Peritonitis is a common and serious complication of peritoneal dialysis (PD) and is one of the main causes of peritoneal dialysis technique failure and long-term hemodialysis conversion.
Peritoneal infections (PI) have been a very relevant representative of peritoneal dialysis (PD) for decades. PI is a very serious complication of PD and is a source of concern because of its high incidence. Each episode carries clinical consequences for the patient, increases in treatment costs, hospital admissions, technical failures and risk of death, especially in the 30 days following an episode. The risk of peritonitis depends on non-modifiable factors (such as age, sex, diabetes) and modifiable factors (such as anti-infective prophylaxis, catheter care, and training). It is important to accurately analyze the effect of modifiable factors, as they are the most relevant in reducing the rate of peritonitis. Patient education is very important and can affect the success of the technique and clinical results. Therapeutic education has been considered a key factor in PD outcomes. The PD nurse is responsible for training the patient and/or caregiver to be self-sufficient and autonomous in care, reinforce and highlight the importance of adherence to treatment, and promote safe actions to prevent technique-related infections when this one is made at home. This is a pragmatic, retrospective-prospective (ambispective) study of educational intervention for patients with stage V advanced chronic kidney disease and those with cardiorenal syndrome starting a peritoneal dialysis program. A retrospective control group with patients starting PD before January 2020 will be included and compared with an intervention group that will systematically include all patients starting DP since the start of the study and they will be implemented a new educational intervention based on a systematic review that has been carried out with the most recent evidence.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
80
* Before catheter placement: The nurse and doctor provide the patient and/or caregiver with a PD simulation. * Initial training: from the placement of the catheter to the beginning of the technique at home, approximately 4 weeks, 6 and 7 sessions, duration 1-2 hours per session. Individualized learning taking into account learning abilities and education. It includes the explanation of the PD and the display of informational pictograms/capsules. * Step-by-step teaching: peritoneal exchange, peritoneal orifice care, administration of intraperitoneal medication, recording of constants, detection of complications and risk behaviors. * Nutritional education and water intake. * Administration of the Objective Structured Assessment (OSA) checklist. * Retraining: between the 1st and 3rd month of the start, after an episode of peritonitis and/or hospitalization, risk behaviors, functional/cognitive impairment, passivity/demotivation behaviors, and regularly once the year.
Data collection from the patient's clinical history because this new standardized educational intervention was not used.
Rate of peritonitis
It is calculated as the number of episodes of peritonitis per patient and year at risk.
Time frame: 1 year after educational intervention.
Age
In years
Time frame: Day 1 of peritoneal technique training.
Gender
Male or female
Time frame: Day 1 of peritoneal technique training.
Language barrier
Yes or not
Time frame: Day 1 of peritoneal technique training.
Marital status
Single, married, coupled, separated - divorced, widowed
Time frame: Day 1 of peritoneal technique training.
Educational level
Not finished primary studies, primary schools, secondary, middle/higher grade cycle, high school, university studies, doctorate
Time frame: Day 1 of peritoneal technique training.
Caregiver disposition
Yes or not
Time frame: Day 1 of peritoneal technique training.
Drinking water supply
Yes or not
Time frame: Day 1 of peritoneal technique training.
Weight
In kilograms
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: Day 1 of peritoneal technique training.
Height
In meters
Time frame: Day 1 of peritoneal technique training.
Body Mass Index (BMI)
BMI= Current weight (kg) ÷ height (m) x height (m)= kg/m2. Low weight: Less than 18.4 Normal weight: 18.5 to 24.9 Overweight: 25 to 29.9 Grade I Obesity: 30 to 34.9 Grade II Obesity: 35 to 39.9 Grade III Obesity: Equal to or greater than 40.
Time frame: Day 1 of peritoneal technique training.
Diabetes
Yes or not
Time frame: Day 1 of peritoneal technique training.
Cardiovascular disease
Yes or not
Time frame: Day 1 of peritoneal technique training.
Cerebrovascular disease
Yes or not
Time frame: Day 1 of peritoneal technique training.
Hypertension
Yes or not
Time frame: Day 1 of peritoneal technique training.
Cancer
Yes or not
Time frame: Day 1 of peritoneal technique training.
The primary cause of kidney disease
Glomerular disease, tubulointerstitial disease, diabetes mellitus, hypertension, other systemic diseases, familial/hereditary nephropathy, various renal disorders
Time frame: Day 1 of peritoneal technique training.
Barthel index
Scores of 100 imply total independence. Scores between 100 and 60 indicate the existence of a slight dependency or need for help, between 55 and 40 a moderate dependency, from 35 to 20 we would speak of severe dependency and scores below 20 points would indicate that the subject has a total dependence
Time frame: Day 1 of peritoneal technique training.
Lawton and Brody scale
The 8 points indicate total independence to carry out the instrumental activities of daily life.- A lower result indicates functional deterioration.
Time frame: Day 1 of peritoneal technique training.
Assessment of quality of life with the questionnaire EuroQol-5D (EQ-5D)
They are coded as 1 if the response option is "I have no problems"; with a 2 if the response option is "some or moderate problems"; and with a 3 if the answer option is "many problems." In such a way that the higher the value reflected, the worse the assessment that the subject makes of his or her state.
Time frame: Day 1 of peritoneal technique training.
Cognitive impairment -PFEIFFER Test
From 0 to 2 errors: The patient is considered to have no cognitive impairment. 3 to 4 errors: The patient is considered to have mild cognitive impairment. From 5 to 7 errors: The patient is considered to have moderate cognitive impairment
Time frame: Day 1 of peritoneal technique training.
Fragility detection - Q-Scale FRAIL
Between 1-2 affirmative answers: pre-fragile. \>2 fragile
Time frame: Day 1 of peritoneal technique training.
The origin before arriving at peritoneal dialysis
Pre-dialysis, hemodialysis, transplantation, cardiorenal syndrome
Time frame: Day 1 of peritoneal technique training.
Residual renal function
Yes or not
Time frame: Day 1 of peritoneal technique training.
Type of peritoneal catheter
Self-positioning catheter/Tenckhoff straight
Time frame: Day 1 of peritoneal technique training.
Hemoglobin
12.0 - 16.0 gr/dl
Time frame: First month of the start of the technique at home.
Serum albumin
3.4 - 5.2 g/dL
Time frame: First month of the start of the technique at home.
Serum potassium
3.50 - 5.50 mmol/L
Time frame: First month of the start of the technique at home.
Serum sodium
135.0 - 150.0 mmol/L
Time frame: First month of the start of the technique at home.
Serum bicarbonate
23.0 - 27.0 mmol/L
Time frame: First month of the start of the technique at home.
Serum calcium
8.80 - 10.60 mg/dL
Time frame: First month of the start of the technique at home.
Serum phosphorus
2.70 - 4.50 mg/dL
Time frame: First month of the start of the technique at home.
Blood urea nitrogen
10 - 50 mg/dL
Time frame: First month of the start of the technique at home.
Serum creatinine
0.50 - 0.90 mg/dL
Time frame: First month of the start of the technique at home.
Peritonitis
Yes or not
Time frame: Follow-up during the first year after educational intervention.
Time to first peritonitis
In months without peritonitis
Time frame: Follow-up during the first year after educational intervention.
Orifice infection
Yes or not
Time frame: Follow-up during the first year after educational intervention.
Peritoneal orifice tunnelitis
Yes or not
Time frame: Follow-up during the first year after educational intervention.
Result of peritoneal fluid culture
positive, negative
Time frame: Follow-up during the first year after educational intervention.
Type of peritoneal infection
Germ, fungus, biofilm
Time frame: Follow-up during the first year after educational intervention.
Reinfection
Yes or not
Time frame: Follow-up during the first year after educational intervention.
Relapse
Yes or not
Time frame: Follow-up during the first year after educational intervention.
Complicated peritonitis
change of technique/death
Time frame: Follow-up during the first year after educational intervention.
Antibiotic administered
Type of antibiotic administered, the dosage.
Time frame: Follow-up during the first year after educational intervention.