Risk factors for subsequent recurrent, relapsing, and repeat peritonitis in peritoneal dialysis

Peritoneal dialysis (PD)-associated peritonitis may be followed by recurrent, relapsing, or repeat episodes, but factors associated with these subsequent phenotypes remain incompletely defined.

We conducted a 16-year episode-based study of PD-associated peritonitis. Episodes after which PD was not continued were excluded, and outcomes were defined by the next peritonitis episode. The broader outcome was subsequent recurrent/relapsing/repeat peritonitis, and the narrower outcome was subsequent relapsing/repeat peritonitis. Patient-level and PD prescription-related factors were evaluated for the broader outcome, whereas acute microbiology, antibiotic-management, and severity factors were evaluated for the narrower outcome using logistic generalized estimating equation models. Cross-outcome analyses evaluated both predictor domains against both outcomes.

Among 385 PD-associated peritonitis episodes from 216 patients, 275 episodes from 152 patients were included. Subsequent recurrent/relapsing/repeat peritonitis occurred after 63 episodes. Male sex was associated with lower odds of this outcome, whereas diabetes mellitus, current recurrent/relapsing/repeat phenotype, fewer automated PD treatment days, and greater manual exchange burden were associated with higher odds. However, the two prescription measures were strongly inversely correlated, and neither remained significant when mutually adjusted. Subsequent relapsing/repeat peritonitis occurred after 57 episodes. Ineffective initial antibiotic therapy and delayed adequate antibiotic therapy were associated with higher odds. Organism group and acute severity markers were not significantly associated with this outcome after adjustment. Cross-outcome analyses were broadly compatible with the main findings.

Patient vulnerability, recent episode history, PD prescription-related patterns, and antibiotic-management factors were associated with subsequent peritonitis phenotypes among patients who continued PD. These findings may inform post-peritonitis risk assessment.