis occurrence in individuals undergoing peritoneal dialysis

BACKGROUND: Since albumin and platelet had been reported to govern the risk of infection, their impact in the case of peritoneal dialysis (PD) – related peritonitis should be investigated. OBJECTIVES: To assess the association between albumin levels and platelet – to – albumin ratio and the risk of PD-related peritonitis. METHODS: We conducted a retrospective study in Saiful Anwar General Hospital, Malang, Indonesia during July 2019 and July 2021. Data related to albumin levels and platelet – to – albumin ratio as well as the incidence of PD-related peritonitis were collected from medical record using a standardized pilot form. The association between the albumin levels and platelet – to – albumin ratio and the risk of PD-related peritonitis was analyzed using multiple logistic regression. RESULTS: We included 123 PD patients during study period. Of them, 20 patients were PD-related peritonitis. Our study found that lower albumin levels were associated with increased risk of PD-related peritonitis with the mean difference was -0.30 (MD: -0.30; 95%CI: [-0.55], [-0.05]). We also found that platelet – to – albumin ratio was observed higher in PD-related to peritonitis compared to control (MD: 14420.10; 95%CI: 832.08, 28008.12). However, the role of albumin levels and platelet – to – albumin ratio had weak association to the risk of PD-related peritonitis with the area under curve were 61% and 59%, respectively. CONCLUSION: Our study provides the preliminary data regarding the potential role of albumin and platelet – to – albumin ratio for predicting the risk of PD-related peritonitis. However, further large – scale study should be performed to reclarify our findings.

Uptake and Outcomes of Peritoneal Dialysis among Aboriginal and Torres Strait Islander People: Analysis of Registry Data

Peritoneal dialysis (PD) enables people to use kidney replacement therapy (KRT) outside of healthcare-dependent settings, a strong priority of Aboriginal and Torres Strait Islander people. We undertook an observational study analyzing registry data to describe access to PD and its outcome as the first KRT among Aboriginal and Torres Strait Islander people between January 1, 2004 and December 312020. Out of 4604 Aboriginal and Torres Strait Islander people, reflecting 10.4% of all Australians commencing KRT, PD was the first KRT modality among 665 (14.4%). PD utilization was 17.2% in 2004 to 2009 and 12.7% in 2016 to 2020 (P= 0.002); 1105 episodes of peritonitis were observed in 413 individuals, median of 3 (interquartile range [IQR], 2-5) episodes/patient. The crude peritonitis rate was 0.53 (95% confidence interval [CI], 0.50-0.56) episodes/patient-years without any significant changes over time. The median time to first peritonitis was 1.1 years. A decrease in the peritonitis incidence rate ratio (IRR) was observed in 2016 to 2020 (IRR, 0.63 [95% CI, 0.52-0.77], P< 0.001) compared to earlier eras (2010-2015: IRR, 0.90 [95% CI, 0.76-1.07], P= 0.23; Ref: 2004-2009). The cure rates decreased from 80.0% (n= 435) in 2004 to 2009, to 70.8% (n= 131) in 2016 to 2020 (P< 0.001). Aboriginal and Torres Strait Islander people who utilized PD as their first KRT during 2004 to 2020 recorded a higher peritonitis rate than the current benchmark of 0.4 episodes/patient-years. The cure rates have worsened recently, which should be a big concern. There is an exigent need to address these gaps in kidney care for Aboriginal and Torres Strait Islander people.