Efficacy of Prophylactic Antibiotics at Peritoneal Catheter Insertion on Early Peritonitis: Data from the Catheter Section of the French Language Peritoneal Dialysis Registry

2016 ◽  
Vol 44 (6) ◽  
pp. 419-425 ◽  
Author(s):  
Antoine Lanot ◽  
Thierry Lobbedez ◽  
Clémence Bechade ◽  
Christian Verger ◽  
Emmanuel Fabre ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Beneficial Effect ◽  
Lower Risk ◽  
Random Effect ◽  
Prophylactic Antibiotic ◽  
Prophylactic Antibiotics ◽  
Catheter Placement ◽  
French Language ◽  
Peritoneal Catheter ◽  
The Individual

Background: International guidelines recommend the use of a prophylactic antibiotic before the peritoneal dialysis (PD) catheter can be inserted. The main objective of this study was to assess whether this practice is associated with a lower risk of early peritonitis and to estimate the magnitude of the centre effect. Methods: A retrospective, multi-centric study was conducted, in which data from the French Language Peritoneal Dialysis Registry was analysed. Patients were separated into 2 groups based on whether or not prophylactic antibiotics were used prior to catheter placement. Results: Out of the 2,014 patients who had a PD catheter placed between February 1, 2012 and December 31, 2014, 1,105 were given a prophylactic antibiotic. In a classical logit model, the use of prophylactic antibiotics was found to protect the individual against the risk of early peritonitis (OR 0.67, 95% CI 0.49-0.92). However, this association lost significance in a mixed logistic regression model with centre as a random effect: OR 0.73 (95% CI 0.48-1.09). Covariates associated with the risk of developing early peritonitis were age over 65: OR 0.73 (95% CI 0.39-0.85), body mass index over 35 kg/m2: OR 1.99 (95% CI 1.13-3.47), transfer to PD due to graft failure: OR 2.24 (95% CI 1.22-4.11), assisted PD: OR 1.96 (95% CI 1.31-2.93), and the use of the Moncrief technique: OR 3.07 (95% CI 1.85-5.11). Conclusion: There is a beneficial effect of prophylactic antibiotic used prior to peritoneal catheter placement, on the occurence of early peritonitis. However, the beneficial effect could be masked by a centre effect.

scholarly journals Estimation of the Center Effect on Early Peritoneal Dialysis Failure: A Multilevel Modelling Approach

2016 ◽  
Vol 36 (5) ◽  
pp. 519-525 ◽  
Author(s):  
Sonia Guillouët ◽  
Ghislaine Veniez ◽  
Christian Verger ◽  
Clémence Béchade ◽  
Maxence Ficheux ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Random Effect ◽  
Multilevel Modelling ◽  
French Language ◽  
Significant Heterogeneity ◽  
Individual Level ◽  
Center Effect ◽  
The Individual ◽  
Observation Period ◽  
Modelling Approach

IntroductionThis study was carried out to investigate the center effect on the risk of peritoneal dialysis (PD) failure within the first 6 months of therapy using a multilevel approach.MethodsThis was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analyzed 5,406 incident patients starting PD between January 2008 and December 2012 in 128 PD centers. The end of the observation period was December 31, 2013.ResultsOf the 5,406 patients, 415 stopped PD within the first 6 months. There was a significant heterogeneity between centers (variance of the random effect: 0.10). Only 3% of the variance of the event of interest was attributable to differences between centers. At the individual level, only treatment before PD (odds ratio [OR]: 1.93 for hemodialysis and OR: 2.29 for renal transplantation) and underlying nephropathy ( p < 0.01) were associated with early PD failure. At the center level, only center experience was associated (OR: 0.78) with the risk of PD failure. Center effect accounted for 52% of the disparities between centers.ConclusionCenter effect on early PD failure is significant. Center experience is associated with a lower risk of transfer to hemodialysis.

Impact of Assisted Peritoneal Dialysis Modality on Outcomes: A Cohort Study of the French Language Peritoneal Dialysis Registry

2018 ◽  
Vol 48 (6) ◽  
pp. 425-433 ◽  
Author(s):  
Solène Guilloteau ◽  
Thierry Lobbedez ◽  
Sonia Guillouët ◽  
Christian Verger ◽  
Maxence Ficheux ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Lower Risk ◽  
Regression Models ◽  
Cox Regression ◽  
French Language ◽  
Dialysis Modality ◽  
Technique Survival ◽  
Hazard Ratios ◽  
Effect Of Pd ◽  
Assisted Peritoneal Dialysis

Background: Patients on peritoneal dialysis (PD) can be assisted by a nurse or a family member and treated either by automated PD (APD) or continuous ambulatory PD (CAPD). The aim of this study was to evaluate the effect of PD modality and type of assistance on the risk of transfer to haemodialysis (HD) and on the peritonitis risk in assisted PD patients. Method: This was a retrospective study based on data from the French Language PD Registry. All adults starting assisted PD in France between 2006 and 2015 were included. Events of interest were transfer to HD, peritonitis and death. Cox regression models were used for statistical analysis. Results: Among the 12,144 incident patients who started PD in France during the study period, 6,167 were assisted. There were 5,060 nurse-assisted and 1,095 family-assisted PD patients. Overall, 5,171 were treated by CAPD and 996 by APD. In multivariate analysis, CAPD, compared to APD, was not associated with the risk of transfer to HD (cause specific hazard ratios [cs-HR] 0.96 [95% CI 0.84–1.09]). Patients on nurse-assisted PD had a lower risk of transfer to HD than family assisted PD patients (cs-HR 0.85 [95% CI 0.75–0.97]). Neither PD modality nor type of assistance were associated with peritonitis risk. Conclusions: In assisted PD, technique survival was not associated with PD modality. Nurse-assisted patients had a lower risk of transfer to HD than family assisted patients. Peritonitis risk was not influenced either by PD modality, or by type of assistance. Both APD and CAPD should be offered to assisted-PD patients.

Clusters of Practice in Peritoneal Dialysis in France: Data from the Catheter Section of the RDPLF

2017 ◽  
Vol 38 (2) ◽  
pp. 89-97 ◽  
Author(s):  
Antoine Lanot ◽  
Clémence Bechade ◽  
Christian Verger ◽  
Emmanuel Fabre ◽  
Isabelle Vernier ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Outcomes ◽  
Prophylactic Antibiotic ◽  
French Language ◽  
Standards Of Care ◽  
Hierarchical Analysis ◽  
Exit Site ◽  
Adherence To Guidelines ◽  
International Guidelines ◽  
Retrospective Multicenter Study

Background Peritonitis is a major cause of peritoneal dialysis (PD) failure. Recommendations for the prevention of peritonitis are available, but wide variations exist in the peritonitis rate among countries and PD units. The objective of this study was to describe the different pattern of practices in France. Methods This was a retrospective, multicenter study based on data from the French Language Peritoneal Dialysis Registry. Center practices were described and mapped. Clusters of practices were sought in a hierarchical analysis and centers belonging to the same clusters of practices were mapped. Results Data from 2,770 catheters placed in 64 centers in France between 1 February 2012 and 31 December 2016 were considered. A median of 34 (ranging from 5 to 133) catheters was reported in each center. Twenty-eight (43.8%) centers routinely administered a prophylactic antibiotic prior to catheter placement, and 8 (12.5%) centers applied a local prophylactic antibiotic at the exit site, as recommended by International guidelines. The presence of a PD nurse specialized in PD or PD referent nephrologist was not associated with better adherence to guidelines. Practices were heterogeneous across centers. We identified 5 clusters of centers according to practice. Geographical proximity was not associated with homogeneity in practices. Conclusion Peritoneal dialysis practices are heterogeneous in France, even those that are subject to International guidelines. Studies to identify associations between center-specific practices and PD patient outcomes remain mandatory. Efforts should be made to standardize the PD standards of care in France.

Outcome of Peritoneal Catheter Placement in the High-Risk Patient

1984 ◽  
Vol 4 (2_suppl) ◽  
pp. 112-114 ◽  
Author(s):  
A.S. Levey ◽  
G.M. Simon ◽  
J. McCauley ◽  
T.J. Smith ◽  
S. I. Cho ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
High Risk ◽  
Abdominal Surgery ◽  
High Risk Patient ◽  
Catheter Insertion ◽  
Catheter Placement ◽  
Major Abdominal Surgery ◽  
Early Complications ◽  
Peritoneal Catheter ◽  
History Of

Serious early complications of catheter insertion and catheter outcomes are compared in patients with or without a history of major abdominal surgery or peritonitis. Previous major surgery and peritonitis are important risk factors for early serious complications of catheter placement. Despite the higher risk of early complications, subsequent attempts at catheter placement were successful in all but one of the high risk patients. Patients with previous major abdominal surgery or peritonitis generally are considered to be at high risk for complications of permanent peritoneal catheter placement. However, few physicians would refuse to attempt catheter insertion in patients highly motivated to undergo peritoneal dialysis. In this setting, the patient and the physician must decide whether the motivation and potential benefit justify the risk. Unfortunately, extensive quantitative data on the success rate and the likelihood of complications in the high-risk patient are not available. In order to determine the success rate and relative risk, we reviewed the outcome of catheter placement for continuous ambulatory peritoneal dialysis (CAPD) in our patients. In this report, we identify the serious early complications of catheter insertion and compare the outcomes in patients with and without a history of major abdominal surgery or peritonitis.

Colonoscopy in Automated Peritoneal Dialysis Patients: Value of Prophylactic Antibiotics: A Prospective Study on a Single Antibiotic

2017 ◽  
Vol 40 (10) ◽  
pp. 550-557 ◽  
Author(s):  
Abdullah K. Al-Hwiesh ◽  
Ibrahiem S. Abdul-Rahman ◽  
Mohammad A. Hussameldeen ◽  
Nadia Al-Audah ◽  
Abdalla Abdelrahman ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Peritoneal Dialysis ◽  
Randomized Study ◽  
Multiple Logistic Regression Analysis ◽  
Prophylactic Antibiotic ◽  
Colonic Polyps ◽  
Antibiotic Use ◽  
Prophylactic Antibiotics ◽  
Automated Peritoneal Dialysis ◽  
Group B

Objective To evaluate the need for prophylactic antibiotics in automated peritoneal dialysis (APD) patients undergoing flexible colonoscopy. Patients and Methods A total of 93 patients on automated peritoneal dialysis (APD) undergoing diagnostic colonoscopy were enrolled in a prospective, randomized study. Patients were randomized into 2 age- and sex-matched groups; group A (46 patients) with intraperitoneal (IP) ceftazidime prior to colonoscopy and group B (47 patients) without prophylactic antibiotics. The relations between peritonitis and different parameters were analyzed. Results: Of all colonoscopies, 60.2% showed normal findings, 17.2% with colonic polyps at different sites, 12.9% with angiodysplastic-like lesions, 5.4% with colonic ulcer(s), 3.2% with diverticulae without diverticulitis and 1.1% had transverse colon stricture. Post-colonoscopy peritonitis was documented in 3 (6.5%) and 4 (8.5%) patients in groups A and B, respectively (p = 0.2742); the causative organisms were mainly gram negative bacteria. Polypectomy was not associated with increased peritonitis episodes. By multiple logistic regression analysis, diabetes mellitus was the only independent variable that entered into the best predictive equation over the development of post-colonoscopy peritonitis but not antibiotic use. Conclusions The relation between prophylactic antibiotic use prior to colonoscopy in APD patients and the risk of peritonitis was lacking. Only diabetes mellitus appears to be of significance. Polypectomy did not increase peritonitis episodes.

scholarly journals Is Peritonitis Risk Increased in Elderly Patients on Peritoneal Dialysis? Report from the French Language Peritoneal Dialysis Registry (RDPLF)

2016 ◽  
Vol 36 (3) ◽  
pp. 291-296 ◽  
Author(s):  
Simon Duquennoy ◽  
Clémence Béchade ◽  
Christian Verger ◽  
Maxence Ficheux ◽  
Jean-Philippe Ryckelynck ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Elderly Patients ◽  
Lower Risk ◽  
Retrospective Cohort ◽  
Cox Model ◽  
Age Groups ◽  
French Language ◽  
Increased Risk ◽  
Peritoneal Infection ◽  
Observation Period

Introduction This study was carried out to examine whether or not elderly patients on peritoneal dialysis (PD) had an increased risk of peritonitis. Methods This was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analyzed 8,396 incident patients starting PD between January 2003 and December 2010. The end of the observation period was 31 December 2012. Patients were separated into 2 age groups: up to 75 and over of 75 years old. Results Among 8,396 patients starting dialysis there were 3,173 patients older than 75. When using a Cox model, no association was found between age greater than 75 years and increased risk of peritonitis (hazard ratio [HR]: 0.97 [0.88 – 1.07]). Diabetes (HR: 1.14 [1.01 – 1.28] and continuous ambulatory PD (HR: 1.13 [1.04 – 1.23]) were significantly associated with a higher risk of peritoneal infection whereas nurse-assisted PD was associated with a lower risk of peritonitis (HR: 0.85 [0.78 – 0.94]. In the analysis restricted to the 3,840 self-care PD patients, there was no association between age older than 75 years and risk of peritonitis. Conclusion The risk of peritonitis is not increased in elderly patients on PD in a country where assisted PD is available.

Trends in Peritoneal Dialysis Technique Survival, Death, and Transfer to Hemodialysis: A Decade of Data from the RDPLF

2021 ◽  
pp. 1-10
Author(s):  
Annabel Boyer ◽  
Antoine Lanot ◽  
Mark Lambie ◽  
Christian Verger ◽  
Sonia Guillouet ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
French Language ◽  
Limited Information ◽  
Start Time ◽  
Calendar Time ◽  
Technique Survival ◽  
End Point ◽  
The Individual ◽  
Retrospective Multicenter Study ◽  
Over Time

<b><i>Introduction:</i></b> There is limited information on the trends of peritoneal dialysis (PD) technique survival over time. This study aimed to estimate the effect of calendar time on technique survival, transfer to hemodialysis (HD) (and the individual causes of transfer), and patient survival. <b><i>Methods:</i></b> This retrospective, multicenter study, based on data from the French Language Peritoneal Dialysis Registry, analyzed 14,673 patients who initiated PD in France between January 1, 2005, and December 31, 2016. Adjusted Cox regressions with robust variance were used to examine the probability of a composite end point of either death or transfer to HD, death, and transfer to HD, accounting for the nonlinear impact of PD start time. <b><i>Results:</i></b> There were 10,201 (69.5%) cases of PD cessation over the study period: 5,495 (37.4%) deaths and 4,706 (32.1%) transfers to HD. The rate of PD cessation due to death or transfer to HD decreased over time (PR 0.96, 95% CI: 0.95–0.97). Compared to 2009–2010, starting PD between 2005 and 2008 or 2011 and 2016 was strongly associated with a lower rate of transfer to HD (PR 0.88, 95% CI: 0.81–0.96, and PR 0.91, 95% CI: 0.84–0.99, respectively), mostly due to a decline in the rate of infection-related transfers to HD (PR 0.96, 95% CI: 0.94–0.98). <b><i>Conclusions:</i></b> Rates of the composite end point of either death or transfer to HD, death, and transfer to HD have decreased in recent decades. The decline in transfers to HD rates, observed since 2011, is mainly the result of a significant decline in infection-related transfers.

Assisted peritoneal dialysis and transfer to haemodialysis: a cause-specific analysis with data from the RDPLF

2020 ◽  
Author(s):  
Antoine Lanot ◽  
Clémence Bechade ◽  
Annabel Boyer ◽  
Maxence Ficheux ◽  
Thierry Lobbedez
Keyword(s):  
Peritoneal Dialysis ◽  
Lower Risk ◽  
Social Issues ◽  
Decision Makers ◽  
French Language ◽  
Risk Of Death ◽  
Specific Analysis ◽  
Competing Events ◽  
Using Data ◽  
Renal Transplantations

Abstract Background Technique failure, defined as death or transfer to haemodialysis (HD), is a major concern in peritoneal dialysis (PD). Nurse-assisted PD is globally associated with a lower risk of transfer to HD. We aimed to evaluate the association between assisted PD and the risk of the different causes of transfer to HD. Methods This was a retrospective study using data from the French Language PD Registry of patients on incident PD from 2006 to 2015. The association between the use of assisted PD and the causes of transfer to HD was evaluated using survival analysis with competing events in unmatched and propensity score-matched cohorts. Results The study included 11 093 incident PD patients treated in 123 French PD units. There were 4273 deaths, 3330 transfers to HD and 2210 renal transplantations. The causes of transfer to HD were inadequate dialysis (1283), infection (524), catheter-related problems (334), social issues (250), other causes linked to PD (422), other causes not linked to PD (481) and encapsulating peritoneal sclerosis (6). Nurse-assisted PD patients were older and more comorbid. Assistance by nurse was associated with a higher risk of death [cause-specific hazard ratio (cs-HR) 2.49, 95% confidence interval (CI) 2.26–2.74], but with a lower risk of transfer to HD [subdistributionHR (sd-HR) 0.68, 95% CI 0.62–0.76], especially due to inadequate dialysis (cs-HR 0.83, 95% CI 0.75–0). Conclusions The lower risk of transfer to HD associated with nurse assistance should encourage decision makers to launch reimbursement programmes in countries where it is not available.

scholarly journals Peritoneal catheter infections : data from the French language peritoneal dialysis registry (RDPLF), risk factors

2019 ◽  
Vol 2 (3) ◽  
pp. 135-141
Author(s):  
Isabelle Vernier ◽  
Emmanuel Fabre ◽  
Max Dratwa ◽  
Christian Verger
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Nasal Carriage ◽  
Catheter Insertion ◽  
French Language ◽  
Clinical Practices ◽  
Peritoneal Catheter ◽  
Wide Variability ◽  
Catheter Infections

Peritoneal catheter infections : data from the French language peritoneal dialysis registry (RDPLF), risk factors The French Language Peritoneal Dialysis Registry (RDPLF) record since 1997 all data dealing with peritoneal catheter insertion and follow up. The aim of this study is to analyze catheter infections on 10801 catheters in 144 centres from January 1, 1997 and December 31, 2018. Infections are more common in the first month and 50% occur before the tenth month. The risk of infection increases in case of wall hematoma, initial fluid leakage, and obesity. It decreases with the use of prophylactic antibiotics at the time of catheter insertion, with experienced operator, if the first dressing is delayed for 7 days, and with mupirocin as exit-site prophylaxis. During last two decades the percentage of Staphylococcus aureus infections has decreased, whereas the proportion of Pseudomonas, Corynebacterium and other Gram + cocci increased. The incidence of catheter infections is low compared to literature data: it decreased to 0.16 episodes per year for the 2013-2017 period. Adherence to ISPD guidelines: preoperative antibioprophylaxis is the most followed guideline (70.7% of catheter implantations in 2018). Local antibioprophylaxis concerns only 15.6% of catheters, and remains concentrated in a few centres ; mupirocin is the most frequently used agent. Screening for nasal carriage of S. aureus is performed in only 42% of cases. The catheter section of the RDPLF has allowed the follow-up of clinical practices incidence of infections and ecology for 21 years, both at the national and center level Our study confirms a wide variability in clinical practices, compared to ISPD guidelines.

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