From the pre course on ASN 2011, on Dialysis Modalities
The following are different strategies to decrease risk of peritonitis; they are unrelated concepts.
1-Russo et al in KI did a multi center Italian study. 353 pts answered a questionnaire. 191 pts had home visits with a score card. 23% were non-compliant with exchange procedure. This was associated with increased peritonitis rates. So it maybe worthwile retraining Pd patients for 4days yearly to decrease the risk.
2-Diverticulitis may be associated with increased peritonitis rates.
3-Hypokalemia and constipation can cause peritonitis; Bacteria in the colon migrate across the visceral peritoneum and enter the peritoneal cavity which is filled with dialysis fluid which inhibits immune function.
4-We should use prophylaxis medications for GI procedures to decrease risk of infections.
5-Fix all hernias before starting PD. On exam, one needs to have patients stand to uncover hernias and leaks. Umbilical hernias may be the smallest but have the biggest risk of incarciration.
And one more interesting tit bit of information was a new way of reporting Peritonitis instead of N of months between episodes; is to use the number of infections per year and this will help compare centers to each other and also get a sepecific bug rates internally and within centers.
Hofstra NSLIJ Nephrology