Journal Watch
Stepwise PD Starts vs. Conventional PD Starts—Which is Better?
Stepwise Initiation of PD (SIPD) is an approach that uses a gradual introduction to PD (perhaps like incremental PD in the U.S.?). In a retrospective look at 39 SIPD patients vs. 78 conventional PD (CPD) starts during a 13-year period matched for age and sex, early complications and PD catheter survival were similar between groups. But, late complications were significantly lower in the SIPD group. The authors believe SIPD may aid tissue healing and reduce biofilms, which may reduce infections. As always, more studies are needed…
Read the abstract » | (added 2024-11-21)
Tags: Stepwise Initiation Of PD, Incremental PD, Late Complications, Infection, Tissue Healing, Biofilms
More Nephrologist Time Linked with Lower PD Peritonitis and Catheter Infection Rates
A PDOPPS study in Korea divided 276 incident PD patients into two groups based on whether they got <15 minutes (n=184;66.7%) vs. >15 (n=92; 33.3%) minutes of nephrologist time during each visit. Average age between groups did not differ, but the group that had more nephrologist time had significantly fewer 3- and 12-month PD-related infections.
Read the abstract » | (added 2024-10-15)
Cloudy-only Peritonitis May Point to Vancomycin First
A study that looked at clinical characteristics of PD-associated peritonitis (PDAP) was able to correlate the signs and symptoms with the pathogen, allowing the team to choose antibiotics in a more informed way. The researchers divided the records of 162 patients with culture-positive PDAP into those who had cloudy effluent only vs. those who also had pain and/or fever, and compared the culture and sensitivity results. All 30 of the cloudy-only group had gram-positive infections; significantly more than the multi group (P<0.001), and 29 of those infections were susceptible to vancomycin, for specificity of 98.48%. This insight may help guide a first choice of antibiotic.
Read the abstract » | (added 2024-10-15)
Tags: PD associated Peritonitis, Cloudy Effluent, Vancomycin
Is There a Best Practice for PD Exit Site Care to Prevent Infection?
In a systematic review and meta-analysis, 2,092 studies were examined and 13 comprising 1,229 PD patients were selected for analysis (9 RCTs, 3 quasi-experimental, and one self-controlled trial). Five types of exit site care dressings were compared: named disinfection, antibacterial, non-antibacterial occlusive, sterile gauze, and no-particular dressings. No dressing was more effective than any other for preventing exit site infections or peritonitis.
Read the abstract » | (added 2024-08-16)
Tags: Systematic Review, Meta analysis, PD, Exit Site Infection. Peritonitis
Which is Safer: Urgent Start HD or Urgent Start PD?
Analysis of data from 9 studies (941 PD and 779 HD patients) revealed that the risk of all-cause mortality, dialysis-related infections, and mechanical complications were higher in patients who started HD urgently than in those who started PD urgently.
Read the abstract » | (added 2024-07-12)
Tags: PD, HD, All cause Mortality, Dialysis related Infections, Mechanical Complications, Urgent start
Meta-analysis of Urgent Start vs. Conventional Start PD
Analysis of data from 27 studies found comparable post-procedure infections, peritonitis, and exit site infections, technique survival, and transfer to HD for urgent and conventional start PD. Urgent start PD had a signficantly higher risk of mechanical complications such as leaks, and significantly higher mortality rates.
Read the abstract » | (added 2024-03-15)
Tags: Chronic Kidney Disease, Meta analysis, Peritoneal Dialysis
Lessons from Almost 15,000 PD Catheter Placements
Of the various PD catheter placement techniques, laparoscopy had higher 6-month mechanical complications, exit site infections, revision, and removal rates, while fluoroscopy had higher rates of sepsis and death. Open surgery had higher rates of catheter displacement.
Read the abstract » | (added 2023-12-15)
Tags: PD Catheter Placement Technique, Laparoscopy, Mechanical Complications, Exit Site Infections, Revision, Removal Rates, Fluoroscopy, Sepsis, Death
PD vs. Home HD for Severe Infections
In a Finnish study of 536 patients using home dialysis, the risk of a severe infection (C-reactive protein of 100mg/L or higher) in year 1 of CAPD was 35%, APD was 25% and home HD was 11%. Over a 5-year period, compared to home HD, the hazard ratio of severe infection for APD was 2.2 and for CAPD, 2.8. PD peritonitis accounted for the difference.
Read the abstract » | (added 2023-07-17)
Tags: Home Dialysis, Severe Infection, C reactive Protein, CAPD, APD, HD, Home HD, PD Peritonitis
Can People do Urgent Start PD and Intermittent PD?
Yes. Among 169 people starting PD urgently, 111 had fewer than four exchanges per day (intermittent) and 58 received full-dose PD. A year later, both groups had adequate PD and similar peritoneal transport, residual kidney function, blood pressure control, anemia management, and correction of bone minerals. Infections, complications, and technique survival were similar as well.
Read the abstract » | (added 2022-04-18)
Tags: Urgent Start PD, Incremental Peritoneal Dialysis, USPD, IPD
Pilot: Chlorhexidine-impregnated Sponge Dressings to Prevent Exit Site Infections
In a single-center study, 50 incident PD patients were taught to use a weekly chlorhexidine dressing on their exit sites, and followed for a year. While 12% developed contact dermatitis, 73% found the dressings acceptable. Episodes per patient year of exit-site/tunnel infections and peritonitis were 0.09 and 0.07, respectively, while 1-year technique and patient survival rates were 86% and 96%, respectively.
Read the abstract » | (added 2020-10-12)
Tags: Chlorhexidine Dressing, Exit site Infection, Peritoneal Dialysis