Peritonitis risk among patients on peritoneal dialysis (PD) differs internationally, according to a new study of 7051 adult PD patients from 209 facilities in 7 countries.
The countries, which are participants in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), included the United States, Canada, United Kingdom, Japan, Thailand, and Australia/New Zealand.
Facility peritonitis rates were variable within each country and exceeded 0.50 episodes per patient-year in 10% of facilities, Jeffrey Perl, MD, of Arbor Research Collaborative for Health in Ann Arbor, Michigan, and St. Michael’s Hospital in Toronto, and colleagues reported in the American Journal of Kidney Diseases. Overall peritonitis rates, in episodes per patient-year, were 0.40 in Thailand, 0.38 in the United Kingdom, 0.35 in Australia/New Zealand, 0.29 in Canada, 0.27 in Japan, and 0.26 in the United States, the investigators reported.
Greater use of automated PD was significantly associated with lower peritonitis risk, with the risk decreasing by 5% with each 10 percentage point increase in the proportion of patients using this modality, after adjusting for patient factors. Facilities that used antibiotics at catheter insertion, compared with those that did not, had a significant 17% decreased risk of peritonitis. Facilities with PD training duration of 6 or more days compared with shorter periods had a significant 19% decreased risk of peritonitis. The risk of peritonitis was significantly associated with facility size only in Japan, with the risk rising 7% for each 10 patients receiving PD at a facility.
In addition, the investigators reported that the microbiology of peritonitis was similar across countries, except for Thailand, where Gram-negative peritonitis rates exceeded Gram-positive rates. Dr Perl and his collaborators said this finding likely reflects under-recognition of Gram-positive episodes that is driven by a disproportionately high rate of culture-negative peritonitis (0.11 episodes per year) in that country, a rate nearly twice that in the United States, United Kingdom, and Canada.
“We have identified important regional differences in the risk for peritonitis and potentially modifiable practices that may reduce these risks,” Dr Perl’s team reported. “Improvement in culture-negative peritonitis rates should be a priority of all participating countries.”
They added, “The study sets the stage for future PDOPPS studies of other practices related to peritonitis prevention; for example, highlighting differences in patient training strategies and novel technologies such as remote patient monitoring.”
Regarding study limitations, the authors noted, “As in most observational studies, patients and facilities agreeing to participate in PDOPPS may be different and could have somewhat higher performance on average than other facilities, which may explain the lower rates of peritonitis that we observed when compared with some of the national reports.”
Perl J, Fuller DS, Bieber BA, et al. Peritoneal dialysis-related infection rates and outcomes: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Am J Kidney Dis. 2020;76:42-53.