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Peritonitis is a common and serious complication of peritoneal dialysis (PD) and is one of the main causes of peritoneal dialysis technique failure and long-term hemodialysis conversion.
Peritoneal infections (PI) have been a very relevant representative of peritoneal dialysis (PD) for decades. PI is a very serious complication of PD and is a source of concern because of its high incidence. Each episode carries clinical consequences for the patient, increases in treatment costs, hospital admissions, technical failures and risk of death, especially in the 30 days following an episode.
The risk of peritonitis depends on non-modifiable factors (such as age, sex, diabetes) and modifiable factors (such as anti-infective prophylaxis, catheter care, and training).
It is important to accurately analyze the effect of modifiable factors, as they are the most relevant in reducing the rate of peritonitis.
Patient education is very important and can affect the success of the technique and clinical results. Therapeutic education has been considered a key factor in PD outcomes.
The PD nurse is responsible for training the patient and/or caregiver to be self-sufficient and autonomous in care, reinforce and highlight the importance of adherence to treatment, and promote safe actions to prevent technique-related infections when this one is made at home.
This is a pragmatic, retrospective-prospective (ambispective) study of educational intervention for patients with stage V advanced chronic kidney disease and those with cardiorenal syndrome starting a peritoneal dialysis program.
A retrospective control group with patients starting PD before January 2020 will be included and compared with an intervention group that will systematically include all patients starting DP since the start of the study and they will be implemented a new educational intervention based on a systematic review that has been carried out with the most recent evidence.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Retrospective control group | Other | This is the PD population sample from before January 2020. |
|
| Prospective study group | Experimental | It will be the incident patients in PD who will receive the educational intervention contained in this project and whose results will be compared with the control group. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Intervention to reduce infectious complications of peritoneal dialysis | Behavioral |
|
| Measure | Description | Time Frame |
|---|---|---|
| Rate of peritonitis | It is calculated as the number of episodes of peritonitis per patient and year at risk. | 1 year after educational intervention. |
| Measure | Description | Time Frame |
|---|---|---|
| Age | In years | Day 1 of peritoneal technique training. |
| Gender | Male or female | Day 1 of peritoneal technique training. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Elena Fernร ndez Labadรญa, PhD student | Contact | +34626-321-345 | elena.fernandez@udl.cat |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32471380 | Background | Bonnal H, Bechade C, Boyer A, Lobbedez T, Guillouet S, Verger C, Ficheux M, Lanot A. Effects of educational practices on the peritonitis risk in peritoneal dialysis: a retrospective cohort study with data from the French peritoneal Dialysis registry (RDPLF). BMC Nephrol. 2020 May 29;21(1):205. doi: 10.1186/s12882-020-01867-w. | |
| 28505351 |
| Label | URL |
|---|---|
| Clinical guide of the Spanish Society of Nephrology on the prevention and treatment of peritoneal infection in peritoneal dialysis | View source |
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| ID | Term |
|---|---|
| D010538 | Peritonitis |
| ID | Term |
|---|---|
| D059413 | Intraabdominal Infections |
| D007239 | Infections |
| D010532 | Peritoneal Diseases |
| D004066 | Digestive System Diseases |
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A retrospective control group with patients starting DP before January 2020 will be included and compared with an intervention group that will systematically include all patients starting DP since the start of the study.
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|
|
| Data collection from the patient's clinical history | Behavioral | Data collection from the patient's clinical history because this new standardized educational intervention was not used. |
|
|
| Language barrier | Yes or not | Day 1 of peritoneal technique training. |
| Marital status | Single, married, coupled, separated - divorced, widowed | Day 1 of peritoneal technique training. |
| Educational level | Not finished primary studies, primary schools, secondary, middle/higher grade cycle, high school, university studies, doctorate | Day 1 of peritoneal technique training. |
| Caregiver disposition | Yes or not | Day 1 of peritoneal technique training. |
| Drinking water supply | Yes or not | Day 1 of peritoneal technique training. |
| Weight | In kilograms | Day 1 of peritoneal technique training. |
| Height | In meters | Day 1 of peritoneal technique training. |
| Body Mass Index (BMI) | BMI= Current weight (kg) รท height (m) x height (m)= kg/m2. Low weight: Less than 18.4 Normal weight: 18.5 to 24.9 Overweight: 25 to 29.9 Grade I Obesity: 30 to 34.9 Grade II Obesity: 35 to 39.9 Grade III Obesity: Equal to or greater than 40. | Day 1 of peritoneal technique training. |
| Diabetes | Yes or not | Day 1 of peritoneal technique training. |
| Cardiovascular disease | Yes or not | Day 1 of peritoneal technique training. |
| Cerebrovascular disease | Yes or not | Day 1 of peritoneal technique training. |
| Hypertension | Yes or not | Day 1 of peritoneal technique training. |
| Cancer | Yes or not | Day 1 of peritoneal technique training. |
| The primary cause of kidney disease | Glomerular disease, tubulointerstitial disease, diabetes mellitus, hypertension, other systemic diseases, familial/hereditary nephropathy, various renal disorders | Day 1 of peritoneal technique training. |
| Barthel index | Scores of 100 imply total independence. Scores between 100 and 60 indicate the existence of a slight dependency or need for help, between 55 and 40 a moderate dependency, from 35 to 20 we would speak of severe dependency and scores below 20 points would indicate that the subject has a total dependence | Day 1 of peritoneal technique training. |
| Lawton and Brody scale | The 8 points indicate total independence to carry out the instrumental activities of daily life.- A lower result indicates functional deterioration. | Day 1 of peritoneal technique training. |
| Assessment of quality of life with the questionnaire EuroQol-5D (EQ-5D) | They are coded as 1 if the response option is "I have no problems"; with a 2 if the response option is "some or moderate problems"; and with a 3 if the answer option is "many problems." In such a way that the higher the value reflected, the worse the assessment that the subject makes of his or her state. | Day 1 of peritoneal technique training. |
| Cognitive impairment -PFEIFFER Test | From 0 to 2 errors: The patient is considered to have no cognitive impairment. 3 to 4 errors: The patient is considered to have mild cognitive impairment. From 5 to 7 errors: The patient is considered to have moderate cognitive impairment | Day 1 of peritoneal technique training. |
| Fragility detection - Q-Scale FRAIL | Between 1-2 affirmative answers: pre-fragile. >2 fragile | Day 1 of peritoneal technique training. |
| The origin before arriving at peritoneal dialysis | Pre-dialysis, hemodialysis, transplantation, cardiorenal syndrome | Day 1 of peritoneal technique training. |
| Residual renal function | Yes or not | Day 1 of peritoneal technique training. |
| Type of peritoneal catheter | Self-positioning catheter/Tenckhoff straight | Day 1 of peritoneal technique training. |
| Hemoglobin | 12.0 - 16.0 gr/dl | First month of the start of the technique at home. |
| Serum albumin | 3.4 - 5.2 g/dL | First month of the start of the technique at home. |
| Serum potassium | 3.50 - 5.50 mmol/L | First month of the start of the technique at home. |
| Serum sodium | 135.0 - 150.0 mmol/L | First month of the start of the technique at home. |
| Serum bicarbonate | 23.0 - 27.0 mmol/L | First month of the start of the technique at home. |
| Serum calcium | 8.80 - 10.60 mg/dL | First month of the start of the technique at home. |
| Serum phosphorus | 2.70 - 4.50 mg/dL | First month of the start of the technique at home. |
| Blood urea nitrogen | 10 - 50 mg/dL | First month of the start of the technique at home. |
| Serum creatinine | 0.50 - 0.90 mg/dL | First month of the start of the technique at home. |
| Peritonitis | Yes or not | Follow-up during the first year after educational intervention. |
| Time to first peritonitis | In months without peritonitis | Follow-up during the first year after educational intervention. |
| Orifice infection | Yes or not | Follow-up during the first year after educational intervention. |
| Peritoneal orifice tunnelitis | Yes or not | Follow-up during the first year after educational intervention. |
| Result of peritoneal fluid culture | positive, negative | Follow-up during the first year after educational intervention. |
| Type of peritoneal infection | Germ, fungus, biofilm | Follow-up during the first year after educational intervention. |
| Reinfection | Yes or not | Follow-up during the first year after educational intervention. |
| Relapse | Yes or not | Follow-up during the first year after educational intervention. |
| Complicated peritonitis | change of technique/death | Follow-up during the first year after educational intervention. |
| Antibiotic administered | Type of antibiotic administered, the dosage. | Follow-up during the first year after educational intervention. |
| Cho Y, Htay H, Johnson DW. Centre effects and peritoneal dialysis-related peritonitis. Nephrol Dial Transplant. 2017 Jun 1;32(6):913-915. doi: 10.1093/ndt/gfx054. No abstract available. |
| 22753455 | Background | Gadola L, Poggi C, Poggio M, Saez L, Ferrari A, Romero J, Fumero S, Ghelfi G, Chifflet L, Borges PL. Using a multidisciplinary training program to reduce peritonitis in peritoneal dialysis patients. Perit Dial Int. 2013 Jan-Feb;33(1):38-45. doi: 10.3747/pdi.2011.00109. Epub 2012 Jul 1. |
| 30876613 | Background | Bieber S, Mehrotra R. Peritoneal Dialysis Access Associated Infections. Adv Chronic Kidney Dis. 2019 Jan;26(1):23-29. doi: 10.1053/j.ackd.2018.09.002. |