2) We welcome first-time @ckd_ce author Jade Teakell PhD MD @jmteakell, #Nephrologist, Fellowship APD @UTKidney. This is another #tweetorial with 🆓 CE/#CME brought to you by the collaboration of @ckd_ce & @KIReports. No industry funding was provided for this program. pic.twitter.com/3aTaLp09c9
— @CKD_ce (@ckd_ce) February 14, 2024
4) #Peritonitis is a very serious complication of #PeritonealDialysis. Prompt identification & treatment are key. #Intraperitoneal (IP) #vancomycin is a 1st-line antimicrobial agent recommended by @ISPD1 to be given at the 1st suspicion of peritonitis.
— @CKD_ce (@ckd_ce) February 14, 2024
🔓 https://t.co/6SIUEX8rD9 pic.twitter.com/Y1F3BXxvLc
6a) Knowledge check: After a 4-6 hour dwell, how much Intraperitoneal (IP) #Vancomycin, is absorbed into systemic circulation?
— @CKD_ce (@ckd_ce) February 14, 2024
7a) But wait—there’s more!! What’s the target serum #vancomycin trough level for treatment of PD-associated #peritonitis?
— @CKD_ce (@ckd_ce) February 14, 2024
8) Here’s a table summary of prior studies comparing #Vancomycin level and peritonitis outcomes in #PeritonealDialysis (all retrospective): pic.twitter.com/dt6G5dDKZa
— @CKD_ce (@ckd_ce) February 14, 2024
9b) . . . and that higher peritoneal solute transport status was associated with suboptimal trough serum levels on day 5.https://t.co/uw2OY7ybNJ pic.twitter.com/qE1mjhtgFx
— @CKD_ce (@ckd_ce) February 14, 2024
11) Secondary objective:
— @CKD_ce (@ckd_ce) February 14, 2024
Investigate confounders (e.g. #eGFR, body weight) that might affect the association between nadir trough level and likelihood of cure.
13) Variables:
— @CKD_ce (@ckd_ce) February 14, 2024
Exposure = nadir serum vanc level (lowest recorded during treatment episode)
Outcome = composite relapse/recurrent #peritonitis, catheter removal, transfer to #HD, or death
Covariates = index demographics, clinical data (wgt, eGFR, time on PD, infectious organism)
15) The mean nadir vanc level =16.4 (4.8) mg/l.
— @CKD_ce (@ckd_ce) February 14, 2024
The average # of vanc levels measured = 2.3
(similar between those who experienced cure and those who did not, 2.18 vs 2.68). pic.twitter.com/0xMAUNvuJk
17) After adjustment for age, sex, wgt, eGFR, days on #PD (covariates not independently associated with outcome) …
— @CKD_ce (@ckd_ce) February 14, 2024
Nadir vanc level ≥15 mg/L → 7.5 times more likely to experience cure compared to those w/ nadir level <15 mg/l
OR 7.58, 95%CI 1.71–33.57
P = 0.008 pic.twitter.com/h08EJslMF8
19) Study limitations:
— @CKD_ce (@ckd_ce) February 14, 2024
🤔 Single center
🤔 Small sample size
🤔 No comorbidity information
🤔 No cases with #MRSA
🤔 Frequency/timing of vanc levels not standardized
21) ✅ In agreement with prior @ISPD1 peritonitis guidelines, target for serum vancomycin level
— @CKD_ce (@ckd_ce) February 14, 2024
Check out this awesome #VisualAbstract by @ckd_ce faculty @brian_rifkin 👇 pic.twitter.com/bOoQwFvwNt
23) Thank you! This #KIReports #Tweetorial brought to you by @jmteakell for the @KIReports Social Media Team, have a great day!https://t.co/G1m5iYuTVMhttps://t.co/Zap2Al75YOhttps://t.co/eXdinpTAQ2@ghobby @Sophia_Kidney #NephTwitter #MedTwitter
— @CKD_ce (@ckd_ce) February 14, 2024