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Training practices and peritonitis rates in children on maintenance peritoneal dialysis: results from the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) collaborative

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Abstract

Background

Comprehensive training of children on peritoneal dialysis (PD) and their caregivers is crucial to minimize peritonitis risk. Few studies have evaluated the impact of training on infection, so many published recommendations rely on expert opinion. This study uses data from the SCOPE collaborative to examine the impact of compliance with 4 components of PD training on the risk for peritonitis.

Methods

A retrospective cohort study of children enrolled in the SCOPE collaborative between 2011 and 2021 who received training prior to initiating PD. Compliance with 4 training components were assessed: performance of a home visit, 1:1 training, delaying training ≥ 10 days after PD catheter insertion and average individual training session length ≤ 3 h. Univariate and multivariable generalized linear mixed modeling were used to assess relationships between peritonitis ≤ 90 days after PD training and median days to peritonitis and compliance with each component as well as all-or-none compliance.

Results

Among 1450 trainings, 51.7% had median session length ≤ 3 h, 67.1% delayed training ≥ 10 days after catheter insertion, 74.3% had a home visit and 94.6% had 1:1 training. Only 333 trainings (23%) were compliant with all 4 training components. There was no statistically significant association between compliance with individual components, or all-or-none compliance and either the percentage of catheters with peritonitis ≤ 90 days after training end or median days to peritonitis.

Conclusion

No associations between 4 PD training components and risk for peritonitis were found. SCOPE requires monthly review of PD catheter practices which may have decreased the impact of training non-compliance.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to SCOPE data use agreements but are available from the corresponding author on reasonable request.

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Acknowledgements

The authors acknowledge the work of Nancy McAfee, former SCOPE nurse faculty, who was instrumental in developing the SCOPE training bundle and initiating this analysis, as well as the SCOPE participating centers and the patients they serve. No additional funding was received for conducting this study.

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Authors and Affiliations

  1. Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR, USA

    Brandy Begin

  2. Children’s Hospital Association, Lenexa, KS, USA

    Troy Richardson

  3. Stead Children’s Hospital, Iowa City, IA, USA

    Jennifer Ehrlich

  4. Division of Pediatric Nephrology, Children’s Mercy Kansas City, Kansas City, MO, USA

    Bradley A. Warady

  5. Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, 200 N Wolfe Street, Room 3055, Baltimore, MD, 21287, USA

    Alicia M. Neu

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  1. Brandy Begin
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  4. Bradley A. Warady
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on behalf of the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) collaborative participating centers

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Correspondence to Alicia M. Neu.

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Begin, B., Richardson, T., Ehrlich, J. et al. Training practices and peritonitis rates in children on maintenance peritoneal dialysis: results from the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) collaborative. Pediatr Nephrol 38, 3401–3406 (2023). https://doi.org/10.1007/s00467-023-05975-1

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  • DOI: https://doi.org/10.1007/s00467-023-05975-1

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