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. 2017 Jun 5;18(1):186.
doi: 10.1186/s12882-017-0588-4.

The impact of peritoneal dialysis-related peritonitis on mortality in peritoneal dialysis patients

Hongjian Ye  1   2   3 , Qian Zhou  1   2   3   4 , Li Fan  1   2   3 , Qunying Guo  1   2   3 , Haiping Mao  1   2   3 , Fengxian Huang  1   2   3 , Xueqing Yu  1   2   3 , Xiao Yang  5   6   7
Affiliations

The impact of peritoneal dialysis-related peritonitis on mortality in peritoneal dialysis patients

Hongjian Ye et al. BMC Nephrol. .

Abstract

Background: Results concerning the association between peritoneal dialysis-related peritonitis and mortality in peritoneal dialysis patients are inconclusive, with one potential reason being that the time-dependent effect of peritonitis has rarely been considered in previous studies. This study aimed to evaluate whether peritonitis has a negative impact on mortality in a large cohort of peritoneal dialysis patients. We also assessed the changing impact of peritonitis on patient mortality with respect to duration of follow-up.

Methods: This retrospective cohort study included incident patients who started peritoneal dialysis from 1 January 2006 to 31 December 2011. Episodes of peritonitis were recorded at the time of onset, and peritonitis was parameterized as a time-dependent variable for analysis. We used the Cox regression model to assess whether peritonitis has a negative impact on mortality.

Results: A total of 1321 patients were included. The mean age was 48.1 ± 15.3 years, 41.3% were female, and 23.5% with diabetes mellitus. The median (interquartile) follow-up time was 34 (21-48) months. After adjusting for confounders, peritonitis was independently associated with 95% increased risk of all-cause mortality (hazard ratio, 1.95; 95% confidence interval: 1.46-2.60), 90% increased risk of cardiovascular mortality (hazard ratio, 1.90; 95% confidence interval: 1.28-2.81) and near 4-fold increased risk of infection-related mortality (hazard ratio, 4.94; 95% confidence interval: 2.47-9.86). Further analyses showed that peritonitis was not significantly associated with mortality within 2 years of peritoneal dialysis initiation, but strongly influenced mortality in patients dialysed longer than 2 years.

Conclusions: Peritonitis was independently associated with higher risk of all-cause, cardiovascular and infection-related mortality in peritoneal dialysis patients, and its impact on mortality was more significant in patients with longer peritoneal dialysis duration.

Keywords: Mortality; Peritoneal dialysis; Peritonitis; Time-dependent variable.

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Figures

Fig. 1
Fig. 1
Flow chart for the study participants enrollment and outcomes. Abbreviations: CVD, cardiovascular disease; PD, peritoneal dialysis
Fig. 2
Fig. 2
The proportion of patients experienced peritonitis events in different duration of peritoneal dialysis
Fig. 3
Fig. 3
Cumulative risk of experiencing peritonitis events and all-cause mortality in all patients, estimated by Kaplan-meier survival analysis
Fig. 4
Fig. 4
The crude hazard ratios (a) and adjusted hazard ratios (b) of peritonitis for all-cause and infection-related mortality over the follow-up times. Note: Adjusted hazard ratio for peritonitis event was adjusted for age, sex, diabetes, history of CVD, 24-h urine output, hemoglobin, serum phosphorus, and serum albumin in the multivariable COX regression models
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