Risk Factors for The First Episode of Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients in Pranangklao Hospital

2021 ◽  
Vol 104 (12) ◽  
pp. 1966-1970
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Laboratory Data ◽  
First Episode ◽  
Coagulase Negative Staphylococcus ◽  
Technical Failure ◽  
The Mean ◽  
Stage Renal Disease

Background: Continuous ambulatory peritoneal dialysis (CAPD) is a renal replacement therapy for end stage renal disease patients. Peritonitis is a common complication in CAPD patients leading cause of technical failure and patient mortality. Investigating the risk for the first episode of peritonitis could help to prevent and improve CAPD outcomes. Objective: To investigate the risk factors for the first episode of peritonitis in CAPD patients in Pranangklao Hospital. Materials and Methods: A single-center, retrospective descriptive study was conducted to evaluate patients undergoing peritoneal dialysis (PD). All incident CAPD patients between October 1, 2011 and March 1, 2021 were recruited. Baseline demographic, and clinical and laboratory data were collected from medical records. Results: In a cumulative 10,916.9 patient-months follow-up of the 411 CAPD patients, 227 were male and 184 were female. One hundred eightyeight (45.7%) patients presented the first episode of peritonitis. The mean age of peritonitis free group and first peritonitis group was 58.2 years and 56.7 years, respectively. The mean duration from starting CAPD to the first episode of peritonitis was 19.4 months. The average peritonitis rate was 0.26 episodes per year, or one episode per 46.84 patient-months. There were no significant differences in clinical characteristics and laboratory data between these two groups, except there were more diabetes mellitus in the infectious peritonitis group at 72.6% versus 62.8% (p=0.03). Coagulase-negative Staphylococcus was the most common organism causing peritonitis. The multivariate logistic regression showed that diabetes mellitus (OR 1.59, 95% CI 1.03 to 2.46, p=0.04) was the risk factors associated with peritonitis. Conclusion: Diabetes mellitus was the risk factor associated with the first episode of peritonitis. Therefore, special supervision should be provided to this group of patients by optimally controlling the diabetic conditions. Keywords: Continuous ambulatory peritoneal dialysis; First peritonitis episode; Risk factors

scholarly journals Risk Factors for the First Episode of Peritonitis in Southern Chinese Continuous Ambulatory Peritoneal Dialysis Patients

PLoS ONE ◽  
2014 ◽  
Vol 9 (9) ◽  
pp. e107485 ◽  
Author(s):  
Xiaoguang Fan ◽  
Rong Huang ◽  
Juan Wang ◽  
Hongjian Ye ◽  
Qunying Guo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
First Episode ◽  
Dialysis Patients ◽  
Southern Chinese

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

2021 ◽  
pp. 1-8
Author(s):  
Qiaoyan Guo ◽  
Yangyang Chen ◽  
Liming Yang ◽  
Xueyan Zhu ◽  
Xiaoxuan Zhang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Early Onset ◽  
Patient Survival ◽  
Cox Proportional Hazards Model ◽  
First Episode ◽  
Technical Failure ◽  
Patients With Diabetes ◽  
The Impact

<b><i>Introduction:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> Ultimately, 202 patients were enrolled for the analysis. Compared to the EOP group, the LOP group had more <i>Streptococcus</i> (<i>p</i> = 0.033) and <i>Pseudomonas</i> (<i>p</i> = 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, <i>p</i> = 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 (<i>p</i> = 0.019, <i>p</i> = 0.004, and <i>p</i> &#x3c; 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, <i>p</i> = 0.007), technical failure (HR 6.37, CI: 2.21–18.38, <i>p</i> = 0.001), and poorer patient survival (HR 3.09, CI: 1.45–6.58, <i>p</i> = 0.003). <b><i>Conclusions:</i></b> The occurrence of EOP is significantly associated with lower rates of PDAP-related death and poorer clinical outcomes in patients with diabetes undergoing PD.

Comparison of Peritonitis Rates during Long Term Use of Standard Spike versus Ultraset in Continuous Ambulatory Peritoneal Dialysis (CAPD)

1990 ◽  
Vol 10 (1) ◽  
pp. 41-43 ◽  
Author(s):  
John M. Burkart ◽  
Britta Hylander ◽  
Theresa Durnell-Figel ◽  
Denise Roberts
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
First Episode ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
The Impact

Continuous ambulatory peritoneal dialysis (CAPD) is an increasingly popular means of end-stage renal disease replacement therapy. Unfortunately, peritonitis continues to be a major source of both morbidity and mortality. The Ultraset incorporates a “flush-before-fill” concept which should theoretically decrease peritonitis rates when compared to the standard spike procedure, while allowing patients the convenience of disconnect. To investigate the impact of long-term use of the Ultraset on peritonitis rates, we conducted the following study. We prospectively compared 21 new CAPD patients using the standard spike to 20 new CAPD patients using the Ultraset. Peritonitis episodes, episodes of exit -site infection, and the association of peritonitis with exit-site infection were monitored. Peritonitis rates were 7.57 months/episode for the group using the standard spike vs. 27.79 months/episode in the group using the Ultraset. Exit-site infection rates were 22.21 months/infection with the standard spike vs. 37.05 months/infection with the Ultraset. Using Kaplan-Meier plots, there was a statistically significant difference in the estimated time to the first episode of peritonitis, but there was no statistically significant difference regarding the risk of exit-site infections.

Peritonitis during Continuous Ambulatory Peritoneal Dialysis (CAPD): Risk Factors, Clinical Severity, and Pathogenetic Aspects

1988 ◽  
Vol 8 (4) ◽  
pp. 253-263 ◽  
Author(s):  
Anders Tranæus ◽  
Olof Heimbürger ◽  
Bengt Lindholm
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Patient Characteristics ◽  
Observation Time ◽  
Clinical Severity ◽  
First Episode ◽  
First Year ◽  
Total Observation Time ◽  
Total Observation

This study of 228 episodes of peritonitis occurring during a total observation time of 2365 treatment months over a six-year period in a uniformly selected, trained, and treated continuous ambulatory peritoneal dialysis (CAPD) population (N = 124) showed the following major findings: 1) the risk of developing peritonitis was 55% within the first year and 89% within the first three years on CAPD; 2) high age (≥60 years) and year of CAPD start were risk factors for peritonitis; 3) neither sex, diabetes, or hypoalbuminemia were found to be risk factors for peritonitis; 4) the year of start, but neither the degree of severity, nor the time of the first episode affected the risk of developing a second episode of peritonitis; 5) no specific characteristics were identified in patients with the highest mean peritonitis incidence or in the patients without peritonitis; 6) in 27% of all episodes, turbidity of the dialysate was the only clinical finding; 7) the proportion of asymptomatic episodes was lower in patients ≥ 60 years; 8) the degree of clinical severity of peritonitis was not statistically influenced by the number of previous episodes; 9) the cause of peritonitis was established in only 26% of all cases; and 10) no statistical association was found between the cause of peritonitis and patient characteristics.

Risk Factors for Hyperaluminemia in Continuous Ambulatory Peritoneal Dialysis

1986 ◽  
Vol 6 (4) ◽  
pp. 188-191 ◽  
Author(s):  
Robert A. Mactier ◽  
Karl D. Nolph ◽  
Ramesh Khanna ◽  
Zbylut Twardowski
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Aluminum Toxicity ◽  
Elevated Serum ◽  
Phosphate Binders ◽  
Untreated Water ◽  
Stage Renal Disease ◽  
End Stage

The authors evaluated risk factors for hyperaluminemia and aluminum toxicity in 51 CAPD patients, who received aluminum-containing phosphate binders. Serum aluminum correlated with total intake of elemental aluminum after starting CAPD (p = 0.001), with aluminum intake in the previous six months (p = 0.001), with duration of CAPD (p = 0.003), and with serum phosphate (p = 0.05). Eight patients had elevated serum aluminum, but only one had clincial evidence of aluminum toxicity (he had been on hemodialysis with untreated water until he was changed to CAPD 30 months before the study). Although the incidence of clinical aluminum toxicity appears to be low, we conclude that the aluminum intake from aluminum-containing phosphate binders is a major factor in the evolution of hyperaluminemia and, potentially, aluminum toxicity in CAPD patients. We believe that alternative effective, phosphate binders are much needed. It has been shown that tissue accumulation of aluminum in brain, bone and blood in uremic patients causes encephalopathy (I. 2), osteomalacia (3, 4), and anemia (5, 6). Clinically aluminum toxicity has been observed mainly in hemodialysis patients (1–6), although it has been reported in few cases before dialysis (7–9) and in those on continuous ambulatory peritoneal dialysis (10. II). The major cause of aluminum toxicity during hemodialysis has been transfer of aluminum from untreated water in the dialysate (1–5); this mechanism has tended to obscure the contribution of other factors, such as diet and drugs. Peritoneal dialysate contains a low concentration of aluminum (less than 15 μg/L) and there is a net removal of aluminum in the dialysate in those with serum aluminum levels within the reference range for dialysed uremics (11–13). Serial aluminum levels in CAPD patients not receiving aluminum -containing phosphate binders (ACPB) showed no significant change during a two-year follow-up (12, 14); this suggests that aluminum removal in the dialysate compensates for the failure of the kidney to excrete absorbed dietary aluminum in end-stage renal disease. Since the combination of CAPD and diet appears to have minimal influence on serum aluminum, this study was done to identify those factors which determine serum aluminum levels in CAPD patients, receiving aluminum-containing phosphate binders.

scholarly journals MO699PERITONITIS RISK OF PD MODALITIES AND TECHNICAL SURVIVAL ACCORDING TO BASELINE PERITONEAL TRANSPORT STATUS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Hasan Haci Yeter ◽  
Omer Faruk Akcay ◽  
Galip Güz
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Peritoneal Dialysis ◽  
Survival Rates ◽  
Significant Risk ◽  
Technical Failure ◽  
Peritoneal Transport ◽  
The Mean ◽  
The Impact

Abstract Background and Aims The PD modality is usually modulated according to the PET and dialysis adequacy during follow-up but, initial modality choice generally depends on patient preferences and lifestyle regardless of patients’ baseline transport status. However, the relationship between baseline transport status, the PD modality chosen, and technical survival is not well established. Peritonitis is one of the leading causes of technical failure, hospitalization, and death in PD. While obesity, low albumin levels, exit-site infections, and nasal staphylococcus carriage are well-defined risk factors for peritonitis, some suggest CAPD could be another risk factor due to increased daily connection to PD. Many studies indicated that CAPD and APD have similar technical survival rates. In this study, we aimed to identify the impact of the baseline transport status on technical survival of CAPD and APD. We also investigated peritonitis risk of modalities considering all defined risk factors. Method This is a retrospective, single-center, cohort study of incident adult PD patients followed-up between January 2010 and January 2020. One hundred and thirty-six patients, followed-up for at least three years, were included. Patients with malignancy and who had less than 1.7 Kt/V per week were excluded. Peritonitis is defined according to the "International Society Peritoneal Dialysis" guideline. According to the baseline PET, patients were divided into two groups as follows; 1) high or high average transporters and 2) low or low average transporters. Risk factors for peritonitis, five years, and overall technical survival of both modalities according to baseline transport status were determined. Results The mean age was 35.5±12 years, and the median follow-up time was 47 (36-178) months. Sixty-six (48%) of the patients were female. Patients' first-year Kt/V per week was 2.18±0.4, and the mean ultrafiltration was 0.9±0.4 liters. 26 (19%) of the patients had diabetes mellitus, 57(42%) patients had hypertension, and 27 (20%) of the patients had a history of hemodialysis of more than three months. 89 (65%) of the patients were performing CAPD, 59 (66%) of whom were low or low-average transporters. 47(35%) of patients were performing APD and 28(60%) of whom were high or high-average transporters. During the follow-up, a total of 71 peritonitis episodes were observed, and the incidence of peritonitis was 0.13 episodes/year. Univariate logistic regression analysis showed that CAPD, low education level (being primary school graduate or illiterate), HD treatment before PD, and bathing less than once per week were associated with peritonitis risk. However, multivariate analysis of associated factors demonstrated that only CAPD was a significant risk factor for peritonitis [odds ratio:2.360 (95% confidence interval:1.075-5.180), p=0.03]. Kaplan-Meier survival analysis showed that low or low-average transporters and high or high-average transporters had similar technical survival rates in both CAPD or APD at the end of three years (figure 1). Similar rates were found in overall survival. Conclusion In our study, APD and CAPD patients had similar technical survival regardless of the peritoneal transport characteristics. However, CAPD was found to be a factor for peritonitis. Thus, it may be appropriate to initiate the PD treatment with APD modality and evaluate patients to switch modalities with PET only in case of peritoneal dialysis inadequacy.

A Risk Analysis of Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis

2005 ◽  
Vol 25 (4) ◽  
pp. 374-379 ◽  
Author(s):  
Kai Ming Chow ◽  
Cheuk Chun Szeto ◽  
Chi Bon Leung ◽  
Bonnie Ching-Ha Kwan ◽  
Man Ching Law ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Confidence Interval ◽  
Serum Albumin ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Hazard Ratio ◽  
Albumin Concentration ◽  
Serum Albumin Concentration ◽  
Increased Risk

Objective We studied the clinical characteristics that influence the risk of dialysis-related peritonitis complication in incident Chinese patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods A single center, retrospective, observational cohort study was carried out to examine the risk factors of developing a first episode of dialysis-related peritonitis. Results Between 1995 and 2004, 246 incident CAPD patients were recruited for analysis. During the study period of 897.1 patient-years, 85 initial episodes of peritonitis were recorded. The median peritonitis-free time for diabetic subjects was significantly worse than for nondiabetic subjects (49.0 ± 10.5 vs 82.3 ± 12.6 months, p = 0.0019). The difference was due mainly to a higher likelihood of developing peritonitis with gram-negative organisms in patients with diabetes mellitus ( p = 0.038). Low serum albumin concentration was also associated with worse peritonitis-free survival. There was a nonsignificant trend toward an increased risk for peritonitis in the group of patients with cerebrovascular disease. According to multivariate Cox proportional hazards model for the analysis of time to first peritonitis episode, the two independent risk factors were presence of diabetes mellitus and initial serum albumin concentration. In particular, diabetes mellitus was associated with a hazard ratio of 1.50 and a 95% confidence interval of 1.05 – 2.40 ( p = 0.030) to develop an initial peritonitis. Lower serum albumin level at the start of CAPD was a significant predictor of peritonitis, with hazard ratio of 1.67 for every decrease of 10 g/L, and 95% confidence interval 1.08 – 2.60 ( p = 0.021). Conclusions Our results confirm the susceptibility of diabetic CAPD and hypoalbuminemic patients to peritonitis, and highlight the role of further studies in reducing this complication.

scholarly journals Patient Survival and Technique Failure in Continuous Ambulatory Peritoneal Dialysis Patients with Prior Stroke

2016 ◽  
Vol 36 (3) ◽  
pp. 308-314 ◽  
Author(s):  
Xianfeng Wu ◽  
Xiao Yang ◽  
Xinhui Liu ◽  
Chunyan Yi ◽  
Qunying Guo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Patient Survival ◽  
First Episode ◽  
Technical Failure ◽  
All Cause Mortality ◽  
Stroke Group ◽  
History Of ◽  
Technique Failure ◽  
Prior Stroke

Background To investigate patient survival and technical failure of patients with prior stroke receiving continuous ambulatory peritoneal dialysis (CAPD) in Southern China. Methods This was a retrospective study. All subjects were recruited from the peritoneal dialysis center in The First Affiliated Hospital of Sun Yat-sen University from 1 January 2006 to 31 December 2010. All eligible patients were assigned to stroke group and non-stroke group according to a history of stroke before receiving CAPD. The primary outcomes were all-cause mortality and death-censored technical failure. Cox regression was used to estimate risk factors of all-cause mortality and death-censored technique failure. Results Of the 1,068 recruited patients, 75 (7.0%) patients had a previous history of stroke. The all-cause mortality and death-censored technique failure were significantly higher in the stroke group compared with the non-stroke group, respectively (odds ratio [OR] 2.67, 95% confidence interval [CI] 1.59 – 4.46 and OR 2.52, 95% CI 1.19 – 5.34). Older age (changed by 10 years, hazard ratio [HR] 1.90, 95% CI 1.07 – 3.38), lower body mass index (BMI 18.5 – 23.9 vs < 18.5 kg/m2 reference, HR 0.17, 95% CI 0.05 – 0.55) and time to the first episode of peritonitis (HR 0.93, 95% CI 0.89 – 0.96) were independently associated with increased risk of all-cause mortality in patients with prior stroke. In addition, time to the first episode of peritonitis was associated with decreased risk of death-censored technique failure (HR 0.91, 95% CI 0.84 – 0.99) in those with prior stroke. Conclusions Continuous ambulatory peritoneal dialysis patients with prior stroke had high rates of all-cause mortality and technique failure compared with those without prior stroke. Older age, lower BMI, and time to the first episode of peritonitis were independent risk factors of all-cause mortality in patients with prior stroke.

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