Frequency and Microbiology of Peritonitis and Exit-Site Infection among Obese Peritoneal Dialysis Patients

Nessim, Sharon J.; Komenda, Paul; Rigatto, Claudio; Verrelli, Mauro; Sood, Manish M.

doi:10.3747/pdi.2011.00244

Cited by 29 publications

(24 citation statements)

References 18 publications

(25 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, we are confident our study features the highest percentage of Indigenous Canadians compared with any other KFRE validation cohort for the following reasons: (1) Manitoba's population is ~10% Indigenous, (2) the prevalence of CKD and end-stage kidney disease is higher in predominately Indigenous communities in Manitoba, and (3) recently published research where race was reported among Manitoba dialysis cohorts ranged from 22% to 24% Indigenous on peritoneal dialysis to 32% of those on dialysis overall. [31][32][33][34][35][36][37] Second, only 11.7% of stage 3-5 CKD patients had simultaneous ACR measurement. Therefore, 88.2% of patients with eGFR between 10 and 60 mL/min/1.73 m 2 were excluded from our sample.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Kidney Failure Risk Equation in Manitoba

Whitlock

Chartier

Komenda

et al. 2017

Can J Kidney Health Dis

Self Cite

View full text Add to dashboard Cite

Background:Patients with chronic kidney disease (CKD) are at risk to progress to kidney failure. We previously developed the Kidney Failure Risk Equation (KFRE) to predict progression to kidney failure in patients referred to nephrologists.Objective:The objective of this study was to determine the ability of the KFRE to discriminate which patients will progress to kidney failure in an unreferred population.Design:A retrospective cohort study was conducted using administrative databases.Setting:This study took place in Manitoba, Canada.Measurements:Age, sex, estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (ACR) were measured.Methods:We included patients from the Diagnostic Services of Manitoba database with an eGFR <60 mL/min/1.73 m2 and ACR measured between October 2006 and March 2007. Five-year kidney failure risk was predicted using the 4-variable KFRE and compared with treated kidney failure events from the Manitoba Renal Program database. Sensitivity and specificity for KFRE risk thresholds (3% and 10% over 5 years) were compared with eGFR thresholds (30 and 45 mL/min/1.73 m2).Results:Of 1512 included patients, 151 developed kidney failure over the 5-year follow-up period. The 4-variable KFRE showed a superior prognostic discrimination compared with eGFR alone (area under the receiver operating characteristic curve [AUROC] values, 0.90 [95% confidence interval {CI}: 0.88-0.92] for KFRE vs 0.78 [95% CI: 0.74-0.83] for eGFR). At a 3% threshold over 5 years, the KFRE had a sensitivity of 97% and a specificity of 62%. At 10% risk, sensitivity was 86%, and specificity was 80%.Limitations:Only 11.7% of stage 3-5 CKD patients had simultaneous ACR measurement. The KFRE does not account for other indications for referral such as suspected glomerulonephritis, polycystic kidney disease, and recurrent stone disease.Conclusions:The KFRE has been validated in a population with a demographic and referral profile heretofore untested and performs well at predicting 5-year risk of kidney failure in a population-based sample of Manitobans with CKD stages 3 to 5. Thresholds of 3% and 10% over 5 years are sensitive, specific, and can be used in clinical decision making. Further testing of the 4-variable KFRE and these thresholds in clinical practice should be considered.

show abstract

Section: Discussionmentioning

confidence: 99%

Validation of the Kidney Failure Risk Equation in Manitoba

Whitlock

Chartier

Komenda

et al. 2017

Can J Kidney Health Dis

Self Cite

View full text Add to dashboard Cite

show abstract

“…Lower residual GFR has been reported to be associated with a greater risk of peritonitis (38). In a recently published study of 938 Canadian PD patients, Nessim et al (39) reported that obesity was not associated with an increased overall risk of peritonitis, but might be associated with a higher risk of peritonitis caused by coagulase-negative Staphylococcus.…”

Section: Resultsmentioning

confidence: 99%

Effect of Body Mass Index on Outcomes of Peritoneal Dialysis Patients in India

et al. 2014

View full text Add to dashboard Cite

♦ Objectives: We studied the effect of body mass index (BMI) at peritoneal dialysis (PD) initiation on patient and technique survival and on peritonitis during follow-up. ♦ Methods: We followed 328 incident patients on PD (176 with diabetes; 242 men; mean age: 52.6 ± 12.6 years; mean BMI: 21.9 ± 3.8 kg/m 2 ) for 20.0 ± 14.3 months. Patients were categorized into four BMI groups: obese, ≥25 kg/m 2 ; overweight, 23 -24.9 kg/m 2 ; normal, 18.5 -22.9 kg/m 2 (reference category); and underweight, <18.5 kg/m 2 . The outcomes of interest were compared between the groups. ♦ Results: Of the 328 patients, 47 (14.3%) were underweight, 171 (52.1%) were normal weight, 53 (16.2%) were overweight, and 57 (17.4%) were obese at commencement of PD therapy. The crude hazard ratio (HR) for mortality (p = 0.004) and the HR adjusted for age, subjective global assessment, comorbidities, albumin, diabetes, and residual glomerular filtration rate (p = 0.02) were both significantly greater in the underweight group than in the normal-weight group. In comparison with the reference category, the HR for mortality was significantly greater for underweight PD patients with diabetes [2.7; 95% confidence interval (CI): 1.5 to 5.0; p = 0.002], but similar for all BMI categories of nondiabetic PD patients. Median patient survival was statistically inferior in underweight patients than in patients having a normal BMI. Median patient survival in underweight, normal, overweight, and obese patients was, respectively, 26 patient-months (95% CI: 20.9 to 31.0 patient-months), 50 patient-months (95% CI: 33.6 to 66.4 patient-months), 57.7 patient-months (95% CI: 33.2 to 82.2 patient-months), and 49 patientmonths (95% CI: 18.4 to 79.6 patient-months; p = 0.015). Death-censored technique survival was statistically similar in all BMI categories. In comparison with the reference category, the odds ratio for peritonitis occurrence was 1.8 (95% CI: 0.9 to 3.4; p = 0.086) for underweight patients; 1.7 (95% CI: 0.9 to 3.2; p = 0.091) for overweight patients; and 3.4 (95% CI: 1.8 to 6.4; p < 0.001) for obese patients. ♦ Conclusions: In our PD patients, mean BMI was within the normal range. The HR for mortality was significantly greater for underweight diabetic PD patients than for patients in the reference category. Death-censored technique survival was similar in all BMI categories. Obese patients had a greater risk of peritonitis.

show abstract

“…However, other studies showed that older age was a risk factor for peritonitis 19,20. Two prior studies reported different results regarding BMI; one found that obesity is a risk factor for peritonitis when patients start PD,21 while the other found no association between obesity and the risk of developing peritonitis 22…”

Section: Discussionmentioning

confidence: 98%

Peritoneal dialysis related infections in a tertiary care hospital in Riyadh, Saudi Arabia

Alfayez

Alsaqoub

Qattan

et al. 2019

SMJ

View full text Add to dashboard Cite

Objectives: To detect the incidence of and risk factors for infections among patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD). Methods: A retrospective cohort study was conducted at the PD unit of King Fahad Medical City. End-stage renal disease patients above the age of 12 years who were undergoing PD management between January 2006 and March 2016 were included. Results: One hundred PD patients were enrolled in the study and examined over a total observation period of 2,553 patient-months. The leading ESRD etiology was hypertension (26.3%). The mean duration of PD was 28.05 months. A total of 45 patients developed 101 episodes of technique-related infections (TRIs). Peritonitis represented the majority of these episodes (90 episodes), with an overall rate of one episode per 28.3 patient-months. TRIs were mostly caused by coagulase-negative staphylococci. A total of 12 patients developed non-technique related infections (NTRIs). There was a statistically significant difference between patients with TRI and non-infected patients regarding the presence of diabetes and duration of dialysis. No peritonitis-related deaths were noted. In total, 21 patients continued on PD and 18 patients were shifted to hemodialysis (HD). Conclusion: In our setting, ESRD patients undergoing PD are more susceptible to TRIs than NTRIs. Diabetes increases the risk of developing TRIs. The high incidence of coagulase-negative staphylococcal TRI suggests touch contamination.

show abstract

Frequency and Microbiology of Peritonitis and Exit-Site Infection among Obese Peritoneal Dialysis Patients

Cited by 29 publications

References 18 publications

Validation of the Kidney Failure Risk Equation in Manitoba

Validation of the Kidney Failure Risk Equation in Manitoba

Effect of Body Mass Index on Outcomes of Peritoneal Dialysis Patients in India

Peritoneal dialysis related infections in a tertiary care hospital in Riyadh, Saudi Arabia

Contact Info

Product

Resources

About