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Effect of duration of chronic peritoneal dialysis therapy on the development of peritonitis
L Troidle1, N Gorban-Brennan, A S Kliger
1New Haven CPD, Renal Research Institute, Connecticut 06405, USA.
Objective:
Long-term chronic peritoneal dialysis (CPD) therapy has been associated with alterations in peritoneal membrane structure and peritoneal macrophage function. We thus reviewed our experience with the development of peritonitis among patients maintained on CPD therapy for various time periods to determine if the spectrum of organisms, rates of peritonitis, and outcome changed with the duration of CPD therapy.
Setting And Patients:
Patients maintained on CPD therapy in our out-patient unit in New Haven, Connecticut.
Design:
Retrospective review of the charts of patients maintained on CPD therapy (HomeChoice Cycler or Ultrabag, Baxter, McGaw Park, IL, U.S.A.) between 1 January 1997 and 31 March 1998. These patients were divided into three groups: group 1, patients maintained on CPD therapy < or = 12 months; group 2, patients maintained on CPD therapy for 13-36 months; and group 3, patients maintained on CPD therapy for > or = 37 months.
Results:
The study included 256 patients: 101 patients in group 1, 110 patients in group 2, and 45 patients in group 3. All groups of patients were similar in age. There were significantly fewer Caucasians and fewer males in group 3 in comparison to groups 1 and 2. The incidence of diabetes mellitus, coronary artery disease, and peripheral vascular disease was significantly lower among patients in group 3 in comparison to groups 1 and 2. There were 155 episodes of peritonitis during the study period for an overall rate of 1 episode in 18.7 patient-months. The overall, gram-positive, and gram-negative rates of peritonitis were not significantly different among the patients in groups 1, 2, and 3. There were more episodes of Staphylococcus aureus peritonitis among patients in group 3 in comparison to group 2 (1 episode in 59.6 vs 1 episode in 280.2 patient-months, respectively). Two weeks after the development of peritonitis, 94.6% of the patients in group 3 continued CPD therapy, while 79.4% of the patients in group 1 continued CPD therapy (p < 0.05). No patient in group 3 transferred to hemodialysis, while 10.3% and 8.2% of the patients in groups 1 and 2 transferred to hemodialysis (p < 0.05). The death rate 2 weeks after the onset of peritonitis was 10.3%, 9.8%, and 5.4% in groups 1, 2, and 3, respectively (p = NS).
Conclusions:
Despite the immunological and morphological changes that occur in the peritoneal cavity with increased time on CPD therapy, there was no difference in the overall, gram-positive, or gram-negative rates of peritonitis for patients maintained on CPD therapy for various time periods. Patients in group 3 continued CPD therapy more often than did patients in group 1. Patients in group 3 transferred to hemodialysis less often than did the remaining patients in the study period. The incidence of death was not significantly different for the three groups of patients.
Insights
Long-term chronic peritoneal dialysis (CPD) therapy did not alter peritonitis rates or outcomes. Patients on CPD for over 37 months continued therapy more often and transferred to hemodialysis less frequently than shorter-term patients.
Area of Science:
- Nephrology
- Internal Medicine
- Peritoneal Dialysis
Background:
- Chronic peritoneal dialysis (CPD) may alter peritoneal membrane structure and macrophage function over time.
- Understanding the impact of CPD duration on peritonitis is crucial for patient management.
Purpose of the Study:
- To investigate if the duration of CPD therapy affects peritonitis rates, causative organisms, and patient outcomes.
- To compare peritonitis incidence and outcomes across different CPD treatment durations.
Main Methods:
- Retrospective chart review of 256 patients on CPD, categorized into three groups based on therapy duration (<12 months, 13-36 months, >37 months).
- Analysis of peritonitis episodes, organism spectrum, and patient outcomes including therapy continuation and transfer to hemodialysis.
Main Results:
- No significant differences in overall, gram-positive, or gram-negative peritonitis rates were observed across CPD duration groups.
- Patients on CPD for >37 months were more likely to continue CPD therapy and less likely to transfer to hemodialysis post-peritonitis compared to shorter-term patients.
- Staphylococcus aureus peritonitis was more frequent in the longest-term CPD group.
Conclusions:
- CPD duration does not significantly impact peritonitis rates or common causative organisms.
- Longer-term CPD patients demonstrate better outcomes regarding therapy continuation and reduced hemodialysis transfer after peritonitis.
- The study suggests that prolonged CPD therapy is safe and effective, even with potential immunological changes.