Comparison of Clinical Presentation and Outcomes of Peritonitis in the Elderly and Younger Peritoneal Dialysis Patients

Abstract

Background The incidence of elderly patients receiving peritoneal dialysis (PD) has increased. This study aimed to examine the clinical presentation and outcomes of peritonitis in elderly PD patients compared with younger PD patients. Methods This single-center, retrospective, observational cohort study included all adult PD patients who developed peritonitis between January 2011 and December 2014. Elderly was defined as ≥ 65 years old at PD initiation. The primary outcome was medical cure, defined as a peritonitis episode cured by antibiotics without being complicated by catheter removal, transfer to hemodialysis (HD), relapsing peritonitis, or death. The secondary outcomes were clinical manifestations (fever, cloudy dialysate) and complications (catheter removal, transfer to HD, relapse, hospitalization, and mortality). Peritonitis outcomes were compared using multivariable logistic regression. Results Overall, 377 peritonitis episodes occurred in 247 patients. Of these, 126 episodes occurred in 79 elderly patients and 251 episodes occurred in 168 younger patients. Baseline demographic data were comparable between the 2 groups, except that elderly patients were significantly more likely to have diabetes mellitus (66% vs 46%), diabetic nephropathy (55% vs 39%), and a lower serum albumin than younger patients. Medical cure was comparable between the 2 groups (71% vs 72%, respectively, p = 0.67, adjusted odds ratio [AOR] 0.89, 95% confidence interval [CI]: 0.52 – 1.53). Compared with younger patients, elderly patients experiencing peritonitis had lower odds of fever (OR 0.53, 95% CI: 0.30 – 0.94), cloudy dialysate (OR 0.45, 95% CI: 0.23 – 0.88), and catheter removal (AOR 0.50, 95% CI: 0.26 – 0.98), but similar odds of transfer to HD (AOR 0.70, 95% CI: 0.32 – 1.51), relapse (AOR 1.57, 95% CI: 0.46 – 5.40), hospitalization (AOR 1.55, 95% CI: 0.52 – 4.56), and all-cause mortality (AOR 1.88, 95% CI: 0.83 – 4.26). Conclusions Compared with younger patients, elderly PD patients with peritonitis achieved similar medical cure rates, a lower catheter removal rate, and comparable rates of HD transfer, relapse, hospitalization, and death. Elderly PD patients experiencing peritonitis were less likely to present with fever or cloudy dialysate.

Incidence and risk factors of peritoneal dialysis-related peritonitis in elderly patients: A retrospective clinical study

“…Likewise, peritonitis-related catheter removal was lower in elderly PD patients in Htay's study, and they ascribed this different to the physicians' preference when treating refractory or relapsing peritonitis that the elderly patient is likely to adopting a more conservative approach. 28 Elderly patients had higher peritonitis-related mortality than younger subjects with peritonitis, which are likely a consequence of advanced age and a greater prevalence of comorbid disease. 27 Controversial conclusions were made in previous studies regarding the peritonitis on technique failure in elderly patients.…”

Multicentre registry data analysis comparing outcomes of culture-negative peritonitis and different subtypes of culture-positive peritonitis in peritoneal dialysis patients

“…Medical cure was defined as an episode of peritonitis treated successfully with antibiotics without being complicated by catheter removal, hemodialysis (HD) transfer, relapsing/recurrent peritonitis (combined outcome) or peritonitis-related death. 3,4,23…”

“…Medical cure was defined as an episode of peritonitis treated successfully with antibiotics without being complicated by catheter removal, hemodialysis (HD) transfer, relapsing/recurrent peritonitis (combined outcome) or peritonitis-related death. 3,4,23 The secondary aims were to compare peritonitis complications, including peritonitis-related catheter removal, hemodialysis transfer (defined as transfer to HD for 30 days), recurrent or relapsed peritonitis, hospitalization and peritonitis-related death (defined as death within 30 days of onset of peritonitis) between culture-negative and organismspecific culture-positive peritonitis. In addition, the study aimed to examine predictors of culture-negative peritonitis as compared to culture-positive peritonitis and the associations between initial antibiotic regimen, antibiotic therapy duration and outcomes of culture-negative peritonitis.…”

Outcomes of peritoneal dialysis in elderly vs non-elderly patients: A systemic review and meta-analysis

“…This demonstrates that peritonitis episodes in the elderly can be managed similar to those of younger patients and do not necessitate discontinuation of PD and transfer to HD. Htay et al [ 11 ] in their study have demonstrated that the odds of treating peritonitis with antibiotics are similar between elderly and non-elderly patients. Furthermore, the rate of peritonitis-related catheter removal was found to be lower in the elderly and there was no difference in relapsing peritonitis or peritonitis-related hospitalization based on age group.…”

“…However, there still exists a perception that PD may also be associated with an increased risk of complications in this cohort [7]. To answer this clinical query, several studies in the past decade have compared outcomes of PD between elderly and non-elderly patients, but with variable results [8][9][10][11][12]. While some studies [8,10] have reported no difference in the risk of peritonitis between elderly and non-elderly patients undergoing PD, others [12] have reported significantly increased risk of peritonitis amongst older adults.…”