Incidence and risk factors of peritoneal dialysis-related peritonitis in elderly patients: A retrospective clinical study.

BACKGROUND

This study was to analyze the incidence, risk factors, and clinical outcomes of peritonitis in elderly continuous ambulatory peritoneal dialysis (CAPD) patients.

METHODS

Incident patients undergone CAPD from 1 January 2006 to 30 June 2015 in our center were enrolled and divided into aged < 65 years and ≥ 65 years groups. Risk factors were evaluated using a logistic regression model, and outcome comparison was evaluated using a Cox proportional model.

RESULTS

Among 1953 patients, 111(33.2%) in elderly ( = 334) and 470 (29.0%) in younger ( = 1619) developed at least one episode of peritonitis. Comparing with younger patients, elderly ones had a higher peritonitis rate (0.203 vs. 0.145 episodes/patient-year,  < 0.05). The multivariate Cox regression showed that advanced age (hazard ratio (HR) = 1.06, 95% confidence interval (CI) = 1.01-1.11,  = 0.015), assistant-assisted peritoneal dialysis (PD; HR = 2.64, 95% CI = 1.23-5.64,  = 0.012), higher body mass index (BMI; HR = 1.11, 95% CI = 1.02-1.20,  = 0.010), and low serum albumin level (HR = 0.94, 95% CI = 0.90-0.98,  = 0.004) were associated with increased peritonitis risk in elderly patients. Compared with younger ones with peritonitis, elderly patients had an approximately fourfold increased risk of peritonitis-related mortality (odd ratio (OR) = 3.57, 95% CI = 1.38-9.28,  = 0.009). During the cohort, peritonitis was the risk factor associated with technique failure (HR = 3.19, 95% CI = 2.33-4.39,  < 0.001) in younger patient but not in the elderly population (HR = 1.82, 95% CI = 0.84-3.94,  = 0.132).

CONCLUSIONS

Elderly PD patients had higher prevalence for peritonitis and peritonitis-related mortality. Advanced age, assistant-assisted PD, a higher BMI, and lower serum albumin level were independently associated with the first episode of peritonitis in elderly patients. However, peritonitis was not the predictor of death-censored technique failure in elderly ones.