Survey of exit-site management practices of peritoneal dialysis in Japan

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Survey of exit-site management practices of peritoneal dialysis in Japan

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Co-author 1

Hiroyuki Kadoya kadoya-hiro@med.kawasaki-m.ac.jp Kawasaki Medical School Department of General Geriatric Medicine Kurashiki Japan *

Co-author 2

Satoshi Kurahashi satoshi0909271828@gmail.com Graduate School of Medicine, Kyoto University Department of Nephrology Kyoto Japan -

Co-author 3

Satoshi Ototake ototake26@med.nagoya-u.ac.jp Nagoya University Graduate School of Medicine Department of Renal Replacement Therapy Nagoya Japan -

Co-author 4

Takaaki Kosugi taka_kosugi25@yahoo.co.jp Nara Medical University Department of Nephrology Kashihara Japan -

Co-author 5

Masahiro Nakagaki masa.nakagaki@gmail.com Kokura Memorial Hospital Division of Nephrology Kitakyushu Japan -

Co-author 6

Ai Nagashima nagashima.ai.479@mail.aichi-med-u.ac.jp Aichi Medical University Department of Nephrology and Rheumatology Nagakute Japan -

Co-author 7

Kenji Harada kenkenharada19790531@yahoo.co.jp Kokura Memorial Hospital Division of Nephrology Kitakyushu Japan -

Co-author 8

Naohiro Toda natoda@kuhp.kyoto-u.ac.jp Kansai Electric Power Hospital Department of Nephrology Osaka Japan -

Co-author 9

Masahiro Eriguchi meriguci@gmail.com Nara Medical University Department of Nephrology Kashihara Japan -

Co-author 10

Yukinao Sakai y-sakai@nms.ac.jp Graduate School of Medicine, Nippon Medical School Department of Endocrinology, Metabolism and Nephrology Tokyo Japan -

Co-author 11

Masashi Mizuno mizuno.masashi.z6@f.mail.nagoya-u.ac.jp Nagoya University Graduate School of Medicine Department of Renal Replacement Therapy Nagoya Japan -

Co-author 12

Yasuhiko Ito yasuito57@gmail.com Aichi Medical University Department of Nephrology and Rheumatology Nagakute Japan -

Co-author 13

Co-author 14

Co-author 15

Introduction

Peritoneal dialysis (PD) is a well-established renal replacement therapy used worldwide for end-stage renal disease. PD-related infections, including peritonitis and exit-site infections/tunnel infections, remain frequent and significant complications. One crucial factor in the success of a PD program is proper catheter and exit-site care. However, methods for caring for the peritoneal catheter and exit-sites are not established and vary among facilities. No survey has been conducted on exit-site management in Japan. Here, we aimed to identify successful examples that led to best practices.

Methods

The Japanese Society for Peritoneal Dialysis-led PD-related infection project was launched in 2023, under which a survey was conducted at 14 facilities nationwide that provide PD therapy. The survey content included questions about the timing of the initiation of exit-site care, materials used in exit-site protection, and disinfectants used for exit-site care.

Results

Seventy-one percent of the exit-site direction was downward. In all facilities, the exit-site was dressed immediately after its creation for several days up to a certain period. Many facilities started exit-site care within 1–2 weeks of PD initiation. Notably, 50% of the facilities did not use disinfectants. Twelve facilities used gauze or film dressings to protect the exit site. The catheter was secured in many facilities; however, the distance of fixation varied. The timing for starting a shower after exit-site creation was commonly 1–4 weeks post-surgery. Nine facilities allowed bathing without a cover, typically after >1 month. Of these, 7 did not use Spa Clean.

Conclusion

This survey provides insights into the trends in exit-site care across facilities. Our findings are important for advancing the optimal approach to exit-site care in Japan. Further studies and trials are needed to establish the best practice on exit site care for Japanese patients undergoing PD.

Kewords