Risk Factors for Peritonitis in Patients With Systemic Lupus Erythematosus Undergoing Peritoneal Dialysis

Limited evidence exists regarding medication regimens for infection-prone patients with systemic lupus erythematosus (SLE) undergoing peritoneal dialysis (PD). This study evaluated the association between medication use and peritonitis in patients with SLE on PD and compared peritonitis rates between patients with and without SLE.

We retrospectively studied patients who underwent PD between 2007 and 2023. Using propensity score matching, we compared 46 patients with SLE and 46 non-SLE controls matched by sex, date of PD initiation, diabetes mellitus, and age at PD initiation. Peritonitis incidence and risk ratios were calculated using Poisson regression. Time-dependent Cox proportional hazards model identified risk factors for peritonitis.

Incidence of peritonitis was higher in patients with SLE at 0.32 episodes per patient-year compared with 0.25 in the controls (risk ratio 1.30, p = 0.15). Time to first peritonitis episode, peritonitis-associated catheter removal, and mortality rates were similar between the groups. Independent risk factors for peritonitis included male sex (hazard ratio [HR]: 2.29, 95% confidence interval [CI]: 1.22-4.27, p = 0.009), gastric acid suppressants (GAS, HR: 8.71, 95% CI: 2.53-30.05, p < 0.001), and glucocorticoid (GC, HR: 1.16, 95% CI: 1.08-1.26, p < 0.001) in patients with SLE on PD. A significant number of peritonitis was still observed in patients not receiving GC.

PD is a safe dialysis modality for patients with SLE, with comparable outcomes to non-SLE controls. Nevertheless, the risk of peritonitis in patients with SLE undergoing PD may be increased by the administration of GAS and GC, as well as male sex.