Risk factors of peritoneal dialysis–related peritonitis in the Japan Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS)

Background Peritoneal dialysis (PD)-related peritonitis is a major complication of PD. Wide variations in peritonitis prevention, treatment strategies and consequences are seen between countries. These between-country differences may result from modifiable risk factors and clinical practices. Method...

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Veröffentlicht in:Clinical kidney journal 2024-07, Vol.17 (7), p.sfae202
Hauptverfasser: Ito, Yasuhiko, Tu, Charlotte, Yamaguchi, Makoto, Koide, Shigehisa, Ryuzaki, Munekazu, Bieber, Brian, Pisoni, Ronald L, Perl, Jeffrey, Minakuchi, Jun, Kawanishi, Hideki
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Sprache:eng
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Zusammenfassung:Background Peritoneal dialysis (PD)-related peritonitis is a major complication of PD. Wide variations in peritonitis prevention, treatment strategies and consequences are seen between countries. These between-country differences may result from modifiable risk factors and clinical practices. Methods A total of 1225 Japanese PD patients were included and prospectively followed in the Peritoneal Dialysis Outcomes and Practice Patterns Study phase 1 (2014–2018) and phase 2 (2018–2022). Associations between PD-related peritonitis and various risk factors were assessed by Cox proportional hazards survival models. Results During follow-up (median 1.52 years), 539 peritonitis episodes were experienced by 364 patients. The country crude peritonitis rate was 0.27 episodes/patient-year. In the fully adjusted model, noticeable patient-level factors associated with experiencing any peritonitis included age {hazard ratio [HR] 1.07 per 5-year increase [95% confidence interval (CI) 1.01–1.14]}, serum albumin level [HR 0.63 per 1 g/dl higher (95% CI 0.48–0.82)] and continuous ambulatory peritoneal dialysis (PD) [HR 1.31 versus automated PD (95% CI 1.05–1.63)]. The adoption of antibiotic prophylaxis practice at the time of PD catheter insertion [HR 0.63 (95% CI 0.51–0.78)] or when having complicated dental procedures [HR 0.74 (95% CI 0.57–0.95)] or lower endoscopy [HR 0.69 (95% CI 0.54–0.89)] were associated with lower hazards of any peritonitis, while a routine facility practice of having more frequent regular medical visits was associated with a higher hazard. Conclusion Identification of risk factors in Japan may be useful for developing future versions of guidelines and improving clinical practices in Japan. Investigation of country-level risk factors for PD-related peritonitis is useful for developing and implementing local peritonitis prevention and treatment strategies Graphical Abstract Graphical Abstract
ISSN:2048-8505
2048-8513
DOI:10.1093/ckj/sfae202