Muthana Al Sahlawi1,2, Gregory Wilson3, Belinda Stallard3, Karine E Manera4, Allison Tong4, Ronald L Pisoni5, Douglas S Fuller5, Yeoungjee Cho3, David W Johnson3,6,7, Beth Piraino8, Martin J Schreiber9, Neil C Boudville10, Isaac Teitelbaum11, Jeffrey Perl1. 1. Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. 2. Department of Internal Medicine, College of Medicine, King Faisal University, Al-Hasa, Saudi Arabia. 3. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia. 4. Sydney School of Public Health, The University of Sydney, New South Wales, Australia. 5. Arbor Research Collaborative for Health, Ann Arbor, MI, USA. 6. Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia. 7. Translational Research Institute, Brisbane, Australia. 8. Renal Electrolyte Division, University of Pittsburgh, PA, USA. 9. Home Modalities, DaVita Kidney Care, Denver, CO, USA. 10. Medical School, University of Western Australia, Perth, Australia. 11. Division of Hypertension and Renal Diseases, University of Colorado Denver, Aurora, CO, USA.
Abstract
BACKGROUND: Peritoneal dialysis (PD)-associated peritonitis carries significant morbidity, mortality, and is a leading cause of PD technique failure. This study aimed to assess the scope and variability of PD-associated peritonitis reported in randomized trials and observational studies. METHODS: Cochrane Controlled Register of Trials, MEDLINE, and Embase were searched from 2007 to June 2018 for randomized trials and observational studies in adult and pediatric patients on PD that reported PD-associated peritonitis as a primary outcome or as a part of composite primary outcome. We assessed the peritonitis definitions used, characteristics of peritonitis, and outcome reporting and analysis. RESULTS: Seventy-seven studies were included, three were randomized trials. Thirty-eight (49%) of the included studies were registry-based observational studies. Twenty-nine percent (n = 22) of the studies did not specify how PD-associated peritonitis was defined. Among those providing a definition of peritonitis, three components were reported: effluent cell count (n = 42, 54%), clinical features consistent with peritonitis (e.g. abdominal pain and/or cloudy dialysis effluent) (n = 35, 45%), and positive effluent culture (n = 19, 25%). Of those components, 1 was required to make the diagnosis in 6 studies (8%), 2 out of 2 were required in 22 studies (29%), 2 out of 3 in 11 studies (14%), and 3 out of 3 in 4 studies (5%). Peritonitis characteristics and outcomes reported across studies included culture-negative peritonitis (n = 47, 61%), refractory peritonitis (n = 42, 55%), repeat peritonitis (n = 9, 12%), relapsing peritonitis (n = 5, 7%), concomitant exit site (n = 16, 21%), and tunnel infections (n = 8, 10%). Peritonitis-related hospitalization was reported in 38% of the studies (n = 29), and peritonitis-related mortality was variably defined and reported in 55% of the studies (n = 42). Peritonitis rate was most frequently reported as episodes per patient year (n = 40, 52%). CONCLUSION: Large variability exists in the definitions, methods of reporting, and analysis of PD-associated peritonitis across trials and observational studies. Standardizing definitions for reporting of peritonitis and associated outcomes will better enable assessment of the comparative effect of interventions on peritonitis. This will facilitate continuous quality improvement measures through reliable benchmarking of this patient-important outcome across centers and countries.
BACKGROUND: Peritoneal dialysis (PD)-associated peritonitis carries significant morbidity, mortality, and is a leading cause of PD technique failure. This study aimed to assess the scope and variability of PD-associated peritonitis reported in randomized trials and observational studies. METHODS: Cochrane Controlled Register of Trials, MEDLINE, and Embase were searched from 2007 to June 2018 for randomized trials and observational studies in adult and pediatric patients on PD that reported PD-associated peritonitis as a primary outcome or as a part of composite primary outcome. We assessed the peritonitis definitions used, characteristics of peritonitis, and outcome reporting and analysis. RESULTS: Seventy-seven studies were included, three were randomized trials. Thirty-eight (49%) of the included studies were registry-based observational studies. Twenty-nine percent (n = 22) of the studies did not specify how PD-associated peritonitis was defined. Among those providing a definition of peritonitis, three components were reported: effluent cell count (n = 42, 54%), clinical features consistent with peritonitis (e.g. abdominal pain and/or cloudy dialysis effluent) (n = 35, 45%), and positive effluent culture (n = 19, 25%). Of those components, 1 was required to make the diagnosis in 6 studies (8%), 2 out of 2 were required in 22 studies (29%), 2 out of 3 in 11 studies (14%), and 3 out of 3 in 4 studies (5%). Peritonitis characteristics and outcomes reported across studies included culture-negative peritonitis (n = 47, 61%), refractory peritonitis (n = 42, 55%), repeat peritonitis (n = 9, 12%), relapsing peritonitis (n = 5, 7%), concomitant exit site (n = 16, 21%), and tunnel infections (n = 8, 10%). Peritonitis-related hospitalization was reported in 38% of the studies (n = 29), and peritonitis-related mortality was variably defined and reported in 55% of the studies (n = 42). Peritonitis rate was most frequently reported as episodes per patient year (n = 40, 52%). CONCLUSION: Large variability exists in the definitions, methods of reporting, and analysis of PD-associated peritonitis across trials and observational studies. Standardizing definitions for reporting of peritonitis and associated outcomes will better enable assessment of the comparative effect of interventions on peritonitis. This will facilitate continuous quality improvement measures through reliable benchmarking of this patient-important outcome across centers and countries.
Authors: Saeed M AlZabli; Mohammed A Alsuhaibani; Meshail A BinThunian; Dayel A Alshahrani; Abdulkarim Al Anazi; Sibi Varghese; Vernice Rose; Khawla A Rahim Journal: Int J Pediatr Adolesc Med Date: 2020-09-19
Authors: Jeffrey Perl; Douglas S Fuller; Neil Boudville; Alan S Kliger; Douglas E Schaubel; Isaac Teitelbaum; Bradley A Warady; Alicia M Neu; Priti R Patel; Beth Piraino; Martin Schreiber; Ronald L Pisoni Journal: Clin J Am Soc Nephrol Date: 2020-08-06 Impact factor: 8.237
Authors: Jenny I Shen; Yeoungjee Cho; Karine E Manera; Fiona Brown; Jie Dong; Muthana Al Sahlawi; Rafael G Acevedo; Htay Htay; Yasuhiko Ito; Talerngsak Kanjanabuch; Sharon J Nessim; Grace Ngaruiya; Beth Piraino; Cheuk-Chun Szeto; Isaac Teitelbaum; Noa Amir; Jonathan C Craig; Amanda Baumgart; Andrea M Gonzalez; Nicole Scholes-Robertson; Andrea K Viecelli; Martin Wilkie; Allison Tong; Jeffrey Perl Journal: Kidney Int Rep Date: 2022-05-26