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Acute PD in the treatment of COVID-19-related AKI

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Acute kidney injury (AKI) may occur in 4-23% of patients with COVID-19. Those who require renal replacement therapy have mainly been treated with extracorporeal dialysis. However, peritoneal dialysis (PD) may also be considered as a valuable treatment option in such cases when there is a capacity limit or availability constraint of equipment and supplies for extracorporeal dialysis techniques. Automated PD is the preferred option, but if not available, continuous ambulatory PD could also be used. The initial prescription should be 10 to 12 exchanges per day, tapered to 4 to 5 exchanges after 3 to 4 days, depending on the clinical evolution.

Read more about the practical aspects of prescribing, delivering and monitoring PD in COVID 19-related AKI here: https://academic.oup.com/ckj/article/13/3/269/5864956

 

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Results from the PDOPPS on peritoneal dialysis related infection are available

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Peritonitis is still a major concern for peritoneal dialysis (PD) patients and caregivers. The latest Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) reports the results from an observational prospective cohort investigation of 7,051 adult PD patients from seven countries. The crude peritonitis rate was 0.28 episodes per patient-year, ranging from 0.26 in the United States to 0.40 in Thailand. The microbiology patterns were similar across countries, except in Thailand, where Gram-negative infections and culture-negative peritonitis were more common. Lower peritonitis risk was observed in facilities where PD training duration lasted for six or more days, there was a higher rate of automated PD use and where antibiotics were used at the time of catheter insertion or topical exit-site antibiotic ointment was utilized.

Read more https://www.sciencedirect.com/science/article/pii/S0272638619311059

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Cefepime vs. conventional combination therapy for PD-associated peritonitis

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Intraperitoneal cefepime monotherapy is noninferior to conventional combination therapy for resolution of continuous ambulatory peritoneal dialysis-associated peritonitis.

A new randomized controlled study evaluated whether intraperitoneal (IP) cefepime monotherapy is noninferior to combination regimens for continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis. Results showed that IP cefepime monotherapy was noninferior to conventional combination therapy for resolution of CAPD-associated peritonitis at day 10 and may be a reasonable alternative first-line treatment.

Find out more here

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ISPD Guidelines update: Creating and maintaining optimal PD access in adults

A recent update of ISPD Guidelines describes the novel advances in the understanding of the key aspects of providing successful placement and maintenance of peritoneal catheters in adult patients.

With improvements in prevention and treatment of peritonitis, the impact of catheter-related infections and mechanical problems on peritoneal dialysis (PD) technique survival has become more apparent. Guideline committees under the sponsorship of the International Society for Peritoneal Dialysis (ISPD) periodically update best practices for optimal peritoneal access. Their latest update describes the recent advances in the understanding of the key aspects of providing successful placement and maintenance of peritoneal catheters.

Find out more in the full paper here

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