Early-onset Peritonitis Research Articles

Poorer clinical outcomes of early-onset peritonitis in elderly peritoneal dialysis patients: A longitudinal and multicenter study.

Early-onset peritonitis (EOP) is a risk factor for mortality in peritoneal dialysis (PD) patients. This study investigates the clinical features and outcomes of EOP in elderly patients. This multicenter retrospective study evaluated 433 elderly PD patients with end-stage renal disease. The cohort was divided into nonperitonitis group (n=239), EOP group (≤12 months, n=109) and late-onset peritonitis (LOP) group (>12 months, n=85). Clinical data, treatment results, and outcomes were compared between the groups. Compared with LOP group, there were no significant intergroup differences in the rate of primary recovery, complete cure, relapse, catheter removal, or death from PDAP (p >0.05) in the most recent PDAP episode. However, Kaplan-Meier analysis showed that patients in the EOP group were likely to have multiple episodes of PD-associated peritonitis (PDAP), technique failure, all-cause death, and composite endpoint in the long-term prognostic outcomes (p <0.001). EOP is significantly associated with poorer clinical outcomes in older PD patients.

Influence of Early-Onset Peritonitis on Mortality and Clinical Outcomes in ESRD Patients with Diabetes Mellitus on Peritoneal Dialysis: A Retrospective Multicenter Study

Introduction: The impact of early-onset peritonitis (EOP) on patients with diabetes undergoing peritoneal dialysis (PD) has not been adequately addressed. We therefore sought to investigate the effects of EOP on the therapeutic response to management and long-term prognostic outcomes in patients with diabetes undergoing PD. Methods: For this retrospective cohort study, we analyzed the data for patients with end-stage renal disease, who were also suffering from diabetes mellitus and had undergone PD between January 1, 2013, and December 31, 2018. EOP was defined as the first episode of peritoneal dialysis-related peritonitis (PDAP) occurring within 12 months of PD initiation. All patients were divided into an EOP group and a later-onset peritonitis (LOP) group. Clinical data, treatment results, and outcomes were compared between groups. Results: Ultimately, 202 patients were enrolled for the analysis. Compared to the EOP group, the LOP group had more Streptococcus (p = 0.033) and Pseudomonas (p = 0.048). Patients with diabetes in the EOP group were less likely to have PDAP-related death (OR 0.13, CI: 0.02–0.82, p = 0.030). Patients with diabetes in the EOP group were more likely to have multiple episodes of PDAP and had higher rates of technical failure and poorer patient survival than those in the LOP group, as indicated by Kaplan-Meier analysis (p = 0.019, p = 0.004, and p < 0.001). In the multivariate Cox proportional hazards model, EOP was a significant predictor for multiple PDAP (HR 4.20, CI: 1.48–11.96, p = 0.007), technical failure (HR 6.37, CI: 2.21–18.38, p = 0.001), and poorer patient survival (HR 3.09, CI: 1.45–6.58, p = 0.003). Conclusions: The occurrence of EOP is significantly associated with lower rates of PDAP-related death and poorer clinical outcomes in patients with diabetes undergoing PD.

Baseline serum triglyceride predicts early-onset peritonitis and prognosis in incident CAPD patients.

We aimed to investigate the hypothesis that serum triglyceride (TG) may be an independent predictor of early-onset peritonitis and prognosis in incident continuous ambulatory peritoneal dialysis (CAPD) patients.In this retrospective, observational study, we screened 291 adults admitted to the PD center of the Wuhan No. 1 hospital from August 1, 2013 to November 31, 2017. All biochemical data were collected at the first 1 to 3 months after the initiation of CAPD. Early-onset peritonitis was defined as peritonitis occurring within 6 months after the initiation of PD. All of PD patients were followed up to July 31, 2018. The primary endpoint was the incidence of early-onset peritonitis while the second endpoints included overall mortality and technical failure.A total of 38 patients occurred early-onset PD peritonitis and the Lasso logistic regression selected TG and age in the final model for early-onset peritonitis. We divided patients into two groups based on the median baseline TG levels: TG ≥ 1.4mmo/L group (n = 143) and TG < 1.4mmol/L group (n = 148). There were 34 (11.7%) patients died and 33 (11.3%) patients transferred to hemodialysis during the follow-up, Moreover, a level of TG ≥ 1.4mmol/L at the initiation of CAPD was associated with a significantly increased probability of technical failure (hazard ratio, HR, 1.30; 95% confidence interval, 95% CI, 1.09 to 2.19, P = .043) and overall mortality (HR, 2.33; 95% CI, 1.16–4.72, P = .018).Serum TG levels measured at the initiation of PD therapy is an independent predictor of early-onset peritonitis and prognosis of CAPD patients.

Derivation and validation of a risk score predicting risk of early-onset peritonitis among patients initializing peritoneal dialysis: A cohort study

ObjectivesEarly onset peritonitis (EOP) increases the risk of clinical complications in patients initializing peritoneal dialysis (PD). This study aimed to develop and validate a risk prediction model for EOP among patients initializing PD. Methods3772 patients registered with the Henan Peritoneal Dialysis Registry (HPDR) between 2007 and 2015 were included. The main outcome, EOP, was defined as incident peritonitis occurring within 6 months of the initialization of PD. Multivariable logistic regression modeling was applied to derive the risk score. All accessible clinical measurements were screened as potential predictors. Assessment of the developed model in terms of model discrimination and calibration was performed using C statistics and a calibration slope, respectively, and validated internally through a bootstrapping (1000-fold) method to adjust for over-fitting. ResultsThe absolute risk of EOP was 14.5%. Age, cardiac function measurements, serum electrolyte test items, lipid profiles, liver function test items, blood urea nitrogen, and white cell count were significant predictors of EOP in the final risk score. Good model discrimination, with C statistics above 0.70, and calibration of agreed observed and predicted risks were identified in the model. ConclusionA prediction model that quantifies risks of EOP has been developed and validated. It is based on a small number of clinical metabolic measurements that are available for patients initializing PD in many developing countries, and could serve as a tool to screen the population at high risk of EOP.

Analysis of risk factors and outcome in peritoneal dialysis patients with early-onset peritonitis: a multicentre, retrospective cohort study

ObjectivesTo investigate the risk factors associated with early-onset peritonitis (EOP) and their influence on patients’ technique survival and mortality.Study designRetrospective, cohort study.SettingThree peritoneal dialysis (PD) units in Shanghai.ParticipantsPD patients from...

Risk factors for early onset peritonitis: the SCOPE collaborative.

Peritoneal dialysis (PD) is the preferred chronic dialysis modality amongst pediatric patients. Peritonitis is a devastating complication of PD. Adult data demonstrates early onset peritonitis (EP) is associated with higher rates of subsequent peritonitis and technique failure. Limited data exists regarding EP in the pediatric population, here defined as peritonitis occurring within 60days of catheter insertion. PD catheter insertion practices and EP episodes were examined from the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) collaborative database. There were 98 episodes of EP amongst 1106 PD catheters inserted. Multivariable analysis demonstrated a significant association between early use of the PD catheter and EP (P =0.001). Age less than 1year at the time of catheter insertion (P < 0.001), first catheter placed (P < 0.001) for the patient, use of a plastic adapter (P = 0.003), placement of sutures at the exit site (ES) (P = 0.032), and dressing change prior to 7days post-operatively (P < 0.001) were all significantly associated with early PD catheter use. Concurrent placement of a hemodialysis catheter was associated with a decreased risk for early PD catheter use (P = 0.010). In this large cohort of pediatric PD recipients, 8.4% of PD catheters were associated with the development of EP. The finding of an association between early use of the PD catheter and EP represents a potentially modifiable risk factor to reduce infection rates within this patient population.

EARLY PERITONITIS AND ITS OUTCOME IN INCIDENT PERITONEAL DIALYSIS PATIENTS.

Early-onset peritonitis is a serious complication of peritoneal dialysis (PD) and is associated with heightened risks of technique failure and death. The risk factors for early peritonitis and its outcomes are unknown. This registry study examined all incident Australian PD patients between 2003 and 2014. The primary outcome was early peritonitis, defined as onset within 12 months of starting therapy. Secondary outcomes were medical cure, relapse/recurrence, catheter removal, peritonitis-associated technique failure, and peritonitis-associated death. Of 9,845 patients, 2,615 experienced 3,827 early-peritonitis episodes (0.50 episodes per patient-year). Early peritonitis was more common in patients who were male, obese, had a history of cigarette smoking or cerebrovascular disease, used continuous ambulatory PD, and had received prior renal replacement therapy for > 90 days. Remoteness was a risk modifier for the association between race and early peritonitis; remote Aboriginal, Torres Strait Islander, Maori and Pacific Islander patients had the highest risk. Obese patients were more likely to achieve medical cure. Older patients were less likely to achieve cure and more likely to experience peritonitis-associated death. In summary, several factors predicted early peritonitis in incident PD patients. Modified approaches to patient selection, training techniques, and prevention strategies should be considered in high-risk individuals.

Risk Factors and Outcomes of Early-Onset Peritonitis in Chinese Peritoneal Dialysis Patients

Background/Aims: Studies on the risk factors and outcomes of peritonitis within the first 6 months in peritoneal dialysis patients are sparse. This study aims to investigate the risk factors associated with early-onset peritonitis (EOP) and its influence on patients’ technique survival and mortality. Methods: This is a retrospective observational cohort study. A total of 483 patients who had at least one episode of peritonitis were enrolled and followed from March 1, 2002, to August 31, 2016, at our center. According to the time to first peritonitis, we divided patients into two groups: EOP (≤ 6 months, n=167) and late-onset peritonitis (LOP, >6 months, n=316). Logistic regression was used to analyze the factors associated with EOP. A Cox proportional hazards model was constructed to examine the influence of EOP on clinical outcomes. Results: Of the 483 patients, 167 (34.6%) patients developed their first episode of peritonitis within the first 6 months. The EOP patient group had more male patients, a shorter time on peritoneal dialysis (PD), lower serum albumin levels at the time of PD initiation and a higher peritonitis rate (P<0.05). The EOP patient group had fewer infections with Gram-negative organisms (P=0.013) and more culture-negative peritonitis (P=0.014) than the LOP patient group for the first episode of peritonitis. The multivariate logistic regression analysis showed that factors associated with EOP included male gender (odds ratio (OR) 1.920, 95% confidence interval (CI) 1.272-2.897, P=0.002) and a low serum albumin level at the start of PD (OR 0.950, 95% CI 0.914-0.986, P=0.007). In the Cox proportional hazards model, EOP was a significant predictor of all-cause mortality (hazard ratio (HR) 2.766, 95% CI 1.561-4.900, P<0.001). There were no differences between EOP and LOP for technique failure. However, in continuous analyses, a negative correlation was observed between the time to first peritonitis and technique failure (HR 0.988, 95% CI 0.980-0.997, P=0.006). In the Spearman analysis, the time to first peritonitis was negatively correlated with the peritonitis rate (r=-0.573, P<0.001). Conclusion: Male gender and a low serum albumin level before PD were strongly associated with EOP. Additionally, EOP patients had a higher risk of poor clinical outcomes. More importantly, an early peritonitis onset was associated with a high peritonitis rate.

Early Onset Peritoneal Dialysis-Related Peritonitis

Peritonitis is a serious and common complication of peritoneal dialysis (PD), representing the commonest cause of technique failure and a not infrequent cause of patient death. Early onset peritonitis, variously defined in the literature as peritonitis occurring within the first 3-20 months of PD, is increasingly being recognised as a discrete and important clinical problem with appreciably heightened risks of technique failure and death. The aim of this review is to provide a comprehensive up to date summary of current evidence surrounding early onset peritonitis and to discuss how to better manage the condition, including suggestions for future research directions.

Impact of early-onset peritonitis on mortality and technique survival in peritoneal dialysis patients.

BackgroundEarly onset peritonitis (EOP) is not uncommon in peritoneal dialysis patients. We aimed to compare the prognosis of EOP and non-EOP peritoneal dialysis patients.MethodsThis study included subjects that underwent PD from January 1, 2004 to July 31, 2013. Patient characteristics were collected. EOP was defined as peritonitis occurring within 6 months after initiation of PD. Patient and technique survival were compared between EOP and non-EOP patients using Cox regression analyses.ResultsIn total, 189 subjects were included in this study. Patients were divided into EOP (n = 55) and non-EOP groups (n = 134). There was no significant difference in the causative organisms of peritonitis between the two groups. After adjusting for age, diabetes status, serum albumin level and residual renal function, the multivariable Cox regression model revealed that EOP was an independent risk factor for patient mortality (HR 2.03, RI 1.09–3.80, p = 0.026), technique failure (HR 1.69, RI 1.12–2.87, p = 0.015) and total survival (HR 1.73, RI 1.12–2.68, p = 0.013).ConclusionsEOP was identified as an independent risk factor for mortality and technique failure in peritoneal dialysis patients.

Péritonite infectieuse sur cathéter de dialyse péritonéale chez l’enfant

BackgroundPeritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children. MethodsIn this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis. ResultsPeritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis. ConclusionConsidering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice.

Clinical Characteristics and Risk Factors Associated with Early-onset Peritonitis Among Patients On Peritoneal Dialysis

Clinical Characteristics and Risk Factors Associated with Early-onset Peritonitis Among Patients On Peritoneal Dialysis