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      Icodextrin does not impact infectious and culture-negative peritonitis rates in peritoneal dialysis patients: a 2-year multicentre, comparative, prospective cohort study

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          Abstract

          Background. Icodextrin is a glucose polymer derived by hydrolysis of cornstarch. The different biocompatibility profile of icodextrin-containing peritoneal dialysis (PD) solutions may have a positive influence on peritoneal host defence. Furthermore, cases of sterile peritonitis potentially associated with icodextrin have been reported.

          Methods. The primary objective of this multicentre, longitudinal, observational, non-interventional, prospective cohort study, which included 722 PD patients, was to evaluate the incidence of overall peritonitis in patients treated with icodextrin-containing PD solutions (Extraneal™) used during one long-dwell exchange/day compared with those treated with non-icodextrin-containing PD solutions. The secondary objective was to determine if culture-negative peritonitis rates differed between patients treated with icodextrin from two independent manufacturers. All peritonitis episodes were assessed by a Steering Committee in a blind manner.

          Results. There was no significant difference between icodextrin-treated and control patients in the adjusted overall, culture-positive or culture-negative peritonitis rates. When stratified by the icodextrin supplier, there was no significant difference in the adjusted rate of culture-negative peritonitis episodes between groups.

          Conclusion. Subjects receiving icodextrin as part of their PD regimen experienced neither a higher rate of culture-negative peritonitis nor a lower rate of infectious peritonitis compared with non-icodextrin users. There was no significant influence of the icodextrin raw material supplier on peritonitis rates.

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          Peritoneal dialysis-related infections recommendations: 2005 update.

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            Peritonitis-related mortality in patients undergoing chronic peritoneal dialysis.

            Peritonitis is a well-known cause of mortality in peritoneal dialysis (PD) patients. We carried out a retrospective study to disclose the clinical spectrum and risk profile of peritonitis-related mortality. We analyzed 693 episodes of infectious peritonitis suffered by 565 patients (follow-up 1149 patient-years). Death was the final outcome in 41 cases (5.9% of episodes), peritonitis being directly implicated in 15.2% of the global mortality and 68.5% of the infectious mortality observed. In 41.5% of patients with peritonitis-related mortality, the immediate cause of death was a cardiovascular event. Highest mortality rates corresponded to fungal (27.5%), enteric (19.3%), and Staphylococcus aureus (15.2%) peritonitis. Multivariate analysis disclosed thatthe baseline risk of peritonitis-related mortality was significantly higher in female [relative risk (RR) 2.13, 95% confidence interval (CI) 1.24-4.09, p = 0.02], older (RR 1.10/year, CI 1.06-1.14, p < 0.0005), and malnourished patients (RR 2.51, CI 1.21-5.23, p = 0.01) with high serum C-reactive protein (s-CRP) levels (RR 4.04, CI 1.45-11.32, p = 0.008) and a low glomerular filtration rate (RR 0.75 per mL/minute, CI 0.64 -0.87, p < 0.0005). Analysis of risk after a single episode of peritonitis and/or subanalysis restricted to peritonitis caused by more aggressive micro-organisms disclosed that overall comorbidity [odds ratio (OR) 1.21, CI 1.05-1.71, p = 0.005], depression (OR 2.35, CI 1.14-4.84, p = 0.02), and time on PD at the time of the event (OR 1.02/month, CI 1.00-1.03, p = 0.02) were other predictors of mortality. In summary, the etiologic agent is a definite marker of peritonitis-related mortality but gender, age, residual renal function, inflammation (s-CRP), malnutrition, and depression are other significant correlates of this outcome. Most of these risk factors are common to cardiovascular and peritonitis-related mortality, which may explain the high incidence of cardiovascular event as the immediate cause of death in patients with peritonitis-related mortality.
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              Predictors of outcome following bacterial peritonitis in peritoneal dialysis.

              No studies have been done to examine factors that predict the outcome of bacterial peritonitis during peritoneal dialysis (PD), beyond the contribution of the organism causing the peritonitis, concurrent exit-site or tunnel infection, and abdominal catastrophes. In this study we examined several clinical and laboratory parameters that might predict the outcome of an episode of bacterial peritonitis. Between March 1995 and July 2000, we identified 399 episodes of bacterial peritonitis in 191 patients on dialysis. There were 260 episodes of gram-positive peritonitis, 99 episodes of gram-negative peritonitis, and 40 episodes of polymicrobial peritonitis. Gram-positive peritonitis had a significantly higher resolution rate than either polymicrobial peritonitis or gram-negative peritonitis. Staphylococcus aureus episodes had poorer resolution than other gram-positive infections. Nonpseudomonal peritonitis had a better outcome than Pseudomonas aeruginosa episodes. Among all the gram-negative infections, Serratia marcescens had the worst outcome. Episodes associated with a purulent exit site had poor outcome only on univariate analysis. For those peritonitis episodes in which the PD fluid cell count was > 100/microL for more than 5 days, the nonresolution rate was 45.6%, compared to a 4.2% nonresolution rate when the cell count returned to 100/microL or less in less than 5 days. Those patients that had a successful outcome had been on continuous ambulatory PD for a significantly shorter period of time than those patients that had nonresolution. The nonresolution rate for those patients that had been on PD for more than 2.4 years was 24.4%, compared to 16.5% for those that had been on PD for less than 2.4 years (p = 0.05). The duration of PD and the number of days the PD effluent cell count remained > 100/microL were the only factors that independently predicted the outcome of an episode of peritonitis. Caucasians seem to have a higher nonresolution (failure) rate compared to Blacks. Other variables, such as the number of peritonitis episodes before the episode in question, vancomycin-based initial empiric treatment, serum albumin level, total lymphocyte count and initial dialysate white blood cell count, age, sex, diabetes, previous renal transplantation, and the use of steroids did not affect the outcome of peritonitis.
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                Author and article information

                Journal
                Nephrol Dial Transplant
                ndt
                ndt
                Nephrology Dialysis Transplantation
                Oxford University Press
                0931-0509
                1460-2385
                November 2008
                13 June 2008
                13 June 2008
                : 23
                : 11
                : 3711-3719
                Affiliations
                [1 ]Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna , Austria
                [2 ]Division of Nephrology, Hospital Puerto Real , Cadiz, Spain
                [3 ]Division of Nephrology, Hôpital Bichat , Paris, France
                [4 ]Division of Nephrology, The Ipswich Hospital , Ipswich, UK
                [5 ]Division of Nephrology, Hospital Juan Canalejo , Coruna, Spain
                [6 ]Baxter Healthcare, Brussels, Belgium
                Author notes
                Correspondence and offprint requests to: Andreas Vychytil, Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Tel: +43-1-40400-4495; Fax: +43-1-40400-4499; E-mail: andreas.vychytil@ 123456meduniwien.ac.at
                [*]

                Sites and members of the Extraneal Peritonitis Study Group are listed in the Appendix.

                Article
                gfn322
                10.1093/ndt/gfn322
                2568004
                18556747
                62234a47-e589-441e-a13c-f746e2f91dfc
                © The Author [2008].

                The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

                History
                : 28 December 2007
                : 19 May 2008
                Categories
                Dialysis

                Nephrology
                glucose degradation products,glucose polymer,peptidoglycan,sterile peritonitis,biocompatibility

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