Peritoneal dialysis-associated peritonitis: clinical features and predictors of outcome

Kofteridis, Diamantis P.; Valachis, Antonios; Perakis, Kostas; Maraki, Sofia; Daphnis, Eugenios; Samonis, George

doi:10.1016/j.ijid.2009.07.016

Cited by 43 publications

(35 citation statements)

References 25 publications

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“…In addition, the presented data regarding the incidence of peritonitis are reflective of children with positive peritoneal cultures. Additional factors suggestive of complicated peritonitis that should be considered are: concomitant exit-site infection, greater than 5 days with a peritoneal dialysis effluent cell count greater than 100×10 6 /L, prior antimicrobial use, and low serum total protein level [21]. The use of laparoscopy during the experience reviewed in this study was limited and does not provide a sufficient volume to enable definitive conclusions regarding its effectiveness in reducing the rate of primary catheter failure.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes analysis of pediatric peritoneal dialysis catheter function in a rural region

Stone

LaPar

Barcia

et al. 2013

Journal of Pediatric Surgery

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Purpose The purpose of this study was to analyze the experience with peritoneal dialysis (PD) at a high-volume, single center institution that supports a rural population. Methods From 2000 to 2010, 88 children (median age: 1.98 years, [range: 2 days–20.2 years]) received 134 PD catheters for the management of acute and chronic renal failure. The primary outcome of interest was the incidence of primary PD catheter failure (replacement or revision within 60 days). Operative technique, longitudinal outcomes, and time intervals to transplantation were analyzed. Results Median time to transplant from the institution of dialysis was 1.4 years [range: 0.3–6.4 years]. Primary catheter failure occurred in 24.6% of cases. Infants less than 6 months of age demonstrated an increased incidence of primary catheter failure (p =0.02). The operative technique for catheter placement was not associated with the incidence of primary failure. Postoperative complications included peritonitis (22.7%), omental plugging (11.9%), pericatheter drainage (9.0%), and exit site infection (3.0%). Conclusion Peritoneal dialysis provides a safe and effective renal replacement therapy for regional pediatric centers that serve a rural population. However, primary catheter failure rates remain high at 24.6%. The surgical technique for placement had no effect on this failure rate in our patient population. Infants less than 6 months of age are at increased risk for primary catheter failure and warrant intensive surveillance.

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Section: Discussionmentioning

confidence: 99%

Surgical outcomes analysis of pediatric peritoneal dialysis catheter function in a rural region

Stone

LaPar

Barcia

et al. 2013

Journal of Pediatric Surgery

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“…Peritoneal dialysis (PD) is a widely accepted renal replacement therapy for end-stage renal disease (ESRD) [1]. The number of patients undergoing PD treatment in the world population was estimated as 272,000 at the end of 2013.…”

Section: Introductionmentioning

confidence: 99%

Relationship between trajectories of serum albumin levels and technique failure according to diabetic status in peritoneal dialysis patients: A joint modeling approach

Khoshhali

Kazemi

Hosseini

et al. 2017

Kidney Res Clin Pract.

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BackgroundIn peritoneal dialysis, technique failure is an important metric to be considered. This study was performed in order to identify the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure on end-stage renal disease patients according to diabetic status. Furthermore, this study was performed to reveal predictors of serum albumin and technique failure simultaneously.MethodsThis retrospective cohort study included 300 (189 non-diabetic and 111 diabetic) end-stage renal disease patients on continuous ambulatory peritoneal dialysis treated in Al-Zahra Hospital, Isfahan, Iran, from May 2005 to March 2015. Bayesian joint modeling was carried out in order to determine the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure in the patients according to diabetic status. Death from all causes was considered as a competing risk.ResultsUsing joint modeling approach, a relationship between trajectories of serum albumin with hazard of transfer to hemodialysis was estimated as −0.720 (95% confidence interval [CI], −0.971 to −0.472) for diabetic and −0.784 (95% CI, −0.963 to −0.587) for non-diabetic patients. From our findings it was showed that predictors of low serum albumin over time were time on peritoneal dialysis for diabetic patients and increase in age and time on peritoneal dialysis, history of previous hemodialysis, and lower body mass index in non-diabetic patients.ConclusionThe results of current study showed that controlling serum albumin over time in non-diabetic and diabetic patients undergoing continuous ambulatory peritoneal dialysis treatment can decrease risk of adverse outcomes during the peritoneal dialysis period.

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“…Specifically, the relatively low impact of classic risk factors of exit‐site, tunnel infections, and Staphylococcal nasal carriage may reflect the aggressive prophylaxis regimen and regular catheter ultrasound surveillance undertaken at our unit. This may be the reason for the low prevalence of exit‐site and tunnel infections found in these severe peritonitis cases, as opposed to other reports with a higher impact of purulent exit‐site infection on the risk for complicated peritonitis (24). Additionally, the relatively low number of our cases precludes the execution of reliable multivariate statistics.…”

Section: Discussionmentioning

confidence: 61%

Severe Peritonitis in Patients Treated With Peritoneal Dialysis: A Case Series Study

Pajek¹,

A²,

Škoberne³

et al. 2011

Ther Apher Dial

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Severe peritonitis causing death and/or technique termination (catheter explanted) is one of the most devastating complications of peritoneal dialysis (PD). The aim of this case series study was to reveal the predictors of risk and clinical characteristics of these cases. We included 38 patients with either peritonitis causing death (18 patients, 47%) or catheter removal (20 patients, 53%) in the period 1996-2006. Their last clinical, laboratory and peritoneal equilibration test data before the peritonitis episode and hospitalization data after the start of peritonitis were reviewed. Their median (range) age was 66 (25-85) years, 61% were male, and the median PD duration was 60 (1-144) months. Baseline C-reactive protein (17.5 ± 19.1 mg/L) was substantially higher than in contemporary stable controls from our unit (3.5 ± 4.2 mg/L, P = 0.002). For 14 patients (37%), this was their first episode, with a significantly lower mortality of 14% as opposed to 47% across the whole group (P = 0.002). Almost half the patients (42%) had a causative abdominal condition identified, such as diverticulitis or cholecystitis. Clinical and laboratory data at presentation were variable and not different according to survival. Non-surviving cases had a significantly larger proportion of fast transporters (83 vs. 45%, P = 0.03), a significantly lower estimate of daily protein intake (0.72 vs. 0.88 g/kg/day, P = 0.007), and a significantly higher proportion of non-Gram-positive causative microorganisms (72 vs. 40%, P = 0.019). The patients with severe peritonitis were characterized as older with a longer PD duration, and a higher baseline C-reactive protein. Fast peritoneal transport, lower normalized protein catabolic rate, and non-Gram-positive causative bacteria were associated with mortality.

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Peritoneal dialysis-associated peritonitis: clinical features and predictors of outcome

Abstract: Exit-site infection, more than 5 days with a peritoneal dialysis effluent cell count >100 x 10(6)/l, prior use of antimicrobials, and low serum total protein level are potential predictors of complicated PD-associated peritonitis and may distinguish high-risk cases.

Cited by 43 publications

References 25 publications

Surgical outcomes analysis of pediatric peritoneal dialysis catheter function in a rural region

Surgical outcomes analysis of pediatric peritoneal dialysis catheter function in a rural region

Relationship between trajectories of serum albumin levels and technique failure according to diabetic status in peritoneal dialysis patients: A joint modeling approach

Severe Peritonitis in Patients Treated With Peritoneal Dialysis: A Case Series Study

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