Hu Shouci, Ming Pei, Qureshi Abdul Rashid, Lindholm Bengt, Bo Yang, Yang Hongtao
Division of Nephrology, First Affiliated Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Kidney Blood Press Res. 2018;43(5):1573-1584. doi: 10.1159/000494443. Epub 2018 Oct 22.
BACKGROUND/AIMS: This study investigated peritonitis episodes with regard to time sequence, microbiological variation, factors associated with peritonitis and clinical outcomes in peritoneal dialysis (PD) patients.
This single-center cohort study enrolled all incident patients who met the inclusion criteria at our center from June 1, 2012 to June 30, 2015 and who were followed until June, 2017. Clinical, biochemical characteristics and detailed data on peritonitis episodes, and hospitalizations were recorded.
A total of 218 episodes of peritonitis corresponding to a rate of 0.27 episode per patient-year were recorded. Gram positive bacteria, identified in 115 (52.8%) episodes, were the most common pathogens. The occurrence of enterococcus peritonitis increased from 15.1% of the first to 27.3% of the later episodes. Multivariate logistic regression showed that the presence of cardiovascular disease (CVD, odds ratio [OR] 2.177, 95% confidence interval [95%CI] 1.214-3.903, P=0.009), age≤ 55 (OR 2.282, 95%CI 1.062-4.906, P=0.035), non-independent operator (OR 0.440, 95%CI 0.206-0.938, P=0.034), lower values of potassium (OR=0.671,95%CI 0.472-0.954, P=0.026) and higher values of calcium-phosphate product (OR 1.410, 95%CI 1.065-1.868, P=0.017) were associated with peritonitis. Besides CVD (risk ratio [RR] 2.591, 95%CI 1.893-3.543, P< 0.001) and non-independent operator (RR 0.583, 95%CI 0.439-0.776, P< 0.001), a lower level of education (RR 0.641, 95%CI 0.487-0.842, P=0.001) was associated with higher peritonitis rates in log-linear analysis. Spearman analyses indicated that the time to the 1st episode was negatively related to the peritonitis rate (r=-0.291, P=0.001). Time-dependent Cox regression showed no association between the time to the 1st episode and patient survival (P=0.151). Patients with a high peritonitis rate (HPR) demonstrated worse technique survival (P< 0.001).
The present study has revealed several center-based features and modifiable risk factors for peritonitis. The presence of CVD and the need for assistance with PD operation not only increased the odds of peritonitis but were also associated with more peritonitis episodes. Time to first peritonitis was related to the peritonitis rate but not associated with patient survival. Patients with HPR had worse technique survival.
背景/目的：本研究调查了腹膜透析（PD）患者腹膜炎发作的时间顺序、微生物学变化、与腹膜炎相关的因素及临床结局。
这项单中心队列研究纳入了2012年6月1日至2015年6月30日在本中心符合纳入标准的所有新发病例患者，并随访至2017年6月。记录临床、生化特征以及腹膜炎发作和住院的详细数据。
共记录了218次腹膜炎发作，发生率为0.27次/患者年。在115次（52.8%）发作中鉴定出的革兰氏阳性菌是最常见的病原体。肠球菌性腹膜炎的发生率从首次发作的15.1%增加到后来发作的27.3%。多因素逻辑回归显示，心血管疾病（CVD，比值比[OR]2.177，95%置信区间[95%CI]1.214 - 3.903，P = 0.009）、年龄≤55岁（OR 2.282，95%CI 1.062 - 4.906，P = 0.035）、非独立操作者（OR 0.440，95%CI 0.206 - 0.938，P = 0.034）、较低的血钾值（OR = 0.671，95%CI 0.472 - 0.954，P = 0.026）和较高的钙磷乘积值（OR 1.410，95%CI 1.065 - 1.868，P = 0.017）与腹膜炎相关。除CVD（风险比[RR]2.591，95%CI 1.893 - 3.543，P < 0.001）和非独立操作者（RR 0.583，95%CI 0.439 - 0.776，P < 0.001）外，在对数线性分析中，较低的教育水平（RR 0.641，95%CI 0.487 - 0.842，P = 0.001）与较高的腹膜炎发生率相关。Spearman分析表明，首次发作时间与腹膜炎发生率呈负相关（r = -0.291，P = 0.001）。时间依赖性Cox回归显示首次发作时间与患者生存率之间无关联（P = 0.151）。腹膜炎发生率高（HPR）的患者技术生存率较差（P < 0.001）。
本研究揭示了一些基于中心的腹膜炎特征和可改变的危险因素。CVD的存在以及PD操作需要协助不仅增加了腹膜炎的几率，还与更多的腹膜炎发作相关。首次腹膜炎发作时间与腹膜炎发生率相关，但与患者生存率无关。HPR患者的技术生存率较差。
