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Kidney Week

Abstract: PO0994

Protective Association Found Between Peritoneal Dialysis Patients Prescribed Home Antibiotics Kits and In-Center Hemodialysis Transition

Session Information

  • Peritoneal Dialysis
    November 04, 2021 | Location: On-Demand, Virtual Only
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Blankenship, Derek M., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Carver, Michelle, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Chatoth, Dinesh K., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Mysayphonh, Chance, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Ray, Debu, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Mccarley, Patricia, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Usvyat, Len A., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Hymes, Jeffrey L., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Maddux, Franklin W., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
Background

Peritonitis is a complication of peritoneal dialysis (PD) and is likely associated with technique failure. To decrease time to peritonitis treatment, Fresenius Kidney Care (FKC) clinicians can prescribe broad-spectrum intraperitoneal and oral antibiotic kits. Kits are self-administered by home PD patients for suspected wet contamination or peritonitis per algorithm. The study purpose is to assess hemodialysis (HD) transition as well as peritonitis among PD patients receiving a home antibiotic kit.

Methods

This retrospective cohort study identified FKC PD patients prescribed home antibiotic kits between June 1st, 2019 and June 30th, 2020. Home FKC PD patients not receiving kit during same period composed the control pool. Patients are matched in a 1:4 ratio on clinical and demographic data using propensity scores. Patients were followed up to 6 months for transition to HD and first peritonitis event. Outcomes were analyzed with weighted competing risk Cox Proportional Hazards Models.

Results

2,888 treatment and 10,613 controls were studied. Of the 2,888 treatment patients and weighted 1,921.2 matched controls, 11.9% and 13.5% transitioned to HD, respectively. A 0.88 hazard ratio (p=0.0448) determined treatment group is 12% less likely to transition to HD at any point during follow-up period. 10.4% treatment patients and 8.5% controls have at least one peritonitis event. The treatment group is 23% more likely to have a Peritonitis event (p=0.0019).

Conclusion

The study identified a protective association in HD attrition for home PD patients receiving peritonitis kits despite a positive association between patients receiving the kits and peritonitis. These findings may reflect residual confounding factors such as clinicians prescribing kits for patients at higher risk of peritonitis for uncontrolled or unmeasurable factors since kits do not prevent peritonitis but increase uniformity of treatment. The findings justify need for further research including prospective randomized studies.

Funding

  • Commercial Support