Standardized, evidence-based strategies might reduce peritoneal dialysis infections
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Implementing evidence-based prevention practices across the nephrology community may be a solution to limiting peritoneal dialysis infections, according to a speaker at ASN Kidney Week.
“There’s an association between having a peritonitis event and the downstream risk of death. It’s a leading cause of transfer to hemodialysis,” Jeffrey Perl, MD, FRCP(C), DM, investigator at St. Michael’s Hospital in Toronto, said. “When we think about interventions to prevent peritonitis, I broke it down into three groups: pre-[peritoneal dialysis] PD interventions, transition to PD interventions and post-PD initiation interventions.”
What is known about pre-PD practices is that it is important for surgeons and interventional colleagues to plan and locate exit sites and to fully educate patients about preoperative PD catheter care.
“Prevention of infections begins at the pre-dialysis stage for patients that will soon be started on dialysis,” Perl said. “The earlier in the trajectory we can plan for PD, the potential we have for reducing peritonitis once patients are started [increases].”
In the transition to PD, it is critical that patients receive antibiotics at the time of PD catheter insertion, he said. Perl highlighted a survey in the U.S. that revealed 63% of medical directors participating in Peritoneal Dialysis Outcomes and Practice Patterns Study said the patients in their programs were receiving antibiotics at the time of catheter insertion.
“This needs to move up to 100%,” Perl said. “And what we don’t know is how do we knowledge-translate best practices to all, across all facilities in this country, to make sure that everybody’s practicing evidence-based peritonitis prevention strategies. One thing that I think will be critical is education.”
Currently, the Teach PD study is examining whether protocolized and standardized training can improve the downstream risk of peritonitis. The results of this study will most likely shape the way peritonitis prevention is targeted and help determine whether standardized training can establish standardized practices, Perl said.
Post-PD initiation strategies that are known to prevent infection include connectology, aseptic technique, retraining, hand hygiene and the application of prophylactic antibiotics at the time of catheter insertion, as well as prior to invasive procedures, he said.
Retraining patients may also affect the downstream risk of peritonitis. Perl said racial disparities also contribute to the heighted risk for PD among patients, and the Improving Access to Home Dialysis Act has been proposed to solve this issue.
“A take-home point here is that if we come together as a nephrology community and try to make sure that we standardize and implement best practices for infection prevention, we can make an impact on downstream risk of infection,” Perl said.
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Perl J, et al. Reducing peritoneal dialysis infections: What we know and what we need to know. Presented at: ASN Kidney Week; Nov. 4-7, 2021 (virtual meeting).
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