Peritoneal Dialysis-Related Peritonitis: Rate, Clinical Outcomes and Patient Survival

Abstract

Peritoneal dialysis-related peritonitis remains the major complication and primary challenge to the long-term success of peritoneal dialysis (PD). The study aimed to analyze the peritonitis rate, the cause, the outcomes, and the association of peritonitis with the survival of patients on peritoneal dialysis. Patient data were collected retrospectively from medical charts. A total of 96 patients received peritoneal dialysis in the PD center from 1 January 1999 to 31 December 2018. Episodes of peritonitis (n=159) were registered in 54 (56.3%) patients. The study population was divided into two groups, a group of patients (n=54) who experienced peritonitis and a group of patients free of peritonitis (n=42). The peritonitis rate was 0.47 episodes per patient year. The majority of causative microorganisms were gram-positive bacteria (53.5%). Outcomes of the episodes of peritonitis were resolved infection in 84.9% of episodes, catheter removal in 11.3% of episodes, and death in 3.8% of the episodes of peritonitis. A Kaplan–Meier analysis and log-rank test revealed that the group with peritonitis tended to survive significantly longer than the peritonitis-free group. A 67% reduction rate in the risk of patient mortality was observed for the peritonitis group compared with the peritonitis-free group (hazard ratio: 0.33, 95% CI 0.19-0.57, P=0.000). The prevention and management of PD-related infections, resulted in their worldwide reduction, supporting the use of PD as a first-line dialysis modality.

Classification of bacteria and fungi in peritoneal dialysis fluids of patients with chronic kidney disease based on metagenomic analysis

“…analysis in a recent study (72). Another study revealed the causative microorganisms in PDE samples based on traditional culture and found both gram-positive bacteria (i.e., Staphylococcus, Streptococcus, Enterococcus) and gram-negative bacteria (i.e., Escherichia, Klebsiella, Pseudomonas) which are partially consistent to our study (74).…”

Histone deacetylase 8 inhibition prevents the progression of peritoneal fibrosis by counteracting the epithelial-mesenchymal transition and blockade of M2 macrophage polarization

“…Peritoneal dialysis (PD) is an effective renal replacement therapy (1), however, the proportion of ESRD patients treated with PD is lower than hemodialysis in developed countries (2). Clinical studies have demonstrated that peritoneal ultrafiltration declines gradually 2 -4 years after the initiation of PD (3)(4)(5). The induction of peritoneal fibrosis is a complex pathological event, and is characterized by epithelial-to-mesenchymal transition (EMT), activation of fibroblasts, deposition of extracellular matrix (ECM) components and angiogenesis (6).…”

Prevalence of chronic periodontitis in patients undergoing peritoneal dialysis and its correlation with peritoneal dialysis-related complications

“…Local inflammation of the periodontal tissue affects body systems by altering the levels of blood inflammatory mediators, increasing the probability of systemic inflammation in PD patients [ 7 , 13 ]. Peritoneal dialysis-associated peritonitis (PDAP) is the most common clinical complication of PD and seriously affects peritoneal ultrafiltration and dialysis efficiency, and it is an important cause of the termination of PD and even death [ 14 – 17 ]. Cardio- and cerebrovascular events (CCEs) are the first and most important cause of death among PD patients [ 18 ].…”