Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Perit Dial Int. 2011 Jul-Aug;31(4):440-9. doi: 10.3747/pdi.2009.00224. Epub 2010 Jul 29.
Infection is a major cause of morbidity and mortality in the dialysis population. This study compares the rates of infection-related hospitalization (IRH) in incident chronic dialysis patients initiating outpatient peritoneal dialysis (PD) and hemodialysis (HD).
This was a retrospective cohort study at the dialysis program of a tertiary-care center in Toronto, Canada. Incident chronic dialysis patients that were eligible for both PD and HD and started outpatient dialysis between 1 January 2004 and 31 August 2008 were included. Dialysis modality was assigned at the start of outpatient dialysis treatment. All hospital admissions were reviewed and incidence of IRH was compared between PD and HD using Poisson regression.
Of 264 incident chronic dialysis patients, 168 (64%) were eligible for both treatment modalities: 71 (42%) started outpatient PD and 97 (58%) started outpatient HD. The unadjusted and adjusted incidence rate ratios (IRR) of IRH did not differ significantly between PD and HD: 1.23 [95% confidence interval (CI) 0.65-2.32, p=0.37] and 1.14 (95% CI 0.58-2.23, p=0.71) respectively. There was no difference between PD and HD in the risk of access loss (28% vs 35%, p=0.73), modality change (22% vs 0%, p=0.10), or death (17% vs 6%, p=0.60) following hospitalization for infection. Patients starting outpatient treatment on PD versus HD were more likely to be hospitalized for peritonitis (IRR 3.20, 95% CI 1.16-9.09; p=0.029) and there was a trend for fewer hospitalizations for bacteremia (IRR 0.19, 95% CI 0.028-1.30; p=0.091). The risk of IRH did not differ between PD and HD in the subgroup of patients that received adequate predialysis care (IRR 1.16, 95% CI 0.59-2.27; p=0.67) or when patients starting outpatient HD with a central venous catheter were excluded (IRR 1.52, 95% CI 0.53-4.37; p=0.44).
Patients that initiate outpatient peritoneal dialysis do not have a significantly increased risk of infection-related hospitalization compared to those that initiate outpatient hemodialysis.
感染是透析人群发病和死亡的主要原因。本研究比较了开始门诊腹膜透析（PD）和血液透析（HD）的慢性透析患者中与感染相关的住院（IRH）的发生率。
这是在加拿大多伦多一家三级护理中心的透析项目中进行的回顾性队列研究。符合 PD 和 HD 条件且 2004 年 1 月 1 日至 2008 年 8 月 31 日开始门诊透析的慢性透析患者均纳入研究。在开始门诊透析治疗时，分配透析方式。对所有住院治疗进行审查，并使用泊松回归比较 PD 和 HD 之间的 IRH 发生率。
在 264 名新诊断的慢性透析患者中，有 168 名（64%）适合两种治疗方式：71 名（42%）开始门诊 PD，97 名（58%）开始门诊 HD。PD 和 HD 之间的未调整和调整后的 IRH 发生率比值（IRR）无显著差异：1.23[95%置信区间（CI）0.65-2.32，p=0.37]和 1.14（95%CI 0.58-2.23，p=0.71）。PD 和 HD 之间在因感染住院后的通路损失（28%vs35%，p=0.73）、方式改变（22%vs0%，p=0.10）或死亡（17%vs6%，p=0.60）方面无差异。与开始门诊 HD 治疗的患者相比，开始门诊 PD 治疗的患者更有可能因腹膜炎（IRR 3.20，95%CI 1.16-9.09；p=0.029）而住院，且因菌血症（IRR 0.19，95%CI 0.028-1.30；p=0.091）而住院的趋势较低。在接受充分透析前护理的患者亚组中（IRR 1.16，95%CI 0.59-2.27；p=0.67）或排除开始门诊 HD 时伴有中央静脉导管的患者（IRR 1.52，95%CI 0.53-4.37；p=0.44）时，PD 和 HD 之间的 IRH 风险无差异。
与开始门诊血液透析的患者相比，开始门诊腹膜透析的患者发生与感染相关的住院治疗的风险并未显著增加。
