The impact of peritoneal dialysis-related peritonitis on mortality in peritoneal dialysis patients

Abstract

BackgroundResults concerning the association between peritoneal dialysis-related peritonitis and mortality in peritoneal dialysis patients are inconclusive, with one potential reason being that the time-dependent effect of peritonitis has rarely been considered in previous studies. This study aimed to evaluate whether peritonitis has a negative impact on mortality in a large cohort of peritoneal dialysis patients. We also assessed the changing impact of peritonitis on patient mortality with respect to duration of follow-up.MethodsThis retrospective cohort study included incident patients who started peritoneal dialysis from 1 January 2006 to 31 December 2011. Episodes of peritonitis were recorded at the time of onset, and peritonitis was parameterized as a time-dependent variable for analysis. We used the Cox regression model to assess whether peritonitis has a negative impact on mortality.ResultsA total of 1321 patients were included. The mean age was 48.1 ± 15.3 years, 41.3% were female, and 23.5% with diabetes mellitus. The median (interquartile) follow-up time was 34 (21–48) months. After adjusting for confounders, peritonitis was independently associated with 95% increased risk of all-cause mortality (hazard ratio, 1.95; 95% confidence interval: 1.46–2.60), 90% increased risk of cardiovascular mortality (hazard ratio, 1.90; 95% confidence interval: 1.28–2.81) and near 4-fold increased risk of infection-related mortality (hazard ratio, 4.94; 95% confidence interval: 2.47–9.86). Further analyses showed that peritonitis was not significantly associated with mortality within 2 years of peritoneal dialysis initiation, but strongly influenced mortality in patients dialysed longer than 2 years.ConclusionsPeritonitis was independently associated with higher risk of all-cause, cardiovascular and infection-related mortality in peritoneal dialysis patients, and its impact on mortality was more significant in patients with longer peritoneal dialysis duration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0588-4) contains supplementary material, which is available to authorized users.

Long-term clinical outcomes of peritoneal dialysis patients: 9-year experience of a single centre in Turkey

“…Maybe we can explain this with a longer follow-up period than others. Comparing with the other study patients our rate of transferred to haemodialysis (30.9% vs 8.4%-29.4%) and renal transplantation (9% vs. 1.6%-39%) were similar [10,18,19,23].…”

“…Although rates varied from our results, the same reasons were reported in the other studies. In some studies, cardiovascular diseases were shown to be the most common cause of death (39%-60%), infectious causes were the second most common cause of death (17.6%-40%) among PD patients [8,9,14,17,19,23,24]. The rate of PD survivors was reported to be 58.9% in a 6-year study from Japan [18] and %46.3 in a 2-year study from China [23].…”

Peritoneal dialysis after kidney transplant failure: a nationwide matched cohort study from the French Language Peritoneal Dialysis Registry (RDPLF)

“…Peritonitis episodes could cause membrane permeability changes and ultrafiltration declines with time on PD, which finally leads to technique failure. Peritonitis is widely recognized in the literature as affecting PD patients' 'technique survival and mortality' [14][15][16]. In our study, it is only by using a competing risk model that we found previous history of a peritonitis episode as a predictive factor of transfer to HD.…”

Association Between Comprehensive Nutritional Scoring System (CNSS) and Outcomes of Continuous Ambulatory Peritoneal Dialysis Patients

“…In china, the number of ESRD patients receiving PD therapy is rapidly growing in recent years [37]. Patients on long-term dialysis have a significantly increased risk of mortality, and cardiovascular disease (CVD) and infection are most common causes of death in dialysis patients [38,39] have shown a variety of risk factors that predict the outcomes of dialysis patients, including age [40], sex [41], RRF [42], blood pressure [43,44], comorbidity [45], BMI [46][47][48][49], serum ALB [50,51], pre-ALB [52][53][54], TC [55][56][57][58], TG [59,60], VLDL [61], HB [62], Ca, P [63], PTH, ALP [64], UA [65,66], K, CRP [67], dialysis adequacy [68,69], incident peritonitis [70,71] and so on. Much effort has been done to maintain stable blood pressure, correct anemia and electrolyte disturbance as well as ensure dialysis adequacy and prevent peritonitis, in order to improve the long-term outcomes of dialysis patients.…”