CHARACTERISTICS OF PERITONEAL DIALYSIS-RELATED PERITONITIS DURING THE COVID-19 PANDEMIC
Dr Jessica Davies1, Ms Maella Teele2, Dr Louis Huang1,2, Professor Lawrence McMahon1,2
1Eastern Health, Box Hill, Australia, 2Monash University Eastern Health Clinical School, Box Hill, Australia
Aim: To examine patient and unit factors associated with peritoneal dialysis (PD)-related peritonitis and the effect of the COVID-19 pandemic.
Background: Melbourne endured the toughest and the longest COVID-19 lockdowns. An increased PD-related peritonitis rate was observed at our centre from 0.09 episodes/patient-year in 2019 to 0.3 in 2022. Risk factors for PD-related peritonitis are well documented; however, it is unknown if and how the COVID-19 pandemic modified this risk.
Methods: A retrospective analysis examined all peritonitis cases at Eastern Health between January 2018 to December 2022. Data collected included patient demographics, peritonitis risk factors, microbiology, and clinical outcomes. Results were then analysed pertaining to era: preceding, during, or post COVID-19 lockdowns.
Results: Seventy-one episodes of peritonitis were recorded during the study period, affecting 43 patients. There were 29 (40.1%) preceding, 21 (29.6%) during, and 21 (29.6%) post lockdowns. There were no differences in age, gender, body mass index, smoking status, diabetes prevalence or residual renal function between eras. Cases of culture-negative peritonitis were significantly higher during the lockdowns, while Gram-positive infections were less prevalent (P<0.05). Compared to the pre-lockdown era, nurse interaction with patients was also significantly reduced during the lockdown (68+/-22 vs. 52+/-21 min/patient-month, P<0.05). Dialysate neutrophil count at the time of peritonitis diagnosis was significantly higher post-lockdowns compared to pre-lockdowns (5300 [IQR 2100-18750] vs. 1100 [IQR 485-7100] cells/microlitre, P<0.05), possibly related to delayed presentation. However, all patients were treated with adherence to international guidelines and there were no significant differences in clinical outcomes.
Conclusions: The COVID-19 lockdowns altered the microbiology of PD-related peritonitis and reduced nurse interactions with patients. These findings will help inform future pandemic management.
Biography:
Dr Davies is an advanced trainee in nephrology from Eastern Health, Victoria.