Epidemiology and outcomes of peritonitis in children on peritoneal dialysis in Australasia

Peritonitis is a common complication and major cause of morbidity in children on peritoneal dialysis. In this retrospective longitudinal study, we analysed data retrieved from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) on 167 patients aged less than 18 years of age who were treated with peritoneal dialysis during the period from October 2003 to December 2007. During this period there were 100 episodes of peritonitis in 57 patients (0.71 episodes/patient-year), with Gram-positive organisms most commonly isolated (44%). Peritonitis occurred frequently in the first 6 months after starting dialysis, with survival analysis showing peritonitis-free survival rates of 72%, 56% and 36% at 6 months, 1 year and 2 years respectively. Age was a weak predictor of peritonitis on univariate analysis, but previous peritonitis was the only significant predictor in a multivariate Cox proportional hazards model (adjusted hazard ratio 2.02; 95% CI: 1.20 to 3.40, p = 0.008). Peritonitis episodes infrequently resulted in relapse (5%), recurrence (7%) or the need for either temporary or permanent haemodialysis (5% and 7% respectively) and there were no patient deaths directly attributable to peritonitis. Compared with single organism peritonitis, polymicrobial peritonitis was not associated with any statistically significant differences in outcome. Further prospective studies are required to determine the most appropriate prophylactic measures and antibiotic regimens for use in pediatric patients.     

Peritonitis in children on peritoneal dialysis in Cape Town, South Africa: epidemiology and risks

Peritonitis is a frequent complication of peritoneal dialysis (PD) in children as well in adults. Data on PD and peritonitis in pediatric patients are very scarce in developing countries. A retrospective cohort study was performed between 2000 and 2008 with the aim to evaluate PD treatment and peritonitis epidemiology in pediatric patients in South Africa and identify risk factors for peritonitis. Baseline characteristics and potential risk factors of peritonitis were recorded, including housing, socio-economic circumstances, distance to PD center, type of PD, mode of catheter placement, race, presence of gastrostomy tube, weight, and height. Outcome indices for peritonitis were peritonitis rate, time to first peritonitis, and number of peritonitis-free patients. The patient cohort comprised 67 patients who were on PD for a total of 544 months. The total number of peritonitis episodes was 129. Median peritonitis rate was one episode every 4.3 patient months (2.8 episodes/patient-year, range 0–21.2). Median time to first infection was 2.03 months (range 0.1–21.5 months), and 28.4% of patients remained free from peritonitis. Patients with good housing and good socio-economic circumstances had a significantly lower peritonitis rate and a longer time to first peritonitis episode. Peritonitis rate was high in this cohort, compared to numbers reported for the developed world; the characteristics of causative organisms are comparable. The most important risk factors for the development of peritonitis were poor housing and poor socio-economic circumstances. More intensive counseling may be beneficial, but improvement of general socio-economic circumstances will have the greatest influence on PD success.     

Peritoneal dialysis-associated peritonitis in Scotland (1999-2002).

BACKGROUND: Peritonitis is a major complication of peritoneal dialysis (PD). We have performed a national study of all patients on PD in Scotland over a 3.5 year period examining the causes of technique failure, rates of peritonitis, causative organisms, clinical outcomes and differences between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). METHODS: All 10 adult renal units in Scotland participated in the study and the data include all 1205 patients who were on PD in Scotland from January 1999 to June 2002. The data were collected prospectively by the PD nurses and reported to the Scottish Renal Registry every 6 months. RESULTS: Refractory or recurrent peritonitis was the cause of technique failure in 167 patients (42.6% of all cases of technique failure). There were 928 cases of peritonitis in 1487 patient-years, which equates to an overall peritonitis rate of one episode every 19.2 months. The peritonitis rates for APD and CAPD were similar at one episode every 20.3 months and one episode every 18.6 months, respectively. These results include 88 cases of peritonitis due to relapse or re-infection. There was a statistically significant difference (P = 0.012) in peritonitis rates between units using nasal mupiricin (one episode every 21.9 months) and those that did not (one episode every 18.3 months). Coagulase-negative Staphylococcus was the most common cause of peritonitis (29%), although this rate is lower than in historic studies. The overall initial cure rate was 75%. The initial cure rate for APD was 77.2% and for CAPD was 73.7%. No causative organism was isolated in 17% of cases. CONCLUSION: PD-associated peritonitis is the leading cause of technique failure in Scotland. We validate previous studies showing a decrease in the proportion of peritonitis episodes that are caused by coagulase-negative staphylococci. APD peritonitis rates are not significantly better than CAPD peritonitis rates in Scotland, and the initial cure rates for APD and CAPD are similar.     

腹膜透析中腹膜炎发病率统计方法的评估

目的 评估腹膜透析(腹透)中腹膜炎发病率的统计方法。方法 回顾性的分析仁济医院腹透中心1999年8月1日至2004年6月30日之间使用双联系统的腹透患者腹膜炎发病率,分别采用队列特异性腹膜炎发病率、负二项分布模型、腹膜炎发病率的中位数和无腹膜炎的生存率等方法进行统计。结果队列特异性腹膜炎发病率为1／56.14患者月,负二项分布模型统计的腹膜炎发病率为1／49.58患者月,腹膜炎发病率的中位数为0,平均无腹膜炎的生存时间为39.71月。无腹膜炎生存时间与个体特异性腹膜炎发病率负相关(P<0.05)。结论 队列特异性腹膜炎发病率能描述一个腹透中心的腹膜炎发病率,便于各中心之间进行比较。负二项分布模型能反映患者腹膜炎发病频数的分布趋势,有助于发现高危人群和高危因素,并加强预防。腹膜炎发病率的中位数可用于腹膜炎发生人数超过50％的腹透中心,无腹膜炎生存率能预示腹膜炎的易感性,适用于规模较大的腹透中心评估腹膜炎发病率。综合使用这些方法能更真实的描述腹膜炎发病情况,为针对性的预防腹膜炎提供科学依据。     

Peritonitis in children with automated peritoneal dialysis: a single-center study of a 10-year experience

Peritoneal dialysis (PD) constitutes the preferred dialysis modality for children requiring renal replacement therapy with peritonitis being one of the most common complications of PD. This study was performed to evaluate the epidemiology, microbiology, and outcomes of PD-associated peritonitis in Greek children for a 10-year period. A total of 27 patients (16 males) with a mean age 121.8?±?57.2 months were retrospective analyzed. Patients were on PD therapy for a mean duration of 45.2?±?26.1 months. We found 23 episodes of PD-associated peritonitis occurred in 9 out of 27 patients (0.23 episodes/patient-year), with four patients experienced two or more peritonitis episodes. Gram-positive bacteria were responsible for 15 (65.2%) peritonitis episodes, with Staphylococcus aureus being the predominant specie isolated in 30.4% of cases. A total of seven episodes of exit-site infections (ESIs) were identified in five patients (0.069 episodes/patient-year) with the most common bacteria isolated being S. aureus (57.4%). Initial antibiotic treatment included intraperitoneal vancomycin plus ceftazidime in the majority of cases (82.6%). At the end of study, 12 (44.4%) patients remained on PD, 11 (41.8%) underwent renal transplantation, 2 (7.4%) shifted to hemodialysis and unfortunately, two patients (7.4%) died. Conclusively, our study revealed a noticeable low peritonitis and ESIs rate as compared to international data and represents the first evaluation of the characteristics and outcomes of peritonitis in the Greek pediatric PD population.     

Mannose binding lectin level and polymorphism in patients on long-term peritoneal dialysis.

BACKGROUND: Infection is a leading cause of mortality and morbidity in patients with end-stage renal disease. The increased susceptibility to infection is probably secondary to the impaired immune defence in uraemia and other co-morbid factors such as diabetes mellitus. Peritonitis remains the most common and major complication in the treatment modality of peritoneal dialysis (PD) for uraemic patients. Mannose binding lectin (MBL) is a calcium dependent C-type lectin that acts as an important first line defence mechanism against infection by its capability to activate the complement system and enhance phagocytosis. METHODS: We examined whether serum concentration of MBL and the point mutation of MBL may act as a risk factor in PD-related peritonitis. We studied four groups of dialysis patients: PD patients with two or more episodes of peritonitis, peritonitis-free PD patients, haemodialysis (HD) patients not previously on PD, and HD patients who were converted from PD due to technique failure following peritonitis-related abdominal adhesion. Results. Both homozygous and heterozygous patients had profoundly reduced serum level of MBL. The codon 54 point mutation rate amongst our dialysis patients was comparable with that of healthy subjects. Dialysis patients had a significantly lower serum level of MBL than healthy controls independent of the MBL gene mutation or the mode of dialysis treatment. Patients on PD with codon 54 point mutation were found to have a lower serum MBL level compared with HD patients with similar MBL gene mutation. However, we found no difference in the serum MBL level or frequency of codon 54 point mutation between four groups of dialysis patients. CONCLUSIONS: Dialysis patients have lower MBL levels that may increase the susceptibility of infection. However, the existence of other risk factors such as connection technique, nasal bacterial carriers, bowel pathology and personal hygiene precludes the MBL level as the sole primary factor for peritonitis in patients on maintenance PD treatment.     

Non-tuberculous mycobacterial PD peritonitis in Australia

Purpose

Peritonitis can be a severe complication of peritoneal dialysis (PD) due to associated morbidity and mortality. Non-tuberculous mycobacteria (NTM) are a rare cause of PD peritonitis, with high rates of catheter removal and conversion to haemodialysis, and a reported mortality as high as 40 %. The incidence, culprit NTM species, and outcomes associated with PD peritonitis have not been described in many countries, including Australia.

Methods

We examined the Australia and New Zealand Dialysis and Transplant Registry from 1 October 2003 to 31 December 2009 for all prevalent peritoneal dialysis patients. Patient characteristics, organisms, treatment and outcome for all NTM PD peritonitis episodes were obtained.

Results

Twelve cases of NTM PD peritonitis were reported, including the first reports of infection due to Mycobacterium hassiacum and Mycobacterium neoaurum. The incidence of NTM PD peritonitis was approximately 1 per 1000 PD patient-years. Recovery occurred in 11 patients, including 3 without removal of their Tenckhoff catheters. A range of antibiotics were utilised. One patient died of sclerosing peritonitis 5 months after diagnosis of PD peritonitis.

Conclusion

Non-tuberculous mycobacteria PD peritonitis is a rare cause of peritonitis, and mortality may be lower than previously reported. Catheter removal occurred in the majority of patients, and adverse outcomes were not observed for those in whom it was retained.     

Nocardia peritonitis and abdominal abscess complicating continuous ambulatory peritoneal dialysis

Peritonitis is a common problem in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and represents the most frequent cause of peritoneal catheter loss and discontinuation of CAPD. The incidence of peritonitis remains less than one episode per patient year of treatment. Common bacteria, particularly staphyloccal species, are the usual causative agents. Fungi and higher bacteria such as Nocardia as aetiological agents have been infrequent in patients undergoing CAPD. We report a case of Nocardia nova peritonitis complicated by an intra‐abdominal abscess requiring surgical drainage and a protracted course of antibiotics.     

A survey of peritonitis and exit-site and/or tunnel infections in Japanese children on PD

To obtain data on peritonitis and exit-site and/or tunnel infections (ESI/TI) in Japanese children undergoing peritoneal dialysis (PD) from January 1999 through June 2003, we surveyed 22 members of the Japanese Study Group of Pediatric Peritoneal Dialysis (JSPPD) by questionnaire. One hundred and thirty patients were eligible. Seventy episodes of bacterial peritonitis occurred in 45 patients (0.17 episodes/patient-year), and 123 ESI/TI occurred in 60 patients (0.29 episodes/patient-year). S. aureus and MRSA were found to be the causative organisms in 39% and 13% of the peritonitis episodes, and in 59% and 20% of the ESI/TI, respectively. Tunnel infection was found in 55% of the MRSA peritonitis episodes. Eleven percent of the peritonitis episodes relapsed, and 19% needed hemodialysis. One patient died due to MRSA peritonitis. The PD catheter was removed in all fungal and 78% of MRSA peritonitis. However, the type of organism did not influence the need for catheter-related surgery for ESI/TI. Neither peritonitis nor ESI/TI was prevented by the use of a swan-neck catheter, a downward-pointing exit site, povidone iodine exit-site care, bathing instruments, or nasal mupirocin. In conclusion, MRSA peritonitis was not uncommon in children in Japan, was frequently associated with tunnel infections, and had a poor outcome. No association was found between the occurrence of infection and preventive measures previously reported as effective. Alternative approaches are needed in children, especially for MRSA.Members of the Japanese Study Group of Pediatric Peritoneal Dialysis (JSPPD) that participated in this survey: Yuko Akioka (Chiba), Kazumoto Iijima (Tokyo), Masahiro Ikeda (Tokyo), Masaaki Ikoma (Kawasaki), Yuhei Ito (Kurume), Osamu Uemura (Ohbu), Yoshiyuki Ohtomo (Iwatsuki), Yoshitsugu Kaku (Fukuoka), Takashi Sakano (Hiroshima), Kenichi Satomura (Osaka), Junzo Suzuki (Fukushima), Eihiko Takahashi (Yokohama), Masafumi Taki (Okayama), Motoshi Hattori (Tokyo), Hitoshi Nakazato (Kumamoto), Shinya Nakamura (Sagamihara), Kandai Nozu (Kobe), Toshio Yanagihara (Niigata), Hiroshi Yoshimura (Uruma)     

Peritonitis in continuous ambulatory peritoneal dialysis in children living in Saudi Arabia

The clinical aspects of peritonitis and catheter infections were reviewed in 64 children on continuous ambulatory peritoneal dialysis living in Saudi Arabia over a period of 6 years. Peritonitis occurred in 41 children (64%). The mean time from starting dialysis to the first episode of peritonitis was 7.2 months. The incidence of peritonitis was 1 episode in 9 treatment months. Gram-negative organisms were responsible for the majority of episodes (42%), followed by Gram-positive organisms (20%), and Candida albicans (6%); 32% were culture negative. Recurrent peritonitis was present in 20 cases. Catheter was replaced in 24 patients: 44% due to recurrent peritonitis. Peritoneal membrane loss occurred in 7 patients, 3 had Candida peritonitis and 3 had recurrent peritonitis due to Pseudomonas. The mortality rate was 4.6% but none of the deaths were related to peritonitis or dialysis. Received August 23, 1995; received in revised form October 2, 1996; accepted October 18, 1996     

Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis

BackgroundPeritoneal dialysis has become commonly used for renal replacement therapy; however, some patients withdraw from peritoneal dialysis due to complications, including peritoneal dialysis-related peritonitis, resulting in the low number of patients on peritoneal dialysis. Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis are less certain. This retrospective study aimed to investigate these risk factors.MethodsWe retrospectively analyzed clinical characteristics, laboratory data, and causative microorganisms of 204 episodes of peritoneal dialysis-related peritonitis between 2007 and 2018 at our institution.ResultsOf the 204 episodes, 38 resulted in withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis. The number of peritonitis episodes per patient-year and the incidence of cardiovascular disease were significantly higher in the withdrawal group. Similarly, this group had low levels of serum creatinine, urea nitrogen, serum albumin, alanine aminotransferase, cholinesterase and high C-reactive protein, and second dialysate cell counts after antibiotic administration. Multivariate logistic regression analysis revealed that serum albumin (odds ratio: 0.465; 95% confidence interval: 0.249–0.868; P = 0.016) and cardiovascular disease (odds ratio: 2.508; 95% confidence interval: 1.184–5.315; P = 0.016) exhibited significant differences.ConclusionsThe results of this study suggest that hypoalbuminemia and the presence of cardiovascular disease were independent risk factors for withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis.     

Rothia dentocariosa Repeat and Relapsing Peritoneal Dialysis-Related Peritonitis: A Case Report and Literature Review

Peritonitis is well recognized as the Achilles tendon of peritoneal dialysis (PD). Reoccurrence of peritonitis due to the same organism, defined as either repeat or relapsing peritonitis under the 2005 guidelines by the International Society for Peritoneal Dialysis, often results in PD technique failure. Rothia dentocariosa, a low-virulent human oropharynx commensal, is a rarely reported pathogen in human infection, particularly infective endocarditis. R. dentocariosa PD-related peritonitis is exceedingly uncommon yet potentially results in repeat or relapsing peritonitis which requires catheter removal. We report a case of R. dentocariosa repeat and relapsing peritonitis in a PD patient who was treated successfully with antimicrobial therapy.     

Efficacy of a non-vancomycin-based peritoneal dialysis peritonitis protocol

BACKGROUND: Peritonitis has a significant impact upon morbidity and mortality of peritoneal dialysis (PD) patients. Gram-positive organisms account for the majority of infections and vancomycin is a cost effective broad-spectrum antimicrobial treatment for PD peritonitis, but this may lead to the emergence of multiple antibiotic-resistant organisms. The purpose of the present paper was to evaluate the efficacy of a non-vancomycin-based protocol comprising cephazolin and gentamicin, which was introduced in the present PD population as empirical treatment for peritonitis. METHODS: The study involved 82 peritonitis episodes over a 4-year period in 58 patients, excluding those with previous methicillin-resistant staphylococcal peritonitis. RESULTS: With cephazolin and gentamicin there was no apparent difference in response or relapse rates in comparison to reported studies using vancomycin-based first-line therapy protocols. CONCLUSION: We advocate initial treatment of PD peritonitis with non-vancomycin-based therapy given similar efficacy and the potential for reduction of resistant organisms.     

Increased risk of Staphylococcus epidermidis peritonitis in patients on dialysate containing 1.25 mmol/L calcium.

Peritoneal macrophage function is decreased in vitro in the presence of dialysate with 1.25 mmol/L calcium compared with that containing 1.75 mmol/L calcium. Theoretically, patients using this dialysate may have a higher risk of peritonitis. Nineteen patients on continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD) were converted from dialysate with 1.75 mmol/L calcium (mean time, 33 +/- 26 months) to that with 1.25 mmol/L calcium, for some or all exchanges (mean time, 10 +/- 4.7 months). Peritonitis rates were compared with 19 control patients who remained on dialysate with 1.75 mmol/L calcium. The two groups were matched for the proportion of diabetics, sex, age, use of the Y-set, and dialysis modality (CAPD, CCPD). Peritonitis rates were similar in the study patients before conversion to 1.25 mmol/L calcium dialysate and in the control patients (0.49 v 0.58 episodes/patient-year, respectively). After conversion to dialysate with 1.25 mmol/L calcium, the peritonitis rate was 0.82 episodes/patient-year contrasted to 0.58 episodes/patient-year in the control patients (P = 0.09). The peritonitis rate due to Staphylococcus epidermidis was 0.51 episodes/patient-year when 1.25 mmol/L calcium dialysate was used, and 0.19 episodes/patient-year for the comparable period in the control patients on 1.75 mmol/L calcium dialysate (P = 0.005). The proportion of peritonitis episodes due to S epidermidis increased from 20% to 61% after conversion to 1.25 mmol/L calcium (P = 0.01). The increased risk of peritonitis due to S epidermidis in patients using dialysate with 1.25 mmol/L calcium is consistent with a previous study demonstrating that clearance of S epidermidis by peritoneal macrophages is less effective with a decrease in the dialysate calcium content.(ABSTRACT TRUNCATED AT 250 WORDS)     

Impaired outcome of continuous ambulatory peritoneal dialysis in immunosuppressed patients

BACKGROUND.: Although immunodeficiency predisposes to CAPD peritonitis withfungal or unusual organisms, the role of immunosuppression asa predisposing factor for CAPD peritonitis, as well as the outcomeof such episodes, remains uncertain. METHODS.: The incidence, spectrum of infectious organisms, and outcomeof CAPD peritonitis was retrospectively reviewed in 39 immunosuppressedand 146 non-immunosuppressed patients treated with CAPD overthe calendar year 1993. RESULTS.: Immunosuppressed patients were younger (mean 44 vs 57 years,P<0.001) and had an increased incidence of previous transplantation,glomerulonephritis, systemic lupus erythematosus, and vasculitis.Immunosuppressed patients had more episodes of peritonitis (69/39patients vs 99/147, P<0.001), required more frequent hospitaladmission (25/39 vs 33/146, P<0.001), had more days off CAPD(331 vs 242, P< 0.001), and required more laparotomies toremove infected CAPD catheters (11/39 vs 14/146, P<0.01).Immunosuppression was associated with increased infection dueto S. aureus and fungi, which may have contributed towards increasedmorbidity in this group. Current immunosuppression or a recenthistory of immunosuppression appeared to be equally potent riskfactors for infection. There was a trend for the incidence ofinfection to parallel the aggressiveness of immunosuppression. CONCLUSIONS.: Immunosuppression is an important risk factor for CAPD peritonitis.A high index of suspicion for infection and aggressive chemotherapyare mandatory. CAPD may not be the initial therapy of choicein this high-risk group.     

Impact of new connectology in reducing peritonitis

Summary: A computer initiated literature search for publications addressing the association between connectology and peritonitis in continuous peritoneal dialysis patients identified 23 relevant articles. These publications used one of four basic clinical research designs (before-after; single centre prospective cohort; multi-centre prospective cohort and randomized clinical trial). the methodologic weaknesses inherent in the first two designs significantly impaired the validity of their conclusions. the two multi-centre cohort studies and the five randomized clinical trials have external and internal validity, respectively. Combined, they suggest that the Y connector-disinfectant system and the twin bag systems are associated with less peritonitis than standard, ultraviolet and possibly the Y set without disinfectant. the effect is entirely due to decreased infection with Staphylococcus epidermidis and other organisms associated with touch contamination. Peritonitis due to these organisms does not cause significant loss of peritoneal dialysis catheters or transfer to haemodialysis. the decreased hospitalization due to fewer episodes of peritonitis will become less important with more outpatient antibiotic treatment of these mild infections. Significant improvement in the morbidity associated with peritoneal dialysis related infection will require effective strategies for prevention of infection due to Staphylococcus aureus and gram-negative organisms.     

Higher rate and earlier peritonitis in Aboriginal patients compared to non-Aboriginal patients with end-stage renal failure maintained on peritoneal dialysis in Australia: analysis of ANZDATA

BACKGROUND: Aboriginal patients maintained on peritoneal dialysis (PD) have a higher rate of technique failure than any other racial group in Australia. Peritonitis accounts for the bulk of these technique failures, but it is uncertain whether the increased risk of peritonitis in Aboriginal patients was independent of associated comorbid conditions, such as diabetes mellitus. METHODS: Using data collected by the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), peritonitis rates and time to first peritonitis were compared between Aboriginal (n = 238) and non-Aboriginal patients (n = 2924) commencing PD in Australia between 1 April 1999 and 31 March 2003. RESULTS: Aboriginal PD patients were younger, and had a higher incidence of diabetes than their non-Aboriginal counterparts. Mean peritonitis rates were significantly higher among Aboriginal (1.15 episodes/year; 95% confidence interval (CI): 1.03-1.28) than non-Aboriginal patients (0.60 episodes/year; 95% CI: 0.57-0.62, P < 0.05). Using multivariate negative binomial regression, independent predictors of higher peritonitis rates include Aboriginal racial origin (adjusted odds ratio 1.78; 95% CI: 1.45-2.19), obesity, age and absence of a recorded dialysate : plasma creatinine ratio (D/P creatinine) measurement. Aboriginal racial origin was also associated with a shorter median time to first peritonitis (9.9 vs 19.3 months, P < 0.05), which remained statistically significant in a multivariate Cox proportional hazards model (adjusted hazard ratio 1.76; 95% CI: 1.47-2.11, P < 0.05). CONCLUSION: Aboriginal and obese PD patients have a higher rate of peritonitis and a shorter time to first peritonitis, independent of demographic and comorbid factors. Further investigation of the causes of increased peritonitis risk in Aboriginal patients is needed.     

Comparison of peritonitis rates and patient survival in automated and continuous ambulatory peritoneal dialysis: a 10-year single center experience

Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In this retrospective study, peritonitis rates and patient survival of 180 patients on CAPD and 128 patients on APD were compared in the period from January 2005 to December 2014 at Al-Nafisi Center in Kuwait. All patients had prophylactic topical mupirocin at catheter exit site. Patients on CAPD had twin bag system with Y transfer set. The peritonitis rates were 1 in 29 months in CAPD and 1 in 38 months in APD (p?<?0.05). Percentage of peritonitis free patients over 10-year period in CAPD and APD were 49 and 60%, respectively (p?<?0.05). Time to develop peritonitis was 10.25?±?3.1 months in CAPD compared to 16.1?±?4 months in APD (p?<?0.001). Relapse and recurrence rates were similar in both groups. Median patient survival in CAPD and APD groups with peritonitis was 13.1?±?1 and 14?±?1.4 months respectively (p?=?0.3) whereas in peritonitis free patients it was 15?±?1.4 months in CAPD and 23?±?3.1 months in APD (p?=?0.025). APD had lower incidence rate of peritonitis than CAPD. Patient survival was better in APD than CAPD in peritonitis free patients but was similar in patients who had peritonitis.     

Hepatitis C Infection and Related Factors in Hemodialysis Patients in China: Systematic Review and Meta-Analysis

Background and Aims. To provide a comprehensive and reliable tabulation of available data on the epidemiological characteristics and risk factors for hepatitis C virus (HCV) infection in maintenance hemodialysis (HD) patients in China, and to help inform prevention programs and guide future research. Methods. A systematic review was constructed based on the computerized literature database by two reviewers independently. Ninety-five percent confidence intervals (CI) of infection rates were calculated using the approximate normal distribution model. Odds ratios and 95% CI were calculated by fixed or random effects models. Results. Forty-three studies met our inclusion criteria. The pooled prevalence of HCV infection among HD patients in China was 41.1% (95% CI 39.5–42.6%). No significant difference was found in HCV infection rates between male and female HD patients (OR = 0.75, 95% CI 0.52–1.07, p = 0.11). HD patients with blood transfusion were 5.65 times more likely to be infected with HCV than HD patients without blood transfusion. A longer duration of HD was associated with increased HCV prevalence. Co-infection with hepatitis B virus did not increase the probability of HCV infection among HD patients (OR = 1.19, 95% CI 0.34–3.20, p = 0.73). Conclusions. Viral hepatitis is still one of the main complications in HD patients, with hepatitis C being the most common one. The key to reducing the incidence of viral hepatitis in HD patients is to control contagion and reduce the frequency of blood transfusion and cross-infection.     

Infectious and catheter-related complications in pediatric patients treated with peritoneal dialysis at a single institution

Continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) are the predominant dialytic modalities for the majority of children while awaiting transplantation. Wide acceptability of peritoneal dialysis is hindered by infectious complications. A retrospective review of 367 pediatric patients treated with CAPD/CCPD for at least 3 months from September 1980 through December 1994 revealed that the peritonitis incidence ranged from 1.7 to 0.78 episodes per patient-year. No differences in peritonitis rates were observed between patients treated with CAPD or CCPD. Gram-positive organisms were responsible for the majority of peritonitis episodes. Age, sex, race, primary renal disease, presence of nephrotic syndrome, and serum albumin level were not associated risk factors. Longer time on treatment and diminished serum IgG level were associated with increased peritonitis incidence. Treatment was successfully completed at home in most cases. Almost half of the catheter losses were caused byStaphylococcus, Pseudomonas, and fungal peritonitis and tunnel/exit-site infections. Infectious complications are still the major causes of morbidity and treatment failure in patients treated with CAPD/CCPD. Thus, controlled studies are needed to assess methods for prevention or improvement of peritonitis rates in this patient population.