PD infection risk overstated?

Some mistaken beliefs about PD could partially explain its low usage in the United States. “One of the biggest hurdles peritoneal dialysis has to overcome is its reputation,” Dr. Saxena stated. “Some professionals may not be aware of the improvement in PD outcomes. The infection rate has fallen from more than once a year to once every 40 months or perhaps even more infrequently, thanks to numerous clinical and technological advances.”

She cited studies from the University of Pittsburgh School of Medicine that make her point. One trial, which referred to infection as “the Achilles heel” of PD (J Am Soc Nephrol. 2005;16:539-545), demonstrated the prophylactic effectiveness of gentamicin cream at the exit site. Another study found that very low rates of peritonitis could be achieved through proper care and periodic retraining of patients (Kidney Int Suppl. 2006 Nov; [103]:S44-S54). A third study pointed to the high risk of infection in HD patients (Clin J Am Soc Nephrol. 2006;1:1226-1233).

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“Peritonitis is one of the biggest fears for nephrologists and patients, but the actual infection rate in peritoneal dialysis is much less than with hemodialysis, especially hemodialysis using a catheter,” Dr. Saxena said. “Patients who start hemodialysis with a catheter have a very high risk of bacteremia, which is a much more serious infection than peritonitis—but that’s not often thought of.”

Home therapy returning?

The availability of more compact, less expensive equipment has contributed to a renewed interest in home HD that drew in 838 new patients in 2005-2006, bringing the number of users in 2006 to 2,455, according to the USRDS annual report. “We have a long way to go to get more people on home hemodialysis, but a change is coming,” Dr. Blagg said. “Home hemodialysis is starting to become acceptable again, and people are using it.”