Effects of Age and Diabetes Mellitus on Clinical Outcomes in Patients with Peritoneal Dialysis-Related Peritonitis

Tsai, Chia-Chi; Lee, Jie-Jen; Liu, Tsang-Pai; Ko, Wen-Ching; Wu, Chih‐Jen; Pan, Chi-Feng; Cheng, Shih‐Ping

doi:10.1089/sur.2012.195

Cited by 31 publications

(31 citation statements)

References 41 publications

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“…Piccoli et al (37) previously reported that the direct mortality of PD-related peritonitis increased with age. Similarly, Lim et al (38) showed that older patients have a higher peritonitis-related mortality than young patients, and Tsai et al (39) found that old age and diabetes are the 2 major risk factors for adverse outcomes of PD-related peritonitis. Specifically, Barretti et al (40) noted that the outcome of PD-related peritonitis due to Staphylococcus aureus is negatively influenced by age and diabetic status.…”

Section: Treatment Of Pd-related Infectionsmentioning

confidence: 96%

Peritoneal Dialysis-Related Infection in the Older Population

Szeto

2015

Perit Dial Int

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With appropriate training and adequate support, it is possible to keep the peritonitis rate of elderly peritoneal dialysis (PD) patients at a highly respectable level. In general, the latest recommendations for the treatment and prevention of PD-related infections by the International Society for Peritoneal Dialysis (ISPD) are applicable to older patients. However, there are minor differences in the spectrum of causative organisms amongst elderly patients, with coagulase-negative staphylococcal species (CNSS) and Enterobacteriaceae species being more common in elderly patients. Elderly PD patients who develop peritonitis have an excessive short-term mortality, and, amongst elderly patients, a high burden of comorbid load increases the risk of relapsing episodes. In addition, technical problems, social difficulties, and concomitant comorbid diseases often have profound effects on the risk of peritonitis as well as its management. KEY WORDS: Chronic kidney disease; infection; survival T he proportion of elderly people in the general population is increasing, and a similar trend can be observed in patients treated with long-term dialysis. Data from the United States Renal Data System (USRDS) show that over 60% of the endstage renal disease patients in the US are over the age of 60 (1). Similarly, over half of the new dialysis patients in Hong Kong are now over 60 years of age (2). Peritoneal dialysis (PD) offers many potential advantages, such as a stable internal milieu and less hemodynamic disturbance than hemodialysis (3,4). Worldwide experience also suggests satisfactory tolerance to PD as long-term renal replacement therapy for older patients (5-8). THE EFFECT OF AGE ON PD-RELATED INFECTIONSIt remains controversial whether older PD patients have a substantially increased risk of peritonitis than their younger counterparts. A number of observational studies published in the 1990s reported that age is not a major risk factor of PD-related peritonitis (9-11), and the peritonitis-free survival is similar between PD patients above and below 65 years of age (12). On the other hand, 3 retrospective studies noted that patients above 65 or 70 years old have a significantly higher peritonitis rate than younger patients (8,13,14), although there is no difference in peritonitis-free survival or the rate of exit-site infection between older and younger patients (8).More recently, a retrospective study of 391 PD patients found that older age (above 65 years) was the only identified risk factor associated with peritonitis (15). Nonetheless, we believe the important clinical question is not whether older PD patients have a higher peritonitis rate than young patients, but whether their absolute peritonitis rate is acceptable. In this regard, a retrospective dialysis registry study of 1,613 patients older than 75 years reported that the median peritonitis-free survival was 32.1 months, and neither the modality of assistance nor the center size was associated with peritonitis risk (16). Similar peritonitis rates amongst older PD...

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Section: Treatment Of Pd-related Infectionsmentioning

confidence: 96%

Peritoneal Dialysis-Related Infection in the Older Population

Szeto

2015

Perit Dial Int

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“…It seems highly probable that touch contamination and bowel dysfunction are important underlying causes of peritonitis episodes in older PD patients [22]. Diabetic mellitus and low education were risk factors of PD-related peritonitis in previous studies [22][23][24]. As diabetes mellitus is regarded as a risk factor for infections in general, it seems to be reasonable to consider it also as a risk factor for peritonitis in PD patients [24].…”

Section: Prevalence Peritonitismentioning

confidence: 95%

“…More recently, retrospective studies found that older age (more than 65 years) was the only identi ed risk factor associated with peritonitis [20,21]. It seems highly probable that touch contamination and bowel dysfunction are important underlying causes of peritonitis episodes in older PD patients [22]. Diabetic mellitus and low education were risk factors of PD-related peritonitis in previous studies [22][23][24].…”

Section: Prevalence Peritonitismentioning

confidence: 99%

Overhydration and low serum prealbumin predict peritoneal dialysis-related peritonitis in continuous ambulatory peritoneal dialysis patients

Quy

Huy

Duc³

et al. 2020

Preprint

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Background In this study, we focused on the role of overhydration (OH) and low serum prealbumin concentration in predicting 3-year peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patientsMethods We measured serum prealbumin concentration and OH by body composition monitor on 278 CAPD patients (159 males and 119 females) to predict 3-year peritonitis. We created the baseline demographics of all patients with the mean age of 46 years and the median peritoneal dialysis (PD) duration of 21 months.Results After the 3-year follow-up, 44 patients diagnosed PD-related peritonitis (15.8%). Low education, serum albumin, prealbumin, high CRP-hs and OH were independent risk factors for predicting peritonitis during 36 months in CAPD patients. Based on the Kaplan–Meier analysis, we realized that patients with low prealbumin and high OH were the good predictors of 3-year peritonitis in CAPD patients (Prealbumin: AUC = 0.838, cut-off value = 32.5 mg/dL, Se = 90.9%, OH: AUC = 0.851, cut-off value = 1.33 L, Se = 79.5%, Sp = 85.5%), (Log-rank test p < 0.001).Conclusion Overhydration and low serum prealbumin level were the good predictors of PD-related peritonitis in CAPD patients.

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“…These encouraging trends suggest that modality selection is becoming more appropriate as the selection of older patients with comorbidity is at variance with benefits suggested by registry analyses and observational studies . Both peritonitis and death from peritonitis have been associated with advanced age at the start of PD and with diabetes mellitus …”

Section: Improving Patient Outcomesmentioning

confidence: 99%

“…42,43 Both peritonitis and death from peritonitis have been associated with advanced age at the start of PD and with diabetes mellitus. 44,45 Select motivated patients and consider the need for support Success with PD requires significant patient motivation and self-support. 1 This may be supplemented with support from friends, partners and other family members.…”

Section: Consider Peritoneal Dialysis For Patients <60 Years Without mentioning

confidence: 99%

Peritoneal dialysis practice in Australia and New Zealand: A call to sustain the action

et al. 2016

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This paper updates a previous ‘Call to Action’ paper (Nephrology 2011; 16: 19–29) that reviewed key outcome data for Australian and New Zealand peritoneal dialysis patients and made recommendations to improve care. Since its publication, peritonitis rates have improved significantly, although they have plateaued more recently. Peritoneal dialysis patient and technique survival in Australian and New Zealand have also improved, with a reduction in the proportion of technique failures attributed to ‘social reasons’. Despite these improvements, technique survival rates overall remain lower than in many other parts of the world. This update includes additional practical recommendations based on published evidence and emerging initiatives to further improve outcomes.

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Effects of Age and Diabetes Mellitus on Clinical Outcomes in Patients with Peritoneal Dialysis-Related Peritonitis

Abstract: Old age and diabetes mellitus are two major risk factors for adverse outcomes of PD-related peritonitis. Although they are not contraindications to PD, our results suggest that these patients need meticulous care when peritonitis occurs.

Cited by 31 publications

References 41 publications

Peritoneal Dialysis-Related Infection in the Older Population

Peritoneal Dialysis-Related Infection in the Older Population

Overhydration and low serum prealbumin predict peritoneal dialysis-related peritonitis in continuous ambulatory peritoneal dialysis patients

Peritoneal dialysis practice in Australia and New Zealand: A call to sustain the action

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