Kamath Nivedita, Borzych-Dużałka Dagmara, Kaur Amrit, Neto Gisela, Arbeiter Klaus, Yap Yok Chin, Lahoche Annie, Eid Loai, Hooman Nakysa, Richardson Troy, Schaefer Franz, Warady Bradley A
St John's Medical College Hospital, Bangalore, India.
Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland.
Pediatr Nephrol. 2023 Dec;38(12):4111-4118. doi: 10.1007/s00467-023-05995-x. Epub 2023 Jul 5.
The guidelines for training of patients and caregivers to perform home peritoneal dialysis (PD) uniformly include recommendations pertaining to the prevention of peritonitis. The objective of this study conducted by the International Pediatric Peritoneal Dialysis Network (IPPN) was to investigate the training practices for pediatric PD and to evaluate the impact of these practices on the peritonitis and exit-site infection (ESI) rate.
A questionnaire regarding details of the PD program and training practices was distributed to IPPN member centers, while peritonitis and ESI rates were either derived from the IPPN registry or obtained directly from the centers. Poisson univariate and multivariate regression was used to determine the training-related peritonitis and ESI risk factors.
Sixty-two of 137 centers responded. Information on peritonitis and ESI rates were available from fifty centers. Training was conducted by a PD nurse in 93.5% of centers, most commonly (50%) as an in-hospital program. The median total training time was 24 hours, with a formal assessment conducted in 88.7% and skills demonstration in 71% of centers. Home visits were performed by 58% of centers. Shorter (< 20 hours) training duration and lower number of training tools (both p < 0.02) were associated with higher peritonitis rate, after adjustment for proportion of treated infants and income of country of residence.
An association between training duration and the number of training tools represent potentially modifiable risk factors to reduce peritonitis rates within the pediatric PD population. A higher resolution version of the Graphical abstract is available as Supplementary information.
针对患者及护理人员进行家庭腹膜透析（PD）培训的指南一致包含有关预防腹膜炎的建议。国际儿科腹膜透析网络（IPPN）开展的这项研究的目的是调查儿科PD的培训实践，并评估这些实践对腹膜炎和出口处感染（ESI）发生率的影响。
向IPPN成员中心分发了一份关于PD项目细节和培训实践的问卷，而腹膜炎和ESI发生率要么来自IPPN登记处，要么直接从各中心获取。采用泊松单变量和多变量回归来确定与培训相关的腹膜炎和ESI危险因素。
137个中心中有62个做出了回应。50个中心提供了腹膜炎和ESI发生率的信息。93.5%的中心由PD护士进行培训，最常见的是（50%）作为住院项目。培训总时长的中位数为24小时，88.7%的中心进行了正式评估，71%的中心进行了技能演示。58%的中心进行了家访。在对治疗婴儿的比例和居住国收入进行调整后，较短（<20小时）的培训时长和较少的培训工具数量（均p<0.02）与较高的腹膜炎发生率相关。
培训时长和培训工具数量之间的关联代表了可潜在改变的危险因素，以降低儿科PD人群中的腹膜炎发生率。更高分辨率版本的图形摘要可作为补充信息获取。
