Optimizing Prevention of PD-Associated Peritonitis in the US

OPPUS is an ancillary study of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Arbor Research and St. Michael’s Hospital in Toronto are co-leading this five-year contract from the Agency for Healthcare Research and Quality to study peritonitis infection in peritoneal dialysis (PD) patients. Co-Principal Investigators Drs. Ronald Pisoni and Jeffrey Perl are joined in this effort by a team of international and interdisciplinary co-investigators and stakeholders.

Home-based PD is used by approximately 10% of dialysis patients in the United States and 20% in Canada. PD is linked to superior survival in the first few years, and patients indicate that PD provides benefits that are meaningful to their quality of life. This is achieved with lower treatment costs while attaining clinical outcomes comparable to hemodialysis (HD). However, PD uptake is limited by technique failure and infections such as peritonitis.

In 2013, 15 percent of PD patients in the United States had at least one reported incident of peritonitis, an inflammation of the tissue lining the inner walls of the abdomen usually caused by an infection. PD-associated peritonitis is a leading cause of PD-related treatment failure requiring transition to in-center HD and is associated with increased risks of hospitalizations and death.

There is a need to identify reversible factors that influence peritonitis and technique failure The OPPUS project aims to identify high-risk patients and clinical practices associated with peritonitis risk to help further inform evidence-based practice guidelines. Working with a broad group of US stakeholders, other key goals of this project are to create a meaningful approach for standardized reporting of peritonitis episodes, and to promote knowledge dissemination strategies that foster continuous quality improvement and the development of clinical treatment pathways to prevent peritonitis in PD care settings.

The PDOPPS is the largest multinational prospective cohort study of PD to date, engaging more than 280 randomly selected PD units and more than 12,500 PD patients in nine countries, including Canada and the US. The large and highly detailed international data collection afforded by the PDOPPS provides us with a unique opportunity to understand the key aspects of PD practices that are associated with decreased occurrence of peritonitis.

“We are very excited and honored to have the opportunity to carry out this work aimed at decreasing peritonitis rates in the US and more broadly across the world.”

Co-Principal Investigator Ronald Pisoni of Arbor Research Collaborative for Health

“I am thrilled for this important and highly relevant research opportunity. Many patients prefer home-based peritoneal dialysis, so it is important that we identify and address any issues associated with it, and reduce any subsequent risks.”

Co-Principal Investigator Jeffrey Perl of St. Michael’s Hospital