Analysis of risk factors and outcome in peritoneal dialysis. The influence of duration of peritoneal dialysis therapy on the outcomes of initial and subsequent peritonitis is. Creating and maintaining optimal peritoneal dialysis access in the adult patient. See clinical manifestations and diagnosis of peritonitis in peritoneal dialysis. Studies in children have demonstrated chronic alterations of peritoneal membrane. Enterobacteriaceae peritonitis complicating peritoneal dialysis.
Complications of continuous ambulatory peritoneal dialysis. First peritonitis episode influences peritoneal sizeselectivity to macromolecules in peritoneal dialysis patients anouk t. Peritonitis is a common and severe complication in peritoneal dialysis pd. Diagnosis and management of enteric disease and abdominal. Although certain advancements in technology, such as the y set tubing with. Antifibrotic effect of decorin in peritoneal dialysis and.
Jun 06, 2019 many patients with endstage kidney disease prefer peritoneal dialysis pd to hemodialysis to replace kidney function 1 but avoid pd due to fears of serious complications, such as peritonitis or catheter exit site and tunnel infections, which often have higher incidences than those recommended by the international society for peritoneal dialysis ispd. May 31, 2014 dialysis related peritonitisdialysis related peritonitis diagnosis 2 of 3diagnosis 2 of 3 1. Cefepime as empirical peritoneal dialysisassociated. Peritoneal dialysis pd is a major form of renal replacement. Peritonitis is a major cause of pd technique failure and conversion to longterm hemodialysis 1,5,7,8. Catheter placement and care a tube or catheter is placed through the abdominal muscles. Peritoneal dialysisrelated peritonitis caused by pseudomonas. We report a case of a 52yearold man on pd, who developed refractory polymicrobial peritonitis necessitating pd catheter removal and shift to hemodialysis. Microbiology and therapy of peritonitis in peritoneal. Early onset peritonitis, variously defined in the literature as peritonitis occurring within the first 320 months of pd, is increasingly being recognised as a discrete and important clinical problem with appreciably. Impact of age on peritonitis risk in peritoneal dialysis.
Peritonitis is associated with significant morbidity, catheter loss, transfer to hemodialysis, transient loss of ultrafiltration, possible permanent membrane damage, and occasionally death. Very low rates of peritonitis in a program are possible if close attention is paid to the causes of peritonitis and. Understanding the characteristics and risk factors for peritonitis can guide regional development of prevention strategies. The cause of eosinophilic peritonitis is obscure, however it may be related to some etiologies. Fish, 6 eric goffin, 7 yonglim kim, 8 william salzer, 9 dirk g. Peritoneal dialysis peritoneal dialysis is a treatment used to clean the blood of extra fluid and waste that builds up in the body when the kidneys do not work. Struijk1 1division of nephrology academic medical centre, university hospital and dianet amsterdam the netherlands introduction and aims. Because center variation in pd related peritonitis outcomes and the relative contributions of center and patient effects have not been previously examined, the present study aimed to evaluate the associations of key peritonitis outcomes cure, catheter removal, hd therapy transfer, relapsedrecurrent peritonitis, hospitalization, and mortality with centerlevel characteristics, after. Early onset peritoneal dialysisrelated peritonitis.
Bacteria on catheters in patients undergoing peritoneal dialysis. Prevention of infectious complications in peritoneal. Challenges and solutions article pdf available in international journal of nephrology and renovascular disease volume 11. For capd, several prospective studies confirm that the use of. This study aimed to characterize 27 escherichia coli isolates obtained from peritoneal dialysis pdrelated peritonitis that occurred at the university hospital of botucatu medical school, brazil, between 1997 and 2015. Peritonitis can be associated with pain, hospitalization and catheter loss as well as a risk of death. Peritonitis is a serious and common complication of peritoneal dialysis pd, representing the commonest cause of technique failure and a not infrequent cause of patient death. Many patients with endstage kidney disease prefer peritoneal dialysis pd to hemodialysis to replace kidney function 1 but avoid pd due to fears of serious complications, such as peritonitis or catheter exit site and tunnel infections, which often have higher incidences than those recommended by the international society for peritoneal dialysis ispd. In some outstanding centers, peritonitis rates as low as 0.
Although less than 5% of peritonitis episodes result in death, peritonitis is the direct or major contributing cause of death in around 16% of pd patients 16. Prophylactic antibiotics administered before pd catheter insertion. Incremental peritoneal dialysis may be beneficial for preserving residual renal function compared to fulldose peritoneal dialysis. Peritonitis, an infectious complication of peritoneal dialysis, continues to account. Center effects and peritoneal dialysis peritonitis. Eosinophilic peritonitis in continuous ambulatory peritoneal dialysis capd patients was first reported in 1967. Over the past decades, there have been significant reductions in the incidence of pdrelated. The impact of peritoneal dialysisrelated peritonitis on mortality in. We describe peritonitis rates and the associations of selected facility practices with peritonitis risk among countries participating in the peritoneal dialysis outcomes and practice. Peritoneal dialysisrelated peritonitis treatment recommendations.
Peritonitis is a common and potentially serious infection of patients undergoing continuous ambulatory peritoneal dialysis pd. Peritoneal dialysis outcomes after temporary haemodialysis. Peritoneal dialysisassociated peritonitis american. Setting three peritoneal dialysis pd units in shanghai.
Approximately 20% of peritonitis episodes require cessation of pd and transfer to haemodialysis, although this figure varies depending on the. We report the first case of relapsing dokdonella koreensis peritonitis in a patient on peritoneal dialysis. Antifibrotic effect of decorin in peritoneal dialysis and pd. Peritoneal dialysis pdrelated peritonitis carries high morbidity for pd patients. Double bag or y set versus standard transfer systems for continuous ambulatory peritoneal dialysis in endstage renal disease. Peritoneal dialysis remains a pivotal and effective dialysis modality that provides many benefits to both patients and the dialysis healthcare system. Our results from in vitro experiments show that decorin has antifibrotic properties and counters the profibrotic effects of pd fluid, tgf. A 56yearold taiwanese man with endstage renal disease secondary to diabetes mellitus had been on continuous ambulatory peritoneal dialysis pd therapy for 3 years. Peritoneal dialysis pd related infections continue to be a serious complication for pd patients. Peritonitis is a common cause of catheter removal and mortality in the patient undergoing peritoneal dialysis pd. Recommendations under the auspices of the international society for peritoneal dialysis ispd were first published in 1983 and revised in 1993, 1996, 2000, 2005, and 2010 914. Mycobacterium fortuitum and polymicrobial peritoneal dialysis.
Contact the nephrologist or peritoneal dialysis unit covering the patient as. Risk factors and outcomes of earlyonset peritonitis in chinese. Peritonitis due to the pseudomonas species is a serious complication in continuous ambulatory peritoneal dialysis capd patients 1 x 1 juergensen, p. Ispd peritonitis recommendations peritoneal dialysis international. Peritoneal dialysis has better outcomes than hemodialysis during the first couple of years. Peritonitis is a common and serious complication of peritoneal dialysis pd. An experienced nursing staff plays an important role in teaching proper pd technique to new patients, but nursing staff must be cognizant of each patients. Acute peritonitis caused by propionibacterium acnes in a. Prevention of infectious complications in peritoneal dialysis. Significant complications include hospitalization, protracted or recurrent infections, catheter removal, and an attributable mortality approaching 10% 4, 9, 10.
It is the most commonly reported ntm in peritoneal dialysis pd associated peritonitis. Jun 14, 2019 bacterial peritonitis is a serious complication of patients undergoing peritoneal dialysis pd. Capnocytophaga canimorsus is a fastidious and slowgrowing bacterium that forms a. Excluded from the analysis were 167 patients 4% of patients having peritonitis with missing demographic data and 29 patients 0. Dialysis solution volume in 24 hours and utilizing the full 24 hours for dwell time are the two ways to improve the efficiency of peritoneal dialysis. A total of 9,452 pdrelated peritonitis episodes occurred in 4,624 incident pd patients in australia during 2004 through 2014. It is used to remove excess fluid, correct electrolyte problems, and remove toxins in those with kidney failure. A 63yearold chinese man, with history of renal failure on continuous ambulatory peritoneal dialysis, presented with cloudy peritoneal effluent and abdominal pain. There is still much work ahead to provide egalitarian access to pd and to maximize its physiological and socioeconomic advantages. Immediate empiric treatment doses must be added to the patients medication chart to be a valid order. Peritoneal dialysis pd is a modality chosen by approximately 11% of endstage renal disease esrd patients in 2004 and 15. Current treatment guidelines emphasize the use of intraperitoneal antibiotics and onceaday administration of aminoglycosides. Were dickens a nephrologist, this would likely be his current impression of peritoneal dialysis pdassociated peritonitis. Analysis of risk factors and outcome in peritoneal.
Furthermore, concerning the peritonitis risk, most studies primarily examined the risk of developing the first peritonitis episode, rather than a hpr. Peritoneal dialysisperitonitismicrobiologyclinical outcomes. Article pdf available in peritoneal dialysis international. Your peritoneal equilibration test pet this test is done within 48 weeks after starting peritoneal dialysis. Peritoneal dialysis 2 types capd continuous ambulatory peritoneal dialysis involves on average 4 dwells per day of 48 hours of 2 2.
Peritoneal dialysis pd is a type of dialysis which uses the peritoneum in a persons abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood. The patient uses their peritoneum as a dialysis membrane in conjunction with a surgically placed dialysis catheter that penetrates the abdominal wall. Although the identification of causative organisms and use of appropriate antibiotics are essential for treatment, rare and fastidious bacteria are sometimes difficult to detect by conventional biochemical assays. Peritoneal dialysis pdassociated peritonitis carries substantial morbidity, contributing to death in up to 8. Pdf the patient in peritoneal dialysis researchgate. Reducing the frequency of peritonitis for patients undergoing peritoneal dialysis pd continues to be a challenge. Peritonitis is a serious complication of peritoneal dialysis pd responsible for significant morbidity, and accounts for 22% of technique failures and 14% of infectious deaths in australian and new zealand pd patients. Peritoneal dialysis pd effluent gram stain, routine culture, acidfast bacilli. Aeromonas sobria peritonitis in a peritoneal dialysis pd. Peritoneal dialysisrelated infection rates and outcomes. Peritonitis risk is not evenly spread across the pd population or programs.
Nevertheless, peritonitis remains a major problem in pd, with a substantial percent of patients developing persistent or relapsing infections. Do double bag and y set exchange systems reduce peritonitis in patients receiving continuous ambulatory peritoneal dialysis capd compared with. Various pathogenic organisms have been identified as the etiology of pdrelated peritonitis, among which aeromonas sobria is a rare one. Keane wf, everett ed, golper ta, gokal r, halstenson c, kawaguchi y, et al. Objectives to investigate the risk factors associated with earlyonset peritonitis eop and their influence on patients technique survival and mortality.
Pseudomonas peritonitis associated with continuous ambulatory peritoneal dialysis. The present recommendations are organized into 5 sections. Peritonitis for patients treated with peritoneal dialysis pd continues to be a common cause of pd technique failure, hospitalization, and mortality. Participants pd patients from 1 june 2006 to 1 may 2018 were recruited and followed up until 31 december 2018. May 20, 2019 peritonitis is a common cause of catheter removal and mortality in the patient undergoing peritoneal dialysis pd. Microbiology of peritoneal dialysisrelated infection and. In addition, severe or prolonged peritonitis leads to structural and functional alterations of the peritoneal membrane, eventually leading to membrane failure. Peritoneal dialysisrelated peritonitis with klebsiella. The approach to the diagnosis of peritonitis, including exclusion of other intraabdominal diseases, is discussed separately. Twentyfive years ago, most continuous ambulatory peritoneal dialysis programs reported peritonitis rates in excess of 1 to 2 episodes per patient year. Peritoneal dialysis infection exitsite and peritonitis rates should be monitored and reported for every clinical dialysis program annually. Peritonitis in continuous ambulatory peritoneal dialysis.
Incremental peritoneal dialysis may be beneficial for. Peritonitis is a common complication of peritoneal dialysis pd and is associated with signi. Despite reductions in the frequency of peritoneal dialysis pdrelated infectious complications over time, peritonitis and catheter infection remain important causes of morbidity and mortality. Preventing peritoneal dialysis infections wounds research. Peritoneal dialysis pd related peritonitis carries high morbidity for pd patients. Mycobacterium fortuitum is a ubiquitous, rapidly growing nontuberculous mycobacterium ntm. Adequate treatment is essential to reduce morbidity and recurrence.
Several studies have indicated that aeromonas sobria might be of particular clinical significance because of its enterotoxin production. A multicenter randomized clinical trial comparing the y connector disinfectant system to standard systems. Peritonitis is a common complication of peritoneal dialysis. The patient managed pd well figure 1a,f by himself, and he had to that point experienced no episodes of pdrelated infection. Tuberculous peritonitis in peritoneal dialysis nefrologia english. Gramnegative peritonitis is particularly troublesome because it is frequently unresponsive to antibiotic therapy alone, and because it can have longterm adverse consequences on peritoneal membrane function and lead to inability to conduct peritoneal dialysis pd. Pdf peritonitis is a common and serious complication of peritoneal dialysis pd. There are eight key factors in diffusion occurring in peritoneal dialysis.
Clinical course of peritonitis due to pseudomonas species. It tells how your peritoneal membrane is working and helps your doctor decide how many exchanges you. Pde ph is decreased in continuous ambulatory peritoneal dialysis capd peritonitis, even in the. Peritoneal dialysis pdrelated infections, such as peritonitis, exitsite infection, and tunnel infection, are serious complications to patients with pd. Risk factors for peritonitis in patients on continuous. Peritonitis is a common and serious complication of peritoneal dialysis pd with significant morbidity. Oct 20, 2010 peritoneal dialysis 2 types capd continuous ambulatory peritoneal dialysis involves on average 4 dwells per day of 48 hours of 2 2. Characterization of escherichia coli obtained from patients. The ad hoc advisory committee on peritonitis management. Peritonitis is an important complication associated with technical failure and death, as well as an important quality measure, in patients on pd. Peritoneal fluid titer test for peritoneal dialysis. As the most common complication, peritonitis prevented peritoneal dialysis from becoming more widely used. Peritonitis in continuous ambulatory peritoneal dialysis capd. Peritonitis caused by pseudomonas species is a particularly common and serious complication in the asiapacific region, and is often associated with a poor response to antibiotics as well as a high rate of catheter removal 3,4.
Jul 18, 2014 the influence of high peritonitis rate hpr on clinical outcomes of continuous ambulatory peritoneal dialysis capd patients has been far less studied in the chinese population than in those of the usa, australia and europe. What is the treatment for peritoneal dialysisassociated. Until the fall of 1978, peritoneal dialysis solution pd solution was only available in glass containers connected to the permanent catheter with plastic tubes. The primary advantage of pd is patients ability to undertake treatment without having to visit a medical facility frequently. Y connection systems with the flush before fill design results in a lower peritonitis. Decorin is a soluble dermatan sulfate proteoglycan synthesized by peritoneal mesothelial cells. Peritonitis remains the archilles heel of peritoneal dialysis pd and is the major cause of technique failure 1,2. Article information, pdf download for peritonitis in peritoneal dialysis, open epub. Patient is a 50yearold male with a pmhx significant for esrd end stage renal disease on nightly pd peritoneal dialysis who presents to the er secondary to a one week history of gradually increasing abdominal pain, nausea, rare emesis, and fevers up to 102. Treatment for peritoneal dialysisassociated peritonitis. Capnocytophaga canimorsus peritonitis diagnosed by mass. Peritoneal dialysisrelated eosinophilic peritonitis.
Overview of peritoneal dialysis linkedin slideshare. The incidence of peritonitis in peritoneal dialysis pd patients has decreased as a result of improvements in pd technology. Peritoneal dialysis related peritonitis due to mycobacterium spp a. If so, your doctor may need to change your dialysis prescription or other medical care that you are receiving. Given the increasing number of elderly patients reaching endstage renal disease, making informed decisions about pd utilization is contingent on an understanding of the. Although less than 5% of peritonitis episodes result in death, peritonitis is the direct or major contributing cause. We will discuss them in detail in the next two slides. Peritonitis is a serious complication of peritoneal dialysis pd. Peritonitis treatment and prophylaxis amanda walker,1 kym bannister,2 charles george,3 david mudge,6 maha yehia,7 maureen lonergan5 and josephine chow4 1department of nephrology, royal childrens hospital, melbourne, victoria, 2renal unit, royal adelaide hospital, adelaide, south australia, 3renal of.