The success of peritoneal dialysis pd is dependent on the structural and functional integrity of the peritoneal membrane. Peritoneal dialysis was first carried out in the 1920s. In patients without peritonitis, a wbc between 050 with a mononuclear predominance is. Continuous ambulatory peritoneal dialysis capd continuous ambulatory peritoneal dialysis often just called the bags is one type of peritoneal dialysis.
Kidney failure is stage five of chronic kidney disease ckd. The impact of intraperitoneal antibiotic administration in. Detailed recommendations on the prevention and treatment of pd associated peritonitis have been published by the international society for peritoneal dialysis ispd, but there is a substantial variation in clinical practice among dialysis units. Paediatric peritoneal dialysis peritonitis clinical pathway clinical pathways never replace clinical judgement. Jan 26, 2020 peritoneal dialysis or pd is a type of dialysis for patients with kidney failure where the patients abdominal cavity called the peritoneum, itself serves as an artificial kidney. Peritoneal dialysis free download as powerpoint presentation. Pdf peritonitis is a debilitating infectious complication of peritoneal dialysis pd. Feb 04, 2009 peritonitis remains a frequent complication of peritoneal dialysis in children and is the most common reason for technique failure. Treatment for peritoneal dialysisassociated peritonitis.
See microbiology and therapy of peritonitis in peritoneal dialysis. Contact the nephrologist or peritoneal dialysis unit covering the patient as. Pathophysiological changes to the peritoneal membrane. With the following report we discuss the importance of these unusual microorganisms in peritoneal dialysis patients. Risk factors associated with peritonealdialysisrelated. It is used to remove excess fluid, correct electrolyte problems, and remove toxins in those with kidney failure. Prevention of peritonitis in patients undergoing capd requires intensive.
Management of peritoneal dialysisassociated peritonitis in. Renal association clinical practice guideline peritoneal dialysis june 2017 8. Nevertheless, peritonitis remains a major problem in pd, with a substantial percent of patients developing persistent or relapsing infections. Ispd peritonitis recommendations peritoneal dialysis international. Peritoneal dialysis pd has become a real alternative to hemodialysis hd in recent decades, with comparable survival rates, lower costs, and improved patient quality of life. Intra peritoneal dialysis predisposes to peritoneal infection sometimes named primary peritonitis in this context. This form is to be used to assess patients on peritoneal dialysis who present with any of the following symptoms. Peritonitis usually is caused by bacterial infection, but sterile peritonitis does. Gramnegative peritonitis is particularly troublesome because it is frequently unresponsive to antibiotic therapy alone, and because it can have longterm adverse consequences on peritoneal membrane function and lead to inability to conduct peritoneal dialysis pd. Complications of peritoneal dialysis and peritonitis. Unusual causes of peritonitis in a peritoneal dialysis. Peritoneal dialysisassociated peritonitis american society of. Fish, 6 eric goffin, 7 yonglim kim, 8 william salzer, 9 dirk g.
Treatment of peritoneal dialysis pd related peritonitis page 2 of 7 patients receiving more than one dose of gentamicin or vancomycin should have plasma levels monitored for. Peritonitis remains a major complication of pd and is a predominant cause of technique failure, morbidity and mortality amongst pd patients. Peritonitis is a major complication of peritoneal dialysis. This study aimed to evaluate whether peritonitis has a negative impact on mortality in a large cohort of peritoneal dialysis patients. Peritonitis represents a major complication of peritoneal dialysis pd. Jul 25, 2019 a general overview of peritonitis in peritoneal dialysis is presented separately. Peritoneal dialysis pd represents the most common form of homebased dialysis treatment for endstage kidney failure eskf and accounts for approximately 11 % of globally performed dialysis. Peritonitis is associated with significant morbidity, catheter loss, transfer to hemodialysis, transient loss of ultrafiltration, possible permanent membrane damage, and occasionally death 16. We describe peritonitis rates and the associations of selected facility practices with peritonitis risk among countries participating in the peritoneal dialysis outcomes and practice.
Peritoneal dialysis, peritonitis, mortality, timedependent variable background the number of patients with endstage renal disease esrd who receive peritoneal dialysis pd therapy has. In some outstanding centers, peritonitis rates as low as 0. Until the peritonitis is cured, you will need to use another method of dialysis, such as hemodialysis. Peritoneal dialysis peritonitis clinical pathway department. The incidence of peritonitis in peritoneal dialysis pd patients has decreased as a result of improvements in pd technology. Messana division of nephrology, department of internal medicine, university of michigan, ann arbor, michigan abstract reducing the frequency of peritonitis for patients undergoing peritoneal dialysis pd. Peritoneal dialysisrelated infection rates and outcomes. Predictors of peritonitis in patients on peritoneal dialysis.
The aim of this paper was to systematically collect data on patientrelated risk factors for pdassociated peritonitis, to analyze the methodological quality of these studies, and to summarize published evidence on the particular risk factors. Immediate empiric treatment doses must be added to the patients medication chart to be a valid order. A total of 4675 patients received peritoneal dialysis in australia during this time, being followed for 6002 patient years. It was first reported as a complication of intermittent peritoneal dialysis in 1980. Understanding the characteristics and risk factors for peritonitis can guide regional development of prevention strategies. Chronic peritoneal dialysis in children nia fraser,1 farida k hussain,2 roy connell,3 manoj u shenoy1 1department of paediatric urology, 2paediatric nephrology, 3paediatric dialysis, nottingham university hospitals nhs trust, nottingham, uk abstract. Peritoneal dialysis outcomes after temporary haemodialysis. Sclerosis encapsulating peritonitis in continuous ambulatory. Creating and maintaining optimal peritoneal dialysis access in the adult patient.
During this period approximately 6000 dialyses were done in 87 patients who were on chronic peritoneal dialysis for periods up to 38 months average, 9. Peritonitis is associated with significant morbidity, catheter loss, transfer to hemodialysis, transient loss of ultrafiltration, possible permanent membrane damage, and occasionally death. The signs and symptoms of peritonitis associated with peritoneal dialysis include one or more of the following. Either at night or multiple times during the day peritoneal fluid is infused into the abdomen in an ambulatory setting or at home. Adequate treatment is essential to reduce morbidity and recurrence.
Peritonitis in peritoneal dialysis pd continues to be one of the principal complications of this type of dialysis and identification of the modifiable risk factors can contribute to the reduction of morbidity 1. Healthy kidneys clean wastes from blood and remove extra fluid from the body. Peritoneal dialysis pd is a type of dialysis which uses the peritoneum in a persons abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood. Intraperitoneal dialysis predisposes to peritoneal infection sometimes named primary peritonitis in this context. Review of antibiotic dosing with peritonitis in apd.
Since peritonitis is one of the more common complications of pd, it has caused patients to switch from this modality to hemodialysis. The solution used for peritoneal dialysis is on the world health organizations list of essential medicines, the most effective and safe medicines needed in a health system. The topic peritonitis secondary to peritoneal dialysis you are seeking is a synonym, or alternative name, or is closely related to the medical condition peritoneal dialysis associated peritonitis. Peritoneal dialysis pd is the modality of choice in many european countries. Pdf the patient in peritoneal dialysis researchgate.
Paediatric peritoneal dialysis peritonitis clinical pathway. Approximately 20% of peritonitis episodes require cessation of pd and transfer to haemodialysis, although this figure varies depending on the. The impact of peritoneal dialysisrelated peritonitis on. Peritoneal dialysis pd is a treatment for people who have kidney failure. This article is a part of a series that covers complications of dialysis both hemodialysis and peritoneal dialysis. Peritoneal dialysis has better outcomes than hemodialysis during the first couple of years.
We recommend that pd units should undertake regular audit of their peritonitis and exitsite infection rates. In patients without peritonitis, a wbc between 050 with a mononuclear predominance is considered normal. The microbiology is characterized by a predominance of grampositive organisms, with fungi responsible for less than 5%. Feb 09, 2009 the occurrence of peritoneal dialysis pdassociated peritonitis is an important complication of pd. Peritonitis remains the archilles heel of peritoneal dialysis pd and is the major cause of technique failure 1,2.
Clinical practice guideline peritoneal dialysis in adults and. Ispd guidelinesrecommendations consensus guidelines for the. As the most common complication, peritonitis prevented peritoneal dialysis from becoming more widely used. Several predictors have been reported in the literature. The patient uses their peritoneum as a dialysis membrane in conjunction with a surgically placed dialysis catheter that penetrates the abdominal wall. A general overview of peritonitis in peritoneal dialysis is presented separately. Prevention of peritonitis in peritoneal dialysis jonathan h. Among peritoneal dialysis patients, infections of the peritoneal space are usually caused by staphylococcal species. Pdf newer antibiotics for the treatment of peritoneal dialysis. Outbreak of sterile peritonitis among continuous cycling. Until the fall of 1978, peritoneal dialysis solution pd solution was only available in glass containers connected to the permanent catheter with plastic tubes. At present, our understanding of which patients are most at risk for developing peritonitis is limited. Is the distribution of microorganisms and peritonitis. Studies in children have demonstrated chronic alterations of peritoneal membrane.
The mesothelium lines the peritoneal membrane and is the first line of defense against chemical andor bacterial insult. Clinical practice guideline peritoneal dialysis in adults. With capd, you do the exchanges yourself three to four times a day. Scribd is the worlds largest social reading and publishing site. Treatment of peritoneal dialysis pd related peritonitis page 2 of 7 patients receiving more than one dose of gentamicin or vancomycin should have plasma levels monitored for adequacy and nontoxicity. Pd is peritonitis, an infection of the peritoneum the lining of the belly. The topic peritonitis secondary to peritoneal dialysis you are seeking is a synonym, or alternative name, or is closely related to the medical condition peritoneal dialysisassociated peritonitis. With ccpd, a machine called a cycler does the exchanges automatically while you sleep.
Peritoneal dialysis is an effective treatment modality for patients with endstage renal disease. But when your kidneys are not working well, wastes and extra fluid can build up in your blood and make you sick. Drugresistant bacterial peritonitis typically has a lower. Apr 30, 2017 if you have peritoneal dialysis associated peritonitis, you may receive medications that are injected directly into the peritoneal tissue, a strategy that some studies have reported to be more effecti.
Full text chronic peritoneal dialysis in children ijnrd. Spontaneous bacterial peritonitis sbp is a peculiar form of peritonitis occurring in the absence of an obvious source of contamination. Our program resulted in many episodes of peritonitis arising from contamination due to the technical aspects of the procedure. The peritoneal cavity as a dialysis system the same processes are utilized in peritoneal dialysis except that dialysate is introduced into the peritoneal cavity where it comes into contact with capillaries perfusing the peritoneum and viscera. Peritonitis is a common and severe complication in peritoneal dialysis pd. Peritonitis caused by pseudomonas species is a particularly common and serious complication in the asiapacific region, and is often associated with a poor response to antibiotics as well as a high rate of catheter removal 3,4. It cleans your body, helps to control the water and replaces the work of the diseased kidneys. Peritoneal dialysis is an excellent way of maintaining patients in the community with endstage renal failure who would otherwise be dependent on hospital haemodialysis.
Pdf continuous or chronic ambulatory peritoneal dialysis capd has been widely. Selfcare peritoneal dialysis patients with cognitive impairment have a higher risk of peritonitis in the second year view all most cited articles. This form is to be used to assess patients on peritoneal dialysis. Eosinophilic peritonitis and nephrotic syndrome in kimura. Care outlined in this pathway must be varied if it is not clinically appropriate for the individual client. Solutes diffuse from blood in the capillaries into the dialysate and are discarded. Pd related peritonitis is unfortunately a common complication from peritoneal dialysis, and repeated episodes are a good reason why patients may have to switch from pd to hemodialysis. The impact of peritoneal dialysisrelated peritonitis on mortality in. Microbiological trends and patterns of infection in a teaching hospital in argentina. Patients perceptions and factors affecting dialysis modality decisions. Peritoneal dialysisrelated peritonitis caused by pseudomonas. Peritonitis is a serious complication of peritoneal dialysis pd responsible for significant morbidity, and accounts for 22% of technique failures and 14% of infectious deaths in australian and new zealand pd patients.
The combined effects of peritonitis and the continuous exposure to dialysis fluid remain the most likely candidates affecting the peritoneum in the long term. Peritonitis is a common complication of peritoneal dialysis pd and is associated with signi. Peritonitis complicating pd is associated with morbidity and mortality as well as failure of the pd modality, necessitating permanent transfer to haemodialysis. The purpose of this study was to observe the effects of peritonitis and dialysis on longitudinal peritoneal function. We initiated a therapeutic program of continuous ambulatory peritoneal dialysis for patients with chronic renal failure. Pathophysiological changes to the peritoneal membrane during. Among the main causes for interruption of a pd program are. Peritonitis during continuous ambulatory peritoneal dialysis. It occurs in people with ascites, including children. Peritoneal dialysis pdrelated peritonitis carries high morbidity for pd patients. The incidence of endstage renal disease in children is increasing. Approximately 4% of peritonitis episodes result in death. What is the treatment for peritoneal dialysisassociated. Peritoneal dialysis infection exitsite and peritonitis rates should be monitored and reported for every clinical dialysis program annually.
Fungal peritonitis in peritoneal dialysis uptodate. In australia, the median peritonitisfree survival in. Most patients have used the manual peritoneal dialysis, but since february 10 of 1992 is also provided automated peritoneal dialysis with fresenius medical care. The peritoneal dialysis and outcomes practice patterns study pdopps is the largest international observational cohort study to collect detailed information in a uniform manner on the incidence of pdrelated peritonitis and on peritonitis prevention practices and provides a platform for the prospective surveillance of peritonitis. Fortytwo per cent 1984 of patients had 3594 peritonitis episodes with an overall rate of 0. If you have peritoneal dialysisassociated peritonitis, you may receive medications that are injected directly into the peritoneal tissue, a strategy that some studies have reported to be more effective than intravenous medications. Since then most cases have been associated with capd. Background sclerosis encapsulating peritonitis is an uncommon serious complication of continuous ambulatory peritoneal dialysis capd. An 87 yearold female who was undergoing peritoneal dialysis presented with peritonitis caused by alcaligenes faecalis and pantoea agglomerans in consecutive years. Clinical guideline for the treatment of capd peritonitis. Renal association clinical practice guideline peritoneal dialysis june 2017 2 endorsements the national institute for health and care excellence nice has accredited the process used by the renal association to produce its clinical practice guidelines.
1060 1260 1280 235 764 299 756 435 719 1069 966 1181 1187 221 17 847 459 220 67 514 1405 1110 11 1081 808 1241 433 1391 1081 366 1466 1467 1071