Peritonitis and Exit Site Infections in First Nations Patients on Peritoneal Dialysis

Hildebrand, Ainslie M.; Komenda, Paul; Miller, Lisa; Rigatto, Claudio; Verrelli, Mauro; Sood, Amy R.; Sathianathan, Chris; Reslerova, Martina; Eng, Loretta; Eng, Amanda; Sood, Manish M.

doi:10.2215/cjn.04170510

Cited by 16 publications

(12 citation statements)

References 20 publications

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“…Our findings suggest that a racial ethnic disparity may exist for survival on peritoneal dialysis for Aboriginals in Canada. Previous literature has shown conflicting results on peritoneal dialysis and mortality in Aboriginals (10,12,14,15,17). Our findings are consistent with a recent report from Manitoba, where we investigated 161 Aboriginal patients compared with 566 non-Aboriginal patients on peritoneal dialysis and found an increase in mortality (adjusted HR=1.48, 95% CI=1.07-2.03) and peritonitis (adjusted HR=1.79, 95% CI=1.35-2.36) among Aboriginals (10,17).…”

Section: Discussionsupporting

confidence: 89%

“…However, this finding is in direct contrast to some findings from Australia and New Zealand, where Aboriginals on peritoneal dialysis have worse outcomes with an increased risk of peritonitis, technique failure, hospitalizations, and mortality (14)(15)(16). Recently, we have also reported an increase in peritonitis and mortality rates in Aboriginals relative to Caucasians undergoing peritoneal dialysis in Manitoba, Canada (10,17). Whether these differences are caused by differences in patient's characteristics, methods of care delivery, or study design remains unknown.…”

Section: Introductioncontrasting

confidence: 72%

“…Previous literature has shown conflicting results on peritoneal dialysis and mortality in Aboriginals (10,12,14,15,17). Our findings are consistent with a recent report from Manitoba, where we investigated 161 Aboriginal patients compared with 566 non-Aboriginal patients on peritoneal dialysis and found an increase in mortality (adjusted HR=1.48, 95% CI=1.07-2.03) and peritonitis (adjusted HR=1.79, 95% CI=1.35-2.36) among Aboriginals (10,17). An earlier study reported on 101 Aboriginal patients who initiated peritoneal dialysis in the Prairie provinces compared with 734 Caucasian patients from 1990 to 2000 (12).…”

Section: Discussionmentioning

confidence: 99%

“…This finding is consistent with previous reports from Australia/New Zealand (14,15). One of the most common causes for technique failure is peritonitis, and previous work suggests that Aboriginals have a very high risk of peritonitis with differing microbiology profile (17). Of additional concern is that young people are especially prone to technique failure, a population that, theoretically, is better suited for peritoneal dialysis, because it allows one to maintain independence.…”

Section: Discussionmentioning

confidence: 99%

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Association of Modality with Mortality among Canadian Aboriginals

Sood

Hemmelgarn

Rigatto

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Previous studies have shown that Aboriginals and Caucasians experience similar outcome on dialysis in Canada. Using the Canadian Organ Replacement Registry, this study examined whether dialysis modality (peritoneal or hemodialysis) impacted mortality in Aboriginal patients. Design, setting, participants, & measurements This study identified 31,576 adult patients (hemodialysis: Aboriginal=1839, Caucasian=21,430; peritoneal dialysis: Aboriginal=554, Caucasian=6769) who initiated dialysis between January of 2000 and December of 2009. Aboriginal status was identified by self-report. Dialysis modality was determined 90 days after dialysis initiation. Multivariate Cox proportional hazards and competing risk models were constructed to determine the association between race and mortality by dialysis modality. Results During the study period, 939 (51.1%) Aboriginals and 12,798 (53.3%) Caucasians initiating hemodialysis died, whereas 166 (30.0%) and 2037 (30.1%), respectively, initiating peritoneal dialysis died. Compared with Caucasians, Aboriginals on hemodialysis had a comparable risk of mortality (adjusted hazards ratio=1.04, 95% confidence interval=0.96–1.11, P=0.37). However, on peritoneal dialysis, Aboriginals experienced a higher risk of mortality (adjusted hazards ratio=1.36, 95% confidence interval=1.13–1.62, P=0.001) and technique failure (adjusted hazards ratio=1.29, 95% confidence interval=1.03–1.60, P=0.03) than Caucasians. The risk of technique failure varied by patient age, with younger Aboriginals (<50 years old) more likely to develop technique failure than Caucasians (adjusted hazards ratio=1.76, 95% confidence interval=1.23–2.52, P=0.002). Conclusions Aboriginals on peritoneal dialysis experience higher mortality and technique failure relative to Caucasians. Reasons for this race disparity in peritoneal dialysis outcomes are unclear.

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Section: Discussionsupporting

confidence: 89%

Section: Introductioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Association of Modality with Mortality among Canadian Aboriginals

Sood

Hemmelgarn

Rigatto

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Several LMICs have high peritonitis rates often leading to poor outcome ( Figure 1A and B). 41,[53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71] Youmbissi et al 71 concluded that high peritonitis rates will continue to limit the extension of CAPD in the developing world, particularly in tropical Africa, following their experience in Cameroon which showed that there were 40 episodes of peritonitis over 18 patient years, representing 2.2 episodes of peritonitis every patient year. However, other centers have not increased the use of CAPD despite seeing a reduction in peritonitis rates over time due to other factors.…”

Section: Role Of Socio-demographic Factorsmentioning

confidence: 99%

Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

Wearne¹,

Kilonzo²,

Effa³

et al. 2017

IJNRD

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Abstract:Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low-to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT) despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or regionally) in LMICs to improve uptake of patients treated with CAPD. Workforce training and retraining will be necessary to ensure that there is coordination of CAPD programs and increase the use of protocols designed to improve CAPD outcomes such as insertion of catheters, treatment of peritonitis, and treatment of complications associated with CAPD. Training of nephrology workforce in CAPD will increase workforce experience and make CAPD a more acceptable RRT modality with improved outcomes.

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Can procalcitonin be used to distinguish between disease flare and infection in patients with systemic lupus erythematosus: a systematic literature review

et al. 2014

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Distinction between infection and febrile disease flare in patients with systemic lupus erythematosus (SLE) is fundamental but often difficult to make, because clinical presentation can be similar. A systematic review of all articles indexed in PubMed through October 2013 was performed, in order to examine the potential role of procalcitonin (PCT) for the discrimination between SLE flare and infection. Among the 12 papers identified, 5 articles reported on PCT levels in SLE patients without infection, 6 compared PCT levels between SLE patients with flare versus those with infection, and 1 analyzed PCT levels in active patients with and without bacterial infection. These data suggest the absence of correlation between PCT levels and SLE disease activity. Furthermore, PCT levels detected during disease flares are lower than those observed during bacterial infections. PCT can therefore be used accurately in the early differentiation between bacterial infection and flare in febrile SLE patients. Raised PCT levels ≥0.5 μg/L should strongly suggest bacterial infection in the context of SLE, keeping in mind the limited data available in case of hemophagocytic syndrome. Elevated PCT levels in SLE patients should always prompt a thorough search for sources of potential infection.

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Peritonitis and Exit Site Infections in First Nations Patients on Peritoneal Dialysis

Cited by 16 publications

References 20 publications

Association of Modality with Mortality among Canadian Aboriginals

Association of Modality with Mortality among Canadian Aboriginals

Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

Can procalcitonin be used to distinguish between disease flare and infection in patients with systemic lupus erythematosus: a systematic literature review

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