Relationship between serum iPTH and peritonitis episodes in patients undergoing continuous ambulatory peritoneal dialysis.

Abstract

Peritonitis is considered as one of the most serious complications that cause hospitalization in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). There is limited evidence on the impact of the parathyroid hormone (PTH) on the first peritoneal dialysis (PD)-associated peritonitis episode. We aimed to investigate the influence of serum intact parathyroid hormone (iPTH) on peritonitis in patients undergoing PD. This was a retrospective cohort study. Patients undergoing initial CAPD from a single center in China were enrolled. The baseline characteristics and clinical information were recorded. The primary outcome of interest was the occurrence of the first PD-associated peritonitis episode. Five Cox proportional hazard models were constructed in each group set. In group set 1, all participants were divided into three subgroups by tertiles of the serum concentration of iPTH; in group set 2, all participants were divided into three subgroups based on the serum concentration of iPTH with 150pg/ml interval (<150, 150-300, and >300pg/ml). Hazard ratios and 95% confidence intervals (CIs) were calculated for each model. The multivariate linear regression analysis elimination procedure assessed the association between the clinical characteristics at baseline and the iPTH levels. Restricted cubic spline models were constructed, and stratified analyses were also conducted. A total of 582 patients undergoing initial PD (40% women; mean age, 45.1±11.5years) from a single center in China were recruited. The median follow-up duration was 25.3months. Multivariate Cox regression analysis showed that, in the fully adjusted model, a higher serum iPTH level (tertile 3, iPTH>300pg/ml) was significantly associated with a higher risk of PD-associated peritonitis at 3years [tertile 3: hazard ratio (HR)=1.53, 95%CI=1.03-2.55, p=0.03; iPTH>300pg/ml: HR=1.57, 95%CI=1.08-2.27, p=0.02]. The hazard ratio for every 100pg/ml increase in serum iPTH level was 1.12 (95%CI=1.05-1.20, p<0.01) in the total cohort when treating iPTH as a continuous variable. An elevated iPTH level was significantly associated with an increased risk of peritonitis in patients undergoing CAPD.