Issue: March 2020
Perspective from Vesh Srivatana, MD
Disclosures: Perl reports consulting fees from Baxter Healthcare and DaVita, and speaker honoraria from Baxter International, DaVita, Dialysis Clinic Inc. and Fresenius Medical Care. Please see study for all other authors’ relevant financial disclosures.
January 15, 2020
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Peritonitis rates vary by country, facility for patients on PD

Issue: March 2020
Perspective from Vesh Srivatana, MD
Disclosures: Perl reports consulting fees from Baxter Healthcare and DaVita, and speaker honoraria from Baxter International, DaVita, Dialysis Clinic Inc. and Fresenius Medical Care. Please see study for all other authors’ relevant financial disclosures.
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For patients on peritoneal dialysis, the risk of developing peritonitis varies based on country and facility-related factors, according to recently published findings.

Jeffrey Perl, MD, SM, FRCP(C), of Arbor Research Collaborative for Health in Michigan and St. Michael’s Hospital in Toronto, and colleagues argued that PD-related peritonitis is the leading cause of transition to hemodialysis and is associated with adverse patient outcomes. Therefore, “better understanding regarding the incidence and prevalence of PD peritonitis episodes ... is needed to develop and evaluate peritonitis prevention strategies,” they wrote.

Perl and colleagues used data from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) related to 7,051 patients on PD in 209 facilities across Australia, New Zealand, Canada, Japan, Thailand, United Kingdom and United States. Peritonitis rate (by country, overall and variation across facilities) and facility characteristics (census count, facility age, nurse to patient ratio and use of automated PD) were considered.

Researchers identified 2,272 peritonitis episodes, which showed a crude incidence rate of 0.28 episodes per patient per year. Researchers noted facility peritonitis rates were variable within each country and exceeded 0.50 episodes per patient per year in 10% of facilities.

By country, researchers determined peritonitis rates to be 0.40 episodes per patient per year in Thailand, 0.38 in the United Kingdom, 0.35 in Australia/New Zealand, 0.29 in Canada, 0.27 in Japan and 0.26 in the United States. More than two-thirds of peritonitis episodes were associated with hospitalization

As for facility characteristics, size was positively associated with peritonitis risk in Japan (rate ratio per 10 patients = 1.07), while lower risk was observed in facilities that had higher automated PD use, in centers that used antibiotics at catheter insertion and at facilities with PD training duration of 6 or more days.

When examining the microbiology of peritonitis, researchers found that while it was similar across most countries, gram-negative infections and culture-negative peritonitis were more common in Thailand.

“We have identified important regional differences in the risk for peritonitis and potentially modifiable practices that may reduce these risks,” they wrote. “ ... This study sets the stage for future PDOPPS studies of other practices related to peritonitis prevention; for example, highlighting differences in patient training strategies and novel technologies such as remote patient monitoring. In addition, PDOPPS has identified important gaps in translating best practices across facilities, including selected [International Society of Peritoneal Dialysis] ISPD guideline recommendations that may affect the risk for peritonitis.” – by Melissa J. Webb

Disclosures: Perl reports consulting fees from Baxter Healthcare and DaVita, and speaker honoraria from Baxter International, DaVita, Dialysis Clinic Inc. and Fresenius Medical Care. Please see study for all other authors’ relevant financial disclosures.