ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

TLDR

Peritoneal dialysis–associated peritonitis is a serious complication that increases morbidity and mortality, making prevention and treatment essential. The guideline identifies future research priorities for preventing and treating PD‑related peritonitis. The 2022 ISPD update revises peritonitis definitions, introduces new categories and outcomes, sets a target of ≤0.40 episodes per year and >80 % peritonitis‑free patients, and provides updated guidance on contamination control, prophylaxis, training, risk‑factor management, antibiotic selection, and adjunctive N‑acetylcysteine therapy.

Abstract

Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.