Bulletin de la Dialyse à Domicile

Repeat peritonitis in peritoneal dialysis : A cohort study

2024-04-20T09:07:19+00:00

Introduction: The understanding of the pathophysiological mechanisms of repeat peritonitis, defined as the occurrence of peritonitis more than 4 weeks after the end of appropriate antibiotic treatment for a previous episode involving the same germ, remains limited.

Methods: We studied the outcomes of 26 episodes of repeat peritonitis between 2006 and 2024 (Repeat Group) and compared them with 23 episodes of relapsing peritonitis (Relapse Group) and 84 episodes of peritonitis preceded by 4 weeks or more by another episode with a different organism (Control Group).

Results: The majority of cases of repeat peritonitis are caused by gram-positive organisms (65.5%), predominantly Staphylococcus aureus (38.5%), whereas most episodes of relapsing peritonitis are culture-negative (69.5%), followed by gram-negative bacilli episodes (17.4%).
Exit site infection is significantly associated with PD peritonitis. Gram-positive cocci are responsible for 95.5% of exit site infections, mainly due to Staphylococcus aureus.
In the Repeat Group, 14 (66%) patients achieved primary response, and 10 (47%) of them reached complete cure. After the first episode of repeat peritonitis, 3 (14%) patients had their catheter removed and were transferred to long-term hemodialysis. ; however, the risk of developing relapsing peritonitis was 4.7%, and recurrent peritonitis was 9.5%.

Conclusion: The definition of repeat peritonitis is clear. Despite a favorable outcome with antibiotic treatment, the risk of further episodes of peritonitis remains high, threatening the time on peritoneal dialysis therapy and the life of the patient.

Kocuria Rhizophila peritonitis in peritoneal dialysis: About 2 cases and review of the literature

2024-04-20T09:07:22+00:00

Summary

The authors report two clinical cases of peritonitis caused by Kocuria rhizophila, an uncommon but pathogenic bacterium, that occurred in a dialysis center over a three-month period in 2022. These cases required removal of the peritoneal dialysis catheter, illustrating the potential severity of these infections. The authors describe the clinicobiologic features of these peritonitis and highlight the difficulty in distinguishing Kocuria from other gram-positive cocci, such as staphylococci, due to their morphologic similarity and the need for accurate identification for appropriate treatment.

The discussion focuses on the incidence and management of Kocuria peritonitis in France, based on an observational cohort study using data from the Registre de Dialyse Péritonéale de Langue Française (RDPLF) between January 2018 and May 2023. The study found that Kocuria peritonitis accounted for 3.5% of documented peritonitis, with Kocuria rhizophila being the most commonly identified. The study highlights a high recurrence rate and the frequent need for catheter removal, underscoring the severity of these infections.

Conclusion: The authors suggest that rapid catheter removal and replacement should be considered in cases of Kocuria rhizophila peritonitis, given the high rate of relapse. They also call for increased vigilance and close follow-up of patients treated conservatively with antibiotics to minimize the risk of relpase and technical failure, suggesting the need for therapeutic strategies tailored to this specific pathogen.

Testimonial of a patient undergoing long nocturnal home hemodialysis on a conventional cycler.

2024-02-09T17:06:51+00:00

Summary

As a dialysis patient myself, I share here, at his request, the story of Laurent, a 50-year-old dialysis patient who was diagnosed with congenital malformative uropathy at the age of 2. At the age of 25, he was diagnosed with chronic kidney disease (CKD) and received hemodialysis for 5 years.

In 2003, Laurent underwent a kidney transplant in Amiens, resulting in a 17-year period without major complications. However, the constraints of dialysis centers led him to opt for home hemodialysis. With the support of his partner, he learned the necessary procedures.

After more than a year of home dialysis, Laurent discovered long nocturnal dialysis (LNHD) via social networks. After discussing it with his nephrologist, he tried LNHD at home, with 8-hour sessions 3 times a week, adapting to his and his partner’s work schedules.

In the spring of 2023, water quality problems led him to switch to a low-flow dialysate cycler. Technical complications with the Pureflow® osmosis unit led him to return to dialysate bags, causing fatigue and other problems.

After unsuccessfully trialing other equipment, the technicians finally reinstalled an adapted water treatment system, enabling Laurent to return to the conventional generator with water treatment. He quickly regained his previous benefits, underlining the importance of adaptability and collaboration between the patient and the medical team.

In conclusion, home LNHD with a conventional generator and water treatment is currently the treatment mode best suited to Laurent’s needs, enabling him to lead a near-normal life despite the complications. This underlines that caregivers should maintain the possibility of using conventional cyclers even if other new technologies are available.