Nadeau-Fredette Annie-Claire, Johnson David W, Hawley Carmel M, Pascoe Elaine M, Cho Yeoungjee, Clayton Philip A, Borlace Monique, Badve Sunil V, Sud Kamal, Boudville Neil, McDonald Stephen P
Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada.
Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
Perit Dial Int. 2016;36(5):509-18. doi: 10.3747/pdi.2015.00146. Epub 2016 Jan 13.
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Previous studies have reported significant variation in peritonitis rates across dialysis centers. Limited evidence is available to explain this variability. The aim of this study was to assess center-level predictors of peritonitis and their relationship with peritonitis rate variations. ♦
All incident peritoneal dialysis (PD) patients treated in Australia between October 2003 and December 2013 were included. Data were accessed through the Australia and New Zealand Dialysis and Transplant Registry. The primary outcome was peritonitis rate, evaluated in a mixed effects negative binomial regression model. Peritonitis-free survival was assessed as a secondary outcome in a Cox proportional hazards model. ♦
Overall, 8,711 incident PD patients from 51 dialysis centers were included in the study. Center-level predictors of lower peritonitis rates included smaller center size, high proportion of PD, low peritoneal equilibration test use at PD start, and low proportion of hospitalization for peritonitis. In contrast, a low proportion of automated PD exposure, high icodextrin exposure and low or high use of antifungal prophylaxis at the time of peritonitis were associated with a higher peritonitis rate. Similar results were obtained for peritonitis-free survival. Overall, accounting for center-level characteristics appreciably decreased peritonitis variability among dialysis centers (p = 0.02). ♦
This study identified specific center-level characteristics associated with the variation in peritonitis risk. Whether these factors are directly related to peritonitis risk or surrogate markers for other center characteristics is uncertain and should be validated in further studies.
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既往研究报道，各透析中心的腹膜炎发生率存在显著差异。但能解释这种差异的证据有限。本研究旨在评估腹膜炎的中心层面预测因素及其与腹膜炎发生率差异的关系。♦
纳入2003年10月至2013年12月在澳大利亚接受治疗的所有新发病例腹膜透析（PD）患者。数据通过澳大利亚和新西兰透析与移植登记处获取。主要结局为腹膜炎发生率，采用混合效应负二项回归模型进行评估。无腹膜炎生存期作为次要结局，在Cox比例风险模型中进行评估。♦
总体而言，本研究纳入了来自51个透析中心的8711例新发病例PD患者。腹膜炎发生率较低的中心层面预测因素包括中心规模较小、PD比例较高、PD开始时腹膜平衡试验使用率较低以及因腹膜炎住院的比例较低。相比之下，自动腹膜透析暴露比例较低、艾考糊精暴露比例较高以及腹膜炎发生时抗真菌预防用药使用率较低或较高与较高的腹膜炎发生率相关。无腹膜炎生存期也得到了类似结果。总体而言，考虑中心层面特征后，透析中心之间腹膜炎的变异性显著降低（p = 0.02）。♦
本研究确定了与腹膜炎风险差异相关的特定中心层面特征。这些因素是否直接与腹膜炎风险相关，还是其他中心特征的替代标志物尚不确定，应在进一步研究中进行验证。
