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. 2014 Mar-Apr;34(2):171-8.
doi: 10.3747/pdi.2012.00165. Epub 2013 Oct 1.

Predictors of peritonitis, hospital days, and technique survival for peritoneal dialysis patients in a managed care setting

Victoria A Kumar  1 , Margo A Sidell, Wan-Ting Yang, Jason P Jones
Affiliations

Predictors of peritonitis, hospital days, and technique survival for peritoneal dialysis patients in a managed care setting

Victoria A Kumar et al. Perit Dial Int. 2014 Mar-Apr.

Abstract

Introduction: Many clinicians perceive that peritoneal dialysis (PD) should be reserved for younger, healthier, more affluent patients. Our aim was to examine outcomes for PD patients in a managed care setting and to identify predictors of adverse outcomes.

Methods: We identified all patients who initiated PD at our institution between 1 January 2001 and 31 December 2010. Predictor variables studied included age, sex, race, PD modality, cause of end-stage renal disease (ESRD), dialysis vintage, Charlson comorbidity index (CCI) score, education, and income level. Poisson models were used to determine the relative risk (RR) of peritonitis and the number of hospital days per patient-year. The log-rank test was used to compare technique survival by patient strata.

Results: Among the 1378 patients who met the inclusion criteria, only female sex [RR: 0.85; 95% confidence interval (CI): 0.74 to 0.98; p = 0.02] and higher education (RR: 0.77; 95% CI: 0.60 to 0.98; p = 0.04) were associated with peritonitis. For hospital days, dialysis vintage (RR: 1.11; 95% CI: 1.04 to 1.18; p = 0.002), CCI score (RR: 1.06; 95% CI: 1.02 to 1.20; p = 0.002), and cause of ESRD (RR for glomerulonephritis: 0.59; 95% CI: 0.43 to 0.80; p = 0.0006; and RR for hypertension: 0.69; 95% CI: 0.55 to 0.88; p = 0.002) were associated with 1 extra hospital day per patient-year. The 2-year technique survival was 61% for patients who experienced at least 1 episode of peritonitis and 72% for those experiencing no peritonitis (p = 0.0001). Baseline patient age, primary cause of ESRD, and PD modality were the only other variables associated with technique survival in the study.

Conclusions: Neither race nor socio-economic status predicted technique survival or hospital days in our study. Female sex and higher education were the only two variables studied that had an association with peritonitis.

Keywords: CAPD; PD outcome; hospital days; peritonitis; socio-economic status; technique survival.

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Figures

Figure 1 —
Figure 1 —
Technique survival for all study patients (n = 1378), censored for transplantation, death, loss of membership in the Southern California Permanente Medical Group, and renal recovery.
Figure 2 —
Figure 2 —
Technique survival by competing risks. HD = hemodialysis.
Figure 3 —
Figure 3 —
Adjusted peritonitis rate by year. USRDS = US Renal Data System; KP = Southern California Permanente Medical Group; CI = confidence interval.
Figure 4 —
Figure 4 —
Adjusted hospital-day rate by year. USRDS = US Renal Data System; KP = Southern California Permanente Medical Group; CI = confidence interval.
See this image and copyright information in PMC

References

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