Higher incidence of peritonitis in native Canadians on continuous ambulatory peritoneal dialysis

Abstract

Objective: To determine if the rate of peritoneal dialysis (PD)-related infections in our large Native population was higher than in non-Natives.

Design: Prospective study of PD-related infections, 1987 to 1993.

Patients: Forty-eight Natives and 136 non-Natives were studied. Comparisons of infection rates were made as well as determinations of the effect of diabetes and of dialysis techniques on infection rate.

Results: The chance of remaining free of peritonitis was far lower at 6 and 12 months in Natives versus non-Natives, 40% versus 76% at 6 months, and 24% versus 54% at 12 months (p < 0.01). Having diabetes or adding intraperitoneal insulin did not confer additional risk of peritonitis. The Y-line reduced the risk of peritonitis in non-Natives only. Exit-site infection (ESI) was significantly higher in Natives versus non-Natives, 0.42 versus 0.19 episodes per patient year (p < 0.01) mainly due to Staph. aureus. However, less than 30% of episodes of peritonitis were due to that organism. Staph. epidermidis peritonitis episodes were not more common in Native patients, whereas infections due to most other organisms were.

Conclusion: The susceptibility to both peritonitis and exit-site infection is increased in Native Canadians compared to non-Natives. The nonprotective effect of the Y-line combined with increased peritonitis due to most organisms except Staph. epidermidis in Natives suggests that host factors could be important in these patients.