Centre de recherche Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada.
Clin J Am Soc Nephrol. 2012 Oct;7(10):1598-605. doi: 10.2215/CJN.00440112. Epub 2012 Aug 16.
Peritonitis is a well known complication of peritoneal dialysis (PD), whereas in hemodialysis (HD), bacteremia can be life threatening. Whether patients undergoing PD have higher risk than HD patients for infection-related hospitalizations (IRH) remains unknown.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A propensity score-matched retrospective cohort of patients undergoing long-term dialysis between January 2001 and December 2007 was assembled. Propensity scores were calculated using multivariable (demographic characteristics, smoking, body mass index, comorbid conditions, and laboratory data) logistic regression to estimate probability of receiving PD versus HD. A comparison of IRH risk by dialysis modality was estimated using a counting-process survival model.
A total of 910 pairs of patients were matched by propensity scores. During a median follow-up of 2.1 years (interquartile range, 1.1-3.5 years), 341 patients were hospitalized once for an infection, 123 twice, and 106 at least three times. PD was associated with an increased risk for IRH compared with HD (propensity-matched hazard ratio [HR], 1.52). PD was associated with a reduced risk for septicemia (HR, 0.31) and pneumonia (HR, 0.58) but also an increased risk for dialysis-related infectious hospitalizations (HR, 3.44), defined as all cases of peritonitis and vascular access-related bacteremia, but not all septicemia cases.
PD patients are at higher risk for IRH than are HD patients. This risk is mostly explained by dialysis-related infections. However, further studies are needed to evaluate whether the severity of those hospitalizations is similar and whether this increased risk for IRH is associated with worse outcomes.
腹膜炎是腹膜透析（PD）的已知并发症，而血液透析（HD）中，菌血症可能危及生命。 PD 患者是否比 HD 患者更容易发生感染相关住院治疗（IRH）仍不清楚。
设计、地点、参与者和测量方法： 2001 年 1 月至 2007 年 12 月期间，对接受长期透析的患者进行了倾向评分匹配的回顾性队列研究。使用多变量（人口统计学特征、吸烟、体重指数、合并症和实验室数据）逻辑回归计算倾向评分，以估计接受 PD 与 HD 的概率。使用计数过程生存模型估计透析方式对 IRH 风险的影响。
共匹配了 910 对患者的倾向评分。在中位数为 2.1 年（四分位间距，1.1-3.5 年）的随访期间，有 341 名患者因感染住院一次，123 名患者住院两次，106 名患者住院至少三次。与 HD 相比，PD 与 IRH 风险增加相关（倾向匹配的风险比[HR]，1.52）。 PD 与败血症（HR，0.31）和肺炎（HR，0.58）的风险降低相关，但与透析相关感染住院治疗（HR，3.44）的风险增加相关，定义为所有腹膜炎和血管通路相关菌血症病例，但并非所有败血症病例。
PD 患者的 IRH 风险高于 HD 患者。这种风险主要是由透析相关感染引起的。但是，需要进一步研究来评估这些住院治疗的严重程度是否相似，以及这种 IRH 风险增加是否与较差的预后相关。
