Background The most common complication of peritoneal dialysis (PD) is infection. Despite this, there are no clear guidelines for the management of repeat exit-site infection (ESI), and best practice is not known. We describe our unit's experience of repeat ESI and clinical outcomes in this cohort. Methods Retrospective case note review of all PD patients with positive ESI swabs at our center between 1 January 2012 and 1 January 2018. Patients were included in the study if they had 2 or more ESI with the same organism within a 12-month period and an initial positive response to antibiotic therapy. Results Overall, 31 of 248 patients had repeat ESI. The 2 most common causative organisms were Staphylococcus aureus ( n = 16, 52%) and Pseudomonas aeruginosa ( n = 10, 32%). Twenty (65%) patients developed subsequent peritonitis. The infection resolved with further antibiotics alone in 10 (32%) patients and in 6 patients after PD catheter exchange. The PD catheter was removed in 16 (52%) patients (including 5 after an initial catheter exchange) requiring transfer to hemodialysis (HD). Six (19%) patients died within 12 months of repeat ESI. Both repeat Pseudomonas aeruginosa and Staphylococcus aureus infections were associated with high rates of dialysis modality change (70% and 50%, respectively). Conclusion We have developed the first definition for repeat ESI. Repeat ESI is clinically important and results in significant morbidity and mortality. Following repeat ESI, peritonitis rates are high and a significant number of patients switch dialysis modality. Studies are needed to determine whether interventions such as early catheter exchange would improve outcomes.

Background: Patient burnout is a major cause of technique failure on peritoneal dialysis (PD). Reducing the PD prescription on an individual basis, dependent upon residual kidney function (RKF), may have a role in prolonging time on PD by reducing dialysis burden. This retrospective study aimed to determine the safety and impact of flexible PD prescribing on technique and patient survival. Methods: All patients (186) from our centre starting PD from 1st January 2012 to 31st December 2016 were included. Data on dialysis prescription were collected for each patient from the time they had started PD, and dialysis adequacy measured regularly (3–6 monthly) using PD Adequest. Results: Median age at start of dialysis was 61 years. Only 49% started on PD 7 days a week and this dropped to 27% at 3 months following the first clearance test. Over 90% achieved creatinine clearance > 50 L/week/1.73 m2 up to 2 years of follow-up, with 87% achieving this standard at 3 years. Patient and technique survival at 1, 2 and 3 years were 91%, 81%, and 72%, and 89%, 87% and 78% respectively. Factors on univariate analysis affecting technique survival included increasing age (HR 0.98, p = 0.04, 95% CI (0.96–0.999)), two or more episodes of PD-associated peritonitis (HR 4.52, p = 0.00, 95% CI (1.87–10.91)) and increasing PD intensity (HR 3.30, p = 0.02, 95% CI (1.22–8.93)). After multivariate adjustment which included baseline kidney function, low PD intensity continued to be associated with better technique survival (HR 0.17, p = 0.03, 95% CI (0.03–0.85)). Conclusion: Tailoring the PD prescription to RKF enables days off dialysis while still maintaining recommended levels of small solute clearance. This approach reduces dialysis burden and is associated with higher technique survival.

Patient Physiotherapy - How to get Patients Moving on Dialysis?In this talk, Dr Hannah Young will outline current evidence around physical activity, exercise and reducing sedentary behaviour for people who are receiving dialysis. She will discuss some simple and brief strategies that can be used in the clinic to nudge people towards becoming more active, and highlight ways to overcome common barriers to activity that this population describe. She will also cover special considerations for particular groups of people, including those living with frailty, and multiple long term conditions. The importance of health inequalities in relation to physical activity will also be explored. Finally, she will cover practical resources and services that are available to support dialysis patients to be more active. Assisted PD Service, Specialist Role of a PD Nurse in Community Setting & Case PresentationHome visiting program creates an opportunity to develop a holistic care delivery for people on peritoneal dialysis (PD) Community nurse's role in coordinating the care and involving other care partners in delivering quality of care in the community- PD is only one component of over all care. The talk will focus on a patient's story Mr JR. we will explore the different issues and how the roles of a community PD nurse could be beneficial based on his case in improving the quality of life of person on dialysis

Background and Aims Early studies in peritonitis showed no difference in outcomes between anuric and non-anuric patients, despite pharmacokinetic studies showing the effect of residual renal function (RRF) on antibiotic clearance. Recent work identified a relationship between preserved RRF and treatment failure in gram-positive and culture-negative peritonitis. Our centre uses empiric vancomycin and gentamicin dosed by weight (both drugs) and by RRF (gentamicin). We sought to examine whether RRF is associated with treatment failure in our population. Method We retrospectively identified all episodes of PD peritonitis between January 2014 and July 2019 including demographic and clinical information. The RRF measured closest to the peritonitis episode was used. Treatment failure was defined as death, catheter removal or relapse. Results 189 peritonitis episodes occurred in 128 patients (43% female, mean age 61.3±17.9). 80 episodes were caused by gram-positive bacteria, 49 gram-negative, 51 culture-negative, 5 fungal and 4 polymicrobial. 21, 88 and 61 episodes occurred in patients with a creatinine clearance <0.5, 0.5-5, and >5ml/min respectively. Creatinine clearance data was unavailable in 21 patients. Treatment failure occurred in 72 cases (38%) (19 relapses, 52 catheter removals, 7 deaths). Treatment failure for all bacterial peritonitis episodes was not affected by RRF as compared to anuric patients: 0.5-5 (OR 0.41, 95% CI 0.12-1.35, p 0.14) or >5 (OR 0.90, 95% CI 0.22-3.67, p 0.88). There was no difference in outcome in sub-group analysis by type of organism. Antibiotic concentrations did not differ between the RRF groups. Conclusion Although limited by small numbers we found no association between the degree of RRF and outcome. We hypothesise this is because we monitor antibiotic concentrations and therefore dose antibiotics appropriate to the level of RRF. In PD peritonitis regimes that adjust for RRF there is no impact of RRF on treatment outcomes.