Alicia M. Neu

For some patients, peritoneal dialysis (PD) has several advantages over center-based hemodialysis. PD-related infections such as peritonitis and PD catheter exit site and tunnel infections are a significant source of morbidity. Peritonitis leads to increased mortality, and it is the leading cause of transfer off PD. Infection prevention practices may vary widely across dialysis centers, resulting in significant differences in infection rates. To address these issues and improve patient outcomes, the American Society of Nephrology facilitated the development of core interventions aimed at reducing PD-related infections across US dialysis facilities. The core interventions focus on six key strategies: ( 1 ) regular surveillance and feedback on infection rates, ( 2 ) standardized staff training and competency assessments, ( 3 ) standardized patient and care partner/caregiver education, ( 4 ) routine infection prevention assessments, ( 5 ) antimicrobial prophylaxis for PD catheter exit sites, and ( 6 ) prophylactic antimicrobials for certain procedures and events. These strategies, on the basis of evidence and international guidelines, emphasize consistency in implementation and monitoring at the facility level. The workgroup followed an iterative process, incorporating expert review and feedback to inform and refine these interventions. Effective implementation requires coordinated efforts among dialysis teams, patients, and support networks, with ongoing evaluation through surveillance and quality improvement initiatives. Although the interventions are grounded in current evidence, additional research is necessary to refine practices and address emerging challenges. The goal is to reduce infection risks, improve the quality of life for patients on PD, and support national efforts to expand home dialysis use.

Background Comprehensive training of children on peritoneal dialysis (PD) and their caregivers is crucial to minimize peritonitis risk. Few studies have evaluated the impact of training on infection, so many published recommendations rely on expert opinion. This study uses data from the SCOPE collaborative to examine the impact of compliance with 4 components of PD training on the risk for peritonitis. Methods A retrospective cohort study of children enrolled in the SCOPE collaborative between 2011 and 2021 who received training prior to initiating PD. Compliance with 4 training components were assessed: performance of a home visit, 1:1 training, delaying training ≥ 10 days after PD catheter insertion and average individual training session length ≤ 3 h. Univariate and multivariable generalized linear mixed modeling were used to assess relationships between peritonitis ≤ 90 days after PD training and median days to peritonitis and compliance with each component as well as all-or-none compliance. Results Among 1450 trainings, 51.7% had median session length ≤ 3 h, 67.1% delayed training ≥ 10 days after catheter insertion, 74.3% had a home visit and 94.6% had 1:1 training. Only 333 trainings (23%) were compliant with all 4 training components. There was no statistically significant association between compliance with individual components, or all-or-none compliance and either the percentage of catheters with peritonitis ≤ 90 days after training end or median days to peritonitis. Conclusion No associations between 4 PD training components and risk for peritonitis were found. SCOPE requires monthly review of PD catheter practices which may have decreased the impact of training non-compliance. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

Background 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. Methods 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. Results 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. Conclusions 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. Graphical abstract