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Factors associated with time to first dialysis-associated peritonitis episode: Data from the Peritonitis Prevention
Susanne Ljungman1, Jørgen E Jensen2, Dag Paulsen3
1Department of Nephrology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Insights
Older age, higher body weight, and more daily peritoneal dialysis (PD) bags increase peritonitis risk. Low serum albumin also independently predicts earlier peritonitis episodes in PD patients.
Area of Science:
- Nephrology
- Internal Medicine
- Epidemiology
Background:
- Peritonitis is a serious complication of peritoneal dialysis (PD).
- Identifying risk factors is crucial for reducing peritonitis incidence.
- Understanding factors associated with the time to the first peritonitis episode is important for patient management.
Purpose of the Study:
- To identify factors associated with the time to the first peritonitis episode in incident PD patients.
- To analyze biochemical, clinical, and prescription data in relation to peritonitis risk.
Main Methods:
- Prospective randomized controlled study (Peritonitis Prevention Study - PEPS) involving incident PD patients from 57 European centers (2010-2015).
- Patients were followed for 1-36 months after PD initiation.
- Cox proportional hazard regression models were used to analyze associations between various factors and time to first peritonitis episode.
Main Results:
- 33% of participants experienced a first peritonitis episode.
- Increased number of PD bags per 24 hours was strongly associated with earlier peritonitis.
- Independently associated factors included older age, more PD bags/24h, lower serum albumin (<35 g/L), and higher body weight.
Conclusions:
- Older age, higher body weight, increased PD bag usage, and hypoalbuminemia are independently linked to a shorter time to the first peritonitis episode.
- These findings highlight key risk factors for peritonitis in PD patients.
- This knowledge can inform strategies to prevent peritonitis in PD treatment.
Introduction:
Peritonitis remains a potentially serious complication of peritoneal dialysis (PD) treatment. It is therefore important to identify risk factors in order to reduce the incidence of peritonitis. The aim of the present analysis was to identify factors associated with time to first peritonitis episode.
Methods:
Incident PD patients from 57 centres in Europe participated in the prospective randomised controlled Peritonitis Prevention Study (PEPS) from 2010 to 2015. Peritonitis-free, self-care PD patients ≥18 years were randomised to a retraining or a control group and followed for 1-36 months after PD initiation. The association of biochemical, clinical and prescription data with time to first peritonitis episode was studied.
Results:
A first peritonitis episode was experienced by 33% (223/671) of participants. Univariable Cox proportional hazard regression showed a strong association between the time-updated number of PD bags connected per 24 h (PD bags/24 h) and time to first peritonitis episode (HR 1.35; 95% confidence interval (CI) 1.17-1.57), even after inclusion of PD modalities in the same model. Multivariable Cox regression revealed that the factors independently associated with time to first peritonitis episode included age (HR 1.16 per 10 years; 95% CI 1.05-1.28), PD bags/24 h (HR 1.32; 95% CI 1.13-1.54), serum albumin <35 versus >35 g/L (HR 1.39; 95% CI 1.06-1.82) and body weight per 10 kg (HR 1.10; 95% CI 1.01-1.19).
Conclusion:
This study of incident PD patients indicates that older age, greater number of PD bags connected/24 h, higher body weight and hypoalbuminaemia are independently associated with a shorter time to first peritonitis episode.
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