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Article ; Online: Utility of ultrasonographic examination in catheter-related infections in peritoneal dialysis: a clinical approach.

Nardelli, Luca / Scalamogna, Antonio / Castellano, Giuseppe

2023 Volume 36, Issue 7, Page(s) 1751–1761

Abstract: Peritoneal dialysis- (PD) related infections continue to be a major cause of morbidity and mortality in patients on renal replacement therapy via PD. However, despite the great efforts in the prevention of PD-related infectious episodes, approximately ... ...

Abstract	Peritoneal dialysis- (PD) related infections continue to be a major cause of morbidity and mortality in patients on renal replacement therapy via PD. However, despite the great efforts in the prevention of PD-related infectious episodes, approximately one third of technical failures are still caused by peritonitis. Recent studies support the theory that ascribes to exit-site and tunnel infections a direct role in causing peritonitis. Hence, prompt exit site infection/tunnel infection diagnosis would allow the timely start of the most appropriate treatment, thereby decreasing the potential complications and enhancing technique survival. Ultrasound examination is a simple, rapid, non-invasive and widely available procedure for tunnel evaluation in PD catheter-related infections. In case of an exit site infection, ultrasound examination has greater sensitivity in diagnosing simultaneous tunnel infection compared to the physical exam alone. This allows distinguishing the exit site infection, which will likely respond to antibiotic therapy, from infections that are likely to be refractory to medical therapy. In case of a tunnel infection, the ultrasound allows localizing the catheter portion involved in the infectious process, thus providing significant prognostic information. In addition, ultrasound performed after two weeks of antibiotic administration allows monitoring patient response to therapy. However, there is no evidence of the usefulness of ultrasound examination as a screening tool for the early diagnosis of tunnel infections in asymptomatic PD patients.
MeSH term(s)	Humans ; Catheter-Related Infections/diagnostic imaging ; Catheter-Related Infections/drug therapy ; Catheters, Indwelling/adverse effects ; Peritoneal Dialysis/adverse effects ; Peritoneal Dialysis/methods ; Anti-Bacterial Agents/therapeutic use ; Peritonitis/diagnostic imaging ; Peritonitis/drug therapy
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-03-20
Publishing country	Italy
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	1093991-x
ISSN	1724-6059 ; 1120-3625 ; 1121-8428
ISSN (online)	1724-6059
ISSN	1120-3625 ; 1121-8428
DOI	10.1007/s40620-023-01589-w
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Article ; Online: Tunnel ultrasound can guide the use of peritoneal dialysis catheter exit site relocation by external splicing and cuff removal in refractory tunnel infection.

Nardelli, Luca / Scalamogna, Antonio / Tripodi, Federica / De Liso, Chiara / Alfieri, Carlo / Castellano, Giuseppe

International urology and nephrology

2024

Abstract: Background: Peritoneal dialysis (PD) catheter related infections continue to be a major cause of morbidity and transfer to hemodialysis (HD) in PD patients. The treatment of tunnel infection (TI) could be challenging, especially when the infection ... ...

Abstract	Background: Peritoneal dialysis (PD) catheter related infections continue to be a major cause of morbidity and transfer to hemodialysis (HD) in PD patients. The treatment of tunnel infection (TI) could be challenging, especially when the infection involves the superficial cuff requiring the removal of the catheter. To spare the patient the loss of the catheter and the transfer to HD, several mini-invasive surgical techniques have been proposed as rescue therapy. Furthermore, nowadays, the rapid growth of digital technology has enormously increased the diagnostic sensibility of the echo signal allowing to accurately defines the extent of the infectious process along the PD catheter tunnel. Methods: Between 1st January 2020 and 31st December 2021 seven patients who underwent exit-site relocation by external splicing and cuff removal at our institution due to refractory TI were included in the study. All patients were followed until 12 months after the procedure. As soon as TI was defined refractory to the medical therapy, an ultrasonographic examination of the catheter tunnel was performed to define the extent of the infectious episode. Results: Among the 7 infectious episodes, 4 were caused by P. aeruginosa, and 3 by S. aureus. Around the superficial cuff the hypo/anechoic collections detected by ultrasounds showed a mean diameter of 3.05 ± 0.79 mm. The exit-site relocation by external splicing and cuff removal was successful in all cases (7/7, 100%). Conclusions: In our experience the use of exit site relocation by external splicing and cuff removal as rescue therapy for TI with positive ultrasounds for TI limited to superficial cuff involvement and without secondary peritonitis, yielded to promising results with a success rate of 100%. This preliminary experience underlines the paramount usefulness of tunnel echography in accurately defining the extent of TI and, consequently, guiding the choice of the therapeutical approach in refractory TI.
Language	English
Publishing date	2024-03-20
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	204048-7
ISSN	1573-2584 ; 0301-1623 ; 0042-1162
ISSN (online)	1573-2584
ISSN	0301-1623 ; 0042-1162
DOI	10.1007/s11255-024-04023-7
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Article ; Online: The use of mini-invasive surgical techniques to treat refractory exit-site and tunnel infections in peritoneal dialysis patients: a clinical approach.

Scalamogna, Antonio / Nardelli, Luca / Castellano, Giuseppe

Journal of nephrology

2022 Volume 36, Issue 7, Page(s) 1743–1749

Abstract: Peritoneal dialysis-(PD) related infections continue to be a major cause of morbidity and mortality in patients on PD. Although great advances have been made in the prevention and treatment of infectious complications over the past two decades, catheter- ... ...

Abstract	Peritoneal dialysis-(PD) related infections continue to be a major cause of morbidity and mortality in patients on PD. Although great advances have been made in the prevention and treatment of infectious complications over the past two decades, catheter-related infections represent a significant cause of technical failure in PD. Recent studies support the role of exit-site/tunnel infections in causing peritonitis. Peritonitis secondary to tunnel infection led to catheter loss in most cases. Thus, removing the catheter when exit-site/tunnel infection is refractory to medical therapy has been recommended. This approach requires interrupting PD and, after the placement of a central venous catheter, and transferring the patient to haemodialysis. In order to continue PD, simultaneous catheter removal and replacement of the PD catheter has been suggested. Although simultaneous catheter removal and replacement avoids temporary haemodialysis, it implies the removal/reinsertion of the catheter and the immediate initiation of PD with the risk of mechanical complications, such as leakage and malfunction. Hence, several mini-invasive surgical techniques, such as curettage, cuff-shaving, removal of the superficial cuff, and partial reimplantation of the catheter, have been proposed as rescue treatments. These procedures may allow the rescue of the catheter with a success rate of 70-100%. Therefore, in case of refractory exit-site/tunnel infection, a mini-invasive surgical revision should be considered before removing the catheter.
MeSH term(s)	Humans ; Catheters, Indwelling/adverse effects ; Peritoneal Dialysis/adverse effects ; Catheter-Related Infections/prevention & control ; Reoperation/adverse effects ; Peritonitis/etiology
Language	English
Publishing date	2022-12-15
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	1093991-x
ISSN	1724-6059 ; 1120-3625 ; 1121-8428
ISSN (online)	1724-6059
ISSN	1120-3625 ; 1121-8428
DOI	10.1007/s40620-022-01479-7
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Article ; Online: Analysis of mechanical complications in urgent-start peritoneal dialysis.

Scalamogna, Antonio / Nardelli, Luca / Cicero, Elisa / Castellano, Giuseppe

Journal of nephrology

2022 Volume 35, Issue 5, Page(s) 1489–1496

Abstract: Background: Peritoneal dialysis (PD) is an excellent, but underutilized dialysis technique. Thus, its implementation may depend also on the chance to offer this modality of treatment to patients referred late to the nephologists. This approach has ... ...

Abstract	Background: Peritoneal dialysis (PD) is an excellent, but underutilized dialysis technique. Thus, its implementation may depend also on the chance to offer this modality of treatment to patients referred late to the nephologists. This approach has recently been named "urgent-start peritoneal dialysis" (UPD). The main barrier to this practice is represented by the fear of early mechanical complications. Methods: All prevalent patients needing urgent-start PD at our institution between 1 January, 2009 and 31 December, 2019 were included in the study. During this period, 242 peritoneal catheters were inserted in 222 patients. In all patients, an anti-leakage/dislocation suture was made. PD was started within 24 h from catheter placement. Results: The early incidence of leakages, catheter dislocations, omental wrappings, bleedings, peritonitis and exit-site infections was 11/242 (4.5%), 5/242 (2%), 3/242 (1.2%), 2/242 (0.8%), 6/242 (2.5%) and 4/242 (1.6%), respectively. No bowel perforations were observed. Nearly one third of the late complications (13/45; 35.2%) resulted in discontinuation of PD, while one fourth (11/45; 24.4%) required surgical revision. The remaining episodes (21/45; 46.6%) were successfully managed by a conservative approach. The survival of the catheter at 3, 6, 12, 24, 36 and 48 months was 93.6, 91.2, 84.8, 77.4, 65.5 and 59.3%, respectively. The technique survival at 3, 6, 12, 24, 36 and 48 months was 97.2, 94.9, 87.6, 78.9, 66.6 and 60.0%, respectively. The main causes of PD drop-out included infectious complications (36.8%) followed by mechanical complications (17.5%). Conclusions: A tight seal between deep cuff and surrounding tissues (double purse-string technique) in association with a starting low-volume exchange scheme allows to minimize early and late mechanical complication in UPD.
MeSH term(s)	Catheters, Indwelling/adverse effects ; Humans ; Incidence ; Peritoneal Dialysis/adverse effects ; Peritoneal Dialysis/methods ; Peritonitis/epidemiology ; Peritonitis/etiology ; Time Factors
Language	English
Publishing date	2022-03-21
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1093991-x
ISSN	1724-6059 ; 1120-3625 ; 1121-8428
ISSN (online)	1724-6059
ISSN	1120-3625 ; 1121-8428
DOI	10.1007/s40620-022-01294-0
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Article ; Online: Incremental peritoneal dialysis allows to reduce the time spent for dialysis, glucose exposure, economic cost, plastic waste and water consumption.

Nardelli, Luca / Scalamogna, Antonio / Cicero, Elisa / Castellano, Giuseppe

Journal of nephrology

2022 Volume 36, Issue 2, Page(s) 263–273

Abstract: Background: Incremental peritoneal dialysis (incPD) as the initial PD strategy represents a convenient and resource-sparing approach, but its impact on patient, healthcare and environment has not been thoroughly evaluated.: Methods: This study ... ...

Abstract	Background: Incremental peritoneal dialysis (incPD) as the initial PD strategy represents a convenient and resource-sparing approach, but its impact on patient, healthcare and environment has not been thoroughly evaluated. Methods: This study includes 147 patients who started incPD at our institution between 1st January, 2009 and 31st December, 2021. Adequacy measures, peritoneal permeability parameters, peritonitis episodes, hospitalizations and increase in CAPD dose prescriptions were recorded. The savings related to cost, patient glucose exposure, time needed to perform dialysis, plastic waste, and water usage were compared to full-dose PD treatment. Results: During the study follow-up 11.9% of the patients transitioned from incremental to full dose PD. Patient cumulative probability of remaining on PD at 12, 24, 36, 48 and 60 months was 87.6, 65.4, 46.1, 30.1 and 17.5%, respectively. The median transition time from 1 to 2 exchanges, from 2 to 3 and 3 to 4 exchanges were 5, 9 and 11.8 months, respectively. Compared to full dose PD, 1, 2, and 3 exchanges per day led to reduction in glucose exposure of 20.4, 14.8 or 8.3 kg/patient-year, free lifetime gain of 18.1, 13.1 or 7.4 day/patient-year, a decrease in cost of 8700, 6300 or 3540 €/patient-year, a reduction in plastic waste of 139.2, 100.8 or 56.6 kg/patient-year, and a decline in water use of 25,056, 18,144 or 10,196 L/patient-year. Conclusions: In comparison with full-dose PD, incPD allows to reduce the time spent for managing dialysis, glucose exposure, economic cost, plastic waste, and water consumption.
MeSH term(s)	Humans ; Renal Dialysis ; Glucose ; Drinking ; Peritoneal Dialysis/adverse effects ; Water ; Kidney Failure, Chronic/therapy
Chemical Substances	Glucose (IY9XDZ35W2) ; Water (059QF0KO0R)
Language	English
Publishing date	2022-09-20
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1093991-x
ISSN	1724-6059 ; 1120-3625 ; 1121-8428
ISSN (online)	1724-6059
ISSN	1120-3625 ; 1121-8428
DOI	10.1007/s40620-022-01433-7
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Article ; Online: Simultaneous replacement and removal of the peritoneal catheter is effective in patients with refractory tunnel infections sustained by S. aureus.

Scalamogna, Antonio / Nardelli, Luca / Zubidat, Dalia / Castellano, Giuseppe

International urology and nephrology

2022

Abstract: Background: In tunnel infection (TI) refractory to medical therapy or in case of TI that occurs simultaneously with peritonitis, the removal of the peritoneal catheter has been proposed. This approach requires the interruption of peritoneal dialysis (PD) ...

Abstract	Background: In tunnel infection (TI) refractory to medical therapy or in case of TI that occurs simultaneously with peritonitis, the removal of the peritoneal catheter has been proposed. This approach requires the interruption of peritoneal dialysis (PD) and the creation of a temporary vascular access. However, simultaneous removal and reinsertion of the PD catheter (SCR) represents another possible therapeutic approach. Methods: We analysed the outcome of 20 patients (10 men and 10 women, mean age 65.5 ± 16.3 years) treated by CAPD for a mean period of 24.3 ± 14.2 months who underwent to SCR for the treatment of TI unresponsive to medical therapy or TI that occurred simultaneously with peritonitis at Fondazione Ca' Granda Ospedale Maggiore Policlinico. All the patients restarted CAPD exchanges within 24 h from catheter placement. Results: SCR was successful in 80% (16/20) of the cases. In particular, SCR was effective in 100% (11/11) of the TI with or without associated peritonitis sustained by S. aureus. However, SCR failed in 57% (4/7) of TI associated with relapsing peritonitis and in one patient with TI secondary to Enterobacter. No early mechanical complications (within 3 months after SCR) occurred when CAPD was restarted. Conclusions: SCR of the PD catheter through double-purse string technique represents an effective treatment for TI without or with simultaneously peritonitis sustained by S. aureus avoiding the patient the need for temporary hemodialysis and second surgical procedure. However, SCR could be contraindicated in case of relapsing peritonitis.
Language	English
Publishing date	2022-07-11
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	204048-7
ISSN	1573-2584 ; 0301-1623 ; 0042-1162
ISSN (online)	1573-2584
ISSN	0301-1623 ; 0042-1162
DOI	10.1007/s11255-022-03288-0
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Article ; Online: Peritoneal dialysis related peritonitis: insights from a long-term analysis of an Italian center.

Nardelli, Luca / Scalamogna, Antonio / Ponzano, Federico / Sikharulidze, Anna / Tripodi, Federica / Vettoretti, Simone / Alfieri, Carlo / Castellano, Giuseppe

BMC nephrology

2024 Volume 25, Issue 1, Page(s) 163

Abstract: Background: Peritonitis is a common and severe complication of peritoneal dialysis (PD). For comparative analysis standardized definitions as well as measurements and outcomes are crucial. However, most PD-related peritonitis studies have been using ... ...

Abstract	Background: Peritonitis is a common and severe complication of peritoneal dialysis (PD). For comparative analysis standardized definitions as well as measurements and outcomes are crucial. However, most PD-related peritonitis studies have been using heterogenous definitions and variable methods to measure outcomes. The ISPD 2022 guidelines have revised and clarified numerous definitions and proposed new peritonitis categories and outcomes. Methods: Between 1st January 2009 and 31st May 2023, 267 patients who started PD at our institution were included in the study. All PD-related peritonitis episodes that occurred in our unit during the study period were collected. The new definitions and outcomes of ISPD 2022 recommendations were employed. Results: The overall peritonitis rate was 0.25 episode/patient year. Patient cumulative probability of remaining peritonitis-free at one year was 84.2%. The medical cure and refractory peritonitis rates were equal to 70.3 and 22.4%, respectively. Culture-negative peritonitis accounted for 25.6% of all specimens. The rates of peritonitis associated death, hemodialysis transfer, catheter removal and hospitalization were 6.8%, 18.3%, 18.7% and 64.4%, respectively. Relapsing, repeat, recurrent and enteric peritonitis accounted for 7.8%, 6.8%, 4.1% and 2.7% of all episodes, respectively. Catheter insertion, catheter related and pre-PD peritonitis were 4.2, 2.1 and 0.5%. Conclusions: The implementation of PD-related peritonitis reports using standardized definitions and outcome measurements is of paramount importance to enhance clinical practice and to allow comparative studies.
MeSH term(s)	Humans ; Peritonitis/etiology ; Peritonitis/epidemiology ; Male ; Peritoneal Dialysis/adverse effects ; Female ; Middle Aged ; Italy/epidemiology ; Aged ; Retrospective Studies ; Adult ; Kidney Failure, Chronic/therapy ; Hospitalization
Language	English
Publishing date	2024-05-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2041348-8
ISSN	1471-2369 ; 1471-2369
ISSN (online)	1471-2369
ISSN	1471-2369
DOI	10.1186/s12882-024-03594-y
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Article ; Online: Simultaneous removal and replacement of the peritoneal catheter in CAPD patient with refractory peritonitis sustained by P. aeruginosa: A case-report.

Nardelli, Luca / Scalamogna, Antonio / Moscardino, Sara / Tripodi, Federica / Vettoretti, Simone / Alfieri, Carlo / Castellano, Giuseppe

The journal of vascular access

2023 , Page(s) 11297298231178061

Abstract: Pseudomonas peritonitis is often severe and associated with less than 50% complete cure rate, often requiring catheter removal, and transfer to HD. International guidelines recommend that peritoneal catheter should be removed if peritoneal dialysis (PD) ... ...

Abstract	Pseudomonas peritonitis is often severe and associated with less than 50% complete cure rate, often requiring catheter removal, and transfer to HD. International guidelines recommend that peritoneal catheter should be removed if peritoneal dialysis (PD) effluent does not clear after 5 days of appropriate antibiotic therapy defining the episode as refractory peritonitis. To avoid the shift to hemodialysis (HD), the simultaneous removal and replacement of the peritoneal catheter (SCR) has been employed to treat recurrent peritonitis or tunnel infections associated with peritonitis, obtaining satisfactory outcomes. However, the use of SCR is still controversial in refractory episodes. At present there is growing evidence that refractory peritonitis can be sustained by bacterial adherence along the intraperitoneal portion of the catheter, especially when Pseudomonas species are involved. We describe a case of refractory peritonitis sustained by P. aeruginosa that after a partial response to antibiotics has been successfully treated by SCR.
Language	English
Publishing date	2023-05-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2252820-9
ISSN	1724-6032 ; 1129-7298
ISSN (online)	1724-6032
ISSN	1129-7298
DOI	10.1177/11297298231178061
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Article ; Online: Relationship between number of daily exchanges at CAPD start with clinical outcomes.

Nardelli, Luca / Scalamogna, Antonio / Cicero, Elisa / Tripodi, Federica / Vettoretti, Simone / Alfieri, Carlo / Castellano, Giuseppe

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis

2023 Volume 44, Issue 2, Page(s) 98–108

Abstract: Background: Peritoneal dialysis (PD) continues to be demanding for patients affected by kidney failure. In kidney failure patients with residual kidney function, the employment of incremental PD, a less onerous dialytic prescription, could translate ... ...

Abstract	Background: Peritoneal dialysis (PD) continues to be demanding for patients affected by kidney failure. In kidney failure patients with residual kidney function, the employment of incremental PD, a less onerous dialytic prescription, could translate into a decrease burden on both health systems and patients. Methods: Between 1st January 2009 and 31st December 2021, 182 patients who started continuous ambulatory peritoneal dialysis (CAPD) at our institution were included in the study. The CAPD population was divided into three groups according to the initial number of daily CAPD exchanges prescribed: one or two (50 patients, CAPD-1/2 group), three (97 patients, CAPD-3 group) and four (35 patients, CAPD-4 group), respectively. Results: Multivariate analysis showed a difference in term of peritonitis free survival in CAPD-1/2 in comparison to CAPD-3 (hazard ratio (HR): 2.20, Conclusions: One- or two-exchange CAPD start was associated with a lower risk of peritonitis in comparison to three- or four-exchange start. Furthermore, an initial PD prescription with less than three exchanges may be associated with an advantage in term of hospitalisation rate and patient survival.
MeSH term(s)	Humans ; Peritoneal Dialysis, Continuous Ambulatory ; Peritoneal Dialysis ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/therapy ; Renal Dialysis ; Peritonitis/etiology ; Renal Insufficiency
Language	English
Publishing date	2023-12-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	645010-6
ISSN	1718-4304 ; 0896-8608
ISSN (online)	1718-4304
ISSN	0896-8608
DOI	10.1177/08968608231209849
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Article ; Online: [Double purse-string craft around the inner cuff: a new technique for an immediate start of CAPD].

Scalamogna, Antonio / Nardelli, Luca / Messa, Piergiorgio

Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia

2020 Volume 37, Issue 1

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Catheter-Related Infections/etiology ; Catheterization/adverse effects ; Catheterization/methods ; Catheters, Indwelling/adverse effects ; Female ; Humans ; Male ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory/adverse effects ; Peritoneal Dialysis, Continuous Ambulatory/instrumentation ; Peritoneal Dialysis, Continuous Ambulatory/methods ; Peritoneum ; Peritonitis/etiology ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Practice Guidelines as Topic ; Prosthesis Failure ; Suture Techniques ; Time Factors
Language	Italian
Publishing date	2020-02-12
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1237110-5
ISSN	1724-5990 ; 0393-5590
ISSN (online)	1724-5990
ISSN	0393-5590
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