Predictors of Peritonitis in Patients on Peritoneal Dialysis

Abstract

Background and objectives: Despite the decreasing incidence of peritonitis among peritoneal dialysis (PD) patients over time, its occurrence is still associated with significant morbidity and mortality. Determining factors that are associated with PD peritonitis may facilitate the identification of patients who are at risk.Design, setting, participants, & measurements: Using data collected in the multicenter Baxter POET database between 1996 and 2005, the study population included incident Canadian PD patients. Potential predictors of peritonitis were sought using a negative binomial model and an Andersen-Gill model. Study variables included age, gender, race, cause of renal disease, diabetes status, transfer from hemodialysis (HD), previous renal transplant, and continuous ambulatory PD (CAPD) versus automated PD (APD).Results: Data were available for 4247 incident PD patients, including 1605 patients with a total of 2555 peritonitis episodes. Using the negative binomial regression model, factors that were independently associated with a higher peritonitis rate included age, Black race, and having transferred from HD. There was an interaction between gender and diabetes, with an increased risk for peritonitis among female patients with diabetes. The use of CAPD versus APD did not affect the peritonitis rate. The Andersen-Gill model for recurrent events yielded similar results.Conclusions: Predictors of PD peritonitis included Black race, transferring from HD to PD, and diabetes among women. In contrast to previous findings, CAPD and APD were similar with regard to peritonitis risk.

Geographic and Educational Factors and Risk of the First Peritonitis Episode in Brazilian Peritoneal Dialysis Study (BRAZPD) Patients

“…Regarding PD modality, some studies found that APD is associated with a lower peritonitis risk (11,12); however, our results showing no differences between APD and CAPD are in agreement with more recent and larger studies (3,27).…”

“…The ANZDATA analysis, which included data on 3162 patients who started PD from 1999 to 2003, identified Aboriginal race, obesity, and older age as predictors of peritonitis (26). Moreover, in a Canadian study (27) of 4247 incident patients from 25 centers between January 1996 and September 2005, independent predictors of peritonitis included age, black race, diabetes among women, and transfer from HD to PD, whereas CAPD and APD had similar risk. Unfortunately, these studies did not address socioeconomic, educational, and geographic issues and their results were not adjusted for important comorbidities such as collagenosis, malignancies, and cardiac disturbances.…”

The impact of diabetes mellitus on peritoneal dialysis: the Turkey Multicenter Clinic Study

“…[6][7][8] More recently, in a large prospective Canadian cohort, however, higher peritonitis rate was reported only among female patients with diabetes. 9 On the contrary, a prospective study showed that diabetes had no significant impact on peritonitis rates. 10 The effect of peritoneal dialysis modality on peritonitis rates is also controversial after continuous ambulatory peritoneal dialysis patients started to use the Y-disconnect system.…”

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

“…Data regarding this question are unclear. Most studies have found that the rate of peritonitis is lower with CCPD than CAPD (presumably related to fewer connections and disconnections), but others have reported that the rate is higher or the same (73)(74)(75). At this time, neither modality can be recommended over the other to decrease the risk of peritonitis.…”