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Pediatric peritoneal dialysis training program and its relationship to peritonitis: a study of the International Pediatric Peritoneal Dialysis Network

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Abstract

Background

The guidelines for training of patients and caregivers to perform home peritoneal dialysis (PD) uniformly include recommendations pertaining to the prevention of peritonitis. The objective of this study conducted by the International Pediatric Peritoneal Dialysis Network (IPPN) was to investigate the training practices for pediatric PD and to evaluate the impact of these practices on the peritonitis and exit-site infection (ESI) rate.

Methods

A questionnaire regarding details of the PD program and training practices was distributed to IPPN member centers, while peritonitis and ESI rates were either derived from the IPPN registry or obtained directly from the centers. Poisson univariate and multivariate regression was used to determine the training-related peritonitis and ESI risk factors.

Results

Sixty-two of 137 centers responded. Information on peritonitis and ESI rates were available from fifty centers. Training was conducted by a PD nurse in 93.5% of centers, most commonly (50%) as an in-hospital program. The median total training time was 24 hours, with a formal assessment conducted in 88.7% and skills demonstration in 71% of centers. Home visits were performed by 58% of centers. Shorter (< 20 hours) training duration and lower number of training tools (both p < 0.02) were associated with higher peritonitis rate, after adjustment for proportion of treated infants and income of country of residence.

Conclusions

An association between training duration and the number of training tools represent potentially modifiable risk factors to reduce peritonitis rates within the pediatric PD population.

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List of all contributors

Gurinder Kumar, Sheikh Khalifa Medical City, Abu Dhabi, UAE; Sevcan A. Bakkaloglu, Gazi University School of Medicine, Ankara, Turkey; Maria Mila, Aglaia Kyriakou Children’s Hospital, Athens, Greece; William Wong, Starship Hospital, Auckland, New Zealand; Alicia Neu, John Hopkins Hospital, Baltimore, Maryland, USA; Xuhui Zhong, Peking University First Hospital, Beijing, China; Julia Thumfart, Charite Universitatsmedizin, Berlin, Germany; Sahar Fathallah-Shaykh, University of Alabama, Birmingham, Alabama, USA; Brigitte Adams, HUBERF, Brussel, Belgium; Paula Alejandra Coccia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Peter Nourse, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa; Hiren Patel, Nationwide Children’s Hospital, Columbus, Ohio, USA; Ilona Zagożdzon, Medical University of Gdańsk, Gdańsk, Poland; Enrico Eugenio Verrina, IRCCS Instituto Giannina Gaslini, Genoa, Italy; Bassanese Giulia, University of Heidelberg, Heidelberg, Germany; Alex R Constantinescu, Joe DiMaggio Children’s Hospital, Hollywood, Florida, USA; Zeynep Yuruk Yildirim, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Biswanath Basu, NRS Medical College, Kolkata, India; Dorota Drożdz, Jagiellonian University Medical College, Kraków, Poland; Reyner loza, Cayetano Heredia Hospital, Lima, Peru; Rukshana Shroff, Great Ormond Street Hospital for Children, London, UK; Shazia Adalat, Evelina London Children’s Hospital, London, UK; Mark Hanudel, Univeristy of California Los Angeles, Los Angeles, California, USA; Gregor Novljan, University Medical Center Lubljana, Lubljana, Slovenia; Pamela Slack, Royal Manchester Children’s Hospital, Manchester, UK; Richard Baquero Rodriguez, Hospital Universitario San Vicente Fundacion, Medellin, Colombia; Luisa Fernanda Rojas, RTS, Medellin, Colombia; Iliana Principi, Hospital Notti, Mendoza, Argentina; Silvia Consolo, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; Marc Fila, Center Hospitalier Universitaire, Arnaud de Villeneuve, Montpellier, France; Vikki Emmet, Great North Children’s Hospital, Newcastle Upon Tyne, UK; Roy Connel, Nottingham Children’s Hospital, Nottingham, UK; Germana Longo, Dialysis and Transplantation unit, Padova, Italy; Daniel Landau, Schneider Children’s Medical Center, Petach Tikva, Israel; Anjali Nayak, Phoenix Children’s Hospital, Phoenix, USA; Karel Vondrak, Department of Pediatrics, Dialysis Center, Prague, Czech Republic Jyoti Sharma, King Edward Memorial Hospital, Pune, India; Zenaida L. Antonio, National Kidney & Transplant Institute, Quezon City, Philippines; Khawla A. Rahim, Children’s Specialised Hospital, King Fahad Medical City, Riyadh, Saudi Arabia; Lavjay Butani, University of California Davis, Sacramento, California, USA; Macarena Gajardo Zurita, Hospital Roberto del Río, Santiago, Chile; Francisco Cano, Luis Calvo MacKenna Children’s Hospital, Santiago, Chile; Raj Munshi, Seattle Children’s Hospital, Seattle, USA; Yo Han Ahn, Seoul National University Hospital, Seoul, Republic of Korea; Emilija Sahpazova, University Pediatric Clinic, Skopje, N. Macedonia; Elizabeth Harvey, Hospital for Sick Children, Toronto, Canada; Mabrouk Sameh, University of Sahloul, Sousse, Tunisia: Enrico Vidal, Department of Medicine (DAME), University of Udine, Udine, Italy; Augustina Jankauskiene, Vilnius University Hospital, Santaros Klinikos, Vilnius, Lithuania; Kristen Pederson, Winnipeg Children’s Hospital, Winnipeg, Manitoba, Canada; Maria Szczepańska, Dialysis Division for Children, Zabrze, Poland.

Author information

Authors and Affiliations

  1. St John’s Medical College Hospital, Bangalore, India

    Nivedita Kamath

  2. Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland

    Dagmara Borzych-Dużałka

  3. Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany

    Dagmara Borzych-Dużałka & Franz Schaefer

  4. Royal Manchester Children’s Hospital, Manchester, UK

    Amrit Kaur

  5. Pediatric Nephrology Unit, Dona Estefania Hospital, Lisbon, Portugal

    Gisela Neto

  6. Medical University Vienna, Vienna, Austria

    Klaus Arbeiter

  7. Women and Children Hospital Kuala Lumpur, Kuala Lumpur, Malaysia

    Yok Chin Yap

  8. Hospital Jeanne de Flandre CHRU, Lille, France

    Annie Lahoche

  9. Dubai Hospital, Dubai, United Arab Emirates

    Loai Eid

  10. Ali Asghar Clinical Research Development Center, Department of Pediatrics, Iran University of Medical Science, Tehran, Iran

    Nakysa Hooman

  11. Children’s Hospital Association, Lenexa, KS, USA

    Troy Richardson

  12. Division of Pediatric Nephrology, Children’s Mercy Kansas City, Kansas City, USA

    Bradley A. Warady

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  1. Nivedita Kamath
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Consortia

on behalf of the IPPN participants

  • Gurinder Kumar
  • , Sevcan A. Bakkaloglu
  • , Maria Mila
  • , William Wong
  • , Alicia Neu
  • , Xuhui Zhong
  • , Julia Thumfart
  • , Sahar Fathallah-Shaykh
  • , Brigitte Adams
  • , Paula Alejandra Coccia
  • , Peter Nourse
  • , Hiren Patel
  • , Ilona Zagożdzon
  • , Enrico Eugenio Verrina
  • , Bassanese Giulia
  • , Alex R. Constantinescu
  • , Zeynep Yuruk Yildirim
  • , Biswanath Basu
  • , Dorota Drożdz
  • , Reyner Loza
  • , Rukshana Shroff
  • , Shazia Adalat
  • , Mark Hanudel
  • , Gregor Novljan
  • , Pamela Slack
  • , Richard Baquero Rodriguez
  • , Luisa Fernanda Rojas
  • , Iliana Principi
  • , Silvia Consolo
  • , Marc Fila
  • , Vikki Emmet
  • , Roy Connel
  • , Germana Longo
  • , Daniel Landau
  • , Anjali Nayak
  • , Karel Vondrak
  • , Jyoti Sharma
  • , Zenaida L. Antonio
  • , Khawla A. Rahim
  • , Lavjay Butani
  • , Macarena Gajardo Zurita
  • , Francisco Cano
  • , Raj Munshi
  • , Yo Han Ahn
  • , Emilija Sahpazova
  • , Elizabeth Harvey
  • , Mabrouk Sameh
  • , Enrico Vidal
  • , Augustina Jankauskiene
  • , Kristen Pederson
  •  & Maria Szczepańska

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Correspondence to Nivedita Kamath.

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Kamath, N., Borzych-Dużałka, D., Kaur, A. et al. Pediatric peritoneal dialysis training program and its relationship to peritonitis: a study of the International Pediatric Peritoneal Dialysis Network. Pediatr Nephrol 38, 4111–4118 (2023). https://doi.org/10.1007/s00467-023-05995-x

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  • DOI: https://doi.org/10.1007/s00467-023-05995-x

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