Peritoneal dialysis-associated peritonitis outcomes reported in trials and observational studies: A systematic review

Abstract

Background: Peritoneal dialysis (PD)-associated peritonitis carries significant morbidity, mortality, and is a leading cause of PD technique failure. This study aimed to assess the scope and variability of PD-associated peritonitis reported in randomized trials and observational studies. Methods: Cochrane Controlled Register of Trials, MEDLINE, and Embase were searched from 2007 to June 2018 for randomized trials and observational studies in adult and pediatric patients on PD that reported PD-associated peritonitis as a primary outcome or as a part of composite primary outcome. We assessed the peritonitis definitions used, characteristics of peritonitis, and outcome reporting and analysis. Results: Seventy-seven studies were included, three were randomized trials. Thirty-eight (49%) of the included studies were registry-based observational studies. Twenty-nine percent ( n = 22) of the studies did not specify how PD-associated peritonitis was defined. Among those providing a definition of peritonitis, three components were reported: effluent cell count ( n = 42, 54%), clinical features consistent with peritonitis (e.g. abdominal pain and/or cloudy dialysis effluent) ( n = 35, 45%), and positive effluent culture ( n = 19, 25%). Of those components, 1 was required to make the diagnosis in 6 studies (8%), 2 out of 2 were required in 22 studies (29%), 2 out of 3 in 11 studies (14%), and 3 out of 3 in 4 studies (5%). Peritonitis characteristics and outcomes reported across studies included culture-negative peritonitis ( n = 47, 61%), refractory peritonitis ( n = 42, 55%), repeat peritonitis ( n = 9, 12%), relapsing peritonitis ( n = 5, 7%), concomitant exit site ( n = 16, 21%), and tunnel infections ( n = 8, 10%). Peritonitis-related hospitalization was reported in 38% of the studies ( n = 29), and peritonitis-related mortality was variably defined and reported in 55% of the studies ( n = 42). Peritonitis rate was most frequently reported as episodes per patient year ( n = 40, 52%). Conclusion: Large variability exists in the definitions, methods of reporting, and analysis of PD-associated peritonitis across trials and observational studies. Standardizing definitions for reporting of peritonitis and associated outcomes will better enable assessment of the comparative effect of interventions on peritonitis. This will facilitate continuous quality improvement measures through reliable benchmarking of this patient-important outcome across centers and countries.

Scope and heterogeneity of outcomes reported in randomized trials in patients receiving peritoneal dialysis

“…The 2016 ISPD guideline suggests that peritonitis should be reported in a standardized manner as the number of episodes per patient-year, however, this measure was used in only 10% of trials that reported a PD-related infection. A recently published systematic review explored in more detail the outcomes and definitions for peritonitis in trials and observational studies [ 23 ]. Similarly, the review found that there was wide variability in both the reporting of and definitions used for peritonitis, which highlights the need for a standardized definition and greater uptake of ISPD-recommended methods of reporting peritonitis.…”

Peritoneal dialysis access outcomes reported in randomized controlled trials: A systematic review

“…The variability in reporting on infectious outcomes was clear and has been shown in a previous systematic review. 61 The weight and frequency of reporting of infections was surprising, especially considering that many studies (64%) have used infectious outcomes for prolonged periods (one year or more) well after PD catheter insertion, which would usually be related to a heterogeneous group of factors other than the PD access itself (type/technique) after the first few weeks of insertion.…”

EDTA and Taurolidine Affect Pseudomonas aeruginosa Virulence In Vitro —Impairment of Secretory Profile and Biofilm Production onto Peritoneal Dialysis Catheters

“…Peritoneal dialysis (PD)-associated peritonitis is the most concerning complication in PD patients ( 1 ). It carries significant morbidity, mortality, increase in treatment cost, and early failure of peritoneal ultrafiltration ( 2 – 4 ). The most common pathogens leading to peritonitis are Gram-positive bacteria that colonize human skin and hands, but several other organisms, including Gram-negative bacteria, have been involved ( 4 , 5 ).…”

“…It carries significant morbidity, mortality, increase in treatment cost, and early failure of peritoneal ultrafiltration ( 2 – 4 ). The most common pathogens leading to peritonitis are Gram-positive bacteria that colonize human skin and hands, but several other organisms, including Gram-negative bacteria, have been involved ( 4 , 5 ). The source of infection for the vast majority of PD-related cases of peritonitis is the PD catheter ( 6 ).…”