Aslam Nabeel, Bernardini Judith, Fried Linda, Burr Renee, Piraino Beth
Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Clin J Am Soc Nephrol. 2006 Nov;1(6):1226-33. doi: 10.2215/CJN.01230406. Epub 2006 Oct 11.
The impact of dialysis modality on infection, especially early in the course of dialysis, has not been well studied. This study compared infection between hemodialysis (HD) and peritoneal dialysis (PD) from the start of dialysis and evaluated factors that have an impact on infection risk. In this observational cohort study, all incident dialysis patients (n = 181; HD 119 and PD 62) at a single center from 1999 to 2005 had data collected prospectively beginning day 1 of dialysis. Excluded were those with any previous ESRD therapy. Infection rates were evaluated using multivariate Poisson regression. Overall infection rates were similar (HD 0.77 versus PD 0.86/yr; P = 0.24). Only HD patients had bacteremia (0.16/yr), and only PD patients had peritonitis (0.24/yr). Bacteremia that occurred < or =90 d after start of HD was 0.44/yr, increased compared with overall rate of 0.16/yr (P < 0.004). HD catheters, used in 67% of patients who started HD, were associated with a strikingly increased rate of bacteremia. Peritonitis < or =90 d was 0.22/yr, no different from the overall rate. Modality was not an independent predictor of overall infections (PD versus HD: relative risk 1.30; 95% confidence interval 0.93 to 1.8; P = 0.12) using multivariate analysis. PD and HD patients had similar infection rates overall, but type of infection and risk over time varied. HD patients had an especially high risk for bacteremia in the first 90 d, whereas the risk for peritonitis for the PD cohort was not different over time. These results support the placement of permanent accesses (fistula or PD catheter) before the start of dialysis to avoid use of HD catheters.
透析方式对感染的影响，尤其是在透析早期，尚未得到充分研究。本研究比较了血液透析（HD）和腹膜透析（PD）从透析开始时的感染情况，并评估了对感染风险有影响的因素。在这项观察性队列研究中，1999年至2005年在单一中心的所有新发病透析患者（n = 181；HD 119例，PD 62例）从透析第1天开始前瞻性收集数据。排除那些曾接受过任何终末期肾病治疗的患者。使用多变量泊松回归评估感染率。总体感染率相似（HD为0.77/年，PD为0.86/年；P = 0.24）。只有HD患者发生菌血症（0.16/年），只有PD患者发生腹膜炎（0.24/年）。HD开始后≤90天发生的菌血症为0.44/年，与总体发生率0.16/年相比有所增加（P < 0.004）。67%开始HD的患者使用的HD导管与菌血症发生率显著增加相关。≤90天的腹膜炎发生率为0.22/年，与总体发生率无差异。使用多变量分析，透析方式不是总体感染的独立预测因素（PD与HD：相对风险1.30；95%置信区间0.93至1.8；P = 0.12）。PD和HD患者总体感染率相似，但感染类型和随时间的风险有所不同。HD患者在最初90天内菌血症风险特别高，而PD队列中腹膜炎风险随时间无差异。这些结果支持在透析开始前放置永久性通路（动静脉内瘘或PD导管）以避免使用HD导管。
