Impact of early-onset peritonitis on mortality and technique survival in peritoneal dialysis patients

Abstract

BackgroundEarly onset peritonitis (EOP) is not uncommon in peritoneal dialysis patients. We aimed to compare the prognosis of EOP and non-EOP peritoneal dialysis patients.MethodsThis study included subjects that underwent PD from January 1, 2004 to July 31, 2013. Patient characteristics were collected. EOP was defined as peritonitis occurring within 6 months after initiation of PD. Patient and technique survival were compared between EOP and non-EOP patients using Cox regression analyses.ResultsIn total, 189 subjects were included in this study. Patients were divided into EOP (n = 55) and non-EOP groups (n = 134). There was no significant difference in the causative organisms of peritonitis between the two groups. After adjusting for age, diabetes status, serum albumin level and residual renal function, the multivariable Cox regression model revealed that EOP was an independent risk factor for patient mortality (HR 2.03, RI 1.09–3.80, p = 0.026), technique failure (HR 1.69, RI 1.12–2.87, p = 0.015) and total survival (HR 1.73, RI 1.12–2.68, p = 0.013).ConclusionsEOP was identified as an independent risk factor for mortality and technique failure in peritoneal dialysis patients.

Early Onset Peritoneal Dialysis-Related Peritonitis

“…The hypothesis that there are differences in outcomes across patient groups according to time of onset of peritonitis has been suggested as early as 2003 [8]. Overall, it has been postulated that EOP occurs in up to 30% of PD patients [5,7]. However, definitions of "early" have varied significantly across studies, with time points proposed at as early as 3 months [6,9,10] and as late as almost 2 years after initiation of PD [11].…”

“…However, definitions of "early" have varied significantly across studies, with time points proposed at as early as 3 months [6,9,10] and as late as almost 2 years after initiation of PD [11]. The majority of these studies have been single-centre, retrospective observational studies of relatively small patient numbers, and the definition of 'early' was chosen by the investigators with no justification for how this was determined [5,6,8,10]. Hsieh and colleagues from Taiwan proposed a definition based on median time to first episode of peritonitis in their cohort, which was 20.28 months in their study [11].…”

“…This may be almost as long as median PD technique survival in some countries, such as Australia and New Zealand [12]. Most commonly, the definition of 'early' in EOP has been 3 months (or 90 days) [5,10,11], followed equally by 6 [5,7] and 12 months [7,13]. insertion or commencement of dialysis.…”

“…Thirty-two patients (20%) developed peritonitis within six months of treatment initiation, with rates reported as 0.51 episodes per patient-year in the EOP group, compared to 0.33 episodes per patient-year in the late group. In contrast, Feng et al included all incident PD patients regardless of their age (n=189 patients) [5]. Patients were then divided into two groups based on occurrence of EOP.…”

“…Referred to as time of onset of first episode of peritonitis after PD commencement, various definitions have been proposed from 90 days to 20.28 months after PD onset [4][5][6][7][8][9][10][11]. There has been a growing interest in this topic as patients with early onset peritonitis appear to be placed at a heightened risk of complications, including technique failure and all-cause mortality, when compared to those who develop peritonitis later in their PD treatment [4][5][6]. This review will summarise the state of evidence to date on early onset peritonitis, its definition, importance, incidence, risk factors and preventative strategies.…”