| BcakgroudCurrently,peritoneal dialysis(PD)technology has been widely used in the treatment of end-stage renal disease and became one of the major renal replacement therapy of end-stage renal disease(ESRD).Peritonitis has been regarded as the primary and most serious complication of peritoneal dialysis.In the early 1980 s the peritonitis rate was as high as 6.3 episodes/patient-year[1].The continuous ambulatory peritoneal dialysis(CAPD)Registry of the National Institutes of Health’s report in 1986 showed that the rate decreased to 1.07–1.47 episodes/patient-year and in 2004 to 0.4episodes/patient-year[2,3].Although the frequency of peritonitis has decreased over the past decade with the progress of technology,PD peritonitis still accounts for approximately one-third of all technique failures on PD[4],which is still the main reason of leading to increased hospitalization,exit from peritoneal dialysis,functional failure and death.The incidence and risk factors for peritoneal dialysis-related peritonitis vary from country to country,and even from dialysis centers in the same country.Our single-center retrospective study analyzed the risk factors of recurrent PD-related peritonitis,which provided effective theoretical basis for prevention and treatment,thus we could reduce the incidence of PD-related peritonitis and improve the quality of life and survival rate.ObjectiveTo analyze the clinical characteristics of frequent peritoneal dialysis-related peritonitis and to explore its risk factors.MethodsA retrospective study was conducted on 70 patients with ESRD in Anhui Province Hospital undergoing CAPD treatment following PD catheterization from January 2007 to December 2014.The frequent PD-related peritonitis was defined by two or more onsets in one year,and the patients with only one onset served as the control group.The demographic characteristics,clinical and laboratory data of the two groups were compared and the risk factors of frequent PD-related peritonitis were analyzed.ResultsA total of 70 cases of infectious peritonitis occurred,of which 13 cases with peritonitis of 30 cases/times in frequent group,and 57 cases with peritonitis of 57 cases/times in the control group.As compared with those in control group,the patients with frequent peritonitis had higher significantly blood pressure and body mass index(BMI)(P <0.05),but lower hemoglobin and plasma albumin(P < 0.05),with higher intact parathyroid hormone(P < 0.05),total of gram-negative bacteria and fungal infection rates had increased(P<0.05),of which the increasing trend of gram-negative bacteria was more obvious(P<0.05).Moreover,the patients without timely treatment [7cases(53.85%)υs.13cases(22.81%),P<0.05] and adequate anti-infection course [5cases(38.46%)υs.8 cases(14.04%),P<0.05] increased,as well as the invalid extubation rate [5cases(38.46%)υs.7cases(12.28%),P < 0.05].No differences were found between the two group in age,gender,dialysis time,primary disease,education,inducing factors of peritonitis,mortality,residual renal function,blood leukocytes,calcium,phosphorus,C-reactive protein,total cholesterol,triglycerides,leukocyte count of peritoneal fluid for the first time.Logistic regression analysis identified an increased likelihood of frequent PD-related peritonitis with high BMI,severe hypertension,low hemoglobin and low serum albumin.ConclusionThe total proportion of gram-negative bacteria and fungi has increased in frequent PD-related peritonitis.Malnutrition,high body mass index,severe hypertension are risk factors of frequent PD-related peritonitis.Without timely treatment and adequate anti-infection course in the fist time and secondary hyperparathyroidism may also lead to frequent peritonitis.Measures to improve anemia and hypoproteinemia,control blood pressure and maintain standard weight,and timely regular treatment of infectious peritonitis may contribute to the prevention of the disease and improve the prognosis. |
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