BACKGROUND:Effective advance care planning depends on clinician-patient communication quality. However, ACP-CAT, the only validated observer-rated instrument, remains untested in real-world clinical encounters and non-Western contexts. AIM:Validating ACP-CAT in assessing clinician-patient communication quality with advanced cancer and chronic kidney disease in Hong Kong, comparing against patient and family ratings of clinician communication. DESIGN:Cross-sectional study of adult patients with advanced cancer or chronic kidney disease from five hospitals and one hospice service. Two independent raters evaluated audiotaped advance care planning conversations using ACP-CAT, while patients and family members assessed communication quality using the Chinese Quality of Communication Questionnaire (C-QOC). We assessed the psychometric properties, including interrater reliability, convergent and discriminant validity. SETTING/PARTICIPANTS:One hundred and thirty-seven advance care planning conversations involving 84 cancer patients, 53 renal patients, 107 family members, and 20 clinicians. RESULTS:ACP-CAT demonstrated high interrater reliability (mean Gwet's AC1 = 0.81; 88.6% agreement). Convergent validity was demonstrated through significant correlations between ACP-CAT total score and patient-rated C-QOC End-of-life planning subscale (r = 0.29, p < 0.01), family-rated C-QOC summary score (r = 0.27, p < 0.05), and family-rated C-QOC End-of-life planning subscale (r = 0.34, p < 0.01). Discriminant validity was supported by absence of correlations with patients' self-rated health status and information or decision-making preferences (all p > 0.05). Clinicians frequently explored patients' fears and health goals, but rarely discussed nonmedical priorities, valued activities, or surrogate decision makers. CONCLUSIONS:ACP-CAT demonstrates strong concurrent validity with patient- and family-rated measures and ecological validity in real clinical settings. These findings support its reliability for assessing advance care planning communication quality across diverse cultural contexts.

Effective clinician-patient communication is essential for delivering quality end-of-life care. However, there are no validated measures to assess the quality of end-of-life communication for Chinese patients. This study aims to cross-culturally adapt and validate the patient-reported Quality of Communication Questionnaire (QOC) for Chinese speaking patients. The QOC was translated and adapted using a standardized methodology consisting of forward translations, backward translations, expert panel review, and testing with patients. We conducted a cross-sectional study to perform principal component, content validity, internal consistency, convergent and discriminant validity analyses of the 16-item Chinese QOC (C-QOC). Subjects were Chinese-speaking advanced cancer (n = 82) and advanced chronic kidney disease (n = 68) patients attending outpatient clinics in five hospitals or receiving home-based palliative care in Hong Kong. The content validity of the C-QOC was established by an expert panel. The C-QOC has a 3-component structure (general communication skills, communication about illness trajectory, and end-of-life care planning subscales) and demonstrated good internal consistency (Cronbach’s α = 0.88; subscales 0.84–0.90). Convergent validity was supported by positive association between C-QOC score and overall clinician communication quality (r = 0.47, p < 0.001) and clinician comfort in discussing dying (r = 0.63, p < 0.001). Discriminant validity was demonstrated by the stronger association between overall clinician communication quality and general communication skills, compared to the other two subscales. The C-QOC is a valid, reliable, and culturally relevant instrument for evaluating the quality of clinician end-of-life care communication by Chinese patients with advanced cancer and chronic kidney disease.

Journal of Palliative MedicineVol. 26, No. 2 Letters to the EditorLetter to the Editor: Effects of Add-On Metolazone to High-Dose Oral Frusemide on Refractory Fluid Overload in Patients with End-Stage Kidney Disease Opting for Conservative ManagementHo Yan Au, Kwok Ying Chan, Desmond Y.H. Yap, Terence Yip, and Chi Yan WongHo Yan AuPalliative Medical Unit, Grantham Hospital, Hong Kong.Search for more papers by this author, Kwok Ying ChanAddress correspondence to: Kwok Ying Chan, MD, MRCP, FHKCP, Palliative Medical Unit, Grantham Hospital, 125 Wong Chuk Hang, Hong Kong 000 E-mail Address: cky842@yahoo.com.hkhttps://orcid.org/0000-0002-2521-297XPalliative Medical Unit, Grantham Hospital, Hong Kong.Search for more papers by this author, Desmond Y.H. YapDivision of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.Search for more papers by this author, Terence YipDepartment of Medicine, Renal Unit, Tung Wah Hospital, Hong Kong.Search for more papers by this author, and Chi Yan WongPalliative Medical Unit, Grantham Hospital, Hong Kong.Search for more papers by this authorPublished Online:27 Jan 2023https://doi.org/10.1089/jpm.2022.0532AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Letter to the Editor: Effects of Add-On Metolazone to High-Dose Oral Frusemide on Refractory Fluid Overload in Patients with End-Stage Kidney Disease Opting for Conservative Management." Journal of Palliative Medicine, 26(2), pp. 163–164FiguresReferencesRelatedDetails Volume 26Issue 2Feb 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Ho Yan Au, Kwok Ying Chan, Desmond Y.H. Yap, Terence Yip, and Chi Yan Wong.Letter to the Editor: Effects of Add-On Metolazone to High-Dose Oral Frusemide on Refractory Fluid Overload in Patients with End-Stage Kidney Disease Opting for Conservative Management.Journal of Palliative Medicine.Feb 2023.163-164.http://doi.org/10.1089/jpm.2022.0532Published in Volume: 26 Issue 2: January 27, 2023PDF download

Brimonidine eye drops are frequently prescribed for the treatment of glaucoma and ocular hypertension in adults. Systemic toxicities including neurological side effects have been reported with its use, especially in the paediatric population. In this report, we present a case of encephalopathy secondary to the use of brimonidine eye drops in a patient with underlying advanced chronic kidney disease, who recovered promptly after drug cessation. Herein, we also review the pharmacokinetics of eye drops leading to their systemic side effects, especially in the context of renal impairment. We also explore the possibility of extracorporeal treatment, such as by haemodialysis, for the treatment of these manifestations. This case demonstrates the need to clarify a patient's drug history and stop offending medications early on in a patient with delirium, while treatments such as antidotes or extracorporeal treatment are being considered.

NephrologyVolume 26, Issue 9 p. 749-750 Correspondence Blue-green urine Yu-Ting Li, Corresponding Author Yu-Ting Li tinnyli03@gmail.com orcid.org/0000-0003-4825-0546 Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong Correspondence Yu-Ting Li, Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong, Hong Kong. Email: tinnyli03@gmail.comSearch for more papers by this authorWai-Ling Chu, Wai-Ling Chu Renal Unit, Department of Medicine, Tung Wah Hospital, Hong KongSearch for more papers by this authorPui-Chi Hui, Pui-Chi Hui Renal Unit, Department of Medicine, Tung Wah Hospital, Hong KongSearch for more papers by this authorTerence Yip, Terence Yip Renal Unit, Department of Medicine, Tung Wah Hospital, Hong KongSearch for more papers by this authorSing-Leung Lui, Sing-Leung Lui Renal Unit, Department of Medicine, Tung Wah Hospital, Hong KongSearch for more papers by this author Yu-Ting Li, Corresponding Author Yu-Ting Li tinnyli03@gmail.com orcid.org/0000-0003-4825-0546 Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong Correspondence Yu-Ting Li, Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong, Hong Kong. Email: tinnyli03@gmail.comSearch for more papers by this authorWai-Ling Chu, Wai-Ling Chu Renal Unit, Department of Medicine, Tung Wah Hospital, Hong KongSearch for more papers by this authorPui-Chi Hui, Pui-Chi Hui Renal Unit, Department of Medicine, Tung Wah Hospital, Hong KongSearch for more papers by this authorTerence Yip, Terence Yip Renal Unit, Department of Medicine, Tung Wah Hospital, Hong KongSearch for more papers by this authorSing-Leung Lui, Sing-Leung Lui Renal Unit, Department of Medicine, Tung Wah Hospital, Hong KongSearch for more papers by this author First published: 17 May 2021 https://doi.org/10.1111/nep.13887Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume26, Issue9September 2021Pages 749-750 RelatedInformation

Background: Peritoneal dialysis (PD) can offer patients more autonomy and flexibility compared with in-center hemodialysis (HD). However, burnout – defined as mental, emotional, or physical exhaustion that leads to thoughts of discontinuing PD – is associated with an increased risk of transfer to HD. We aimed to describe the perspectives of burnout among patients on PD and their caregivers. Methods: In this focus group study, 81 patients and 45 caregivers participated in 14 focus groups from 9 dialysis units in Australia, Hong Kong, and the United States. Transcripts were analyzed thematically. Results: We identified two themes. Suffering an unrelenting responsibility contributed to burnout, as patients and caregivers felt overwhelmed by the daily regimen, perceived their life to be coming to a halt, tolerated the PD regimen for survival, and had to bear the burden and uncertainty of what to expect from PD alone. Adapting and building resilience against burnout encompassed establishing a new normal, drawing inspiration and support from family, relying on faith and hope for motivation, and finding meaning in other activities. Conclusions: For patients on PD and their caregivers, burnout was intensified by perceiving PD as an unrelenting, isolating responsibility that they had no choice but to endure, even if it held them back from doing other activities in life. More emphasis on developing strategies to adapt and build resilience could prevent or minimize burnout.

Aim To study the epidemiology and clinical outcomes of catheter-related infections of Serratia species in peritoneal dialysis (PD) patients. Methods We retrospectively reviewed the patient characteristics, antibiotics susceptibility/resistance patterns and treatment outcomes of exit site infection (ESI) and peritonitis due to Serratia in PD patients during the period of 2004 to 2017. Results One hundred and sixty-one patients had Serratia ESI, of which 10 (6.2%) progressed to tunnel tract involvement and 11 (6.8%) developed PD peritonitis. Nineteen (11.8%) patients with Serratia ESI failed to respond to medical treatment and required catheter removal. Fifty-six (34.8%) patients had repeat Serratia ESI, which occurred at 12.9 +/- 13.6 months after the previous episode. Twenty-two patients had Serratia peritonitis, which accounted for 1% of peritonitis during the study period. Ten (45.5%) patients responded to medical treatment while 12 (54.5%) patients required catheter removal. Nine patients (36.4%) failed to resume PD and were converted to long-term haemodialysis. Two patients had repeat peritonitis at 2 months and 3 years, respectively, after the initial episode. Serratia species in PD patients showed high rates of resistance to ampicillin, and first- and second-generation cephalosporins, but were generally susceptible to aminoglycosides, carboxy-/ureido-penicillins and carbapenems. Conclusion Our results suggest that Serratia ESI show low risk of progression to peritonitis and favourable response to medical therapy, while Serratia peritonitis was associated with high rates of catheter removal and peritoneal failure.

BACKGROUND While peritoneal dialysis (PD) can offer patients more independence and flexibility compared with in-center hemodialysis, managing the ongoing and technically demanding regimen can impose a burden on patients and caregivers. Patient empowerment can strengthen capacity for self-management and improve treatment outcomes. We aimed to describe patients' and caregivers' perspectives on the meaning and role of patient empowerment in PD. METHODS Adult patients receiving PD (n = 81) and their caregivers (n = 45), purposively sampled from nine dialysis units in Australia, Hong Kong and the USA, participated in 14 focus groups. Transcripts were thematically analyzed. RESULTS We identified six themes: lacking clarity for self-management (limited understanding of rationale behind necessary restrictions, muddled by conflicting information); PD regimen restricting flexibility and freedom (burden in budgeting time, confined to be close to home); strength with supportive relationships (gaining reassurance with practical assistance, comforted by considerate health professionals, supported by family and friends); defying constraints (reclaiming the day, undeterred by treatment, refusing to be defined by illness); regaining lost vitality (enabling physical functioning, restoring energy for life participation); and personal growth through adjustment (building resilience and enabling positive outlook, accepting the dialysis regimen). CONCLUSIONS Understanding the rationale behind lifestyle restrictions, practical assistance and family support in managing PD promoted patient empowerment, whereas being constrained in time and capacity for life participation outside the home undermined it. Education, counseling and strategies to minimize the disruption and burden of PD may enhance satisfaction and outcomes in patients requiring PD.

BACKGROUND:Structured advance care planning (ACP) program is an important service in the end-of-life care for patients with advanced medical illness. We pioneered a structured and coordinated ACP program for patients with advanced malignancies and end-stage organ failure in Hong Kong. This study investigated the impact of a structured ACP program on the concordance rate for patients' final wishes, patient/family satisfaction, and the number of acute admissions (AA) and length of stay (LOS) in hospital.METHODS:Patients with advanced malignancy or end-stage organ failure who were able to complete ACP forms during the current admission to medical units were recruited. Patients who could not complete ACP forms or <18 years of age were excluded. The ACP program comprised the following components: (I) baseline education (workshop/role play) in ACP sessions for linked nurses of different medical units; (II) structured ACP discussions with recruited patients and their proxies during admission, after any change in clinical status, and also at monthly intervals; (III) formal structured review of patients' goals at regular team meetings; (IV) "flagging" of advance directive (AD) in hospital computer system and (V) feedback to linked nurse on the congruence of care. Mentally competent patients who did not receive ACP and matched for disease and demographics were selected as controls in a 1:2.5 ratio.RESULTS:Two hundred forty-three patients were included for analysis between August 2016 and July 2017, of which 69 patients joined the ACP program and 174 of them did not. Two hundred and one patients (83%) had advanced cancer. All had done do-not-attempt-cardiopulmonary-resuscitation (DNACPR) order in the ACP group. The concordance rates for patients' wishes on quality of life, end-of-life and funeral arrangements were 95%, 100% and 100% respectively. Over 70% of patients and their families (N=10) showed satisfaction with the program. The ACP group also had lower mean AA and shorter LOS (0.78±0.23 vs. 1.2±0.8 episode/patient, 4.6±1.7 vs. 7.5±2.5 days, P=0.037 and P=0.023 respectively) in the last 3 months of life compared with the non-ACP group.CONCLUSIONS:This ACP program achieved high concordance rate for patients' wish items and reduced healthcare utilization.

Abstract Background and Aims Serratia species can cause catheter-related infections in peritoneal dialysis (PD) patients but data on this clinical entity remains limited. This study aims to investigate the clinical characteristics, antibiotics susceptibility/resistance profiles and treatment outcomes of Serratia catheter-related infections in PD patients. Method We retrospectively reviewed all PD patients who were followed up at Queen Mary Hospital and Tung Wah Hospital, Hong Kong between 2004 to 2017. Patients with Serratia exit site infection (ESI) or peritonitis were included for analysis. Results One hundred and seventy-three patients with Serratia catheter-related infections were included. 161 patients had ESI, of which 10 (6.2%) progressed to tunnel tract involvement and 11 (6.8%) developed PD peritonitis. Skin abnormalities surrounding the exit site were present in 58 patients (36%), and 40 patients (24.8%) were hospitalized within 1 month prior to Serratia ESI. 142 patients (88.2%) with ESI responded to medical therapy alone, and repeat ESI occurred in 56 patients (34.7%) at a median of 12 months. Twenty-two patients had Serratia peritonitis, which accounted for 1% of peritonitis during the study period. Concomitant intra-abdominal pathologies were detected in 12 patients (54.5%). Ten patients (45.5%) responded to medical treatment while the remaining 12 (54.5%) required catheter removal. Nine patients (36.4%) failed PD resumption and switched to chronic haemodialysis. Repeat peritonitis occurred in two patients at 2 months and 3 years after the initial episode respectively. While Serratia species in PD patients are generally susceptible to aminoglycosides, carboxy-/ureido-penicillins and carbapenems, they exhibit substantial rates of resistance to ampicillin, and 1st- and 2nd-generation cephalosporins. Conclusion Serratia ESI responds favourably to medical therapy and seldom progresses to tunnel tract infection or peritonitis. Serratia peritonitis is associated with considerable risk of catheter loss and peritoneal failure.

Background and objectives The absence of accepted patient-centered outcomes in research can limit shared decision-making in peritoneal dialysis (PD), particularly because PD-related treatments can be associated with mortality, technique failure, and complications that can impair quality of life. We aimed to identify patient and caregiver priorities for outcomes in PD, and to describe the reasons for their choices. Design, setting, participants, & measurements Patients on PD and their caregivers were purposively sampled from nine dialysis units across Australia, the United States, and Hong Kong. Using nominal group technique, participants identified and ranked outcomes, and discussed the reasons for their choices. An importance score (scale 0–1) was calculated for each outcome. Qualitative data were analyzed thematically. Results Across 14 groups, 126 participants (81 patients, 45 caregivers), aged 18–84 (mean 54, SD 15) years, identified 56 outcomes. The ten highest ranked outcomes were PD infection (importance score, 0.27), mortality (0.25), fatigue (0.25), flexibility with time (0.18), BP (0.17), PD failure (0.16), ability to travel (0.15), sleep (0.14), ability to work (0.14), and effect on family (0.12). Mortality was ranked first in Australia, second in Hong Kong, and 15th in the United States. The five themes were serious and cascading consequences on health, current and impending relevance, maintaining role and social functioning, requiring constant vigilance, and beyond control and responsibility. Conclusions For patients on PD and their caregivers, PD-related infection, mortality, and fatigue were of highest priority, and were focused on health, maintaining lifestyle, and self-management. Reporting these patient-centered outcomes may enhance the relevance of research to inform shared decision-making.

BACKGROUND AND OBJECTIVES:The absence of accepted patient-centered outcomes in research can limit shared decision-making in peritoneal dialysis (PD), particularly because PD-related treatments can be associated with mortality, technique failure, and complications that can impair quality of life. We aimed to identify patient and caregiver priorities for outcomes in PD, and to describe the reasons for their choices. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:Patients on PD and their caregivers were purposively sampled from nine dialysis units across Australia, the United States, and Hong Kong. Using nominal group technique, participants identified and ranked outcomes, and discussed the reasons for their choices. An importance score (scale 0-1) was calculated for each outcome. Qualitative data were analyzed thematically. RESULTS:Across 14 groups, 126 participants (81 patients, 45 caregivers), aged 18-84 (mean 54, SD 15) years, identified 56 outcomes. The ten highest ranked outcomes were PD infection (importance score, 0.27), mortality (0.25), fatigue (0.25), flexibility with time (0.18), BP (0.17), PD failure (0.16), ability to travel (0.15), sleep (0.14), ability to work (0.14), and effect on family (0.12). Mortality was ranked first in Australia, second in Hong Kong, and 15th in the United States. The five themes were serious and cascading consequences on health, current and impending relevance, maintaining role and social functioning, requiring constant vigilance, and beyond control and responsibility. CONCLUSIONS:For patients on PD and their caregivers, PD-related infection, mortality, and fatigue were of highest priority, and were focused on health, maintaining lifestyle, and self-management. Reporting these patient-centered outcomes may enhance the relevance of research to inform shared decision-making.

Background: There is little data on pain management in patients with advanced chronic kidney disease (CKD) who have opted for palliative care. Objective: We investigated the prevalence, severity and management of pain in advanced CKD patients attending Renal Palliative Care out-patient clinics under our Division. Methods: Consecutive patients referred to the Renal Palliative Care Clinics at two hospitals under our Division from July 2012 to June 2016 were included. All the patients were managed according to a multi-disciplinary protocol led by palliative care specialists, including serial assessments with the Edmonton Symptom Assessment System. Measurements: Response to pain management was defined as a difference by 2 points or more, and factors predictive of response were assessed by logistic regression. Results: Data from 253 patients were analyzed. Of them 107 patients (42%) experienced pain symptoms: 45 patients (42.1%) rated their pain as mild (score 0-3), 51 (47.7%) as moderate (NRS score 4-6), and 11 (10.2%) as severe (score 7-10) by using numerical rating scale. The response rate to pain management was 53.2%. Neuropathic pain was a predictor for lack of response. Discussion: Pain is common in advanced CKD patients receiving palliative care. While this seems to have been underrecognized, the symptom is potentially amenable to management. We recommend routine assessment of pain burden in this patient population.

NephrologyVolume 22, Issue 7 p. 572-572 Correspondence Acute thyroiditis: An under-recognized complication of parathyroidectomy in end-stage renal failure patients with secondary hyperparathyroidism Gary CW Chan, Gary CW Chan Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong KongSearch for more papers by this authorPaul CH Lee, Paul CH Lee Division of Endocrinology and Metabolism, Department of Medicine, The University of Hong Kong, Hong KongSearch for more papers by this authorLorraine PY Kwan, Lorraine PY Kwan Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong KongSearch for more papers by this authorTerence PS Yip, Terence PS Yip Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong KongSearch for more papers by this authorSydney CW Tang, Corresponding Author Sydney CW Tang scwtang@hku.hk Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong KongSearch for more papers by this author Gary CW Chan, Gary CW Chan Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong KongSearch for more papers by this authorPaul CH Lee, Paul CH Lee Division of Endocrinology and Metabolism, Department of Medicine, The University of Hong Kong, Hong KongSearch for more papers by this authorLorraine PY Kwan, Lorraine PY Kwan Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong KongSearch for more papers by this authorTerence PS Yip, Terence PS Yip Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong KongSearch for more papers by this authorSydney CW Tang, Corresponding Author Sydney CW Tang scwtang@hku.hk Division of Nephrology, Department of Medicine, The University of Hong Kong, Hong KongSearch for more papers by this author First published: 15 June 2017 https://doi.org/10.1111/nep.12825Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume22, Issue7July 2017Pages 572-572 RelatedInformation

♦ BACKGROUND: Acinetobacter spp. is an important cause of peritoneal dialysis (PD)-related peritonitis, but studies on Acinetobacter peritonitis have been scarce. In view of the rising concern of carbapenem-resistant Acinetobacter (CRA) and multidrug-resistant Acinetobacter (MDRA) infections, we conducted this study on the incidence of Acinetobacter peritonitis and the impact of CRA and MDRA on its outcome. ♦ METHODS: We retrospectively evaluated the clinical characteristics, prevalence, antibiotic sensitivity patterns, outcomes, and factors associated with treatment failure over the past 16 years in our patients with Acinetobacter PD-related peritonitis. ♦ RESULTS: Out of 2,389 episodes of peritonitis, there were 66 episodes (3%) of Acinetobacter peritonitis occurring in 59 patients. Twelve episodes were caused by MDRA (18%), of which 5 were CRA (8%). There was a progressive increase in the incidence of MDRA and CRA infections over the study period. Most isolates were sensitive to sulbactam combinations (ampicillin-sulbactam [95.4%] and cefoperazone-sulbactam [93.9%]), aminoglycosides (amikacin [92.4%], tobramycin [90.9%], and gentamicin [89.4%]), and carbapenems (imipenem [92.2%]). There was 1 case of relapse. Fifteen episodes resulted in catheter removal (23%), and 7 patients died (11%). Hypoalbuminemia (odds ratio [OR] = 0.85, p = 0.006) and carbapenem resistance (OR = 18.2, p = 0.049) were significantly associated with higher rates of treatment failure. ♦ CONCLUSION: Both carbapenem resistance and hypoalbuminemia were significantly associated with treatment failure. Up to 80% of peritonitis episodes by CRA resulted in catheter loss or mortality. Sulbactam combinations and/or aminoglycosides remained effective for the majority of Acinetobacter isolates. There seemed to be an increasing relative incidence of MDRA and CRA infections over the past 16 years.