In Peritoneal Dialysis, Substantial Variations in Peritonitis Rates

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Rates of peritonitis related to peritoneal dialysis (PD) vary significantly between countries, and between facilities within countries, reports a study in the American Journal of Kidney Diseases.

The researchers analyzed data on 7051 adult PD patients at 209 facilities in seven countries, drawn from the prospective, observational Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Peritonitis rates were assessed at the country and facility levels, and associations with selected facility practices were assessed.

The data included 2272 episodes of peritonitis: crude rate 0.28 episodes per patient-year. Peritonitis rates varied within countries, exceeding 0.50 per patient-year at 10% of facilities. By country, peritonitis rates (per patient-year) were 0.40 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. Larger center size, based on number of patients, was associated with higher peritonitis risk only in Japan. More than two-thirds of peritonitis episodes led to hospitalization.

Certain facility practices were associated with lower peritonitis rates: greater use of automated PD, rate ratio (RR) 0.95 per 10-percentage point increase; antibiotic use at catheter insertion, RR 0.83; and at least 6 days of PD training, RR 0.81. Data also suggested lower peritonitis risk at facilities using muciprocin or aminoglycoside ointment at the exit site, although this fell short of statistical significance.

Peritonitis is the main cause of permanent transition to hemodialysis in PD patients. Current information on the occurrence of PD-related peritonitis and the factors associated with it are needed to develop effective prevention strategies.

The PDOPPS data show substantial international variations in the risk of peritonitis. The study also identifies potentially modifiable facility practices associated with lower rates of peritonitis, including automated PD use, antibiotic practices, and PD training. “[T]he present findings should inform future guidelines in potentially setting lower maximally acceptable peritonitis rates,” the researchers write [Perl J, et al. Peritoneal dialysis–related infection rates and outcomes: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Am J Kidney Dis 2020; 76:42–53]. doi: 10.1053/j.ajkd.2019.09.016