Workshop establishes a core outcome measure for PD-related peritonitis
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A workshop of health professionals, patients and caregivers recommended that a core outcome measure for peritoneal dialysis-related peritonitis should include symptom-based and laboratory-based criteria.
Further, workshop attendees recommended the measure include all infections from catheter insertion.
“PD-related peritonitis is the most common type of PD-related infection and is a leading cause of discontinuation of PD. [...] Despite this, peritonitis is not routinely or consistently reported in studies of patients on PD,” Jenny I. Shen, MD, an assistant professor of medicine in the division of nephrology and hypertension at the Lundquist Research Institute at Harbor-UCLA Medical Center in California, and colleagues wrote. They added, “We convened a stakeholder workshop to identify the essential features of a core outcome measure for PD-related peritonitis, the most serious infection.”
Researchers hosted the Standardized Outcomes in Nephrology PD (SONG-PD) PD-Related Infection Consensus Workshop via Zoom on Sept. 23, 2020. Among the 53 participants, there were 35 health professionals and 18 patients and caregivers.
In the workshop, participants were placed into six breakout rooms with a facilitator and co-facilitator. Facilitators used the same question guides that consisted of “whether the 2016 International Society for Peritoneal Dialysis-recommended definition should be used for PD-related peritonitis, if the need for culture or cell count limited the feasibility of the definition and whether the definition was relevant to patients.” Additionally, participants discussed if the measure should report the rate of peritonitis episodes alone or also include the percentage of patients impacted and at what time the measure should start being measured.
Following the breakout room sessions, participants rejoined the main Zoom room to share their discussion findings and recommendations. Researchers recorded and transcribed the entirety of the workshop. The information was entered into HyperRESEARCH software to determine common themes.
Researchers identified three common themes: “(i) feasibility and applicability across diverse settings, which reflected the difficulty with implementing laboratory-based measures in resource-limited environments; (ii) ensuring validity, which included minimizing false positives and considering the specificity of symptoms; and (iii) being meaningful and tangible to patients, which meant that the measure should be easy to interpret, reflect the impact that symptoms have on patients and promote transparency by standardizing the reporting of peritonitis among dialysis units.”
Overall, the workshop revealed a main measure of PD-related peritonitis could include both symptom-based and laboratory-based criteria. Participants found the International Society for Peritoneal Dialysis definition of peritonitis acceptable but decided there should be deliberation of reporting suspected peritonitis in cases in which laboratory validation is not possible. Moreover, participants recommended the measure include all infections from the time of catheter insertion and note both the rate of infection and number of patients without peritonitis.
Shen and colleagues wrote, “The adoption of a standard, meaningful outcome measure that is consistently reported will increase the impact of trial results by simplifying the comparison and evaluation of different interventions, which will ultimately inform shared decision-making that improves the care of patients on PD.”
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