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01-08-2021 | Peritonitis | Original Article

Continued reduction in peritonitis rates in pediatric dialysis centers: results of the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative

Authors: Alicia M. Neu, Troy Richardson, Heidi Gruhler De Souza, Allison Redpath Mahon, Mahima Keswani, Joshua Zaritsky, Raj Munshi, Sarah Swartz, Christine B. Sethna, Michael J. G. Somers, Bradley A. Warady, for the SCOPE Collaborative Participants

Published in: Pediatric Nephrology | Issue 8/2021

Abstract

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

Chadha V, Schaefer FS, Warady BA (2010) Dialysis-associated peritonitis in children. Pediatr Nephrol 5:425–440. https://doi.org/10.1007/s00467-008-1113-6CrossRef

NAPRTCS (2011) 2011 Annual Dialysis Report. https://naprtcs.org/. Accessed 30 September 2020

United States Renal Data System (2018) 2018 USRDS annual data report: epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD. https://www.usrds.org/media/1737/v2_c07_esrd_pediatric_18_usrds.pdf Accessed 30 September 2020

Neu AM, Miller MR, Stuart J, Lawlor J, Richardson T, Martz K, Rosenberg C, Newland J, McAfee N, Begin B, Warady BA, SCOPE Collaborative Participants (2014) Design of the standardizing care to improve outcomes in pediatric end stage renal disease collaborative. Pediatr Nephrol 29:1477–1484. https://doi.org/10.1007/s00467-014-2891-7

Neu AM, Richardson T, Lawlor J, Stuart J, Newland J, McAfee N, Warady BA, SCOPE Collaborative Participants (2016) Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis. Kidney Int 89:1346–1354. https://doi.org/10.1016/j.kint.2016.02.015

Sethna CB, Bryant K, Munshi R, Warady BA, Richardson T, Lawlor J, Newland JG, Neu A (2016) Risk factors for and outcomes of catheter-associated peritonitis in children: the SCOPE Collaborative. Clin J Am Soc Nephrol 11:1590–1596. https://doi.org/10.2215/cjn.02540316CrossRefPubMedPubMedCentral

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Zaritsky JJ, Hanevold C, Quigley R, Richardson T, Wong C, Ehrlich J, Lawlor J, Rodean J, Neu A, Warady BA, SCOPE Investigators (2017) Epidemiology of peritonitis following maintenance peritoneal dialysis catheter placement during infancy: a report of the SCOPE collaborative. Pediatr Nephrol 33:713–722. https://doi.org/10.1007/s00467-017-3839-5

10.

Keswani M, Redpath Mahon AC, Richardson T, Rodean J, Couloures O, Martin A, Blaszak RT, Warady BA, Neu A (2019) Risk factors for early onset peritonitis: the SCOPE Collaborative. Pediatr Nephrol 34:1387–1394. https://doi.org/10.1007/s00467-019-04248-0CrossRefPubMed

Title: Continued reduction in peritonitis rates in pediatric dialysis centers: results of the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative
Authors: Alicia M. Neu
Troy Richardson
Heidi Gruhler De Souza
Allison Redpath Mahon
Mahima Keswani
Joshua Zaritsky
Raj Munshi
Sarah Swartz
Christine B. Sethna
Michael J. G. Somers
Bradley A. Warady
for the SCOPE Collaborative Participants
Publication date: 01-08-2021
Publisher: Springer Berlin Heidelberg
Keywords: Peritonitis
Care
Peritoneal Dialysis
Published in: Pediatric Nephrology / Issue 8/2021
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-021-04924-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Continued reduction in peritonitis rates in pediatric dialysis centers: results of the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

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