Early Peritonitis in A Large Peritoneal Dialysis Provider System in Colombia

Abstract

♦ BACKGROUND: Peritonitis is the most important complication of peritoneal dialysis (PD), and early peritonitis rate is predictive of the subsequent course on PD. Our aim was to calculate the early peritonitis rate and to identify characteristics and predisposing factors in a large nationwide PD provider network in Colombia. ♦ METHODS: This was a historical observational cohort study of all adult patients starting PD between January 1, 2012, and December 31, 2013, in 49 renal facilities in the Renal Therapy Services in Colombia. We studied the peritonitis rate in the first 90 days of treatment, its causative micro-organisms, its predictors and its variation with time on PD and between individual facilities. ♦ RESULTS: A total of 3,525 patients initiated PD, with 176 episodes of peritonitis during 752 patient-years of follow-up for a rate of 0.23 episodes per patient year equivalent to 1 every 52 months. In 41 of 49 units, the rate was better than 1 per 33 months, and in 45, it was better than 1 per 24 months. Peritonitis rates did not differ with age, ethnicity, socioeconomic status, or PD modality. We identified high incidence risk periods at 2 to 5 weeks after initiation of PD and again at 10 to 12 weeks. ♦ CONCLUSION: An excellent peritonitis rate was achieved across a large nationwide network. This occurred in the context of high nationwide PD utilization and despite high rates of socioeconomic deprivation. We propose that a key factor in achieving this was a standardized approach to management of patients.

Early Onset Peritoneal Dialysis-Related Peritonitis

“…Overall, it has been postulated that EOP occurs in up to 30% of PD patients [5,7]. However, definitions of "early" have varied significantly across studies, with time points proposed at as early as 3 months [6,9,10] and as late as almost 2 years after initiation of PD [11]. The majority of these studies have been single-centre, retrospective observational studies of relatively small patient numbers, and the definition of 'early' was chosen by the investigators with no justification for how this was determined [5,6,8,10].…”

“…However, definitions of "early" have varied significantly across studies, with time points proposed at as early as 3 months [6,9,10] and as late as almost 2 years after initiation of PD [11]. The majority of these studies have been single-centre, retrospective observational studies of relatively small patient numbers, and the definition of 'early' was chosen by the investigators with no justification for how this was determined [5,6,8,10]. Hsieh and colleagues from Taiwan proposed a definition based on median time to first episode of peritonitis in their cohort, which was 20.28 months in their study [11].…”

“…A subsequent retrospective observational study by Vargas et al examined EOP within 90 days of treatment commencement in 3525 incident PD patients across 49 PD centres belonging to a single dialysis provider in Colombia [6]. The incidence of EOP was reported as 0.23 episodes per patient-year, with a biphasic pattern for onset of peritonitis which demonstrated an initial peak at 3-4 weeks and a second peak starting at 10 weeks after PD commencement and still rising at 12 weeks.…”

“…The findings from this study were strengthened by its large sample size whereby the cohort represented over half the total number of PD patients in Colombia. Furthermore, the cohort represented a diverse range of education levels (none 29.3%; elementary school 36%; high school diploma 26%; technical diploma 3%; university degree 5%; postgraduate degree 1%) and socioeconomic positions [6].…”

“…Referred to as time of onset of first episode of peritonitis after PD commencement, various definitions have been proposed from 90 days to 20.28 months after PD onset [4][5][6][7][8][9][10][11]. There has been a growing interest in this topic as patients with early onset peritonitis appear to be placed at a heightened risk of complications, including technique failure and all-cause mortality, when compared to those who develop peritonitis later in their PD treatment [4][5][6]. This review will summarise the state of evidence to date on early onset peritonitis, its definition, importance, incidence, risk factors and preventative strategies.…”