Original Investigation
Dialysis
Repeated Peritoneal Dialysis–Associated Peritonitis: A Multicenter Registry Study

https://doi.org/10.1053/j.ajkd.2011.06.018Get rights and content

Background

Determinants and outcomes of peritoneal dialysis (PD)-associated peritonitis occurring within 4 weeks of completion of therapy of a prior episode caused by the same (relapse) or different organism (recurrence) recently have been characterized. However, determinants and outcomes of peritonitis occurring more than 4 weeks after treatment of a prior episode caused by the same (repeated) or different organism (nonrepeated) are poorly understood.

Study Design

Observational cohort study using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data.

Setting & Participants

All Australian PD patients between October 1, 2003, and December 31, 2007, with first episodes of repeated or nonrepeated peritonitis.

Predictors

Repeated versus nonrepeated peritonitis, according to International Society of PD (ISPD) criteria.

Outcomes & Measurements

Relapse, hospitalization, catheter removal, hemodialysis transfer, and death.

Results

After a peritonitis episode, the probability that a subsequent episode represented repeated rather than nonrepeated peritonitis was highest in the second month (41%), then progressively decreased to a stable level of 14% from 6 months onward. When first episodes of repeated (n = 245) or nonrepeated peritonitis (n = 824) were analyzed, repeated peritonitis was predicted independently by a shorter elapsed time from the prior episode (adjusted OR per day elapsed, 0.91; 95% CI, 0.88-0.94). Staphylococcus aureus and coagulase-negative staphylococcus were isolated more frequently in repeated peritonitis, whereas Gram-negative, streptococcal, and fungal organisms were recovered more frequently in nonrepeated peritonitis. Using multivariate logistic regression, repeated peritonitis was associated independently with higher relapse (OR, 5.41; 95% CI, 3.72-7.89) and lower hospitalization rates (OR, 0.63; 95% CI, 0.46-0.85), but catheter removal, hemodialysis transfer, and death rates similar to nonrepeated peritonitis.

Limitations

Limited covariate adjustment. Residual confounding and coding bias could not be excluded.

Conclusions

Repeated and nonrepeated peritonitis episodes are caused by different spectra of micro-organisms and have different outcomes. Study findings suggest that the ISPD definition for repeated peritonitis should be limited to 6 months.

Section snippets

Study Population

The study included all Australian adult patients from ANZDATA who were receiving PD between October 1, 2003 (when detailed peritonitis data started to be collected), and December 31, 2007. Data collected included demographic data, cause of primary kidney disease, comorbid conditions at the start of dialysis therapy, smoking status, body mass index, late referral (defined as start of dialysis therapy within 3 months of referral to a nephrologist), microbiology of peritonitis episodes (up to 3

Population Characteristics

A total of 6,024 patients received PD in Australia during the study period (October 1, 2003, to December 31, 2007). They were followed up for 9,330 patient-years (mean follow-up, 1.55 years/patient). In this group, 4,864 episodes of peritonitis occurred in 2,542 (42%) patients and more than one episode of peritonitis occurred in 1,171 patients (range, 2-15 episodes/patient). A total of 485 episodes of repeated peritonitis (10% of all peritonitis episodes) occurred in 348 patients and 1,399

Discussion

To our knowledge, our study is the most extensive report published of the frequency, predictors, treatment, and clinical outcomes of PD-associated repeated peritonitis. Compared with nonrepeated episodes, repeated peritonitis episodes were significantly more likely to occur earlier after a prior peritonitis episode and to be complicated by relapse, but less likely to be cured with antibiotic therapy alone and less likely to be complicated by hospitalization. Rates of catheter removal, transfer

Acknowledgements

We acknowledge the substantial contributions of the entire Australia and New Zealand nephrology community (physicians, surgeons, database managers, nurses, renal operators, and patients) in providing information for and maintaining the ANZDATA database.

Support: None.

Financial Disclosure: Dr Johnson is a consultant for Baxter Healthcare Pty Ltd and has previously received research funds from this company; he has also received speakers' honoraria and research grants from Fresenius Medical Care.

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  • Cited by (0)

    Originally published online August 17, 2011.

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