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Effects of cognitive impairment and assisted peritoneal dialysis on exit-site infection in older patients

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Abstract

Background

Elderly peritoneal dialysis (PD) patients required assistance for a variety of PD-related tasks. The usefulness of assisted PD in reducing the peritonitis risk has been reported; however, there is little evidence on the effectiveness of assisted PD in preventing exit-site infections in older patients.

Methods

This was a single-center, prospective cohort study. Thirty-three patients (mean age: 74.8 ± 5.9 years) on PD were evaluated for cognitive impairment (CI) using the Japanese version of the Montreal Cognitive Assessment. They were also evaluated to determine whether they performed the exit-site care procedure alone or with assistance. Patients were categorized into four groups based on the presence or absence of CI and the presence or absence of exit-site care assistance. They were followed up until the occurrence of peritonitis and exit-site infection at the end of the follow-up.

Results

Altogether, 8, 8, and 17 patients were assigned to the “without CI and without assistance”, “without CI and with assistance”, and “with CI and with assistance groups”, respectively; no patients were assigned to the “with CI and without assistance group”. Six and 16 patients experienced peritonitis and exit-site infection during follow-up, respectively. Kaplan–Meier analysis and log-rank tests revealed that the “without CI and without assistance group” was significantly associated with exit-site infection (log-rank < 0.05).

Conclusion

Patients who did not receive assistance for exit-site care were at a higher risk of exit-site infections, even in the absence of CI. Caregiver assistance is important for preventing exit-site infections in older patients on PD.

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References

  1. Nakamoto H. The current status and future of peritoneal dialysis in Japan. Contrib Nephrol. 2019;198:78–86.

    Article  Google Scholar 

  2. Mendelssohn DC, Mujais SK, Soroka SD, Brouillette J, Takano T, Barre PE, et al. A prospective evaluation of renal replacement therapy modality eligibility. Nephrol Dial Transplant. 2009;24:555–61.

    Article  Google Scholar 

  3. Nitta K, Masakane I, Hanafusa N, Taniguchi M, Hasegawa T, Nakai S, et al. Annual dialysis data report 2017, JSDT renal data registry. Ren Replace Ther. 2019;5:53.

    Article  Google Scholar 

  4. Iyasere OU, Brown EA, Johansson L, Huson L, Smee J, Maxwell AP, et al. Quality of life and physical function in older patients on dialysis: a comparison of assisted peritoneal dialysis with hemodialysis. Clin J Am Soc Nephrol. 2016;11:423–30.

    Article  CAS  Google Scholar 

  5. Kallenberg MH, Kleinveld HA, Dekker FW, van Munster BC, Rabelink TJ, van Buren M, et al. Functional and cognitive impairment, frailty, and adverse health outcomes in older patients reaching ESRD-a systematic review. Clin J Am Soc Nephrol. 2016;11:1624–39.

    Article  Google Scholar 

  6. Li JSC. Prevalence of cognitive impairment among elderly Chinese continuous ambulatory peritoneal dialysis patients. HK J Nephrol. 2004;6:22–30.

    Google Scholar 

  7. Shea YF, Lam MF, Lee MS, Mok MY, Lui SL, Yip TP, et al. Prevalence of CMMSE defined cognitive impairment among peritoneal dialysis patients and its impact on peritonitis. Clin Exp Nephrol. 2016;20:126–33.

    Article  Google Scholar 

  8. Kalirao P, Pederson S, Foley RN, Kolste A, Tupper D, Zaun D, et al. Cognitive impairment in peritoneal dialysis patients. Am J Kidney Dis. 2011;57:612–20.

    Article  Google Scholar 

  9. Liao JL, Zhang YH, Xiong ZB, Hao L, Liu GL, Ren YP, et al. The association of cognitive impairment with peritoneal dialysis-related peritonitis. Perit Dial Int. 2019;39:229–35.

    Article  Google Scholar 

  10. Covic A, Bammens B, Lobbedez T, Segall L, Heimbürger O, van Biesen W, et al. Educating end-stage renal disease patients on dialysis modality selection. NDT Plus. 2010;3:225–33.

    PubMed  PubMed Central  Google Scholar 

  11. Szeto CC, Li PK, Johnson DW, Bernardini J, Dong J, Figueiredo AE, et al. ISPD catheter-related infection recommendations: 2017 update. Perit Dial Int. 2017;37:141–54.

    Article  Google Scholar 

  12. Beckwith H, Clemenger M, McGrory J, Hisole N, Chelapurath T, Newbury S, et al. Repeat peritoneal dialysis exit-site infection: definition and outcomes. Perit Dial Int. 2019;39:344–9.

    Article  Google Scholar 

  13. Masakane I, Nakai S, Ogata S, Kimata N, Hanafusa N, Hamano T, et al. Annual dialysis data report 2014, J SDT renal data registry (JRDR). Ren Replace Ther. 2017;3:18.

    Article  Google Scholar 

  14. Tomlinson GA, Jassal SV. The association between exit site infection and subsequent peritonitis among peritoneal dialysis patients. Clin J Am Soc Nephrol. 2012;7:1266–71.

    Article  Google Scholar 

  15. Lin J, Ye H, Li J, Qiu Y, Wu H, Yi C, et al. Prevalence and risk factors of exit-site infection in incident peritoneal dialysis patients. Perit Dial Int. 2020;40:164–70.

    Article  Google Scholar 

  16. Béchade C, Lobbedez T, Ivarsen P, Povlsen JV. Assisted peritoneal dialysis for older people with end-stage renal disease: the French and Danish experience. Perit Dial Int. 2015;35:663–6.

    Article  Google Scholar 

  17. Sakai K, Nihei H. Peritoneal dialysis in elderly patients. Contrib Nephrol. 2018;196:141–7.

    Article  Google Scholar 

  18. Bieber SD, Mehrotra R. Patient and technique survival of older adults with ESRD treated with peritoneal dialysis. Perit Dial Int. 2015;35:612–7.

    Article  CAS  Google Scholar 

  19. van Diepen AT, Tomlinson GA, Jassal SV. The association between exit site infection and subsequent peritonitis among peritoneal dialysis patients. Clin J Am Soc Nephrol. 2012;7:1266–71.

    Article  Google Scholar 

  20. van Diepen AT, Jassal SV. A qualitative systematic review of the literature supporting a causal relationship between exit-site infection and subsequent peritonitis in patients with end-stage renal disease treated with peritoneal dialysis. Perit Dial Int. 2013;33:604–10.

    Article  Google Scholar 

  21. Lloyd A, Tangri N, Shafer LA, Rigatto C, Perl J, Komenda P, et al. The risk of peritonitis after an exit site infection: a time-matched, case-control study. Nephrol Dial Transplant. 2013;28:1915–21.

    Article  CAS  Google Scholar 

  22. Woodrow G, Turney JH, Brownjohn AM. Technique failure in peritoneal dialysis and its impact on patient survival. Perit Dial Int. 1997;17:360–4.

    Article  CAS  Google Scholar 

  23. Bayston R, Andrews M, Rigg K, Shelton A. Recurrent infection and catheter loss in patients on continuous ambulatory peritoneal dialysis. Perit Dial Int. 1999;19:550–5.

    Article  CAS  Google Scholar 

  24. Okayama M, Inoue T, Nodaira Y, Kimura Y, Nobe K, Seto T, et al. Aging is an important risk factor for peritoneal dialysis-associated peritonitis. Adv Perit Dial. 2012;28:50–4.

    PubMed  Google Scholar 

  25. De Vecchi AF, Maccario M, Braga M, Scalamogna A, Castelnovo C, Ponticelli C. Peritoneal dialysis in nondiabetic patients older than 70 years: comparison with patients aged 40 to 60 years. Am J Kidney Dis. 1998;31:479–90.

    Article  Google Scholar 

  26. Hsieh YP, Chang CC, Wen YK, Chiu PF, Yang Y. Predictors of peritonitis and the impact of peritonitis on clinical outcomes of continuous ambulatory peritoneal dialysis patients in Taiwan–10 years’ experience in a single center. Perit Dial Int. 2014;34:85–94.

    Article  CAS  Google Scholar 

  27. Li PK, Law MC, Chow KM, Leung CB, Kwan BC, Chung KY, et al. Good patient and technique survival in elderly patients on continuous ambulatory peritoneal dialysis. Perit Dial Int. 2007;27:S196-201.

    Article  Google Scholar 

  28. Hung CC, Chang CT, Lee CC, Chen KH, Yu CC, Wu CH, et al. Prognostic predictors of technique and patient survival in elderly Southeast Asian patients undergoing continuous ambulatory peritoneal dialysis. Int J Clin Pract. 2009;63:254–60.

    Article  Google Scholar 

  29. Khatri M, Nickolas T, Moon YP, Paik MC, Rundek T, Elkind MS, et al. CKD associates with cognitive decline. J Am Soc Nephrol. 2009;20:2427–32.

    Article  CAS  Google Scholar 

  30. Miwa K, Tanaka M, Okazaki S, Furukado S, Yagita Y, Sakaguchi M, et al. Chronic kidney disease is associated with dementia independent of cerebral small-vessel disease. Neurology. 2014;82:1051–7.

    Article  CAS  Google Scholar 

  31. Tsuruya K, Yoshida H, Kuroki Y, Nagata M, Mizumasa T, Mitsuiki K, et al. Brain atrophy in peritoneal dialysis and CKD stages 3–5: a cross-sectional and longitudinal study. Am J Kidney Dis. 2015;65:312–21.

    Article  Google Scholar 

  32. Zhang YH, Yang ZK, Wang JW, Xiong ZY, Liao JL, Hao L, et al. Cognitive changes in peritoneal dialysis patients: a multicenter prospective cohort study. Am J Kidney Dis. 2018;72:691–700.

    Article  Google Scholar 

  33. Shea YF, Lam MF, Lee MS, Mok MY, Lui SL, Yip TP, et al. Prevalence of cognitive impairment among peritoneal dialysis patients, impact on peritonitis and role of assisted dialysis. Perit Dial Int. 2016;36:284–90.

    Article  CAS  Google Scholar 

  34. Mizuno M, Ito Y, Tanaka A, Suzuki Y, Hiramatsu H, Watanabe M, et al. Peritonitis is still an important factor for withdrawal from peritoneal dialysis therapy in the Tokai area of Japan. Clin Exp Nephrol. 2011;15:727–37.

    Article  Google Scholar 

  35. Iyasere O, Brown E, Gordon F, Collinson H, Fielding R, Fluck R, et al. Longitudinal trends in quality of life and physical function in frail older dialysis patients: a comparison of assisted peritoneal dialysis and in-center hemodialysis. Perit Dial Int. 2019;39:112–8.

    Article  Google Scholar 

  36. Hofmeister M, Klarenbach S, Soril L, Scott-Douglas N, Clement F. A systematic review and jurisdictional scan of the evidence characterizing and evaluating assisted peritoneal dialysis models. Clin J Am Soc Nephrol. 2020;15:511–20.

    Article  Google Scholar 

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Acknowledgements

We would like to thank the patients who participated in this study and the hospital staff for their tremendous cooperation during the study period.

Author information

Authors and Affiliations

  1. Department of Physical Therapy, School of Rehabilitation Sciences, Seirei Christopher University, 3453 Mikatahara, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan

    Hiroki Yabe

  2. Department of Rehabilitation, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan

    Hiroki Yabe, Yuto Imoto, Ayaka Onoyama & Sayaka Ito

  3. Department of Nephrology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan

    Keiko Okada & Hirotake Kasuga

  4. Department of Physical Therapy, School of Health Sciences at Narita, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan

    Kenichi Kono

  5. Department of Wellness Center, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan

    Yoshifumi Moriyama

  6. Department of Nephrology and Rheumatology, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute, 480-1195, Japan

    Yasuhiko Ito

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  1. Hiroki Yabe
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by KO, YI, AO, SI. The first draft of the manuscript was written by HY and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Conceptualization: HY, KK; methodology: HY, KK; formal analysis and investigation: HY, KO, YI, AO, SI; writing—original draft preparation: HY; writing—review and editing: HK, and YI; supervision: YM, and YI.

Corresponding author

Correspondence to Hiroki Yabe.

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Conflict of interest

The co-author (YI) has received honoraria from Baxter and research funding from Kyowa-Kirin, Chugai, and Baxter.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Seirei Christopher University (IRB approval number 16064) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Yabe, H., Okada, K., Kono, K. et al. Effects of cognitive impairment and assisted peritoneal dialysis on exit-site infection in older patients. Clin Exp Nephrol 26, 593–600 (2022). https://doi.org/10.1007/s10157-022-02199-9

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  • DOI: https://doi.org/10.1007/s10157-022-02199-9

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