Derivation and validation of a risk score predicting risk of early-onset peritonitis among patients initializing peritoneal dialysis: A cohort study

Abstract

Early onset peritonitis (EOP) increases the risk of clinical complications in patients initializing peritoneal dialysis (PD). This study aimed to develop and validate a risk prediction model for EOP among patients initializing PD. Methods: 3772 patients registered with the Henan Peritoneal Dialysis Registry (HPDR) between 2007 and 2015 were included. The main outcome, EOP, was defined as incident peritonitis occurring within 6 months of the initialization of PD. Multivariable logistic regression modeling was applied to derive the risk score. All accessible clinical measurements were screened as potential predictors. Assessment of the developed model in terms of model discrimination and calibration was performed using C statistics and a calibration slope, respectively, and validated internally through a bootstrapping (1000-fold) method to adjust for over-fitting. Results: The absolute risk of EOP was 14.5%. Age, cardiac function measurements, serum electrolyte test items, lipid profiles, liver function test items, blood urea nitrogen, and white cell count were significant predictors of EOP in the final risk score. Good model discrimination, with C statistics above 0.70, and calibration of agreed observed and predicted risks were identified in the model. Conclusion:A prediction model that quantifies risks of EOP has been developed and validated. It is based on a small number of clinical metabolic measurements that are available for patients initializing PD in many developing countries, and could serve as a tool to screen the population at high risk of EOP.

Poorer clinical outcomes of early‐onset peritonitis in elderly peritoneal dialysis patients: A longitudinal and multicenter study

“…Few studies assessed the short-term effect of EOP [12,13,18,20,23], and one study found that the first episode of EOP had a higher cure rate, a lower rate of transfer to hemodialysis, and lower mortality than the first episode of LOP [15]. First, PD did not improve the last PDAP episode in the EOP group in our cohort, which may be due to underlying medical conditions and low residual renal function.…”

“…Older age was a risk factor for the first PDAP episode and a significant predictor of EOP in the final risk score. Although PD is suitable for elderly patients [5], EOP is an independent risk factor for mortality in this population [10,12,18]. Furthermore, EOP worsens the prognosis of PD [13,19,20], and age is positively correlated with poor physical health in elderly PD patients, potentially increasing the risk of peritonitis [21].…”

“…Therefore, our results suggest that EOP is a strong predictor of outcome in elderly PD patients. EOP was previously defined as the occurrence of a PDAP episode within 3-6 months of the initiation of a dialysis program because of the higher incidence of PDAP during this period [13,15,18,22,23]. However, applying this definition would create sampling bias, which could adversely affect the reliability of the statistical analysis.…”