Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
Perit Dial Int. 2019 May-Jun;39(3):220-228. doi: 10.3747/pdi.2018.00179. Epub 2019 Mar 6.
Peritoneal dialysis (PD)-associated peritonitis remains by far the most important complication requiring patients to transfer to hemodialysis and has a major impact on patient morbidity and mortality. Current International Society for Peritoneal Dialysis (ISPD) guidelines on peritonitis recommend analysis of peritonitis episodes only in trained patients. In a large tertiary care center, we analyzed peritonitis episodes accounting for different groups of untrained patients and compared these with episodes in the trained patient population.We analyzed data collected prospectively over a 15-year time span regarding differences between peritonitis episodes in trained patients and episodes in untrained patients post-catheter insertion but prior to training completion as well as on in-center intermittent PD with respect to incidence rates, pathogenic organisms, outcome, and peritonitis predictors.In 275 patients, a total of 160 peritonitis episodes in trained patients were counted. A total of 27 additional episodes in untrained patients were recorded. When accounting for these episodes, the peritonitis incidence significantly increased and the percentage of peritonitis-free patients decreased. Peritonitis episodes in untrained patients were most often culture-negative and the pathogen spectrum differed significantly compared with episodes counted as per ISPD recommendations, while outcome of peritonitis episodes did not differ. Predictors of peritonitis after multivariate logistic regression analysis included glomerulonephritis as primary kidney disease, being on home PD rather than being on in-center intermittent PD, and higher dialysis vintage.Depending on local practice patterns, we argue that centers should additionally monitor peritonitis episodes in untrained patients because computation of statistics as per ISPD recommendations could underestimate peritonitis incidence and may depict a distorted pathogen spectrum.
腹膜透析（PD）相关性腹膜炎仍然是最重要的并发症，需要患者转为血液透析，对患者的发病率和死亡率有重大影响。目前国际腹膜透析学会（ISPD）关于腹膜炎的指南建议仅对经过培训的患者进行腹膜炎发作的分析。在一家大型三级保健中心，我们分析了不同未经培训患者群体的腹膜炎发作，并将其与经过培训的患者人群中的发作进行了比较。我们分析了在 15 年时间跨度内前瞻性收集的数据，这些数据涉及导管插入后但在培训完成之前的训练有素的患者和未经培训的患者之间的腹膜炎发作差异，以及中心间歇性 PD 的发病率、病原体、结果和腹膜炎预测因素。在 275 名患者中，共记录了 160 例训练有素患者的腹膜炎发作。还记录了 27 例未经培训患者的附加发作。当计入这些发作时，腹膜炎的发病率显著增加，无腹膜炎患者的百分比下降。未经培训患者的腹膜炎发作最常见为培养阴性，病原体谱与按 ISPD 建议计数的发作明显不同，而腹膜炎发作的结果并无差异。多变量逻辑回归分析后的腹膜炎预测因素包括肾小球肾炎作为原发性肾脏疾病、在家中 PD 而不是在中心间歇性 PD 以及更高的透析龄。根据当地的实践模式，我们认为中心应该额外监测未经培训患者的腹膜炎发作，因为按 ISPD 建议计算统计数据可能会低估腹膜炎的发病率，并可能描绘出扭曲的病原体谱。
