Reduced residual renal function is a risk of peritonitis in continuous ambulatory peritoneal dialysis patients

Han, Seung Hyeok; Lee, Sang Choel; Ahn, Song Vogue; Lee, Jung Eun; Kim, Yon Su; Lee, Tae Hee; Moon, Sung Jin; Kim, Beom Seok; Kang, Shin Wook; Choi, Kyu Hun; Lee, Ho Yung; Han, Dae Suk

doi:10.1093/ndt/gfm242

Cited by 85 publications

(83 citation statements)

References 32 publications

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“…It is not surprising that diabetes was associated with a higher peritonitis rate, because this has been previously reported (1,4,5); however, in this study, we found for the first time a significant interaction between gender and diabetes, such that the higher peritonitis rate was present only among female patients with diabetes. Although this has not previously been described with respect to peritonitis risk, several large US studies demonstrated a higher incidence of death on PD among women, in particular among female patients with diabetes (17)(18)(19).…”

Section: Discussionsupporting

confidence: 63%

“…Furthermore, a previous peritonitis episode has been shown to increase the risk for developing a subsequent episode (1,2). Although the association between age and peritonitis has been inconsistent across different studies (1,3,5,8,9), we recently reported an era effect for age, such that the increased risk associated with older age disappeared among those who initiated PD after the year 2000 (10). The data regarding other important factors are conflicting.…”

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confidence: 93%

“…Among demographic characteristics, Black race (1,2), Aboriginal race (3), diabetes (1,4,5), and obesity (3,6) have been associated with a higher risk for peritonitis. In addition, hypoalbuminemia (4,7) and lack of residual renal function (5) have been reported to be associated with a shorter time to first peritonitis. Furthermore, a previous peritonitis episode has been shown to increase the risk for developing a subsequent episode (1,2).…”

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confidence: 99%

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Predictors of Peritonitis in Patients on Peritoneal Dialysis

Nessim

Bargman

Austin

et al. 2009

Clinical Journal of the American Society of Nephrology

123

103

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Background and objectives: Despite the decreasing incidence of peritonitis among peritoneal dialysis (PD) patients over time, its occurrence is still associated with significant morbidity and mortality. Determining factors that are associated with PD peritonitis may facilitate the identification of patients who are at risk.Design, setting, participants, & measurements: Using data collected in the multicenter Baxter POET database between 1996 and 2005, the study population included incident Canadian PD patients. Potential predictors of peritonitis were sought using a negative binomial model and an Andersen-Gill model. Study variables included age, gender, race, cause of renal disease, diabetes status, transfer from hemodialysis (HD), previous renal transplant, and continuous ambulatory PD (CAPD) versus automated PD (APD).Results: Data were available for 4247 incident PD patients, including 1605 patients with a total of 2555 peritonitis episodes. Using the negative binomial regression model, factors that were independently associated with a higher peritonitis rate included age, Black race, and having transferred from HD. There was an interaction between gender and diabetes, with an increased risk for peritonitis among female patients with diabetes. The use of CAPD versus APD did not affect the peritonitis rate. The Andersen-Gill model for recurrent events yielded similar results.Conclusions: Predictors of PD peritonitis included Black race, transferring from HD to PD, and diabetes among women. In contrast to previous findings, CAPD and APD were similar with regard to peritonitis risk.

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Section: Discussionsupporting

confidence: 63%

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confidence: 93%

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confidence: 99%

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Predictors of Peritonitis in Patients on Peritoneal Dialysis

Nessim

Bargman

Austin

et al. 2009

Clinical Journal of the American Society of Nephrology

123

103

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“…Obesity (7), malnutrition (8), chronic inflammation (9), reduced residual renal function (10), and previous peritonitis have also been described as risk factors (3). In addition, there are conflicting results regarding the comparison between continuous ambulatory PD (CAPD) and automated PD (APD) (3,11,12).…”

Section: Introductionmentioning

confidence: 99%

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

Martin

Júnior

Fernandes

et al. 2011

Clinical Journal of the American Society of Nephrology

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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.

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“…There are also data that reduced RRF confers a higher risk of peritonitis. In a study of 204 PD patients, time to the first PD peritonitis episode was significantly longer in patients with higher rGFR (P Ͻ 0.001), and the risk of peritonitis decreased by 19% for every 1-ml/min/1.73 m 2 increase in rGFR (HR 0.81, 95% CI 0.74 to 0.88, P Ͻ 0.01) (17). Thus, preservation of RRF is of great importance for survival in PD patients.…”

Section: Introductionmentioning

confidence: 99%

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

Kendrick

Teitelbaum

2010

Clinical Journal of the American Society of Nephrology

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The incidence and prevalence of ESRD in the United States continues to increase. Currently there are over 26,000 patients maintained on peritoneal dialysis. Mortality rates have fallen over the past several years, but long-term survival remains poor, with only 11% of peritoneal dialysis patients surviving past 10 years. Cardiovascular disease accounts for most deaths, and dialysis patients have many traditional and nontraditional cardiovascular risk factors. Lowering of these risk factors has not resulted in reduced cardiovascular morbidity and mortality in dialysis patients. Maneuvers to improve long-term peritoneal dialysis patient survival must therefore focus on modifiable risk factors including residual renal function, peritoneal membrane integrity, rate of infections, and peritoneal dialysis center size. This article reviews strategies for preserving residual renal function and peritoneal membrane integrity as well as strategies for reducing the rate of infections to enhance long-term survival in peritoneal dialysis patients.Clin J Am Soc Nephrol 5: 1123-1131, 2010. doi: 10.2215/CJN.04300709T he incidence and prevalence of ESRD continues to increase worldwide. In the United States alone there are over 480,000 patients on dialysis and the number of incident dialysis patients each year exceeds 100,000 (1). Peritoneal dialysis (PD) is an established treatment modality for patients with ESRD. Currently, 26,082 patients are maintained on PD in the United States (1). Mortality rates in ESRD patients have declined significantly over the past 20 years, but longterm survival remains poor, with the overall survival for all dialysis patients [hemodialysis (HD) and PD] being only 11%. These data were not censored for modality change, the effect of which is difficult to gauge. On a proportional basis, a greater percentage of PD than HD patients switch modality; however, in absolute numbers, more HD patients transition to PD than the reverse. Nevertheless, the overall adjusted probability of survival in incident PD patients at 1 year is 86.8%, but only 11.3% at 10 years (1). The reason for this dramatic decrease in patient survival over time is multifactorial and depends on several patient and dialysis center factors.There are several patient factors that affect survival on PD, most of which are nonmodifiable. Age, presence of diabetes, ESRD etiology, and ESRD vintage are all independent predictors of patient survival (2). For each 1-year increase in age, the risk of death increases by 4% [adjusted hazard ratio (HR) 1.04, P Ͻ 0.0001]. Patients with diabetes have a 30% increased risk of death compared with nondiabetic patients, and dialysis-naive patients have a 28% decreased risk of death compared with patients transferred from HD (2). Cardiovascular disease (CVD) accounts for most deaths in dialysis patients (approximately 50%). The genetics of the patient may be another nonmodifiable determinant of CVD. For example, a recent study of 1200 HD patients found an increased risk of CVD in patients with a specific complemen...

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Reduced residual renal function is a risk of peritonitis in continuous ambulatory peritoneal dialysis patients

Abstract: Our study revealed that RRF and diabetes were risk factors for peritonitis. These results suggest that preservation of RRF should be viewed as a protective strategy to reduce peritonitis.

Cited by 85 publications

References 32 publications

Predictors of Peritonitis in Patients on Peritoneal Dialysis

Predictors of Peritonitis in Patients on Peritoneal Dialysis

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

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

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