Study: Strategies to Prevent Infection-Related Losses in US Peritoneal Dialysis Programs by More Actionable Predictive Data Reporting

Peritoneal dialysis (PD)–associated peritonitis (PTN) accounts for a significant percentage of patients who transition to hemodialysis due to infection-related technique failure. Data reporting to individual PD home programs on PTN rates is designed to drive a proactive approach for optimizing infection rates in PD programs. This study conducted by the Home Dialysis team of DaVita Kidney Care attempted to determine if a more in-depth characterization of PTN events, with reporting on additional metrics, could advance PTN preventive strategies by reducing infection-related PD failure.

Between 2016 and 2020, a standardized reporting of PD-related PTN was implemented for 1,338 affiliated PD programs across the United States (66,687 patients). PTN was reported on a 3-month rolling average for each program, with time to PTN or time between PTN events included. Beginning in 2020, an effort to advance PTN preventive strategies was implemented, with reporting of the following additional data:

• Episodes/patient-year
• PD catheter removal rate post PTN/infection
• Culture‑negative PTN rate
• Organism-specific PTN reporting, with PD failure by organism
• Percentage of patients PTN-free (cumulative patient-months without an infection)
• Percentage of patients with >1 episode/year
• Percentage of events occurring at <30 days or 30 to 90 days
• PTN-associated hospitalization rates and length of stay
• Time at risk calculation (after day 1 training)
• PTN-associated mortality rates

The table below displays PTN rates from 2019 and results of the PTN additional data report from January through July 2020.

Metric	2019 Results	2020 (Jan through July)
Female, n (%)	1,667 (41.9)	961 (41.3)
Observed PTN events	3,992	2,370
PTN rate, overall annualized	1 per 5.9 patient-years; 0.17 per patient per year	1 per 5.2 patient-years; 0.19 per patient per year
Patients with culture-negative PTN, n (%)	678 (17.0)	416 (17.5)
Gram-positive PTN, n (%)	1,446 (36.7)	952 (40.1)
PTN-free patients, n (%)	32,554 (90.8)	28,231 (95.4)
Fungal PTN, n (%)	79 (2.0)	65 (2.7)
Patients with any infection who experienced PD failure <30 days, n (%)	905 (22.7)	381 (17.7)
Patients with Gram-positive infection who experienced PD failure <30 days, n (%)	214 (14.6)	102 (11.9)

Clustering data from 2020 show a significant number of patients with more than 1 PTN episode. Of the 6,302 patients with ≥1 PTN infection:

• 387 patients had 2 PTN episodes
• 85 patients had 3 PTN episodes
• 14 patients had 4 PTN episodes
• 4 patients had 5 PTN episodes
• 1 patient had 8 PTN episodes

In conclusion, reporting on additional metrics for PTN events on a program-by-program basis could assist in developing specific action steps that are critical in reducing infection-related PD failure. Incorporation of this additional data into an early warning system may help keep patients on their modality of choice.

For more information, see the ePoster (presented at the American Society of Nephrology’s virtual meeting in 2020), here.