Department of Medicine and Therapeutics,1 Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; University of Pittsburgh School of Medicine,2 Pittsburgh, PA, USA; Faculdade de Enfermagem, Nutrição e Fisioterapia,3 Pontifícia Universidade Católica do Rio Grande do Sul, Brazil; Sanjay Gandhi Postgraduate Institute of Medical Sciences,4 Lucknow, India; Department of Nephrology,5 Princess Alexandra Hospital, and School of Medicine, University of Queensland, Brisbane, Australia; Department of Medical Microbiology,6 Leiden University Medical Center, Leiden, The Netherlands; Centre for Kidney Diseases,7 Mount Elizabeth Medical Centre, Singapore; Section of Infectious Disease,8 Department of Internal Medicine, University of Missouri-Columbia School of Medicine, Columbia, MO, USA; Pediatric Nephrology Division,9 University Children’s Hospital, Heidelberg, Germany; Dianet Dialysis Centers,10 Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

https://journals.sagepub.com/doi/pdf/10.3747/pdi.2010.00049

Peritoneal dialysis-related infections recommendations: 2010 update

Peritonitis is a common and serious complication of peritoneal dialysis (PD). 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 (1-6). In addition, severe or prolonged peritonitis leads to structural and functional alterations of the peritoneal membrane, eventually leading to membrane failure. Peritonitis is a major cause of PD technique failure and conversion to long-term hemodialysis (1,5,7,8). 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 (9-14). The present recommendations are organized into 5 sections: 1. Peritonitis rate 2. Prevention of peritonitis 3. Initial presentation and management of peritonitis 4. Subsequent management of peritonitis 5.

/pdf/ispd-peritonitis-recommendations-2016-update-on-prevention-28ki6os9ax.pdf

Ispd peritonitis recommendations: 2016 update on prevention and treatment

Technical innovations in peritoneal dialysis (PD), now used widely for the long-term treatment of ESRD, have significantly reduced therapy-related complications, allowing patients to be maintained on PD for longer periods. Indeed, the survival rate for patients treated with PD is now equivalent to that with in-center hemodialysis. In parallel, changes in public policy have spurred an unprecedented expansion in the use of PD in many parts of the world. Meanwhile, our improved understanding of the molecular mechanisms involved in solute and water transport across the peritoneum and of the pathobiology of structural and functional changes in the peritoneum with long-term PD has provided new targets for improving efficiency and for intervention. As with hemodialysis, almost half of all deaths on PD occur because of cardiovascular events, and there is great interest in identifying modality-specific factors contributing to these events. Notably, tremendous progress has been made in developing interventions that substantially reduce the risk of PD-related peritonitis. Yet the gains have been unequal among individual centers, primarily because of unequal clinical application of knowledge gained from research. The work to date has further highlighted the areas in need of innovation as we continue to strive to improve the health and outcomes of patients treated with PD.

/pdf/the-current-state-of-peritoneal-dialysis-58yfox0bix.pdf

The Current State of Peritoneal Dialysis

Prevalence of SARS-CoV-2 antibodies in a large nationwide sample of patients on dialysis in the USA: a cross-sectional study.

Infectious complications remain the most significant cause for morbidity in pediatric patients receiving chronic peritoneal dialysis (PD). Although prophylactic measures have led to improved results in some centers, the frequency of peritonitis in children on PD continues to exceed that seen in adults, and peritonitis remains the most common reason for changing dialysis modality in children (1,2). The serious nature of this infection led to the creation and publication in 2000 of the Consensus Guidelines for the Treatment of Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis (3), under the auspices of the International Society for Peritoneal Dialysis (ISPD). Those largely opinion-based guidelines were composed by an international committee of experts in the field of pediatric dialysis and served as the first such set of recommendations specific to the pediatric PD population. After the publication of those guidelines, the International Pediatric Peritoneal Dialysis Registry (IPPR) was established to support evaluations of the impact of implementing the guidelines on a global basis and to collect data to serve as evidence upon which future guidelines could be based. Data generated from 501 episodes of peritonitis were collected by the IPPR and serve as a foundation for many of the recommendations made in the present publication (4,5).

As with the earlier publication, an international group of experts consisting of pediatric nephrologists, a pediatric dialysis nurse, and a pediatric infectious disease specialist collaborated in the effort. Committee discussions took place face-to-face, during conference calls, and by e-mail.

The strength of each guideline statement is graded as Level 1 or 2, or Not Graded, and the quality of the supporting evidence as A, B, C, or D in accordance with the rating scheme used in the KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice Guideline for the Care of the Kidney Transplant Recipient (6). Table 1 describes the scheme.



TABLE 1

Guideline Rating Scheme



Finally, wherever possible, efforts were made to achieve harmonization between the recently published adult treatment recommendations and those designed for children (7). In addition, supporting information (for example, reporting of peritonitis rates, definitions) that is included in the publication pertaining to adults and that is equally applicable to pediatric populations was included in the present publication.

https://journals.sagepub.com/doi/pdf/10.3747/pdi.2011.00091

Consensus Guidelines for the Prevention and Treatment of Catheter-related Infections and Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis: 2012 Update

The incidence of hepatitis B virus (HBV) infection in dialysis populations has declined over recent decades, largely because of improvements in infection control and widespread implementation of HBV vaccination. Regardless, outbreaks of infection continue to occur in dialysis units, and prevalence rates remain unacceptably high. For a variety of reasons, dialysis patients are at increased risk of acquiring HBV. They also demonstrate different disease manifestations compared with healthy individuals and are more likely to progress to chronic carriage. This paper will review the epidemiology, modes of transmission and diagnosis of HBV in this population. Prevention and treatment will be discussed, with a specific focus on strategies to improve vaccination response, new therapeutic options and selection of patients for therapy. © 2010 Asian Pacific Society of Nephrology. © 2010 The Authors. Journal compilation.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1440-1797.2009.01268.x

Review article: Hepatitis B and dialysis

Background. Enterococcal peritonitis is a serious complication of peritoneal dialysis (PD), although reports of this condition in the literature are exceedingly limited.Methods. The frequency, predictors, treatment and clinical outcomes of enterococcal peritonitis were investigated in all 4675 patients receiving PD in Australia between 1 October 2003 and 31 December 2006.Results. One hundred and sixteen episodes of enterococcal peritonitis occurred in 103 individuals. Enterococcal peritonitis tended to be associated with older age, Maori and Pacific Islander racial origin, renovascular disease and coronary artery disease. Polymicrobial peritonitis, defined as recovery of two or more organisms from dialysate effluent, was significantly more common when an Enterococcus species was isolated than when it was not (45% vs 5%, respectively, P < 0.001, odds ratio 13.4, 95% CI 9.45-19.0). Although international guidelines recommend intraperitoneal ampicillin therapy, only 8% of patients with pure enterococcal peritonitis were treated with this agent, whilst the majority (78%) received vancomycin monotherapy. Overall, 59 (51%) patients with enterococcal peritonitis were successfully treated with antibiotics without experiencing relapse, catheter removal or death. The sole independent predictor of adverse clinical outcomes was recovery of additional (non-Enterococcus) organisms. Polymicrobial enterococcal peritonitis was associated with very high rates of hospitalization (83%), catheter removal (52%), permanent haemodialysis transfer (50%) and death (5.8%). In contrast, clinical outcomes were broadly comparable for pure enterococcal and non-enterococcal peritonitis (hospitalization 75% vs 69%, respectively; catheter removal 25% vs 21%; permanent haemodialysis transfer 17% vs 17%; death 1.6% vs 2.2%) although worse than non-enterococcal Gram-positive peritonitis (63%, 12%, 3% and 0.6%, respectively). Removal of the PD catheter within 1 week of enterococcal peritonitis onset was associated with a lower probability of permanent haemodialysis transfer than later removal (74% vs 100%, P = 0.03).Conclusions. Enterococcal peritonitis is associated with an increased risk of catheter removal, permanent haemodialysis transfer and death, particularly when other organisms are isolated in the same episode.

https://digital.library.adelaide.edu.au/dspace/bitstream/2440/51164/1/hdl_51164.pdf

Matthew Edey

Papers

Review article: Hepatitis B and dialysis

Enterococcal peritonitis in Australian peritoneal dialysis patients: predictors, treatment and outcomes in 116 cases.