Obesity is a Risk Factor for Peritonitis in the Australian and New Zealand Peritoneal Dialysis Patient Populations

Abstract

Objective The aim of the present investigation was to examine the association between body mass index (BMI) and peritonitis rates among incident peritoneal dialysis (PD) patients in a large cohort with long-term follow-up. Design Retrospective observational cohort study of the Australian and New Zealand PD patient population. Setting Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Participants The study included all incident adult patients ( n = 10 709) who received PD in Australia and New Zealand in the 12-year period between 1 April 1991 and 31 March 2003. Patients were classified as obese (BMI ≥ 30 kg/m2), overweight (BMI 25.0 – 29.9 kg/m2), normal weight (20 – 24.9 kg/m2), or underweight (< 20 kg/m2). Main Measurements Time to first peritonitis and episodes of peritonitis per patient-year were recorded over the 12-year period. Results Higher BMI was associated with a shorter time to first peritonitis episode, independent of other risk factors [hazard ratio 1.08 for each 5-kg/m2 increase in BMI, 95% confidence interval (CI) 1.04 – 1.12, p < 0.001]. When peritonitis outcomes were analyzed as episodes of peritonitis per patient-year, these rates were significantly higher among patients with higher BMI: underweight 0.69 episodes/year (95% CI 0.66 – 0.73), normal weight 0.79 (95% CI 0.77 – 0.81), overweight 0.88 (95% CI 0.85 – 0.90), obese 1.06 (95% CI 1.02 – 1.09). Coronary artery disease and chronic lung disease were associated with both shorter time to first peritonitis and higher peritonitis rates, independently of these other factors. There was also a “vintage effect,” with lower peritonitis rates seen among people who commenced dialysis in more recent years. Conclusions Higher BMI at the commencement of renal replacement therapy is a significant risk factor for peritonitis. The mechanisms for this remain undefined.

Risk factors for peritoneal dialysis‐related peritonitis: Can we reduce the incidence and improve patient selection?

“…Other studies have reported risk factors of higher BMI and diabetes mellitus, 11,26 but these were not observed to be associated with an increased risk of peritonitis in our cohort. This result is important as diabetes and those with a higher BMI can be successfully managed as a PD patient in our unit.…”

“…This has only been reported once previously with an increased risk of peritonitis of 15% in PD patient smokers. 11 One possible reason for this association may be hygiene awareness and/or care with sterile no touch disconnection techniques because in our study current smokers exhibited more CNS and streptococcal peritonitis than former or nonsmokers. However, smoking status was only captured at the time of initial end-stage kidney disease therapy and the question of being a current smoker at the time of peritonitis is harder to address.…”

“…The risk factors for peritonitis previously reported include age, race, diabetes mellitus, higher body mass index (BMI), staphylococcal nasal carriage, use of prior antibiotics and low serum albumin. [11][12][13][14][15][16] The aim of this study was to prospectively collect information on PD-related peritonitis in order to identify risk factors that may be contributing to peritonitis in our PD population. A great advantage was that we could closely monitor changes in connections systems matched for time of peritonitis.…”

Sürekli Ayaktan Periton Diyalizi Hastalarında Gelişen Peritonitlerin Epidemiyolojik ve Mikrobiyolojik Özelliklerinin Analizi

“…Ancak SAPD alan hastalarda, sosyodemografik, iklimsel, PD türü ve peritoneal kateter çıkış yeri enfeksiyonu veya kateter tünel enfeksiyonu varlığı gibi birçok faktöre bağlı olarak peritonit gelişebilir (1,2,7). Eşlik eden diabetes mellitus (DM), koroner arter hastalığı, kronik pulmoner hastalık varlığı, obezite, kadın cinsiyet, serum albumin düzeyinin düşük olması, aktif sigara kullanımı, stafilokokal nazal taşıyıcılık ve antibiyotik kullanım hikayesi gibi literatürde birçok risk faktörü bildirilmiştir (8,9,10 Sürekli ayaktan periton diyalizi hastalarında peritonit; periton boşluğuna mikroorganizmaların kateter lümeni vasıtasıyla girmesiyle veya kateter çıkış yeri / kateter tünel enfeksiyonuna sekonder gelişebilir. Kateter lümeninden periton boşluğuna geçiş durumunda etken genellikle cilt flora bakterileri olarak saptanır (11,12).…”

Peritoneal Membrane Structural and Functional Changes during Peritoneal Dialysis

“…Severe and recurrent episodes of peritonitis are consistently associated with peritoneal damage (62,74); therefore, during training, considerable emphasis is placed on peritonitis prevention, including teaching hand washing technique and responses to contamination. Special attention should be paid to patients known to be at the highest risk of peritonitis, including the patients with diabetes, elderly patients, patients with neurological disorders, and patients with a high BMI (75,76). The recent finding that patients with a high intraperitoneal pressure (IPP) are at higher risk for developing enteric peritonitis, probably through a facilitated translocation of microorganisms from the gut, led us to recommend systematic IPP measurement at PD onset and to adequately cover those organisms with antibiotic therapy in cases of peritonitis (77).…”