Preditores de peritonite em pacientes em um programa de diálise peritoneal

Abstract

Introduction: Peritonitis remains a major complication of peritoneal dialysis (PD). Objective: Evaluate peritonitis incidence, etiology and outcome in cronic PD patients. Methods: A retrospective cohort study was carried out on 330 patients (mean age of 53 ± 19 years) who had been treated by PD in a dialysis center in Aracaju/SE, Brazil between January 1st, December 31th, 2007. Data of patients with and without peritonitis were compared using Student's t-test, chi-squared statistic and multiple logistic regression. Results: There were 213 peritonitis among 141 patients (1.51 episode/patient) resulting in a rate of 28.44 patient/episode/ month (0.42 patient/episode/year). Staphylococcus aureus was the most frequent micro-organism isolated (27.8%), followed by Escherichia coli (13.4%) and 32.5% were culture-negative peritonitis. A greater risk of peritonitis was identified at the patients with hypoalbuminemia [relative risk (RR) = 2.0; 95% confidence interval (CI) = 1.21 -3.43; p < 0,01], < 4 school years (RR = 2.15; CI = 1.09 -4.24; p = 0.03) and catheter's exit site infection (RR = 2.63; IC = 1.57 -4.41; p < 0.01). There were no significant difference among gender, age, family income, diabetes mellitus, type of dialysis treatment, type of catheter and its surgical implant. Conclusions: Hypoalbuminemia, low schooling and catheter's exit site infection were associated with greater risk to peritonitis. Although peritonitis rate follow international pattern, prophylactic strategies are recommended.

Predictors of peritoneal dialysis associated peritonitis; application of the zero-inflated negative binomial model

“…Najafi and colleagues reviewed the 12 years data of peritonitis in 27 Iranian centers and reported a rate of one episode in 34.1 patient-months which is lower than our study (19). Lobo et al found a, 42.7% PDAP prevalence with a rate of 28.4 patient/episode/ month in a Brazilian center which was also close to our statistics (11).…”

“…The majority of studies reported the average peritonitis rate in the range of every 26 to 34 months for each patient (10,11,(19)(20)(21). Although some studies have reported approximately the same incidence to our study, the diversity in PDAP rate might be due to the difference in patients' characteristics and definitions of peritonitis.…”

“…Although some studies have reported approximately the same incidence to our study, the diversity in PDAP rate might be due to the difference in patients' characteristics and definitions of peritonitis. Unlike our study, most of the others considered not only CAPD patients but also patients on automated PD (10,11,(19)(20)(21).…”

“…Its prevalence is variable among different centers and has declined over the years due to modifications in connectors and catheters, implantation techniques, and treatment protocols (9). Although several studies have identified some predisposing factors such as age, gender, race, co-existing diseases such as type 2 diabetes mellitus, current smoking, nasal carriage of Staphylococcus aureus, and hypoalbuminemia (10)(11)(12), recent review studies suggest the need for further studies to determine detailed information of causative micro-organisms, risk factors, and proper intervention (13).…”

Papel da insulina na vigência da peritonite decorrente da infecção por Staphylococcus aureus em animais diabéticos e sadios

“…Por este motivo, a DP foi introduzida, em 1960, como uma alternativa viável para substituí-la (ALWAKEEL et al,2011) e passou a ser um dos principais tratamentos para pacientes que apresentam falência renal (LOBO et al, 2010).…”