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Continued reduction in peritonitis rates in pediatric dialysis centers: results of the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative



In its first 3 years, the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative demonstrated a statistically significant increase in the likelihood of compliance with a standardized follow-up care bundle and a significant reduction in peritonitis. We sought to determine if compliance with care bundles and low peritonitis rates could be sustained in centers continuously participating for 84 months.


Centers that participated from collaborative launch through the 84-month study period and provided pre-launch peritonitis rates were included. Children on maintenance peritoneal dialysis were eligible for enrollment. Changes in bundle compliance were assessed using a logistic regression model or a generalized linear mixed model (GLMM). Changes in average annualized peritonitis rates over time were modeled using GLMMs.


Nineteen centers contributed 1055 patients with 1268 catheters and 17,247 follow-up encounters. The likelihood of follow-up compliance increased significantly over the study period (OR 1.05 95% confidence interval (CI) 1.03, 1.07; p < 0.001). Centers achieved ≥ 80% follow-up bundle compliance by 28 months and maintained a mean compliance of 84% between 28 and 84 months post-launch. Average monthly peritonitis rates decreased from 0.53 (95% CI 0.37, 0.70) infections per patient-year pre-launch to 0.30 (95% CI 0.23, 0.43) at 84 months post-launch, p < 0.001.


Centers participating in the SCOPE Collaborative for 84 months achieved and maintained a high level of compliance with a standardized follow-up care bundle and demonstrated a significant and continued reduction in average monthly peritonitis rates.

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  1. 1.

    Chadha V, Schaefer FS, Warady BA (2010) Dialysis-associated peritonitis in children. Pediatr Nephrol 5:425–440.

    Article  Google Scholar 

  2. 2.

    NAPRTCS (2011) 2011 Annual Dialysis Report. Accessed 30 September 2020

  3. 3.

    United States Renal Data System (2018) 2018 USRDS annual data report: epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD. Accessed 30 September 2020

  4. 4.

    Neu AM, Miller MR, Stuart J, Lawlor J, Richardson T, Martz K, Rosenberg C, Newland J, McAfee N, Begin B, Warady BA, SCOPE Collaborative Participants (2014) Design of the standardizing care to improve outcomes in pediatric end stage renal disease collaborative. Pediatr Nephrol 29:1477–1484.

  5. 5.

    Neu AM, Richardson T, Lawlor J, Stuart J, Newland J, McAfee N, Warady BA, SCOPE Collaborative Participants (2016) Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis. Kidney Int 89:1346–1354.

  6. 6.

    Sethna CB, Bryant K, Munshi R, Warady BA, Richardson T, Lawlor J, Newland JG, Neu A (2016) Risk factors for and outcomes of catheter-associated peritonitis in children: the SCOPE Collaborative. Clin J Am Soc Nephrol 11:1590–1596.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A, Chadha V, Yap HK, Schaefer F (2012) Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int 32(Suppl 2):S32–S86.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Schaefer F, Klaus G, Muller-Wiefel DE, Mehls O (1999) Intermittent versus continuous intraperitoneal glycopeptide/ceftazidime treatment in children with peritoneal dialysis-associated peritonitis. The Mid-European Pediatric Peritoneal Dialysis Study Group (MEPPS). J Am Soc Nephrol 10:136–145

    CAS  Article  Google Scholar 

  9. 9.

    Zaritsky JJ, Hanevold C, Quigley R, Richardson T, Wong C, Ehrlich J, Lawlor J, Rodean J, Neu A, Warady BA, SCOPE Investigators (2017) Epidemiology of peritonitis following maintenance peritoneal dialysis catheter placement during infancy: a report of the SCOPE collaborative. Pediatr Nephrol 33:713–722.

  10. 10.

    Keswani M, Redpath Mahon AC, Richardson T, Rodean J, Couloures O, Martin A, Blaszak RT, Warady BA, Neu A (2019) Risk factors for early onset peritonitis: the SCOPE Collaborative. Pediatr Nephrol 34:1387–1394.

    Article  PubMed  Google Scholar 

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Correspondence to Alicia M. Neu.

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Dr. Warady has received research funding from Baxter Healthcare. The authors otherwise declare no competing interests.

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Neu, A.M., Richardson, T., De Souza, H.G. et al. Continued reduction in peritonitis rates in pediatric dialysis centers: results of the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative. Pediatr Nephrol 36, 2383–2391 (2021).

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  • Peritoneal dialysis
  • Infection
  • Prevention
  • Peritonitis
  • Quality improvement