Predictors of peritonitis in peritoneal dialysis: experience during 3 decades

Detalhes bibliográficos
Autor(a) principal: Fiel,David
Data de Publicação: 2020
Outros Autores: Santos,Joana, Vicente,Rita, Santos,Iolanda, Malvar,Beatriz, Silva,Rui, Amoedo,Manuel, Pires,Carlos
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000100003
Resumo: Introduction: Peritonitis is a common complication in peritoneal dialysis patients and a major cause for dropout. Systematic report and frequent trend analysis are thought to be major drivers for improvement in this area. The authors analysed peritonitis outcomes dating back over 20 years in a peritoneal dialysis unit of a central hospital. Methods: Retrospective study from 1993 to 2018: assessment of demographic, clinical and microbiological profiles of patients with peritonitis. We performed univariate and multivariate analysis (multiple logistic regression) to predict peritonitis risk factors, and survival analysis (Cox proportional hazards model) to determine the impact on outcomes (mortality and technique survival). Results: We included 225 patients, average age of 48.3±14.7 years, average time of follow-up of 38±25 months, with a total of 221 episodes of peritonitis (0.31 peritonitis/patient.year), 76% resulting in cure. Most frequent agents were Staphylococci: Coagulase-Negative (23%) and Staphylococcus aureus (19%, of which 24% were methicillin-resistant). Gram-negative infections led to higher rate of catheter removal, transfer to hemodialysis or death (49% of cases vs. 17% in Gram-positive). Primary end-point was death or transfer to hemodialysis, with a median time of 94 (min 4, max 94) and 66 (min 3, max 105) months, respectively. The occurrence of at least one peritonitis was the major variable that influenced transfer to hemodialysis (OR 3.94 [2.12 - 7.58], p < 0.001*], whereas an event in the first year also negatively affected the time to dialysis technique switch (median time 38.7 [26.2 - 58.4] vs. 67.8 [59.5 - 80.3] months, log-rank = 0.02*), but without impact on mortality. Only the peritoneal dialysis modality (OR: automated peritoneal dialysis vs. continuous ambulatory peritoneal dialysis 0.38 [0.19-0.74]) was predictive of peritonitis in multivariate analysis. Conclusions: In this single-center long-term analysis, where the rate of peritonitis was within recommended values, automated peritoneal dialysis seemed to have a protective impact. The number of peritonitis and peritonitis occurrence during the first year worsened technique survival, emphasizing early peritonitis prevention.
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spelling Predictors of peritonitis in peritoneal dialysis: experience during 3 decadesAutomated Peritoneal DialysisContinuous Ambulatory Peritoneal DialysisPeritonitisIntroduction: Peritonitis is a common complication in peritoneal dialysis patients and a major cause for dropout. Systematic report and frequent trend analysis are thought to be major drivers for improvement in this area. The authors analysed peritonitis outcomes dating back over 20 years in a peritoneal dialysis unit of a central hospital. Methods: Retrospective study from 1993 to 2018: assessment of demographic, clinical and microbiological profiles of patients with peritonitis. We performed univariate and multivariate analysis (multiple logistic regression) to predict peritonitis risk factors, and survival analysis (Cox proportional hazards model) to determine the impact on outcomes (mortality and technique survival). Results: We included 225 patients, average age of 48.3±14.7 years, average time of follow-up of 38±25 months, with a total of 221 episodes of peritonitis (0.31 peritonitis/patient.year), 76% resulting in cure. Most frequent agents were Staphylococci: Coagulase-Negative (23%) and Staphylococcus aureus (19%, of which 24% were methicillin-resistant). Gram-negative infections led to higher rate of catheter removal, transfer to hemodialysis or death (49% of cases vs. 17% in Gram-positive). Primary end-point was death or transfer to hemodialysis, with a median time of 94 (min 4, max 94) and 66 (min 3, max 105) months, respectively. The occurrence of at least one peritonitis was the major variable that influenced transfer to hemodialysis (OR 3.94 [2.12 - 7.58], p < 0.001*], whereas an event in the first year also negatively affected the time to dialysis technique switch (median time 38.7 [26.2 - 58.4] vs. 67.8 [59.5 - 80.3] months, log-rank = 0.02*), but without impact on mortality. Only the peritoneal dialysis modality (OR: automated peritoneal dialysis vs. continuous ambulatory peritoneal dialysis 0.38 [0.19-0.74]) was predictive of peritonitis in multivariate analysis. Conclusions: In this single-center long-term analysis, where the rate of peritonitis was within recommended values, automated peritoneal dialysis seemed to have a protective impact. The number of peritonitis and peritonitis occurrence during the first year worsened technique survival, emphasizing early peritonitis prevention.Sociedade Portuguesa de Nefrologia2020-03-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articletext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000100003Portuguese Journal of Nephrology &amp; Hypertension v.34 n.1 2020reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692020000100003Fiel,DavidSantos,JoanaVicente,RitaSantos,IolandaMalvar,BeatrizSilva,RuiAmoedo,ManuelPires,Carlosinfo:eu-repo/semantics/openAccess2024-02-06T17:05:04Zoai:scielo:S0872-01692020000100003Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:19:03.434150Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Predictors of peritonitis in peritoneal dialysis: experience during 3 decades
title Predictors of peritonitis in peritoneal dialysis: experience during 3 decades
spellingShingle Predictors of peritonitis in peritoneal dialysis: experience during 3 decades
Fiel,David
Automated Peritoneal Dialysis
Continuous Ambulatory Peritoneal Dialysis
Peritonitis
title_short Predictors of peritonitis in peritoneal dialysis: experience during 3 decades
title_full Predictors of peritonitis in peritoneal dialysis: experience during 3 decades
title_fullStr Predictors of peritonitis in peritoneal dialysis: experience during 3 decades
title_full_unstemmed Predictors of peritonitis in peritoneal dialysis: experience during 3 decades
title_sort Predictors of peritonitis in peritoneal dialysis: experience during 3 decades
author Fiel,David
author_facet Fiel,David
Santos,Joana
Vicente,Rita
Santos,Iolanda
Malvar,Beatriz
Silva,Rui
Amoedo,Manuel
Pires,Carlos
author_role author
author2 Santos,Joana
Vicente,Rita
Santos,Iolanda
Malvar,Beatriz
Silva,Rui
Amoedo,Manuel
Pires,Carlos
author2_role author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Fiel,David
Santos,Joana
Vicente,Rita
Santos,Iolanda
Malvar,Beatriz
Silva,Rui
Amoedo,Manuel
Pires,Carlos
dc.subject.por.fl_str_mv Automated Peritoneal Dialysis
Continuous Ambulatory Peritoneal Dialysis
Peritonitis
topic Automated Peritoneal Dialysis
Continuous Ambulatory Peritoneal Dialysis
Peritonitis
description Introduction: Peritonitis is a common complication in peritoneal dialysis patients and a major cause for dropout. Systematic report and frequent trend analysis are thought to be major drivers for improvement in this area. The authors analysed peritonitis outcomes dating back over 20 years in a peritoneal dialysis unit of a central hospital. Methods: Retrospective study from 1993 to 2018: assessment of demographic, clinical and microbiological profiles of patients with peritonitis. We performed univariate and multivariate analysis (multiple logistic regression) to predict peritonitis risk factors, and survival analysis (Cox proportional hazards model) to determine the impact on outcomes (mortality and technique survival). Results: We included 225 patients, average age of 48.3±14.7 years, average time of follow-up of 38±25 months, with a total of 221 episodes of peritonitis (0.31 peritonitis/patient.year), 76% resulting in cure. Most frequent agents were Staphylococci: Coagulase-Negative (23%) and Staphylococcus aureus (19%, of which 24% were methicillin-resistant). Gram-negative infections led to higher rate of catheter removal, transfer to hemodialysis or death (49% of cases vs. 17% in Gram-positive). Primary end-point was death or transfer to hemodialysis, with a median time of 94 (min 4, max 94) and 66 (min 3, max 105) months, respectively. The occurrence of at least one peritonitis was the major variable that influenced transfer to hemodialysis (OR 3.94 [2.12 - 7.58], p < 0.001*], whereas an event in the first year also negatively affected the time to dialysis technique switch (median time 38.7 [26.2 - 58.4] vs. 67.8 [59.5 - 80.3] months, log-rank = 0.02*), but without impact on mortality. Only the peritoneal dialysis modality (OR: automated peritoneal dialysis vs. continuous ambulatory peritoneal dialysis 0.38 [0.19-0.74]) was predictive of peritonitis in multivariate analysis. Conclusions: In this single-center long-term analysis, where the rate of peritonitis was within recommended values, automated peritoneal dialysis seemed to have a protective impact. The number of peritonitis and peritonitis occurrence during the first year worsened technique survival, emphasizing early peritonitis prevention.
publishDate 2020
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dc.publisher.none.fl_str_mv Sociedade Portuguesa de Nefrologia
publisher.none.fl_str_mv Sociedade Portuguesa de Nefrologia
dc.source.none.fl_str_mv Portuguese Journal of Nephrology &amp; Hypertension v.34 n.1 2020
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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