Abstract
BackgroundPeritonitis has been independently associated with increased morbidity and mortality in peritoneal dialysis patients. However, there are few reports on peritonitis in hemodialysis patients. We aim at investigating both the risk profiles and prognostic impact of peritonitis in hemodialysis patients.MethodsThis nation-wide longitudinal study uses claims data obtained from the Taiwan National Health Insurance Research Database. A total of 80,733 incident hemodialysis patients of age ≥ 20 years without a history of peritonitis were identified between January 1, 1998 and December 31, 2009. Predictors of peritonitis events were estimated using Cox proportional hazard models. Time-dependent Cox proportional hazard models were used to estimate hazard ratio for mortality attributed to peritonitis exposure.ResultsOf 80,733 incident hemodialysis patients over a 13-year study period, peritonitis was diagnosed in 935 (1.16%), yielding an incidence rate of 2.91 per 1000 person-years. Female gender, liver cirrhosis and polycystic kidney disease were three of the most significant factors for peritonitis in both non-diabetic and diabetic hemodialysis patients. The cumulative survival rate of patients with peritonitis was 38.8% at 1 year and 10.1% at 5 years. A time-dependent Cox multivariate analysis showed that peritonitis had significantly increased hazard ratio for all cause mortality. Additionally, the risk of mortality remained significantly higher for non-diabetic hemodialysis patients that experienced peritonitis.ConclusionsThe risk of peritonitis in hemodialysis patients is higher in female gender, liver cirrhosis and polycystic kidney disease. Although peritonitis is a rare condition, it is associated with significantly poorer outcome in hemodialysis patients.
Highlights
The rapidly expanding global population of dialysis patients represents an important public health challenge in Taiwan, but all around the world [1,2,3,4]
Peritonitis in hemodialysis and related regulations of National Health Insurance Administration and NHRI (National Health Research Institutes), and an agreement must be signed by the applicant and his/her supervisor upon application submission
The risk of peritonitis in hemodialysis patients is higher in female gender, liver cirrhosis and polycystic kidney disease
Summary
The rapidly expanding global population of dialysis patients represents an important public health challenge in Taiwan, but all around the world [1,2,3,4]. At the end of 2013, there were over 70,000 patients living with end-stage renal disease (ESRD) and treated with either hemodialysis (HD) or peritoneal dialysis (PD) in Taiwan [5]. Recent published data from the international comparisons of the United States Renal Data System (USRDS) revealed that Taiwan continues to report the highest prevalence (3,138 per million population) of treated ESRD [2]. Individuals with ESRD have an increased risk of mortality and hospitalization [6]. Infections are the second most likely cause of hospitalization and mortality in dialysis patients [2, 6]. Peritonitis has been independently associated with increased morbidity and mortality in peritoneal dialysis patients. There are few reports on peritonitis in hemodialysis patients. We aim at investigating both the risk profiles and prognostic impact of peritonitis in hemodialysis patients
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