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Optimizing Peritoneal Dialysis–Associated Peritonitis Prevention in the United States

From Standardized Peritoneal Dialysis–Associated Peritonitis Reporting and Beyond

Jeffrey Perl, Douglas S. Fuller, Neil Boudville, Alan S. Kliger, Douglas E. Schaubel, Isaac Teitelbaum, Bradley A. Warady, Alicia M. Neu, Priti R. Patel, Beth Piraino, Martin Schreiber and Ronald L. Pisoni
CJASN January 2021, 16 (1) 154-161; DOI: https://doi.org/10.2215/CJN.11280919
Jeffrey Perl
1Division of Nephrology, St. Michael’s Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
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Douglas S. Fuller
2Arbor Research Collaborative for Health, Ann Arbor, Michigan
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Neil Boudville
3Medical School, University of Western Australia, Perth, Australia
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Alan S. Kliger
4Section of Nephrology, Department of Internal Medicine, Yale School of Medicine and Yale New Haven Health System, New Haven, Connecticut
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Douglas E. Schaubel
5Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
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Isaac Teitelbaum
6Division of Kidney Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado
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Bradley A. Warady
7Division of Nephrology, Children’s Mercy Kansas City, Kansas City, Missouri
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Alicia M. Neu
8Division of Pediatric Nephrology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Priti R. Patel
9Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Beth Piraino
10Department of Medicine, Renal Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania
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Martin Schreiber
11Home Modalities, DaVita Kidney Care, Denver, Colorado
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Ronald L. Pisoni
2Arbor Research Collaborative for Health, Ann Arbor, Michigan
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Abstract

Peritoneal dialysis (PD)–associated peritonitis is the leading cause of permanent transition to hemodialysis among patients receiving PD. Peritonitis is associated with higher mortality risk and added treatment costs and limits more widespread PD utilization. Optimizing the prevention of peritonitis in the United States will first require standardization of peritonitis definitions, key data elements, and outcomes in an effort to facilitate nationwide reporting. Standardized reporting can also help describe the variability in peritonitis rates and outcomes across facilities in the United States in an effort to identify potential peritonitis prevention strategies and engage with stakeholders to develop strategies for their implementation. Here, we will highlight considerations and challenges in developing standardized definitions and implementation of national reporting of peritonitis rates by PD facilities. We will describe existing peritonitis prevention evidence gaps, highlight successful infection-reporting initiatives among patients receiving in-center hemodialysis or PD, and provide an overview of nationwide quality improvement initiatives, both in the United States and elsewhere, that have translated into a reduction in peritonitis incidence. We will discuss opportunities for collaboration and expansion of the Nephrologists Transforming Dialysis Safety (NTDS) initiative to develop knowledge translation pathways that will lead to dissemination of best practices in an effort to reduce peritonitis incidence.

  • dialysis-associated peritonitis
  • dialysis
  • Incidence
  • Quality Improvement
  • Translational Medical Research
  • peritoneal dialysis
  • Peritonitis
  • Health Care Costs
  • Copyright © 2021 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 16 (1)
Clinical Journal of the American Society of Nephrology
Vol. 16, Issue 1
January 07, 2021
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Optimizing Peritoneal Dialysis–Associated Peritonitis Prevention in the United States
Jeffrey Perl, Douglas S. Fuller, Neil Boudville, Alan S. Kliger, Douglas E. Schaubel, Isaac Teitelbaum, Bradley A. Warady, Alicia M. Neu, Priti R. Patel, Beth Piraino, Martin Schreiber, Ronald L. Pisoni
CJASN Jan 2021, 16 (1) 154-161; DOI: 10.2215/CJN.11280919

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Optimizing Peritoneal Dialysis–Associated Peritonitis Prevention in the United States
Jeffrey Perl, Douglas S. Fuller, Neil Boudville, Alan S. Kliger, Douglas E. Schaubel, Isaac Teitelbaum, Bradley A. Warady, Alicia M. Neu, Priti R. Patel, Beth Piraino, Martin Schreiber, Ronald L. Pisoni
CJASN Jan 2021, 16 (1) 154-161; DOI: 10.2215/CJN.11280919
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  • Article
    • Abstract
    • Importance of Peritoneal Dialysis–Associated Peritonitis
    • Considerations in Developing a Standardized Definition for Peritonitis and Related Outcomes
    • Challenges in Operationalizing Standardized Reporting of Peritonitis across Facilities in the United States
    • Success of Standardized Reporting of Dialysis-Related Infections
    • Evidence Gaps in Peritonitis Prevention Strategies
    • Implementation of Best Practices for Peritonitis Prevention
    • Conclusions
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  • Preprint Servers in Kidney Disease Research
  • Health Policy for Dialysis Care in Canada and the United States
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Keywords

  • dialysis-associated peritonitis
  • dialysis
  • incidence
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  • Translational Medical Research
  • peritoneal dialysis
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  • Health Care Costs

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