Risk factors for peritoneal dialysis–associated peritonitis

Abstract

The purpose of this study was to summarize the pathogens that cause peritoneal dialysis (PD)-associated peritonitis and to identify risk factors for PD-associated peritonitis. This retrospective study included 115 end-stage renal disease (ESRD) patients receiving PD therapy. Patients were categorized into two groups: peritonitis group (n = 41) and nonperitonitis group (n = 74). Clinical data and laboratory tests were collected from medical records. The multivariate logistic regression model was used to evaluate associations between PD-associated peritonitis and potential risk factors. PDassociated peritonitis occurred 54 times in 41 patients. The most frequently identified pathogen was Gram-positive cocci (57.78%). Multivariate logistic regression analysis showed that serum albumin (β =-0.208, P < 0.001), blood phosphorus concentration (β =-1.732, P = 0.001), gastrointestinal disorders (β = 1.624, P = 0.043), and use of calcitriol (β =-2.239, P = 0.048) were significantly correlated with PD-associated peritonitis. Receiver operating characteristic (ROC) curves showed that the areas under the curve were 0.832 for serum albumin and 0.700 for blood phosphorus concentration with optimal cutoff values of 29.1 g/L for serum albumin and 1.795 mmol/L for blood phosphorus concentration. Gram-positive coccus is the major pathogen responsible for PD-associated peritonitis. Serum albumin <29.1 g/L, blood phosphorus concentration <1.795 mmol/L, and intestinal disorders are risk factors for PD-associated peritonitis, whereas the use of calcitriol can reduce the risk of PD-associated peritonitis.

Peritoneal Dialysis-Related Peritonitis With Acinetobacter Pittii: A Case Report

“…Many risk factors are known to increase the risk for PD peritonitis, including, but not limited to, low serum albumin, low serum phosphorus, intestinal disorders, and colonic diverticulosis. 1 , 2 The most common pathogens for PD-related peritonitis are coagulase-negative staphylococcal species that commonly colonize human skin and hands and Staphylococcus aureus that together are responsible for 50% or more of infections in most series. 3 , 4 A pittii , a member of the Acinetobacter calcoaceticus - baumannii complex, is a strictly aerobic, gram-negative, nonmotile, nonlactose fermenting, oxidase-negative, catalase-positive coccobacilli.…”

Range and consistency of gastrointestinal outcomes reported in peritoneal dialysis trials: A systematic review

“…[31][32][33] Similarly, both diarrhoea and constipation have been identified as risk factors for PD peritonitis. 34,35 It has been reported that peritonitis can be caused by transmural migration of intestinal microbes during GI upset, potentially facilitated by uraemia-associated gut dysbiosis and enhanced intestinal wall permeability. 34,35 GI symptoms by causing psychological distress, anxiety and depression contribute to fatigue, poor life participation and QOL in patients receiving dialysis.…”

“…34,35 It has been reported that peritonitis can be caused by transmural migration of intestinal microbes during GI upset, potentially facilitated by uraemia-associated gut dysbiosis and enhanced intestinal wall permeability. 34,35 GI symptoms by causing psychological distress, anxiety and depression contribute to fatigue, poor life participation and QOL in patients receiving dialysis. 19,20,27,28 Considering the high importance of GI outcomes to patients, caregivers and clinicians and their impacts on a range of other critically important outcomes, there is a clear and pressing need to standardise the measurement, monitoring and reporting of GI outcomes in PD trials.…”

Hospital‐acquired peritonitis in patients on peritoneal dialysis: A call to action

“…Gastrointestinal disorders (i.e., constipation) were also reported to be associated with peritonitis. Wang et al 17 evaluated the risk factors of PD‐associated peritonitis and demonstrated that the presence of gastrointestinal disorder (i.e. constipation) was positively correlated with peritonitis ( r = 1.694, OR = 5.439, p = 0.036). Malnutrition : Hospitalized patients are also susceptible to developing malnutrition due to various factors, 18 including loss of appetite, alteration in taste perception, protein catabolism due to acute illness, and continued protein losses with PD exchanges.…”

“…Wang et al 17 evaluated the risk factors of PD-associated peritonitis and demonstrated that the presence of gastrointestinal disorder (i.e. constipation) was positively correlated with peritonitis (r = 1.694, OR = 5.439, p = 0.036).…”