High Peritoneal Glucose Exposure Is Associated with Increased Incidence of Relapsing and Recurrent Bacterial Peritonitis in Patients Undergoing Peritoneal Dialysis

Abstract

Aim: We investigated the association of peritoneal glucose exposure and dialysis exchange number with peritonitis outcome in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods: The first episodes of bacterial peritonitis were retrospectively analyzed in 187 CAPD patients. Peritoneal glucose exposure was calculated based on PD prescription at the onset of peritonitis. Results: Patients with peritoneal glucose exposure ≤140 g/day showed a higher and complete cure rate of peritonitis (66 vs. 51.7%, p = 0.047), lower occurrence of relapsing/recurrent peritonitis (10.0 vs. 21.8%, p = 0.026) and catheter removal (14.0 vs. 26.4%, p = 0.033). Patients who exchanged more than three times every day demonstrated marginally higher catheter removal rate (24.1 vs. 13.0%, p = 0.085). Logistic analysis indicated that peritoneal glucose exposure >140 g/day was an independent predictor for relapsing/recurrent peritonitis (RR: 1.959, p = 0.042). Conclusion: High peritoneal glucose exposure is associated with increased incidence of relapsing/recurrent peritonitis in CAPD patients.

Association between Peritoneal Glucose Exposure and Peritonitis in Peritoneal Dialysis Patients: TheBalANZ Trial

“…These results are in keeping with those of a recently published retrospective observational study of 230 PD patients who had experienced peritonitis-free survival for at least 1 year at a single Dutch center between 1990 and 2010 (19,20). This investigation observed a higher crude risk of peritonitis in PD patients with high dialysate glucose exposure (> 44 mmol/L/ day) in the first year compared with those who had a low dialysate glucose exposure (≤ 44 mmol/L/day) (HR 0.71, 95% CI 0.51 -0.99).…”

“…In contrast, a previous retrospective, single-center study of 187 CAPD patients experiencing a first episode of peritonitis between 2009 and 2013 found an association between higher glucose exposure of > 140 g/day and a lower complete cure rate of peritonitis on univariate analysis (51.7% vs 66 %, p = 0.047) (20). In addition, the authors also found that the high glucose exposure group experienced more frequent occurrences of relapsing or recurrent peritonitis (21.8% vs 10%, p = 0.026) and catheter removal (26.4% vs 14%, p = 0.033).…”

“…It has also been suggested that exposure to PD solutions with high glucose content may predispose patients to a heightened risk of peritonitis as a result of impaired host defences stemming at least partly from hyperglycemia, vascular disease, obesity, and peritoneal membrane damage (18)(19)(20). A recent retrospective observational cohort study of 230 PD patients who had survived a year of dialysis without peritonitis at a single Dutch center between 1990 and 2010 reported a significantly lower hazard of peritonitis in the high glucose exposure group on univariable analysis (HR 0.71, 95% CI 0.51 -0.99), which was no longer significant following multivariable adjustment in 3 separate models.…”

Incremental peritoneal dialysis is a safe and feasible prescription in incident patients with preserved residual kidney function

“…21 High glucose exposure on PD has been shown to be a predictor for peritonitis in other observational studies. 22,23 Another explanation for delaying peritonitis may be due to the presence of a higher initial RKF in those treated with incremental PD. Several studies have demonstrated low RKF as an independent risk factor for peritonitis, manifesting as higher peritonitis rates and shorter peritonitis-free survival.…”

Microbiological evaluation safety cap in peritoneal dialysis

“…Sin embargo y a pesar de haber disminuido marcadamente las complicaciones, la peritonitis representa la principal complicación aguda de la diálisis peritoneal, causando hospitalización, pérdida del catéter, abandono de la técnica y trasferencia a hemodiálisis, así como mortalidad [7][8][9][10][11][12] , la etiología bacteriológica es diversa [13][14][15][16][17][18][19][20][21][22][23] , su diagnóstico, tratamiento y pronóstico están, por lo general, claramente definidos 24-28 y su pronóstico es variable [29][30][31][32][33] .…”