Peritonitis Rate Research Articles

Implementation of artificial intelligence Chatbot in peritoneal dialysis nursing care: Experience from a Taiwan medical center.

Coronavirus disease pandemic makes high requirements in delivering remote and efficient communication, and patient education. Because of the increases of digital and social media applications in Taiwan, we aim to apply Artificial Intelligence of LINE Chatbot to improve the self-care ability of patients undergoing peritoneal dialysis. We conducted the project since 1 May 2021 to 30 April 2022. We designed an automatically replied Chatbot system, and divided into six scopes of interaction interfaces, including peritoneal dialysis technique operation video, clinical reminder, home caring, hospital registration service, dietary guideline, and Automatic Peritoneal dialysis guidance. We surveyed patients' satisfaction with the LINE Chatbot 3 months later by the Likert 1-5 score-based questionnaire and the higher score indicated higher satisfaction. There were 440 patients who joined the PD AI Chatbot study and use the Chatbot, but the satisfaction questionnaire recovery rate was only 297 patients. We found that 91.7% of participants agreed 'Overall satisfaction with patient intelligent Chatbot application'. More than 4 points accounted for 86.6%. We traced every click in each section of the Chatbot and explored the potential scenario patients face. The Chatbot statistically significant reduced infection rate of exit site and tunnel infection before using (p = .049 and .024). Furthermore, peritonitis rate decreased from 0.93 to 0.8/100 patient month after using Artificial Intelligence technique. Peritoneal dialysis Artificial Intelligence Chatbot had similar effect with face-to-face education. The innovative Chatbot allowed delivering remote and digital information's to improve patients' self-care ability. Peritoneal dialysis patients were highly recognized and satisfied with the tools. It deserves to further explore the long-term impact of Artificial Intelligence Chatbot in peritoneal dialysis care.

Peritoneal Dialysis Patient Training Program to Enhance independence and Prevent Complications: A Scoping Review.

Peritoneal dialysis (PD) training is essential to ensure patient independence and prevent life-threatening complications, such as peritonitis. The International Society for Peritoneal Dialysis (ISPD) recommends that every PD unit worldwide implement local PD training programs with the goal of improving self-care capabilities. This scoping review aims to give an overview of recent literature and recommendations on PD training programs aiming to improve the quality of care and outcomes for PD patients. The literature search was conducted using the PC (Population, Concept) approach. The population of interest in this study is PD patients, and the study concept is the PD training program. Several databases were used to conduct the literature search, including PubMed, Science Direct, and CINAHL. The search process began from July 2022 until January 2023. The inclusion criteria for the search included research articles and recommendations. The search yielded 22 articles recommending training programs lasting from 5-8 days, with 1-3-hour sessions and a nurse-to-patient ratio of 1:1. A cumulative training time of 15 hours or more is recommended to enhance patient independence and reduce peritonitis rates. Home-based or in-unit PD training, conducted by experienced nurses using adult learning strategies, has shown significant value in improving self-care and preventing peritonitis. Evaluating training outcomes should encompass knowledge, skills, and attitudes, and the impact on peritonitis rates. Training programs should be flexible and consider physiological and psychosocial barriers to achieving the best results. There are a variety of strategies for dialysis training concerning duration, session length, patient-to-trainer ratio, timing, methods, location, compliance, and the need for retraining. More evidence is needed to assess the impact of PD patient training programs on self-care capabilities and peritonitis incidence. Future studies should investigate the effects of training programs on compliance, self-efficacy, and patient and nurse perspectives.

A retrospective clinical and economic analysis of an assisted automated peritoneal dialysis programme in Western Australia .

Assisted peritoneal dialysis (aPD) represents an alternative kidney replacement therapy for dialysis-dependent patients whose only other options are prolonged hospitalisations or transfer to in-centre haemodialysis (HD). Most programmes have not examined the role of temporary aPD, and there is limited data surrounding the economic implications of temporary aPD programmes. The main aim of this study was to describe the cost-effectiveness of an assisted automated peritoneal dialysis (aAPD) programme, for patients whose only reason to stay in hospital was the temporary inability to independently perform PD at home. Retrospective, single-centre analysis of 45 referrals for aAPD from November 2015 to May 2021. Two groups of patients were enrolled in the study: respite patients already established on PD (to facilitate discharge or prevent admission) and new patients who were not yet trained (to facilitate discharge). To calculate the cost differential, patients were allocated to either staying in hospital or transferring to centre-based HD with comparison to costs on aAPD. Costs were calculated using a healthcare system perspective over the duration of aAPD assistance. Clinical outcomes including peritonitis rate, hospitalisation and mortality were also assessed. Overall, 1349 episodes of aAPD care were delivered. One thousand forty-two episodes (77%) were for respite patients and 307 episodes (23%) were for new patients awaiting training. The mean duration of assistance was 18 days for pretraining patients and 37 days for respite patients. Overall, the mean length of stay on the programme was 30 days with a range of 1-263 days (SD 43) and 73% of patients graduated to self-care PD. The cost of the aAPD programme was $242 per visit, with an average cost $7260 per patient-episode. The aAPD programme was significantly cheaper than the alternatives, with average hospitalization costs $46,170 per episode, and in-centre HD costs of $9667. $1.497 million was saved over the course of the study. Eleven hospitalisations occurred and the peritonitis rate was 0.8 episodes per patient-year. Two patients died while on aAPD. This study provides the first detailed description of an aAPD respite programme in Australia. We conclude that the implementation of a temporary aAPD programme could lead to a significant reduction in healthcare costs, however peritonitis rates were high.

Enhancing healthcare quality and outcomes for peritoneal dialysis patients in Thailand: An evaluation of key performance indicators and PDOPPS cohort representativeness.

To assess whether the peritoneal dialysis (PD) centres included in the Peritoneal Dialysis Outcomes and Practise Patterns Study (PDOPPS) in Thailand are representative of other PD centres in the country, based on 8 key performance indicators (KPIs 1-8). A retrospective analysis was conducted comparing PD-related clinical outcomes between PD centres included in the PDOPPS (the PDOPPS group) and those not included (the non-PDOPPS group) from January 2018 to December 2019. Logistic regression analysis was used to identify predictors associated with achieving the target KPIs. Of 181 PD centres, 22 (12%) were included in the PDOPPS. PD centres in the PDOPPS group were larger and tended to serve more PD patients than those in the non-PDOPPS group. However, the process and outcome KPIs (KPIs 1-8) were comparable between the 2 groups. Large hospitals (≥120 beds), providing care to ≥100 PD cases and having experience for >10 years were independent predictors of achieving the peritonitis rate target of <0.5 episodes/year. Most PD centres in Thailand showed weaknesses in off-target haemoglobin levels and culture-negative peritonitis rate. The PD centres included in Thai PDOPPS were found to be representative of other PD centres in Thailand in terms of clinical outcomes. Thus, Thai PDOPPS findings may apply to the broader PD population in Thailand.

Constipation and clinical outcomes in peritoneal dialysis: Results from Thailand PDOPPS.

Patient-reported outcome measures (PROMs) are widely recognized as valuable predictors of clinical outcomes in peritoneal dialysis (PD). Our study aimed to explore the connections between patient-reported constipation and clinical outcomes. We assessed constipation in patients across 22 facilities participating in the Thailand Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) from 2014 to 2017. Constipation diagnosis utilized objective assessment tools such as the Bristol stool form scale (BSFS) and a self-reported questionnaire known as the constipation severity score (CSS). The BSFS is a 7-level scale that visually inspects feces based on texture and morphology, while the CSS measures constipation duration and severity using a 5-point Likert scale for various factors. We employed Cox proportional hazards model regression to determine the associations between constipation and clinical outcomes, including mortality, hemodialysis (HD) transfer and peritonitis. Among 975 randomly selected PD patients from 22 facilities, 845 provided written informed consent, and 729 completed CSS questionnaire. Constipation was prevalent in the PD population (13%), particularly among older patients, those who were caregiver dependent, had diabetes and poorer nutritional status (indicated by lower time-averaged serum albumin, potassium, creatinine and phosphate concentrations). Twenty-seven percent of which experiencing symptoms of constipation for over a year. Notably, self-reported constipation at baseline was significantly associated with a shorter time to first peritonitis and higher rates of peritonitis and death. However, no significant association was found between constipation and HD transfer after adjusting for various factors, including age, gender, PD vintage, comorbidities, shared frailty by study sites and serum albumin. Patient-reported constipation independently correlated with increased risks of peritonitis and all-cause mortality, though no such correlation was observed with HD transfer. These findings underscore the need for further investigation to identify effective interventions for constipation in PD patients.

Components of peritonitis preventive self-care education programs associated with self-care knowledge and behavior among patients undergoing peritoneal dialysis in Japan: a cross-sectional study

BackgroundPreventing peritoneal dialysis (PD)-associated peritonitis remains a major concern in continuing safe treatment and improving patient quality of life. This study aimed to determine the self-care education and quality care initiatives performed for patients undergoing PD and explored their association with patient self-care knowledge and behavior regarding peritonitis prevention.MethodsA nationwide cross-sectional survey was conducted with PD patients and their nurses in Japanese hospitals as respondents. Nurses provided the regular practice of self-care education and quality care initiatives for PD patients within the hospital while patients answered questions on their self-care knowledge and behaviors. Multivariate logistic regression analyses were performed to explore the factors of patients’ self-care knowledge and behaviors.ResultsWe analyzed data on 170 patients (mean age: 65.1 years old) matched with those of 58 nurses from 58 hospitals. Although most educational contents were taught, teaching methods varied; evaluating patients’ learning levels and re-educating during follow-up periods were less frequently performed. As for quality care initiatives, 60% of hospital nurses monitored peritonitis rates, 33% shared peritonitis-associated information with relevant departments, and 47% had performed home visits before PD patients' discharge in the past. The factors of patients’ self-care knowledge include nurses’ re-educating during follow-ups (odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.01–1.22, p = 0.025), sharing information with relevant departments (OR = 1.66, 95% CI = 1.01–2.74, p = 0.047), and patients’ younger age (OR = 0.98, 95% CI = 0.96–1.00, p = 0.019). Hospitals performing home visits and patients’ perceived social support were associated with both self-care knowledge (OR = 1.16, 95% CI = 1.01–1.34, p = 0.038 and OR = 1.33, 95% CI = 1.10–1.61, p = 0.003, respectively) and behavior (OR = 1.29, 95% CI = 1.02–1.64, p = 0.031 and OR = 1.61, 95% CI = 1.14–2.28, p = 0.007, respectively).ConclusionsRe-education during follow-up visits, sharing information, and home visits before discharge may benefit patients in promoting peritonitis preventive self-care.

Assessment of potential peritonitis risk factors in pediatric patients receiving maintenance peritoneal dialysis.

Many recommendations regarding peritonitis prevention in international consensus guidelines are opinion-based rather than evidence-based. The aim of this study was to examine the impact of peritoneal dialysis (PD) catheter insertion technique, timing of gastrostomy placement, and use of prophylactic antibiotics prior to dental, gastrointestinal, and genitourinary procedures on the risk of peritonitis in pediatric patients on PD. We conducted a retrospective cohort study of pediatric patients on maintenance PD using data from the SCOPE collaborative from 2011 to 2022. Data pertaining to laparoscopic PD catheter insertion (vs. open), gastrostomy placement after PD catheter insertion (vs. before/concurrent), and no prophylactic antibiotics (vs. yes) were obtained. Multivariable generalized linear mixed modeling was used to assess the relationship between each exposure and occurrence of peritonitis. There was no significant association between PD catheter insertion technique and development of peritonitis (aOR = 2.50, 95% CI 0.64-9.80, p = 0.19). Patients who had a gastrostomy placed after PD catheter insertion had higher rates of peritonitis, but the difference was not statistically significant (aOR = 3.19, 95% CI 0.90-11.28, p = 0.07). Most patients received prophylactic antibiotics prior to procedures, but there was no significant association between prophylactic antibiotic use and peritonitis (aOR = 1.74, 95% CI 0.23-13.11, p = 0.59). PD catheter insertion technique does not appear to have a significant impact on peritonitis risk. Timing of gastrostomy placement may have some impact on peritonitis risk. Further study must be done to clarify the effect of prophylactic antibiotics on peritonitis risk. A higher resolution version of the Graphical abstract is available as Supplementary information.

Pediatric peritoneal dialysis training program andits relationship to peritonitis: a study of the International Pediatric Peritoneal Dialysis Network.

The guidelines for training of patients and caregivers to perform home peritoneal dialysis (PD) uniformly include recommendations pertaining to the prevention of peritonitis. The objective of this study conducted by the International Pediatric Peritoneal Dialysis Network (IPPN) was to investigate the training practices for pediatric PD and to evaluate the impact of these practices on the peritonitis and exit-site infection (ESI) rate. A questionnaire regarding details of the PD program and training practices was distributed to IPPN member centers, while peritonitis and ESI rates were either derived from the IPPN registry or obtained directly from the centers. Poisson univariate and multivariate regression was used to determine the training-related peritonitis and ESI risk factors. Sixty-two of 137 centers responded. Information on peritonitis and ESI rates were available from fifty centers. Training was conducted by a PD nurse in 93.5% of centers, most commonly (50%) as an in-hospital program. The median total training time was 24hours, with a formal assessment conducted in 88.7% and skills demonstration in 71% of centers. Home visits were performed by 58% of centers. Shorter (< 20hours) training duration and lower number of training tools (both p < 0.02) were associated with higher peritonitis rate, after adjustment for proportion of treated infants and income of country of residence. An association between training duration and the number of training tools represent potentially modifiable risk factors to reduce peritonitis rates within the pediatric PD population. A higher resolution version of the Graphical abstract is available as Supplementary information.

#5871 PERITONEAL DIALYSIS INFECTIONS IN MALTA: AN OVERVIEW OF THIRTEEN YEARS

Abstract Background and Aims Peritoneal dialysis (PD)-related infections are still associated with an increased risk of morbidity and mortality. We describe an overview of PD peritonitis and catheter-related infection (CRI) rates in Malta over a period of thirteen years. Method All patients undergoing PD in Malta from 2008 to 2020 were included. Data from 2008 to 2012 was retrospective (shown as mean), whilst data from 2013 to 2020 was prospective. ISPD guidelines and definitions were followed. Results Study population sizes from 2008 to 2020 were as follows: 137 (2008-2012), 91, 80, 126, 117, 102, 103, 101, and 101 respectively. PD peritonitis rates from 2008 to 2020 were 0.38, 0.31, 0.35, 0.46, 0.43, 0.57, 0.54, 0.43, 0.39, 0.40, 0.46, 0.37, and 0.29 episodes/patient/year respectively. Gram-positive peritonitis episodes predominated, the majority of which were Staphylococcal infections. Methicillin-resistant Staphylococcus aureus (MRSA) rates have overall decreased from 0.03 episodes/patient in 2008–2012 to 0.01 episodes/patient in 2020, to no cases in 2016, 2017 and 2019. Coagulase-negative Staphylococcal (CNS) rates also decreased from 0.26 episodes/patient in 2013 to 0.03 in 2017, 0.11 in 2018, 0.04 in 2019, and 0.08 in 2020. With regards to Gram-negative peritonitis, Pseudomonas rates declined from 0.06 episodes/patient in 2008–2012 to 0.03 in 2018. No cases were recorded in 2016, 2019 and 2020. The rate of Escherichia coli-associated peritonitis was 0.03 episodes/patient/year in 2020, and no cases were found in 2016, 2017, 2018, and 2019. Fungal peritonitis rates varied from 0.03 in 2008–2012 to 0.01 episodes/patient/year in 2013, 2018, 2019 and 2020 with no cases being recorded in 2016 and 2017. CRI rates were as follows: 0.39 (2008-2012), 0.35, 0.91, 0.37, 0.38, 0.25, 0.50, 0.29, and 0.22 episodes/patient/year respectively. The incidence of Gram-negative infections from 2013 to 2020 was 49, 51, 52, 65, 58, 66, 48, 41% respectively, with an average rate of 54%. Gram-positive CRIs were mostly Staphylococcal, peaking in 2014 at 0.38 episodes/patient, down to 0.14 in 2019, and 0.10 in 2020. MRSA rates decreased from 0.15 episodes/patient/year in 2014 to 0.01 in 2018, no cases in 2019, and 0.04 in 2020. CRI Pseudomonas rates have overall improved from 0.12 (2008-2012), to 0.06, 0.09, 0.09, 0.14, 0.03, 0.17, 0.06, 0.04 episodes/patient/year from 2013 to 2020. Conclusion The Maltese PD cohort has been achieving ISPD target requirements. Both PD peritonitis and catheter-related infection rates declined over the last thirteen years. There was no MRSA peritonitis in 2016, 2017 and 2019, no Pseudomonas peritonitis in 2016, 2019 and 2020, no E. coli in 2016,2017, 2018 and 2019 and no fungal PD peritonitis in 2016 and 2017. Overall CRIs were predominantly Gram-negative, but not in 2019 and 2020.

#3281 SAFETY AND EFFICACY OF VIRTUAL OUTPATIENT NEPHROLOGY CONSULTATION IN THE NORTHERN ALBERTA RENAL PROGRAM

Abstract Background and Aims There is a growing awareness among Canadian health care providers of the need to incorporate virtual consultations safely and effectively post pandemic. With the onset of the Covid-19 pandemic in March 2020, outpatient consultation in Northern Alberta Renal Program (NARP) was rapidly transitioned to virtual delivery (telephone or videoconferencing) in place of face-to-face visits. To scale up and sustain virtual consultation in kidney care programs, its safety and effectiveness in improving processes of care (reduced wait time and access to care) and patient-related outcomes must be established. Data establishing safety and effectiveness of virtual consultation in kidney care has been limited. We therefore aimed to evaluate the safety and effectiveness of virtual consultation in patients with advanced CKD or peritoneal dialysis (PD) being cared for in NARP. Method The study was conducted in NARP (one of the largest kidney care programs in Canada). The study populations comprised two categories of patients with kidney disease: 1) CKD (non-dialytic) being followed in the ambulatory care clinics and 2) chronic PD patients being followed up in a dedicated home dialysis clinic at 3-monthly intervals. Data were collected over two-time points, pre and post implementation of virtual kidney following the COVID-19 pandemic: March 2019-February 2020 (pre-implementation), and March 2020- February 2021 (post implementation). We were only allowed to collate data on the processes of care outcomes for CKD (clinic cancellations or no-shows, wait times to see a nephrologist from the point of referral and number of visits), and adverse clinical outcomes (peritonitis rates, all-cause hospitalizations, technique failure, defined as PD failure with transition to hemodialysis) for the patients on PD. Summary statistics and tests of associations applied as appropriate. Interrupted time series analyses were used to evaluate trends. All analyses were conducted using (STATA 15 software (Stata Corporation, 2017). The study was approved by the University of Alberta Research Ethics Board. Results In patients on PD, the studied outcome measures were not significantly impacted (no changes in the trend) pre and post virtual care implementation (Figs 1a-c). The absolute number of clinic visits in patients on PD did not change (data not shown). In the patients with CKD, there were significant reductions in the rate of clinic cancellations/no-show rates (Fig. 2a), and a reduction in wait time (by a median of two weeks) following virtual care implementation (Fig. 2b). The rates of clinic visits pre and post implementation did not change (Fig. 2c) Conclusion The implementation of virtual consultation with the onset of COVID-19 pandemic (and the attendant reduction in face-to-face contacts with patients) did not negatively impact the care of patients on PD regarding risk for adverse clinical outcomes (peritonitis rates, all-cause hospitalizations, and technique failure). In patients with CKD, implementation of virtual care has led to significant improvements in the processes of care (reduction in wait times and enhanced access to care). These findings have implications in the design of sustainable virtual care programs for delivery of specialized kidney care in both dialysis and non-dialytic CKD in Canada and beyond.

#5992 PERITONEAL DIALYSIS-RELATED PERITONITIS: A SINGLE CENTER EXPERIENCE

Abstract Background and Aims Peritonitis is a common and severe complication in Continuous ambulatory peritoneal dialysis (CAPD). A high peritonitis rate affects PD patients’ technique survival and mortality. The aim of this retrospective study is to assess epidemiological aspects, microbiology presentation with antibiotic resistance and clinical outcomes for patients with acute CAPD peritonitis during 5-year period. Method The study included all patients treated by CAPD between the 1st of January 2017 and 1st of January 2022 in the Clinical Hospital Center Zvezdara. We included prevalent patients on CAPD, and analyzed demographic, clinical and microbiological data, and patient's outcomes during 5 year period. The data was collected from patient records, medical history and processed in SPSS. Results This study included 119 patients treated by PD of which 24 (8.13%) had one or more acute episodes of CAPD peritonitis in the designated period. The mean age of the population was 69±9 year, 54% were male, 20% had diabetes mellitus and 60% arterial hypertension as cause of end stage renal disease. During follow up it was diagnosed 41 episodes of CAPD peritonitis. The main characteristics of patients with peritonitis were turbid liquid (100 %), abdominal pain (73 %) and fever (43 %). Gram staining revealed that 53 % were gram-positive, and 10 % were gram-negative. The most frequent bacterial specimen was Staphylococcus epidermidis (11) followed by Streptococcus viridans (6), sterile culture (9), Staphylococcus aureus (3) and other organisms less than 2 episodes. The peritonitis rate was 1 episode per 27.36 patient-months, or 0.44 episodes per patient year. Resistance to Ampicillin and Penicillin occurred most often. In 2 patients, PD peritonitis was present once each, with multi-resistant bacteria: Klebsiella pneumoniae which was treated with parenteral administration of Tigacycline and Methicillin-resistant Staphylococcus aureus (MRSA) which was treated with parenteral administration of Moxifloxacin and Clindamycin. Out of 24 patients, 2 (8.33%) had 4 episodes of peritonitis, 3 (12.5%) had 3 episodes of peritonitis, 6 (25%) had 2 episodes of peritonitis, and the rest (54.16%) were had only one each. Only one patient had an episode of relapsing peritonitis. During 5-year period, 1 (4%) patient died of acute CAPD peritonitis caused by Proteus mirabilis, 7 (29%) died of other causes, 11 (46%) were transferred to hemodialysis and 5 (21%) are still receiving treatment by CAPD modality. CAPD peritonitis was the reason for technical failure in 20% patients. Conclusion PD-associated peritonitis is serious infective complication which could influence the outcome of PD patients, including technique survival. The rate and outcomes of peritonitis in our patients were slightly above of current recommendations.

#4264 PERITONEAL DIALYSIS AFTER FAILED KIDNEY TRANSPLANT: A SUITABLE OPTION

Abstract Background and Aims Despite great advances in graft survival, kidney transplant (KT) recipients frequently return to dialysis. The aim of this study was to perform an analysis of peritoneal dialysis (PD) outcomes of patients with a failed KT. Method Single-center retrospective cohort study with end-stage renal disease (ESRD) patients who started PD from 1st January 2010 to 31st December 2017. Two groups were analyzed - patients who started PD with no previous renal replacement therapy (RRT) - PD first -, and patients who transitioned directly from a failed kidney transplant. Results Among 152 patients who started PD, 115 were PD first and 15 transitioned from KT. The population included 63,1% of male gender, with a mean age of 52,4 ± 15,5 years and had PD median vintage of 30 months (IQR 20,6). Patients who transitioned from KT were significantly younger (mean age 42,8 ± 14,3 vs. 53,7 ± 15,3, p = 0,015) and had lower prevalence of diabetes mellitus (13,3% vs. 40,0%, p = 0,044). In KT patients, glucocorticoids were continued until there was residual diuresis and non-glucocorticoid immunosuppression was maintained for a median of 180 days (± 176) after PD start. Nearly a third (30,0%) of patients had no hospitalizations and 35,5% had more than 2 hospital admissions. Annual hospitalization rate was higher in prior KT group (1,40 vs. 0,48, p = 0,002). Prior KT associated with higher annual peritonitis rate (0,70 vs. 0,20, p = 0,017). A higher number of MACE was also observed in prior KT group (33,3% vs. 7,9%, p = 0,004). Residual diuresis was significantly lower in the group with previous KT. Neither ultrafiltration failure (6,7% vs. 9,9%, p = 0,974), nor technique survival (death or hemodialysis transfer 53,3% vs. 54,8%, p = 0,917; logrank 0,354) were different between groups. Conclusion Although higher incidence of diabetes mellitus was observed in PD first group, no differences were identified in ultrafiltration failure rates between groups. Despite significantly lower diuresis in prior KT group, both groups had adequate dialysis efficacy (mean Kt/V&amp;gt;1,7) and similar technique survival. Higher peritonitis rate and MACE incidence was observed in prior KT group, possibly associated with maintenance immunosuppression. Nevertheless, PD is a valid choice for RRT after a failed KT and should be offered to these patients.

#4939 EFFECTS OF PREVIOUS HEMODIALYSIS TREATMENT ON PERITONEAL DIALYSIS OUTCOMES

Abstract Background and Aims Patients with end-stage renal disease (ESRD) frequently need to change dialysis modality. While the transition from peritoneal dialysis (PD) to hemodialysis (HD) is not an uncommon occurrence, the opposite is less frequent and much less studied. The aim of this study was to compare the outcomes of patients who started renal replacement therapy (RRT) with PD and patients who transitioned from HD to PD. Method Retrospective single-center cohort study with patients who started PD between 1st January 2010 and 31st December 2017, with a median follow-up of 60 months. Patients were separated in two groups, one where the initial RRT was PD (“PD first”) and another who transitioned from HD to PD (“Previous HD”). Clinical outcomes (complications during PD, technique failure, hospitalizations) and dialysis adequacy were compared between the two groups. Results Among the 137 patients included in this study, 22 transitioned directly from HD and 115 were PD first. The population included 63,7% of male gender, with a mean age of 52,9 ± 14,6 years and a mean Charleston score of 4,4 ± 2,2. Sixty percent had diabetes and 65,2% had hypertension. Median time on PD was 112,7 months (IQR 44,2). Patients who transitioned from HD had lower residual diuresis both at start of PD (1153 ± 920 vs. 1880 ± 924; p &amp;lt; 0,007) and at the end of follow-up (750 ± 1074 vs. 1252 ± 836; p &amp;lt; 0,037). A higher rate of UF failure was observed in patients who transitioned from HD (30,1% vs. 10,9%; p = 0,036). Annual rate of peritonitis and hospitalization was the same between groups. Technique failure (death or hemodialysis transfer) was not different between groups (52,1% vs. 53,6%, p = 0,903; logrank 0,301). Conclusion Residual diuresis was lower in the group that was previously in HD, which might be explained by the negative impact of HD in the preservation of renal residual function. Despite comparable DM prevalence and similar rates of PD-related infections a greater proportion of previous HD patients developed UF failure. Previous HD can predict a more complex volemic control in PD because of a lower residual renal function. Despite that, technique failure, hospitalizations, infections and outcomes at end of follow-up were similar in both groups. PD can be considered a viable dialysis technique in terms of outcomes in patients transferred from HD. Table 1:Analysis of HD first versus PD first groups.VariableTotal (n = 135)Previous HD (n = 22)PD first (n = 113)P-valueGender (male), n (%)86 (63.7)14 (60.9)72 (64.3)0.756Age at start of PD (years) (a)52.9 ± 14.652.0 ± 15.553.0 ± 14.60.772Time in PD (months) (a)112.7 ± 44.297.7 ± 56.2115.2 ± 41.60.107Hypertension, n (%)88 (65.2)11 (47.8)77 (68.8)0.055Diabetes, n (%)54 (60)10 (43.5)44 (39.3)0.709Charleston Score (a)4.4 ± 2.24.6 ± 2.34.3 ± 2.20.519PD adequacyKtV at PD start (a)2.7 ± 0.82.5 ± 0.72.7 ± 0.90.201KtV at end of follow-up (a)2.1 ± 0.61.9 ± 0.72.1 ± 0.60.250Residual diuresis at PD start (mL/24h) (a)1769 ± 9551153 ± 9201880 ± 9240.007Residual diuresis at end of follow-up (mL/24h) (a)1175 ± 889750 ± 10741252 ± 8360.037UF failure, n (%)17 (14)6 (30.1)11 (10.9)0.036ComplicationsAnnual peritonitis rate (a)0.1 ± 0.20.1 ± 0.30.1 ± 0.20.855Annual exit tunnel infections rate (a)0.0 ± 0.10.0 ± 0.10.0 ± 0.10.845Annual tunnel infections rate (a)0.0 ± 0.00.0 ± 0.00.0 ± 0.00.890Annual hospitalizations rate (a)0.2 ± 0.50.2 ± 0.50.2 ± 0.50.955Outcomes at end of follow-up, n (%)0.071 PD maintenance31 (23)4 (17.4)27 (24.1) HD transfer52 (38.5)5 (21.7)47 (42) Kidney transplantation29 (21.5)7 (30.4)22 (19.6) Death20 (14.8)7 (30.4)13 (11.6) Loss of follow-up3 (2.2)0 (0)3 (2.7)

#4850 20 YEARS' EXPERIENCE OF PERITONEAL DIALYSIS IN SARAWAK, MALAYSIA

Abstract Background and Aims Peritoneal dialysis is a modality of renal replacement therapy first introduced in the 1960s. In the event of the recent COVID 19 pandemic, peritoneal dialysis is gaining popularity due to the increased preference of home dialysis. Sarawak is the largest state in Malaysia with a population of more than 2 million. Unfortunately, 13% of households in the state are living in poverty. We present our experience with continuous ambulatory peritoneal dialysis (CAPD) for the past years in a geographically and socioeconomically challenging region. Method Sarawak General Hospital is the centre of referral for Tenckhoff catheter insertion from other districts in Sarawak. This is a retrospective record review of all CAPD patients who were under our clinic follow up from 2001 to 2022. Data examined included patient's demographic data, incidence of peritoneal dialysis related peritonitis and their outcome. Results All of the patients on CAPD were recorded by December of each year since we started our service in 2001 which shows a rising trend of patients on CAPD, with the highest in December 2022 at 399 patients. The number of patients with dialysis related peritonitis was also collected. Despite having more patients on CAPD, the number of peritonitis episodes per patient-year were in a decreasing trend. This was the result of the implementation of empirical first line intra-peritoneal antibiotics as part of the CAPD Peritonitis Management Protocol in 2015 and Decontamination Protocol in 2016. Conclusion Despite the headwinds of geographic and socioeconomic challenges, the number of patients on CAPD is on the rise. Over the years, peritonitis rate declined approaching to 0.2 episodes per patient-year. This was made possible with the introduction of local decontamination protocol and CAPD peritonitis management protocol, which helped improve the life expectancy and health of renal patients in the region.

#5564 OUTCOMES OF PERITONEAL DIALYSIS AFTER KIDNEY TRANSPLANT FAILURE: A SINGLE-CENTER EXPERIENCE

Abstract Background and Aims There is a hesitation in returning peritoneal dialysis (PD) after kidney transplant (KTx) failure. Studies in larger multicentre matched cohorts are missing. Method We conducted a retrospective study about 19 patients who started PD after KTx failure (PDpostTx group) between January 2010 and August 2022 in Ankara University School of Medicine who were compared with 70 never-transplanted patients having started PD during the same period (PDnoTx group). Patients’ clinical data and PD technique survival as well as peritonitis episodes were analysed. Results Mean age was 51 years and continuous ambulatory PD was the treatment of choice (59.6%) (Table 1). Even the mean time on PD was similar between groups (45.4 months in PDpostTx vs 51.7 months in PDnoTx, p = 0.525), transfer to HD was more common in PDpostTx patients (36.8% vs 10.0%, p = 0.015). The main cause of transfer to HD was ultrafiltration failure, which was significantly higher in PDpostTx group (p = 0.002). Diuresis at baseline was similar between groups, but decreased significantly in PDpostTx group at first year and final follow-up (p &amp;lt; 0.001, and p = 0.001, respectively). Peritonitis was more common in PDpostTx group (68.4% vs 30.0%, p = 0.002). Diabetes mellitus was a risk factor for peritonitis episode (p = 0.012), but we didn’t observe any effect of immunosuppressive therapy on peritonitis and reduction of the diuresis. In multivariate analysis, KTx failure (p = 0.014), peritonitis episodes (p = 0.011) and ultrafiltration failure (p &amp;lt; 0.001) were associated with a higher risk of transfer to HD. Over the study period, patients’ survival was similar between groups (p = 0.766). Conclusion We reported similar patient survival, but higher peritonitis rates and PD technique failure in the PDpostTx group, when compared to patients who started PD for other reasons. Considering these findings, taking precautions against peritonitis is more important for patients who started PD after KTx failure.

#3493 INCIDENCE, PREVALENCE, DEMOGRAPHIC PROFILE, AND CLINICAL OUTCOMES OF PERITONEAL DIALYSIS IN A TERTIARY MEDICAL CENTER IN THE PHILIPPINES

Abstract Background and Aims Chronic Kidney Disease (CKD) has emerged as a global public health burden. As one of the treatment options for CKD-5, peritoneal dialysis is underutilized, accounting for only 11% of the global distribution of renal replacement therapy (RRT). In the Philippines, PD accounts for only 4.2% [1] of all dialysis. This is perplexing because PD has several advantages over hemodialysis including better survival in the first few years of RRT, better survival of PD to HD than HD to PD [2], more cost-effective [3], can be done at home without sophisticated equipment, and feasible in remote areas. This study aims to characterize the incidence, prevalence, demographic profile, and clinical outcomes of the PD patients in our center to uncover strengths, weaknesses, and roadblocks for a stronger “PD First” program in the Philippines. Method Descriptive retrospective chart review of 146 PD patients of the Southern Philippines Medical Center from January 2018 to September 2022. Results There were a total of 146 adult patients enrolled to the PhilHealth PD Z-package from January 2018 to September 2022. Majority of the patients were aged 50-59 years old (20%), followed by 40-49 years old (19%), and 60-69 years old (19%), mostly male (57%). Predominant etiology of CKD-5 was Chronic Glomerulonephritis (41%), followed by Diabetic Nephropathy (30%), and Hypertensive Nephrosclerosis (19%). Incidence rate of PD was 44%, 22%, and 41% for 2019, 2020, and 2021 respectively. The prevalence rate of PD was 64%, 56%, and 59% for 2019, 2020, and 2021 respectively. The PD peritonitis rate was 1.25, 0.4, 0.24, and 0.3 episodes per patient year in 2018, 2019, 2020, and 2021 respectively. Out of the 146 PD patients, 41 (28%) are still on active PD, 1 (0.07%) underwent Kidney Transplantation, 38 (26%) had PD Technique Failure from peritonitis and catheter malfunction, and 66 (46%) expired due to death at home, sepsis, and acute coronary syndrome. Among those who expired, 22 (33%) were PD First and 44 (67%) were shifted from HD. There was a significant difference in the primary outcomes between those who were PD First and shifted from HD, with a p-value of 0.048. Conclusion PD First is infrequently practiced in our center. There is a significant difference in the number of those who were PD First, and those who were shifted from HD. There is a higher rate of mortality among those who were shifted from HD to PD compared to those who were PD First. PD-peritonitis is the number one cause of PD Technique Failure followed by issues with the PD Catheter. To improve the mortality rate of our CKD-5 patients, it is recommended to do PD First, rather than HD to PD, while awaiting transplant.

INCIDENCE, CLINICAL OUTCOME AND CHANGES OF PERITONEAL MEMBRANE TRANSPORT STATUS IN TREATED CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD) RELATED PERITONITIS

Peritoneal dialysis-related peritonitis remains the most common complication and a key barrier to peritoneal dialysis’ long-term success. The present study aimed to report on the incidence of peritonitis and clinical outcomes in CKD patients on CAPD at a hospital in Vietnam’s south and evaluate the peritoneal membrane transport status before and after peritonitis therapy. This study was a cross-sectional study involving 141 participants sampled from the warded adult patients at An Giang center general hospital, in Vietnam. Peritonitis rate was measured in terms of incidences per patient-year. Dialysis fluid was drawn under aseptic conditions and treated using a culture approach to identify bacteria. The response treatment time for each episode of peritonitis after receiving empirical antibiotic medication. We use Peritoneal Equilibration Test (PET) to determine the peritoneal transport status. Peritonitis was found in 29.8% of the cases. The number of episodes of peritonitis per patient-year was 0.035. Negative bacteria account for 81.0 percent of all cases tested. It took an average of 3 to 5 days for a clinical response. Before and after peritonitis, there was no statistically significant connection between transport status groups. The rate of peritonitis identified in this study was significantly lower than that recommended by the International Society for Peritoneal Dialysis (ISPD) recommendations. More research is needed to fully understand the variables that influence the clinical outcomes of peritonitis and the remaining function of the peritoneal membrane.

Training practices and peritonitis rates in children on maintenance peritoneal dialysis: results from the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) collaborative.

Comprehensive training of children on peritoneal dialysis (PD) and their caregivers is crucial to minimize peritonitis risk. Few studies have evaluated the impact of training on infection, so many published recommendations rely on expert opinion. This study uses data from the SCOPE collaborative to examine the impact of compliance with 4 components of PD training on the risk for peritonitis. A retrospective cohort study of children enrolled in the SCOPE collaborative between 2011 and 2021 who received training prior to initiating PD. Compliance with 4 training components were assessed: performance of a home visit, 1:1 training, delaying training ≥ 10days after PD catheter insertion and average individual training session length ≤ 3h. Univariate and multivariable generalized linear mixed modeling were used to assess relationships between peritonitis ≤ 90days after PD training and median days to peritonitis and compliance with each component as well as all-or-none compliance. Among 1450 trainings, 51.7% had median session length ≤ 3h, 67.1% delayed training ≥ 10days after catheter insertion, 74.3% had a home visit and 94.6% had 1:1 training. Only 333 trainings (23%) were compliant with all 4 training components. There was no statistically significant association between compliance with individual components, or all-or-none compliance and either the percentage of catheters with peritonitis ≤ 90days after training end or median days to peritonitis. No associations between 4 PD training components and risk for peritonitis were found. SCOPE requires monthly review of PD catheter practices which may have decreased the impact of training non-compliance. A higher resolution version of the Graphical abstract is available as Supplementary information.

Natural history of anastomotic leakage after elective stoma closure.

Elective stoma closure (ESC) is a common procedure. The main complication of ESC is anastomotic leakage, which can be revealed by peritonitis or an enterocutaneous fistula (ECF). The objective of the present study was to describe the natural history of AL after ESC. Between January 2015 and March 2020, all patients having undergone AL after loop or double-barreled ESC were included in a retrospective, single-center study. The rate of ECF and peritonitis at presentation, the success rate of a conservative treatment and the factors associated with the success of healing of ECF were evaluated. From January 2015 to March 2020, 619 patients underwent a loop or double-barreled ESC in our department. The AL rate was 6.3% (n=39). The leakage was revealed by an ECF in 72% of cases (n=28). The mean±standard deviation time between the stoma closure and the diagnosis of the AL was 6±4 days. Conservative treatment was successful in 24 (85%) of the 28 patients with ECF, with a mean±SD time to recovery of 6.6±9.4 months. In a univariate analysis, none of the conservative treatments was significantly associated with healing of the ECF. AL is not rare and is mainly revealed by an ECF. Although the fistula heals in most cases, both the surgeon and the patient must be aware that the time to recovery is long.

Characteristics and outcomes of hospital-acquired and community-acquired peritonitis in patients on peritoneal dialysis: a retrospective cohort study.

Peritonitis remains a significant complication of peritoneal dialysis. However, there is limited information on the clinical characteristics and outcomes of hospital-acquired peritonitis compared to community-acquired peritonitis in patients undergoing peritoneal dialysis. Furthermore, the microbiology and outcomes of community-acquired peritonitis may vary from hospital-acquired peritonitis. Therefore, the aim was to gather and analyse data to address this gap. Retrospective review of the medical records of all adult patients on peritoneal dialysis within the peritoneal dialysis units in four university teaching hospitals in Sydney, Australia, who developed peritonitis between January 2010 and November 2020. We compared the clinical characteristics, microbiology and outcomes of community-acquired peritonitis and hospital-acquired peritonitis. Community acquired peritonitis was defined as the development of peritonitis in the outpatient setting. Hospital-acquired peritonitis was defined as: (1) developed peritonitis anytime during hospitalisation for any medical condition other than peritonitis, (2) diagnosed with peritonitis within 7days of hospital discharge and developed symptoms of peritonitis within 3days of the hospital discharge. Overall, 904 episodes of peritoneal dialysis-associated peritonitis were identified in 472 patients, of which 84 (9.3%) episodes were hospital-acquired. Patients with hospital-acquired peritonitis had lower mean serum albumin levels compared to those with community-acquired peritonitis(22.95g/L vs. 25.76g/L, p = 0.002). At the time of diagnosis, lower median peritoneal effluent leucocyte and polymorph counts were observed with hospital-acquired peritonitis compared to community-acquired peritonitis (1236.00/mm3 vs. 3183.50/mm3, p < 0.01 and 1037.00/mm3 vs. 2800.00/mm3, p < 0.01, respectively). Higher proportions of peritonitis due to Pseudomonas spp. (9.5% vs. 3.7%, p = 0.020) and vancomycin-resistant Enterococcus (2.4% vs. 0.0%, p = 0.009), lower rates of complete cure (39.3% vs. 61.7%, p < 0.001), higher rates of refractory peritonitis (39.3% vs. 16.4%, p < 0.001) and higher all-cause mortality within 30days of peritonitis diagnosis (28.6% vs. 3.3%, p < 0.001) were observed in the hospital-acquired peritonitis group compared to the community-acquired peritonitis group, respectively. Despite having lower peritoneal dialysis effluent leucocyte counts at the time of diagnosis, patients with hospital-acquired peritonitis had poorer outcomes, including lower rates of complete cure, higher rates of refractory peritonitis and higher rates of all-cause mortality within 30days of diagnosis, compared to those with community-acquired peritonitis.