Analysis of risk factors and outcome in peritoneal dialysis patients with early-onset peritonitis: a multicentre, retrospective cohort study

Abstract

ObjectivesTo investigate the risk factors associated with early-onset peritonitis (EOP) and their influence on patients’ technique survival and mortality.Study designRetrospective, cohort study.SettingThree peritoneal dialysis (PD) units in Shanghai.ParticipantsPD patients from 1 June 2006 to 1 May 2018 were recruited and followed up until 31 December 2018. According to time-to-first episode of peritonitis, patients were divided into non-peritonitis (n=144), EOP (≤6 months, n=74) and late-onset peritonitis (LOP) (>6 months, n=139).Primary and secondary outcome measuresEOP was defined as the first episode of peritonitis occurring within 6 months after the initiation of PD. The outcomes were all-cause mortality and technique failure.ResultsOf the 357 patients, 74 (20.7%) patients developed their first episode of peritonitis within the first 6 months. Compared with the LOP group, the EOP group had older ages, more female patients, higher Charlson Comorbidity Index (CCI) score, lower serum albumin levels and renal function at the time of initiation of PD, and higher diabetes mellitus and peritonitis rates (p<0.05).Staphylococcuswas the most common Gram-positive organism in both EOP and LOP groups. The multivariate logistic regression analysis showed that factors associated with EOP included a higher CCI score (OR 1.285, p=0.011), lower serum albumin level (OR 0.924, p=0.016) and lower Kt/V (OR 0.600, p=0.018) at start of PD. In the Cox proportional-hazards model, EOP was more likely a predictor of technique failure (HR 1.801, p=0.051). There was no difference between EOP and LOP for all-cause mortality.ConclusionA higher CCI score and lower serum albumin level and Kt/V at PD initiation were significantly associated with EOP. EOP also predicted a high peritonitis rate and poor clinical outcome.

Microbiology and Outcome of Peritoneal Dialysis-related Peritonitis in Elderly Patients: a Retrospective Study in Hunan Province, China

“…Staphylococcus predominated for PD-related peritonitis in both groups. This bacterial ora distribution and high incidence of Staphylococcus were similar to previous reports [8][9][10][11] . And such results of the predominance of gram-positive bacteria were similar to the studies in America, Canada, Scotland, and Hong Kong [12][13][14][15] .…”

Predictors of technique failure and mortality on peritoneal dialysis: An analysis of New Zealand peritoneal dialysis registry data

“…Robust statistical methodology with multivariate imputation variables and if possible model a precise tool for the prediction of technique failure. 42,43 In conclusion, long-term outcome of patients on PD without options for kidney transplantation are either death while on PD or transition on to HD. Technique failure and death on PD are competitive outcome events with distinct risk profiles and the latter may not necessarily be a consequence of PD failure.…”

Nutritional Status in Peritoneal Dialysis: Nutritional Guidelines, Adequacy and the Management of Malnutrition

“…Increased susceptibility to infections in CKD patients may be linked to hypoalbuminemia that results from malnutrition, uremia or the upregulated inflammatory response in dialysis patients [ 61 ]. Furthermore, hypoalbuminemia has been associated with septicemia, pneumonia and other inflammatory responses [ 62 ]. A study by Ozturk et al, demonstrate that PD patients with declining albumin levels are at a significantly increased risk for development of peritonitis [ 63 ].…”