Abstract
As the global burden of chronic kidney disease continues to increase, so does the need for a cost-effective renal replacement therapy. Peritoneal dialysis (PD) offers several advantages in end-stage renal disease but infectious peritonitis (IP) remains one of the most serious and life threatening complications of PD. The purpose of this study is to assess the prevalence and to evaluate the impact of peritonitis on patient mortality and technique survival with respect to duration of follow-up. We conducted a twenty seven years retrospective study from 1990 till december 2017 in the nephrology department, Fattouma Bourguiba University Hospital (Monastir, Tunisia). The rate of peritonitis, the causative organisms as well as the patient's outcome after its occurrence have been analyzed. We used the Cox regression model to assess whether peritonitis has a negative impact on mortality. The 476 episodes of IP were identified in 206 patients. The mean age of our patients was 45.8.1±16.8 years [11–86] (male to female: sex ratio M/F=2.43). The peritonitis rate (months × patients/peritonitis) was 17.6 (0.68 episode per year). Time to occurrence of peritonitis from the start of peritoneal exchange was 14.53±14 months. Gram-positive cocci (GC+) were involved in 54.7% of microbiologically proven IP cases presented mostly by Staphylococcus aureus. Gram-negative bacilli (GB-) ranked second (37.7%) represented mainly by Pseudomonas. The peritonitis was the main influencing factor on the technique survival causing ultrafiltration failure (p=0.02). The median survival of the DP technique was 68 months (95%, CI [47, 90]). After adjusting for confounders, peritonitis was independently associated with 95% increased risk of all-cause mortality and near 4-fold increased risk of infection-related mortality (hazard ratio, 4.98; 95% confidence interval: 2.47–8.86). Further analyses showed that peritonitis strongly influenced mortality in patients dialysed within the first 2 years. Peritonitis was independently associated with higher risk of all-cause and infection-related mortality in peritoneal dialysis patients, and its impact on technique survival was determinate. Despite the gradual decrease of its rate over periods, peritonitis remains frequent in our center and calls for optimization of means of prevention.
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