Abstract
Aim
The influence of high peritonitis rate (HPR) on clinical outcomes of continuous ambulatory peritoneal dialysis (CAPD) patients has been far less studied in the Chinese population than in those of the USA, Australia and Europe. Furthermore, concerning the peritonitis risk, most studies primarily examined the risk of developing the first peritonitis episode, rather than a HPR.
Methods
A single-center, retrospective, observational study was carried out over 10 years in Taiwan. A total of 124 patients with at least one peritonitis episode were the study subjects. The Cox proportional hazard model was used to assess the impact of HPR on clinical outcomes. Multivariate logistic regression was conducted to determine the independent factors associated with a HPR.
Results
In the multivariate Cox regression model, HPR was still a significant predictor for technique failure, patient mortality and dropout from peritoneal dialysis (PD). Factors independently associated with a HPR were peritonitis occurrence during the first year after the start of CAPD and the first peritonitis infected with streptococcus species.
Conclusion
Peritonitis during the first year after PD commencement and the first peritonitis infected by streptococcus species were significantly associated with an increased risk of a HPR. Our data also indicate that HPR was correlated with technique failure, patient mortality and dropout from PD, thus highlighting the need and role of future studies to reduce this complication.
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References
Popovich RP, Moncrief JW, Nolph KD, Ghods AJ, Twardowski ZJ, Pyle WK (1978) Continuous ambulatory peritoneal dialysis. Ann Intern Med 88(4):449–456
Oreopoulos DG, Robson M, Izatt S, Clayton S, deVeber GA (1978) A simple and safe technique for continuous ambulatory peritoneal dialysis (CAPD). Trans Am Soc Artif Intern Organs 24:484–489
Kavanagh D, Prescott GJ, Mactier R (2004) Peritoneal dialysis associated peritonitis in Scotland 1999–2002. Nephrol Dial Transplant 19:2584–2591
Davenport A (2009) Peritonitis remains the major clinical complication of peritoneal dialysis: the London (UK) peritonitis audit 2002–2003. Perit Dial Int 29:297–302
Pérez Fontan M, Rodríguez-Carmona A, García-Naveiro R, Rosales M, Villaverde P, Valdés F (2005) Peritonitis-related mortality in patients undergoing chronic peritoneal dialysis. Perit Dial Int 25:274–284
Kim DK, Yoo TH, Ryu DR (2004) Changes in causative organisms and their antimicrobial susceptibilities in CAPD peritonitis: a single center’s experience over one decade. Perit Dial Int 24(5):424–432
Mujais S (2006) Microbiology and outcomes of peritonitis in North America. Kidney Int 70(Suppl. 103):S55–S62
Digenis GE, Abraham G, Savin E, Blake P, Dombros N, Sombolos K et al (1990) Peritonitis-related deaths in continuous ambulatory peritoneal dialysis (CAPD) patients. Perit Dial Int 10:45–47
Tzamaloukas AH, Murata GH, Fox L (1993) Peritoneal catheter loss and death in continuous ambulatory peritoneal dialysis peritonitis: correlation with clinical and biochemical parameters. Perit Dial Int 13(Suppl 2):S338–S340
Johnson DW, Chang S, Excell L, Livingston B, Bannister K, McDonald SP (2007) Peritoneal dialysis. In: McDonald S, Chang S, Excell L (eds) The twenty-ninth report Australia and New Zealand dialysis and transplant registry 2006. ANZDATA Registry, Adelaide, pp 87–103
Dong J, Chen Y (2010) Impact of the bag exchange procedure on risk of peritonitis. Perit Dial Int 30(4):440–447
Yang Z, Xu R, Zhuo M, Dong J (2012) Advanced nursing experience is beneficial for lowering the peritonitis rate in patients on peritoneal dialysis. Perit Dial Int 32(1):60–66
Chow KM, Szeto CC, Leung CB, Kwan BC, Law MC, Li PK (2005) A risk analysis of continuous ambulatory peritoneal dialysis-related peritonitis. Perit Dial Int 25:374–379
Szeto CC, Chow KM, Wong TY, Leung CB, Li PK (2003) Influence of climate on the incidence of peritoneal dialysis-related peritonitis. Perit Dial Int 23:580–586
Han SH, Lee SC, Ahn SV, Lee JE, Kim DK, Lee TH et al (2007) Reduced residual renal function is a risk of peritonitis in continuous ambulatory peritoneal dialysis patients. Nephrol Dial Transplant 22:2653–2658
Prasad N, Gupta A, Sharma RK, Sinha A, Kumar R (2007) Impact of nutritional status on peritonitis in CAPD patients. Perit Dial Int 27(1):42–47
Wong SS, Chu KH, Cheuk A, Tsang WK, Fung SK, Chan HW et al (2003) Prophylaxis against gram-positive organisms causing exit-site infection and peritonitis in continuous ambulatory peritoneal dialysis patients by applying mupirocin ointment at the catheter exit site. Perit Dial Int 23(Suppl. 2):S153–S158
Kim MJ, Song JH, Park YJ, Kim GA, Lee SW (2000) The influence of seasonal factors on the incidence of peritonitis in continuous ambulatory peritoneal dialysis. Adv Perit Dial 16:243–247
Mactier R (2009) Peritonitis is still the Achilles’ heel of peritoneal dialysis. Perit Dial Int 29:262–266
Fourtounas C, Savidaki E, Dousdabanis P, Hardalias A, Kalliakmani P, Papachristou E et al (2006) Peritonitis during the first year after commencement of peritoneal dialysis has an impact on technique survival and patient morbidity. Adv Perit Dial 22:50–54
Harel Z, Wald R, Bell C, Bargman JM (2006) Outcome of patients who develop early-onset peritonitis. Adv Perit Dial 22:46–49
Oo TN, Roberts TL, Collins AJ (2005) A comparison of peritonitis rates from the United States renal data system database: CAPD versus continuous cycling peritoneal dialysis patients. Am J Kidney Dis 45:372–380
Brown EA (2005) Peritonitis: limiting the damage. Nephrol Dial Transplant 20:1539–1541
Bailie GR (2005) Therapeutic dilemmas in the management of peritonitis. Perit Dial Int 25:152–156
Mizuno M, Ito Y, Tanaka A, Suzuki Y, Hiramatsu H, Watanabe M et al (2011) Peritonitis is still an important factor for withdrawal from peritoneal dialysis therapy in the Tokai area of Japan. Clin Exp Nephrol 15(5):727–737
Sipahioglu MH, Aybal A, Unal A, Tokgoz B, Oymak O, Utas C (2008) Patient and technique survival and factors affecting mortality on peritoneal dialysis in Turkey: 12 years’ experience in a single center. Perit Dial Int 28(3):238–245
Fried LF, Bernardini J, Johnston JR, Piraino B (1996) Peritonitis influences mortality in peritoneal dialysis patients. J Am Soc Nephrol 7:2176–2182
Bunke CM, Brier ME, Golper TA (1997) Outcomes of single organism peritonitis in peritoneal dialysis: gram negatives versus gram positives in the Network 9 Peritonitis Study. Kidney Int 52(2):524–529
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We thank all the PD nursing teams for their help in collecting data. There is absence of any support.
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Hsieh, YP., Chang, CC., Wang, SC. et al. Predictors for and impact of high peritonitis rate in Taiwanese continuous ambulatory peritoneal dialysis patients. Int Urol Nephrol 47, 183–189 (2015). https://doi.org/10.1007/s11255-014-0763-5
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DOI: https://doi.org/10.1007/s11255-014-0763-5