Geographic and Educational Factors and Risk of the First Peritonitis Episode in Brazilian Peritoneal Dialysis Study (BRAZPD) Patients

Abstract

SummaryBackground and objectives Peritonitis remains as the most frequent cause of peritoneal dialysis (PD) failure, impairing patient's outcome. No large multicenter study has addressed socioeconomic, educational, and geographic issues as peritonitis risk factors in countries with a large geographic area and diverse socioeconomic conditions, such as Brazil.Design, setting, participants, & measurements Incident PD patients recruited from 114 dialysis centers and reporting to BRAZPD, a multicenter observational study, from December 2004 through October 2007 were included. Clinical, dialysis-related, demographic, and socioeconomic variables were analyzed. Patients were followed up until their first peritonitis. Cox proportional model was used to determine independent factors associated with peritonitis.Results In a cumulative follow-up of 2032 patients during 22.026 patient-months, 474 (23.3%) presented a first peritonitis episode. In contrast to earlier findings, PD modality, previous hemodialysis, diabetes, gender, age, and family income were not risk predictors. Factors independently associated with increased hazard risk were lower educational level, non-white race, region where patients live, shorter distance from dialysis center, and lower number of patients per center.Conclusions Educational level and geographic factors as well as race and center size are associated with risk for the first peritonitis, independent of socioeconomic status, PD modality, and comorbidities.

Socio-Economic Status and Peritonitis in Australian Non-Indigenous Peritoneal Dialysis Patients

“…SES AND PD PERITONITIS present study, a recent large, multicenter study of 2,032 incident and prevalent Brazilian PD patients (BRAZPD) showed that SES based on family income was not clearly associated with peritonitis risk (14). However, contrary to the findings of the present study, lower educational level was associated with heightened time to first peritonitis risk.…”

“…Finally, the Brazilian Peritoneal Dialysis Multicenter study (BRAZPD) study observed that lower educational level, but not family income, was independently associated with increased risk of peritonitis (14). These studies have all investigated indicators of individual-level SES.…”

Correlation between Glycemic Control and the Incidence of Peritoneal and Catheter Tunnel and Exit-Site Infections in Diabetic Patients Undergoing Peritoneal Dialysis

“…Data from the Canadian registry suggest that the observed risk might be restricted to diabetic women (9). However, other studies have not detected an association between DM and the risk of PD-related peritonitis (8,18). Moreover, consecutive reports from the ANZDATA registry have not shown DM to be a predictor of peritoneal infection caused by S. aureus (19), coagulase-negative staphylococci (20), Pseudomonas species (21), or yeasts (22).…”

Longitudinal Changes in Health-Related Quality of Life Scores in Brazilian Incident Peritoneal Dialysis Patients (Brazpd): Socio-Economic Status Not a Barrier

“…In another BRAZPD publication with incident PD patients, Martin et al (27) reported that education level was associated with risk for a first peritonitis episode, independent of socio-economic status, PD modality, and comorbidities. Thus, the education level of patients may be important in how training programs are presented to patients, but not in the perception patients have of their quality of life.…”