Risk Factors and Prevention of Peritoneal Dialysis-Related Peritonitis

Abstract

Background Peritonitis is a major complication and the main cause of peritoneal dialysis (PD) failure. The aim of the present study was to evaluate peritonitis risk factors and its prevention with a new peritoneal educational program (NPEP). Methods We performed a retrospective analysis of a cohort of chronic PD patients, older than 16 years, who began PD in the period 1 January 1999 to 31 December 2015 at a Uruguayan PD center, with follow-up until 31 December 2016. Results The population included 222 cases (219 patients, 128 men), median age 59 (interquartile range [IQR] 47.0 – 72.0) years, median time on PD 17.5 (IQR 6.0 – 36.2) months. Ninety-five patients suffered 1 or more episodes of peritonitis, and they had been on PD for a longer period and had nasal-positive culture more frequently. A NPEP started in September 2008; patients who trained with it, as well as younger patients, had longer peritonitis-free survival. After the NPEP, global peritonitis rates decreased significantly (from 0.48 to 0.29 episodes/patient-year, respectively), particularly gram-positive bacteria and Staphylococcus aureus / coagulase-negative (CoNS) (from 0.26 to 0.12 and 0.21 to 0.07 episodes/patient-year, respectively). In the multivariate Cox analysis of peritonitis risk factors, survival to first peritonitis was significantly associated only with age (hazard ratio [HR] 1.024, 95% confidence interval [CI] 1.007 – 1.397, p = 0.007) and the NPEP (HR 0.600, 95% CI 0.394 – 0.913, p = 0.017). Conclusion A multidisciplinary peritoneal educational program may improve peritonitis rates, independently of other risk factors.

Overhydration and low serum prealbumin predict peritoneal dialysis-related peritonitis in continuous ambulatory peritoneal dialysis patients

“…Predictive value for peritonitis of serum prealbumin, OH is also evident when we followed-up 3 years CAPD patients by Kaplan-Meier analysis (Figure 2,3). There are some previous reports about predictive factors of PD-related peritonitis in CAPD patients [19,21,22]. Gadola L. et al [19] con rmed that multidisciplinary peritoneal educational program improved peritonitis rates, independently of other risk factors.…”

“…There are some previous reports about predictive factors of PD-related peritonitis in CAPD patients [19,21,22]. Gadola L. et al [19] con rmed that multidisciplinary peritoneal educational program improved peritonitis rates, independently of other risk factors. Okayama M. et al found aging is an important risk factor for peritoneal dialysis-associated peritonitis [21].…”

“…(372/1321 patients), in which in the rst year of PD initiation, 169 (13%) patients had experienced episodes of peritonitis, and the proportion of patients with peritonitis uctuated from 8% to 13% in the subsequent years. Gadola L. et al [19] surveyed the rate of peritonitis in 222 PD patients following-up 6 years, the result showed 95 patients suffered 1 or more episodes of peritonitis (42.79%). In children, the ratio of peritonitis was 25.45% in Ponce's study with 7 years follow-up (125 rst episodes of peritonitis in 491 children PD patients) [21].…”

Overhydration and low serum prealbumin predict peritoneal dialysis-related peritonitis in continuous ambulatory peritoneal dialysis patients

“…There are some previous reports about predictive factors of PDrelated peritonitis in CAPD patients [18,20,21]. Gadola L. et al [18] con rmed that multidisciplinary peritoneal educational program improved peritonitis rates, independently of other risk factors. Okayama M. et al found aging is an important risk factor for peritoneal dialysis-associated peritonitis [20].…”

“…Ye H. et al [5] conducted a study with 1321 PD patients following-up 5 years, the ratio of peritonitis was 28.16% (372/1321 patients), in which in the rst year of PD initiation, 169 (13%) patients had experienced episodes of peritonitis, and the proportion of patients with peritonitis uctuated from 8-13% in the subsequent years. Gadola L. et al [18] surveyed the rate of peritonitis in 222 PD patients following-up 6 years, the result showed 95 patients suffered 1 or more episodes of peritonitis (42.79%). In children, the ratio of peritonitis was 25.45% in Ponce's study with 7 years follow-up (125 rst episodes of peritonitis in 491 children PD patients) [19].…”