Bunnag Sakarn, Thanakitcharu Prasert, Krairittichai Udom, Jirajan Boonthum, Meenune Wanniya, Kanjanapanth Chuleekorn
Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
J Med Assoc Thai. 2011 Sep;94 Suppl 4:S37-43.
Continuous ambulatory peritoneal dialysis (CAPD) is a renal replacement therapy for end stage renal disease (ESRD) patients. Peritoneal infection, peritonitis is a major cause of death and technical failure in ESRD patients receiving CAPD treatment. Previous studies demonstrated that lower serum albumin, higher body mass index, and diabetic kidney disease were associated with increase in incidence of peritonitis. However the demographics of the patients in the Rajavithi hospital such as race, gender, age, socioeconomic status and various other factors were different from the patients in the previous studies. The present study was conducted to investigate the risk factors of peritonitis, causative organisms, and route of infection among CAPD patients in Rajavithi Hospital.
This is a retrospective descriptive study. All patients in the present study are ESRD patients who received CAPD treatment during March 2009 to February 2011 and adhered with the treatment for at least 1 year. The patients were divided into two groups 1) the patients who got infectious peritonitis within 1 year after catheter implantation and 2) the patients who did not get or got infectious peritonitis after 1 years. The medical records were reviewed and the data were analyzed to identify the risk factors of peritonitis, frequency of causative organisms, and the route of infection.
Of 27 patients, 16 patients (59.3%) had peritonitis within the first year, and 11 patients (40.7%) had no peritonitis or had peritonitis after the first year. The risk factors associated with peritonitis were diabetes (62.5 % in patients with peritonitis within first year vs. 18.2% in the patients who had no peritonitis or had peritonitis after the first year, p = 0.047) and higher blood sugar level (139.5 +/- 34.6 mg/dl in patients with peritonitis within first year vs. 115.9 +/- 23.4 mg/dl 18.2% in the patients who had no peritonitis or had peritonitis after the first year, p = 0.011). Transluminal peritoneal catheter route was the route of infection in every subject in the present study. The major causative agents were gram-positive bacteria.
Diabetic kidney disease and high fasting blood sugar were the risk factors of peritonitis and trans-luminal peritoneal catheter are the major route of infection in the present study. Therefore, good blood sugar control and strict adherence with sterile technique for peritoneal dialysis would decrease the incidence of peritonitis in CAPD patients.
持续性非卧床腹膜透析（CAPD）是终末期肾病（ESRD）患者的一种肾脏替代治疗方法。腹膜感染，即腹膜炎，是接受CAPD治疗的ESRD患者死亡和技术失败的主要原因。先前的研究表明，血清白蛋白水平较低、体重指数较高以及糖尿病肾病与腹膜炎发病率增加有关。然而，拉贾维提医院患者的人口统计学特征，如种族、性别、年龄、社会经济地位和其他各种因素，与先前研究中的患者不同。本研究旨在调查拉贾维提医院CAPD患者腹膜炎的危险因素、致病微生物及感染途径。
这是一项回顾性描述性研究。本研究中的所有患者均为2009年3月至2011年2月期间接受CAPD治疗且坚持治疗至少1年的ESRD患者。患者分为两组：1）导管植入后1年内发生感染性腹膜炎的患者；2）1年后未发生或发生感染性腹膜炎的患者。查阅病历并分析数据，以确定腹膜炎的危险因素、致病微生物的频率及感染途径。
27例患者中，16例（59.3%）在第一年发生腹膜炎，11例（40.7%）在第一年未发生或发生了腹膜炎。与腹膜炎相关的危险因素为糖尿病（第一年发生腹膜炎的患者中占62.5%，而第一年未发生或发生腹膜炎的患者中占18.2%，p = 0.047）和血糖水平较高（第一年发生腹膜炎的患者血糖水平为139.5±34.6mg/dl，而第一年未发生或发生腹膜炎的患者中为115.9±23.4mg/dl，p = 0.011）。经腔腹膜导管途径是本研究中每个患者的感染途径。主要病原体为革兰氏阳性菌。
在本研究中，糖尿病肾病和空腹血糖高是腹膜炎的危险因素，经腔腹膜导管是主要感染途径。因此，良好的血糖控制和严格遵守腹膜透析无菌技术可降低CAPD患者腹膜炎的发生率。
