Abstract
Introduction: Peritonitis is the main cause of morbidity and dropout from peritoneal dialysis (PD) program. Objectives: We aimed to determine risk factors predisposing to PD-associated peritonitis. Patients and Methods: As a retrospective cohort research, on 235 PD individuals with 4277 patientmonths of follow up, 170 episodes of peritonitis was reported in 93 patients. Data were extracted from medical records using a template. Standard as well as zero-inflated negative binominal regression was used to model the association between patients’ characteristics and the peritonitis rate. Cox-proportional hazard (PH) adjusted model was used to determine the effect of factors on the peritonitis-free survival. Results: With a mean (SD) body mass index (BMI) of 18.7(3.4) kg/m2, 109 (46.4%) of them were male. With a median (95% CI) follow-up time of 19 (16 to 36) months, the rate of peritonitis was 0.48 episode per patient-year. The most common micro-organism detected was coagulase-negative staphylococci (n=54; 31.7%). The only variable which was associated with a higher rate of peritonitis was BMI (rate ratio [RR]: 1.07; 95% CI 1.01 to 1.14; P value=0.031). Comparing to patients with lower education, patients with higher than elementary school of education had higher peritonitisfree survival (with hazard ratio [HR]=0.51; 95%CI 0.33-0.79, P value=0.003) and higher chance of having no peritonitis [odds ratio (OR):1.97; 95% CI 1.08 to 3.59; P value=0.029]. Conclusion: Peritonitis is still a major concern in PD patients. BMI was a risk factor for higher peritonitis rate. Higher education level was associated with lower peritonitis-free survival and higher chance of having no peritonitis.
Highlights
Peritonitis is the main cause of morbidity and dropout from peritoneal dialysis (PD) program
With a total follow-up time of 4277 patientmonths and after exclusion of relapsing or recurrent peritonitis episodes, defined as the peritonitis occurred within the 4 weeks of completion of previous episode treatment with the same or different organism, the peritonitis rate was one episode per 25.2 patient-months (0.48 episodes per year)
This study showed that lower educational level was associated with earlier occurrence and higher body mass index (BMI) was linked to higher rate of PD associated peritonitis
Summary
Peritonitis is the main cause of morbidity and dropout from peritoneal dialysis (PD) program. Objectives: We aimed to determine risk factors predisposing to PD-associated peritonitis. Cox-proportional hazard (PH) adjusted model was used to determine the effect of factors on the peritonitis-free survival. With a median (95% CI) follow-up time of 19 (16 to 36) months, the rate of peritonitis was 0.48 episode per patient-year. BMI was a risk factor for higher peritonitis rate. It has been reported that PD patients represent around 11% of all dialysis patients worldwide [4], but Despite its advantages, most patients cannot maintain PD for a long-time, as it has some limitations and complications including bleeding, pain, cuff extrusion, catheter-related complications [7], which may cause complications, death, and even switching to HD, or renal transplantation [8]. Several studies have identified some predisposing factors such as age, gender, race, co-existing diseases such as type 2 diabetes mellitus, current smoking, nasal carriage of Staphylococcus aureus, and hypoalbuminemia [10,11,12], recent review studies suggest the need for further studies to determine detailed information of causative micro-organisms, risk factors, and proper intervention [13]
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