Impact of peritonitis on long-term survival of peritoneal dialysis patients.

Abstract

The impact of each episode of peritonitis on long-term survival of peritoneal dialysis (PD) patients has yet to be defined. To determine the risk that each episode of peritonitis poses for patient survival and for the PD technique. 1515 patients included in the Levante registry from 1 January 1993 to 31 December 2005. Retrospective analysis of a multicentre registry using Cox regression for time-dependent variables. We analysed 1609 episodes of peritonitis in 716 patients (47.2%). In the univariate analysis, each case of peritonitis treated in the outpatient unit was associated with an increase in mortality (hazard ratio [HR] 1.99, P<.001), which was greater for episodes that required hospitalisation (HR 3.62, P<.001). Mortality increased with each successive episode in the same patient. Multivariate analysis confirmed the association of each case of peritonitis with lower long-term survival (HR 2.01, P<.001), with a different risk for episodes due to gram-positive and gram-negative bacteria and fungi (HR 1.73, 2.43 and 5.71, respectively; P<.001). Other variables associated with mortality were age, low residual renal function, absence of vascular access and comorbidity. Peritonitis was the only independent variable associated with technique failure (HR 1.29, P<.001), with a different risk for episodes due to gram-positive and gram-negative bacteria and fungi (HR 1.73, 2.43 and 5.71, respectively; P<.001). Episodes of peritonitis negatively influence long-term survival of patients on PD.