Bulletin de la Dialyse à Domicile

Predictive factors for Peritoneal Dialysis Catheter Survival: a ten-year single center study

Bárbara Beirão Rodrigues — 2024-11-09

Introduction and Objectives: Timely insertion and adequate management of peritoneal dialysis catheter (PDC) related complications are crucial for the success of Peritoneal Dialysis. The aim of this study was to review the peritoneal dialysis catheter outcomes at our center, identifying factors that influence catheter survival.

Materials and Methods: A retrospective study was conducted on 146 PD patients who received their first PDC between August/ 2012 and July/2022. The mean follow-up was 26.5 ± 22.7 months.

Results: Mean age was 55.1 ± 16.6 years, and 58.2% were male. Peritonitis occurred in 75 patients (51.4%), with 26 (34.7%) requiring catheter removal. Mechanical complications were observed in 66 patients (45.2%), with 16 requiring catheter removal. Catheter survival at 12, 24, and 36 months was 80.2%, 72.4%, and 61.6%, respectively. Non-infectious complications (p=0.006) and peritonitis episodes (p=0.017) were associated with higher rate of PDC-associated removal. In the multivariate analysis, non-infectious complications were the only independent variable significantly associated with catheter survival (Hazard ratio 2.53; 95% CI 1.383–4.624). No association was found between PDC survival and age, diabetic status, obesity, prior kidney transplant, previous abdominal surgery, or method of catheter insertion.

Conclusions: Despite the significant number of infectious complications, including peritonitis, these did not result in a substantial decrease in catheter survival in the multivariate analysis. These findings emphasize the importance of effectively managing non-infectious complications to ensure successful and long-term use of PDCs. Preventive measures, such as omentectomy simultaneously with PDC implantation, may be considered on a case-by-case basis.

Emergence Infection With Staphylococcus carnosus in Peritoneal Dialysis: Case Report

Justine Schricke — 2024-12-10

We report a rare clinical case of Staphylococcus carnosus infection at a peritoneal dialysis (PD) catheter’s emergence.
The patient is an 81-year-old being treated with PD for end-stage renal disease. The patient started peritoneal dialysis on August 12, 2019, with Tenckhoff catheter placement on July 17, 2019. Since the start of PD, several emergence infections have occurred with different germs. On July 22, 2024, when the dressing was being re-dressed, the private nurse took a bacteriological sample in view of inflammation without discharge at the catheter emergence site. Bacteriological analysis revealed S. carnosus, which was treated with mupirocin for 8 days. The clinical and biological evolution was favorable, with a sterile control sample.
This case appears to be the first known on a worldwide and human scale and adds to the knowledge of rare infections of peritoneal dialysis catheter emergencies. The germ is also present in animals and foodstuffs.

Barriers in adequacy goals in peritoneal dialysis:evaluation of a cohort with negative selection bias

André Luis Marassi — 2024-11-01

Our study aimed to evaluate PD patients by tracing a sociodemographic profile and jointly evaluating the clinical and laboratory parameters of dialysis adequacy, as well as outcomes. A prospective cohort study in the Juiz de Fora Federal University Hospital dialysis unit in Brazil between July 2021 and July 2022. The sociodemographic, clinical, laboratory data and adherence were assessed. The Short Assessment of Health Literacy for Portuguese-speaking Adults score, a score of perception of social support, a tool for evaluating QoL (SF-12), and Malnutrition Inflammation Score (MIS) were performed. The primary outcomes were death and QoL, whereas technique failure and hospitalization were secondary. Fifty-six patients in automated peritoneal dialysis modality were evaluated (73.2% prevalent and 26.8% incident). The majority were women (61.2 ± 13.9 years old), white, illiterate and with low income. All patients were hypertensive, one-third had diabetes mellitus (DM) and 76.8% were compliant. The definition of goals was the patient stayed within the normal range within 80% of the following time. The adequacy goals of blood pressure (30.4%) and phosphorus (28.6%) were the most difficult to achieve. Among the primary outcomes, the physical component of the SF-12 was negatively associated with higher MIS, and the mental component of the SF-12 was negatively correlated with higher age. There was no significant difference in death as an outcome. The factors that were associated with the achievement of goals were age, previous nephrological follow-up, dementia, DM, and adherence.