Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis最新文献

{"title":"Comprehensive Approach to Peritoneal Dialysis-Related Peritonitis by Enteric Microorganisms. Comparison Between Single Organism and Polymicrobial Infections.","authors":"Roi Ribera-Sánchez,&nbsp;Miguel Pérez-Fontán,&nbsp;Antía López-Iglesias,&nbsp;Alba García-Enríquez,&nbsp;Ana Rodríguez-Carmona","doi":"10.3747/pdi.2017.00184","DOIUrl":"https://doi.org/10.3747/pdi.2017.00184","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal infections of enteric origin (EntP) have been classically investigated using partial strategies, focused on particular subgroups of microorganisms. A more comprehensive approach may facilitate the definition of the nomenclature and clinical presentation of these infections.</p><p><strong>Objectives: </strong>To investigate the clinical presentation and outcomes of a full spectrum of EntP, with a particular interest in the comparison between single-organism and polymicrobial infections.</p><p><strong>Method: </strong>Following an observational design, we investigated 165 single-organism and 83 polymicrobial peritonitis episodes with isolation of at least 1 enteric bacteria (<i>Enterobacteriaceae</i>, <i>Enterococcus</i> spp. and/or intestinal anaerobics). We compared the risk of treatment failure for these 2 types of infection and explored the significance of the isolation of specific microorganisms and of their antibacterial susceptibility patterns.</p><p><strong>Results: </strong>Polymicrobial EntP was associated with higher rates of hospitalization, more changes to initial antibiotic therapy, more surgical explorations, and higher mortality and treatment failure rates than monobacterial EntP. However, stratified and multivariate analyses revealed that the burden of these differences rested on the isolation of intestinal anaerobics (odds ratio [OR] 12.05, 95% confidence interval [CI] 2.53-31.09, <i>p</i> < 0.001) and/or <i>Enterococcus faecium</i> (OR 3.37, 95% CI 1.02-11.30, <i>p</i> = 0.046), while other polymicrobial infections were more comparable with single-organism peritonitis, except for even higher mortality rates in the former group. Lower antibiotic susceptibility of the isolations (OR 1.18, 95% CI 0.51-2.70, <i>p</i> = 0.70) did not perform as a predictor of treatment failure.</p><p><strong>Conclusion: </strong>A comprehensive approach to peritoneal infections by intestinal microorganisms may provide a focused perspective of the clinical presentation and outcomes of these complications of peritoneal dialysis.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"139-146"},"PeriodicalIF":2.8,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2017.00184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35780182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Routine Bioimpedance-Guided Fluid Management Provide Additional Benefit to Non-Anuric Peritoneal Dialysis Patients? Results from COMPASS Clinical Trial.","authors":"Kook-Hwan Oh,&nbsp;Seon Ha Baek,&nbsp;Kwon-Wook Joo,&nbsp;Dong Ki Kim,&nbsp;Yon Su Kim,&nbsp;Sejoong Kim,&nbsp;Yun Kyu Oh,&nbsp;Byoung Geun Han,&nbsp;Jae Hyun Chang,&nbsp;Wookyung Chung,&nbsp;Ki Young Na","doi":"10.3747/pdi.2016.00241","DOIUrl":"https://doi.org/10.3747/pdi.2016.00241","url":null,"abstract":"<p><strong>Introduction: </strong>In peritoneal dialysis (PD) patients, volume overload is related to cardiac dysfunction and mortality, while intravascular volume depletion is associated with a rapid decline in the residual renal function (RRF). This study sought to determine the clinical usefulness of bioimpedance spectroscopy (BIS)-guided fluid management for preserving RRF and cardiac function in PD patients.</p><p><strong>Subjects and methods: </strong>This is a multicenter, prospective, open-label study that was conducted over a 1-year period (NCT01887262). Non-anuric (urine volume > 500 mL/day) subjects on PD were enrolled. Subjects in the control group received fluid management based on the clinical information alone. Those in the BIS group received BIS-guided fluid management along with clinical information.</p><p><strong>Results: </strong>The subjects (<i>N</i> = 137, mean age 51.3 ± 12.8 years, 54% male) were randomly assigned to the BIS group (<i>n</i> = 67) or to the control group (<i>n</i> = 70). There were no significant differences between the 2 groups with regard to age, sex ratio, cause of kidney failure, duration of PD, baseline comorbidity, RRF, PD method, or peritoneal transport type. At baseline, the 2 groups were not different in terms of RRF (glomerular filtration rate [GFR], 5.1 ± 2.9 vs 5.5 ± 3.7 mL/min/1.73 m²). After follow-up, changes in the GFR between the 2 groups were not different (-1.5 ± 2.4 vs -1.3 ± 2.6 mL/min/1.73 m², <i>p</i> = 0.593). Over the 1-year study period, both groups maintained stability of various fluid status parameters. Between the 2 groups, there were no differences in the net change of various fluid status parameters such as overhydration (OH) and extracellular water/total body water (ECW/TBW). A net change in ECW over 1 year was slightly but significantly higher in the control group (net increase, 0.57 ± 1.27 vs 0.05 ± 1.63 L, <i>p</i> = 0.047). However, this difference was not translated into an improvement in RRF in the BIS group. There were no differences in echocardiographic parameters or arterial stiffness at the end of follow-up.</p><p><strong>Conclusion: </strong>Routine BIS-guided fluid management in non-anuric PD patients did not provide additional benefit in volume control, RRF preservation, or cardiovascular (CV) parameters. However, our study cannot be generalized to the whole PD population. Further research is warranted in order to investigate the subpopulation of PD patients who may benefit from routine BIS-guided fluid management.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"131-138"},"PeriodicalIF":2.8,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2016.00241","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35781932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Tuberculous Mycobacterial Infections Related to Peritoneal Dialysis.","authors":"Hiroyuki Inoue,&nbsp;Naoki Washida,&nbsp;Kohkichi Morimoto,&nbsp;Keisuke Shinozuka,&nbsp;Takahiro Kasai,&nbsp;Kiyotaka Uchiyama,&nbsp;Hirobumi Tokuyama,&nbsp;Shu Wakino,&nbsp;Hiroshi Itoh","doi":"10.3747/pdi.2017.00172","DOIUrl":"https://doi.org/10.3747/pdi.2017.00172","url":null,"abstract":"Most infections related to peritoneal dialysis (PD) are caused by common bacteria, and non-tuberculous mycobacteria are rare. The clinical characteristics and prognosis of PD patients with non-tuberculous mycobacterial infections were investigated at our hospital. Non-tuberculous mycobacteria were detected in 11 patients (exit-site infection, tunnel infection, and peritonitis in 3, 5, and 3 patients, respectively). Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus were identified in 4, 2, and 2 patients, respectively. Most patients with peritonitis or tunnel infection required catheter removal. During the study period (2007 – 2017), peritonitis occurred in 44 patients, including 3 patients (6.8%) with non-tuberculous mycobacterial peritonitis. When non-tuberculous mycobacterial infection occurs, multi-agent antibiotic therapy, unroofing surgery, and/or catheter replacement should be performed to prevent peritonitis.","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"147-149"},"PeriodicalIF":2.8,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2017.00172","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35934822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized Controlled Trial Comparing Open Versus Laparoscopic Placement of a Peritoneal Dialysis Catheter and Outcomes: The CAPD I Trial.","authors":"Jorinde H H van Laanen,&nbsp;Tom Cornelis,&nbsp;Barend M Mees,&nbsp;Elisabeth J Litjens,&nbsp;Magda M van Loon,&nbsp;Jan H M Tordoir,&nbsp;Arnoud G Peppelenbosch","doi":"10.3747/pdi.2017.00023","DOIUrl":"https://doi.org/10.3747/pdi.2017.00023","url":null,"abstract":"<p><strong>Objective: </strong>To determine the best operation technique, open versus laparoscopic, for insertion of a peritoneal dialysis (PD) catheter with regard to clinical success. Clinical success was defined as an adequate function of the catheter 2 - 4 weeks after insertion.</p><p><strong>Methods: </strong>All patients with end-stage renal disease who were suitable for PD and gave informed consent were randomized for either open surgery or laparoscopic surgery. A previous laparotomy was not considered an exclusion criterion. Laparoscopic placement had the advantage of pre-peritoneal tunneling, the possibility for adhesiolysis, and placement of the catheter under direct vision. Catheter fixation techniques, omentopexy, or other adjunct procedures were not performed. Other measured parameters were in-hospital morbidity and mortality and post-operative infections.</p><p><strong>Results: </strong>Between 2010 and 2016, 95 patients were randomized to this study protocol. After exclusion of 5 patients for various reasons, 44 patients received an open procedure and 46 patients a laparoscopic procedure. Gender, age, body mass index (BMI), hypertension, current hemodialysis, severe heart failure, and previous an abdominal operation were not significantly different between the groups. However, in the open surgery group, fewer patients had a previous median laparotomy compared with the laparoscopic group (6 vs 16 patients; <i>p</i> = 0.027). There was no statistically significant difference in mean operation time (36 ± 24 vs 38 ± 15 minutes) and hospital stay (2.1 ± 2.7 vs 3.1 ± 7.3 days) between the groups. In the open surgery group 77% of the patients had an adequate functioning catheter 2 - 4 weeks after insertion compared with 70% of patients in the laparoscopic group (<i>p</i> = not significant [NS]). In the open surgery group there was 1 post-operative death (2%) compared with none in the laparoscopic group (<i>p</i> = NS). The morbidity in both groups was low and not significantly different. In the open surgery group, 2 patients had an exit-site infection and 1 patient had a paramedian wound infection. In the laparoscopic group, 1 patient had a transient cardiac event, 1 patient had intraabdominal bleeding requiring reoperation, and 1 patient had fluid leakage that could be managed conservatively. The survival curve demonstrated a good long-term function of PD.</p><p><strong>Conclusion: </strong>This randomized controlled trial (RCT) comparing open vs laparoscopic placement of PD catheters demonstrates equal clinical success rates between the 2 techniques. Advanced laparoscopic techniques such as catheter fixation techniques and omentopexy might further improve clinical outcome.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"104-112"},"PeriodicalIF":2.8,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2017.00023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35780765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Reintroduction of Peritoneal Dialysis After Peritoneal-Pericardial Fistula in a Child: A Case Report.","authors":"M R Derynck,&nbsp;S Jones,&nbsp;I V Rachinsky,&nbsp;C W McIntyre,&nbsp;P Blake,&nbsp;G Filler","doi":"10.3747/pdi.2017.00049","DOIUrl":"https://doi.org/10.3747/pdi.2017.00049","url":null,"abstract":"Editor: Pericardial effusion secondary to peritoneal-pericardial fistula is a rare but serious complication of peritoneal dialysis (PD). A recent survey of the European Pediatric Dialysis Working Group reported a prevalence of 0.13% (1). While the pathophysiology of peritoneal-pericardial fistula creation remains unclear, congenital or traumatic peritoneal membrane damage and dialysate-related intra-abdominal pressure changes are likely contributing factors (2). Identified risk factors include previous peritonitis, cardiac and/or abdominal surgery, excessive and/or rapid increase in fill volume, and malnutrition (1,3,4). Suggested management of pericardial effusion includes switch to hemodialysis (HD) and surgical closure of the peritoneal defect. Although previous reports have described spontaneous resolution of peritoneal-pleural fistulae and other late dialysate leaks, the natural history of peritonealpericardial f istulae remains unclear (1,2,5,6). Here, we describe a 9-year-old girl chronically managed with PD and relapsed post-renal transplantation, who presented with pericardial effusion due to peritoneal-pericardial fistula. The patient had a 3.5-year history of biopsy-proven focal segmental glomerulosclerosis (FSGS). She presented with hypertension, hyperlipidemia, nephrotic range-proteinuria, and edema. Renal biopsy was performed after 2 months of steroid-resistant nephrotic syndrome, confirming FSGS. Her post-biopsy course was complicated by bacterial peritonitis and posterior reversible encephalopathy. A gastrostomy tube was endoscopically placed 1 year post-diagnosis to assist with nutrition and growth. Nephrotic syndrome remained refractory to therapy with cyclosporine, mycophenolate mofetil (MMF), rituximab, tacrolimus, and plasmapheresis. Her renal disease progressed to chronic kidney disease stage 5 over the next 2 years. She commenced PD 2.5 years after diagnosis. Following 1 year of PD with a dwell volume of 1,000 mL/m2, she received a living, unrelated-donor kidney transplant. Post-transplant immunosuppression was maintained with thymoglobulin, rituximab, tacrolimus, MMF, and prednisone. She received intravenous immunoglobulin (CytoGam, CSL Behring, Berne, Switzerland) every 2 weeks. Recurrent nephrotic syndrome developed within 48 hours of transplantation, with subsequent oligo-anuria secondary to recurrent FSGS in the allograft. Ultrasound and surgical exploration did not identify a thrombus. She required plasmapheresis and resumed HD on post-operative days 3 – 8 for volume control. She was then transitioned back to PD and continued plasmapheresis 3 times per week. Renal biopsy 1 month post-transplant demonstrated mild tubular injury and glomerular sclerosis without signs of rejection. Two months following kidney transplantation, she pre sented with fever and cough. Chest X ray revealed cardiomegaly. Echocardiography showed a large (2.2-cm posterior, 1.7-cm left lateral) circumferential pericardial effusion. She was mildly t","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"154-156"},"PeriodicalIF":2.8,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2017.00049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35934234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should We Use Adenosine Deaminase Assay for the Differential Diagnosis of Tuberculous Peritonitis in CAPD Patients?","authors":"M A Oktan,&nbsp;C Heybeli,&nbsp;S Yildiz,&nbsp;C Çavdar,&nbsp;A Çelik","doi":"10.3747/pdi.2017.00174","DOIUrl":"https://doi.org/10.3747/pdi.2017.00174","url":null,"abstract":"Editor: We read the recent International Society for Peritoneal Dialysis (ISPD) peritonitis guidelines and recommendations (1). In the guideline, only Löwenstein-Jensen culture of peritoneal fluid, mycobacterial DNA PCR (polymerase chain reaction), and laparoscopic peritoneal biopsy are advised as a diagnostic work-up in tuberculous (TB) peritonitis. The principle of the adenosine deaminase (ADA) assay is to detect either hydrogen peroxide or ammonia after enzymatic deamination of adenosine to inosine. Production of the enzyme ADA in bodily fluids reflects the presence of activated T lymphocytes and monocytes (2). Many studies have investigated the usefulness of ADA in ascites for the diagnosis of TB peritonitis (3,4,5). Two metaanalyses suggested that ADA in the ascites can be a sensitive and specific target and a critical criterion for the diagnosis of TB ascites (6,7). Riquelme et al. reported a meta-analysis which included 12 prospective studies. They investigated 264 patients, of whom 50 (18.9%) had peritoneal tuberculosis. Adenosine deaminase levels showed high sensitivity (100%) and specificity (97%) using cut-off values from 36 to 40 IU/L (8). Some studies have shown that ADA assay sensitivity is substantially lower in patients with cirrhosis due to poor humoral and T-cell mediated response (9). A question that arises here is whether the ADA assay is reliable in immunocompromised patients, such as those with chronic kidney and liver diseases. We would therefore like to discuss using the ADA assay for diagnosis of TB peritonitis in peritoneal dialysis (PD) patients. In the literature, there are limited data for using ADA assay in continuous ambulatory PD (CAPD) patients. In one case report, patients with end-stage renal failure were tested for ADA levels in the peritoneal fluid, allowing an early presumptive treatment and a favorable outcome with a 3-year follow-up (10). On the other hand, in a study by Nakav et al., bacterial peritonitis was induced in mice by intraperitoneal injection of Escherichia coli. Following inoculation, ADA mRNA levels and activity in the lavage fluid significantly increased at 48 hours in the late phase of bacterial peritonitis (11). In conclusion, the ADA assay is inexpensive, quick, and simple to perform and has great value for the immediate diagnosis of tuberculous serositis while culture results are pending. It is clear that large-scale studies on the diagnostic value of the ADA assay in chronic renal failure and CAPD patients are needed. In the next guideline, the usefulness of ADA assay should be evaluated in CAPD patients.","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"153"},"PeriodicalIF":2.8,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2017.00174","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35934229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peritoneal Dialysis in Pregnancy-A Reflection on the Occasion of World Kidney Day.","authors":"Agnese Ruggiero,&nbsp;Philip K T Li,&nbsp;Guillermo Garcia Garcia,&nbsp;Giorgina B Piccoli","doi":"10.3747/pdi.2017.00278","DOIUrl":"https://doi.org/10.3747/pdi.2017.00278","url":null,"abstract":"Pregnancy in women affected by chronic kidney disease (CKD) has been and still is very challenging, with an increased risk of negative outcome compared with the overall population. Higher risk of developing hypertension and proteinuria, as well as preterm delivery, are all complications that are often observed, especially in late CKD stages, and can have a detrimental impact on the future health of the mother and the baby. Fertility may also be affected in kidney patients, advanced CKD in particular causing a decrease in fertility (1). Over the last decades, rates of successful pregnancy in CKD patients on dialysis have increased substantially. This is mainly due to changes in dialysis therapy and the more comprehensive management of pregnant dialysis patients. More intensive dialysis is associated with better outcomes for mother and fetus, irrespective of the type of dialysis (2). In peritoneal dialysis (PD), this generally requires the use of high-dose automated PD (3–4). World Kidney Day is a global awareness campaign aimed at raising awareness of the importance of our kidneys. In 2018, World Kidney Day and International Women’s Day 2018 are commemorated on the same day, offering the opportunity to reflect on the importance of women’s health and specifically their renal health. Particular relevance is given to maternal and child health in kidney patients, as there is a clear need for more education and awareness of CKD in pregnancy. Ideally, kidney patients should seek preconception counseling, physicians should provide timely diagnosis of CKD and associated conditions, and proper follow-up during and after pregnancy should always be offered and asked for. On its 13th anniversary, World Kidney Day promotes affordable and equitable access to health education, healthcare, and prevention for kidney diseases for all women and girls in the world.","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"83"},"PeriodicalIF":2.8,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2017.00278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35934820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary Should We Be Rationing Dialysis in South Africa in the 21^st Century?","authors":"Mohammed Rafique Moosa,&nbsp;Nicola Wearne","doi":"10.3747/pdi.2017.00179","DOIUrl":"https://doi.org/10.3747/pdi.2017.00179","url":null,"abstract":"South Africa faces a quadruple burden of disease, with human immunodeficiency (HIV) infection and tuberculosis, maternal and child health, injury and violence, and non-communicable disease constituting ‘colliding’ epidemics (1). Since 2009, non-communicable diseases (NCD) collectively have overtaken infectious diseases as the leading cause of mortality, accounting for 55.5% of all deaths in South Africa in 2015 (1,2). Kidney disease accounts for an ever-increasing number of these NCD deaths (3). The increase in chronic kidney disease in South Africa has placed an enormous strain on a health system already buckling under the pressure of the HIV/tuberculosis epidemic (4). South Africa has offered limited access to dialysis and kidney transplantation to its citizens since the 1960s, but initially, no clear policy guided the selection of patients for renal replacement treatment. The implicit rationing of dialysis resulted in unacceptable inequities (5), which triggered a response from nephrologists in the Western Cape and ultimately a formal adoption by the provincial government of a priority-setting policy that was acceptable, and could be defended morally, ethically, and legally (6). The South African economy has been buffeted by a combination of the global recession and political uncertainties; the national economy is growing at about 1.1% per annum, while the end-stage kidney disease (ESKD) burden is increasing at an estimated 7% per annum; this discrepancy further compromises the ability of the country to meet the renal replacement needs of ESKD patients (4).","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"84-88"},"PeriodicalIF":2.8,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2017.00179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35934821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clusters of Practice in Peritoneal Dialysis in France: Data from the Catheter Section of the RDPLF.","authors":"Antoine Lanot,&nbsp;Clémence Bechade,&nbsp;Christian Verger,&nbsp;Emmanuel Fabre,&nbsp;Isabelle Vernier,&nbsp;Thierry Lobbedez","doi":"10.3747/pdi.2017.00135","DOIUrl":"https://doi.org/10.3747/pdi.2017.00135","url":null,"abstract":"<p><strong>Background: </strong>Peritonitis is a major cause of peritoneal dialysis (PD) failure. Recommendations for the prevention of peritonitis are available, but wide variations exist in the peritonitis rate among countries and PD units. The objective of this study was to describe the different pattern of practices in France.</p><p><strong>Methods: </strong>This was a retrospective, multicenter study based on data from the French Language Peritoneal Dialysis Registry. Center practices were described and mapped. Clusters of practices were sought in a hierarchical analysis and centers belonging to the same clusters of practices were mapped.</p><p><strong>Results: </strong>Data from 2,770 catheters placed in 64 centers in France between 1 February 2012 and 31 December 2016 were considered. A median of 34 (ranging from 5 to 133) catheters was reported in each center. Twenty-eight (43.8%) centers routinely administered a prophylactic antibiotic prior to catheter placement, and 8 (12.5%) centers applied a local prophylactic antibiotic at the exit site, as recommended by International guidelines. The presence of a PD nurse specialized in PD or PD referent nephrologist was not associated with better adherence to guidelines. Practices were heterogeneous across centers. We identified 5 clusters of centers according to practice. Geographical proximity was not associated with homogeneity in practices.</p><p><strong>Conclusion: </strong>Peritoneal dialysis practices are heterogeneous in France, even those that are subject to International guidelines. Studies to identify associations between center-specific practices and PD patient outcomes remain mandatory. Efforts should be made to standardize the PD standards of care in France.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"89-97"},"PeriodicalIF":2.8,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2017.00135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35574573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice of Peritoneal Dialysis Catheter Flushing in Australia and New Zealand: Multi-Center Cross-Sectional Survey.","authors":"Yeoungjee Cho,&nbsp;Neil Boudville,&nbsp;Suetonia C Palmer,&nbsp;Josephine S F Chow,&nbsp;Carmel M Hawley,&nbsp;Matthew D Jose,&nbsp;Rob MacGinley,&nbsp;Louis Huang,&nbsp;Jo-Anne Moodie,&nbsp;Thu Nguyen,&nbsp;Laura Robison,&nbsp;Jeffrey Wong,&nbsp;David W Johnson","doi":"10.3747/pdi.2017.00108","DOIUrl":"https://doi.org/10.3747/pdi.2017.00108","url":null,"abstract":"<p><strong>Background: </strong>Evidence of effective interventions to prevent peritoneal dialysis (PD) catheter malfunction before first use is presently insufficient to guide clinical care. Regular flushing of the PD catheter (e.g. before PD commencement) has been adopted by some practitioners in the belief that it will prevent catheter obstruction and/or malfunction. The aim of this study was to characterize and evaluate PD catheter flushing practices across Australian and New Zealand PD units.</p><p><strong>Methods: </strong>An on-line survey was distributed to all 62 PD units in Australia (12 August 2016; <i>n</i> = 51) and New Zealand (2 February 2017; <i>n</i> = 11), with questions relating to PD catheter flushing practices, audit, and outcomes.</p><p><strong>Results: </strong>Forty-nine units of variable size (< 16 to > 100 patients) completed the survey (79% response rate). All centers flushed PD catheters at some stage after insertion as routine unit practice. Forty-one units (84%) routinely flushed during periods of PD rest at varying intervals ranging from alternate daily to monthly. The type and volume of solution used to flush varied between units. Units that practised routine flushing of PD catheters were almost twice as likely to audit their catheter-related outcomes (66% vs 38%, <i>p</i> = 0.23) and more likely to have reported blocked catheters in the preceding 12 months (84% vs 0%, <i>p</i> = 0.01) compared with those units that did not routinely flush PD catheters. Thirty units (61%) regularly audited and monitored catheter-related outcomes.</p><p><strong>Conclusions: </strong>This study identified a wide variation in center practices relating to PD catheter flushing. Drawing conclusions about any relationship between flushing practices and clinical outcomes was impeded by the relatively low uptake of regular auditing and monitoring of catheter-related outcomes across surveyed units. Evaluation of the benefits and harms of standardized PD catheter flushing practices on patient outcomes in a randomized trial is needed to guide practice.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"98-103"},"PeriodicalIF":2.8,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2017.00108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35217513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}