Risk Factors And Outcomes Of Peritoneal Dialysis-associated Bacterial Peritonitis In Different Peritoneal Dialysis Centers

Background The risk factors of peritonitis were reported in domestic and foreign studies,most of which were single center studies.The incidence of peritonitis,the positive rate of bacterial culture,the cure rate of peritonitis and the mortality rate of peritonitis were very different.Objective In this study,we collected data from provincial and county peritoneal dialysis centers to explore the differences between the two centers,and to further explore the risk factors and prognosis of recurrent peritonitis.Methods The clinical data of patients with PD related bacterial peritonitis from January 2006 to September 2016 in two peritoneal dialysis centers of the First Affiliated Hospital of Zhejiang University and Dongyang Hospital of Traditional Chinese Medicine were retrospectively analyzed and followed up until December 2016.Patients were divided into two groups according to the peritoneal dialysis centers,provincial peritoneal dialysis center group(the First Affiliated Hospital of Zhejiang University)and county peritoneal dialysis center group(Dongyang Hospital of Traditional Chinese Medicine).Patients were divided into two groups according to the frequency of peritonitis,single episode group and multiple episodes group(with twice and above episodes of peritonitis).Logistic regression was used to analyze the risk factors for outcomes.Patients with bacterial peritonitis,according to the presence or absence of withdrawal from peritoneal dialysis,patients were divided into no withdrawal group(continue to peritoneal dialysis patients)and withdrawal group(transfer to hemodialysis or death patients).Logistic regression analysis was used to analyze the risk factors of peritonitis patients withdrawing from peritoneal dialysis.Results 1.Six hundred and sixty-four patients had PD related bacterial peritonitis,including five hundred and fifty-nine patients in provincial peritoneal dialysis center group,one hundred and five patients in county peritoneal dialysis center group.Patients with peritoneal dialysis at the provincial peritoneal dialysis center have a high cure rate of peritonitis(?2=4.404,P=0.036),a low direct death of peritonitis rate(?2=19.110,P<0.001),a low rate of conversion to hemodialysis(?2=3.901,P=0.048),high rate of missed visits(?2=14.925,P<0.001).The survival was better in provincial peritoneal dialysis center group than that in county peritoneal dialysis center group(?2=10.14,P=0.001).There was no significant difference in the technical survival rate between the two groups(?2=1.005,P=0.316).2.There were 339 patients in single episode group and 220 patients in multiple episodes group.Logistic analysis showed low serum albumin level(OR=0.847,95%CI 0.744?0.975,P=0.003)and malnutrition at baseline(OR=0.576,95%CI 0.420?0.790,P=0.001)were independent risk factors for multiple episodes.The technical survival was better in single episode group than that in multiple episodes group(?2=14.35,P<0.001).There was no significant difference in the survival rate between the two groups(?2=2.312,P=0.128).3.Follow-up to death,conversion to hemodialysis,or until the end of observation in December 2016,296 cases were not withdrawn from the group and 368 cases were withdrawn from the group.The results of logistic regression analysis showed that peritonitis occurred more frequently(OR =1.746,95%CI 1.236?2.469,P=0.002),the age of onset of peritonitis was later(OR ¨1.113,95%CI 1.032?1.200,P=0.005),which were the independent risk factors for patients to withdraw from peritoneal dialysis.High level of serum albumin was the independent protective factor(OR=0.952,95%CI 0.921?0.985,P=0.004).Conclusions Provincial peritoneal dialysis center patients with peritoneal dialysis-related bacterial peritonitis cure rate is higher,peritonitis mortality rate is lower,the rate of hemodialysis is lower.The survival rate of patients in provincial peritoneal dialysis centers was better than that of county peritoneal dialysis patients.Low serum albumin level and malnutrition at baseline were independent risk factors for patients with multiple peritonitis episodes.The independent risk factors for patients to withdraw from peritoneal dialysis were more peritonitis,late onset of peritoneal dialysis,and lower serum albumin level.