Clinical Characteristics And Treatment Outcomes Of Relapsing,Recurrent And Repeat Peritoneal Dialysis Associated Peritonitis:A Multicenter Study

Objective:To review clinical data of multicenter patients with Peritoneal Dialysis Associated Peritonitis(PDAP)in Jilin Province,and to compare clinical characteristics and treatment outcomes of relapsing,recurrent and repeat PDAP with common PDAP,in order to provide theoretical basis for clinical treatment of different types of PDAP.Method:This study retrospectively collected clinical data of all PDAP patients admitted from January 2013 to December 2019 at The Second Hospital of Jilin University,Second Department of the First Hospital of Jilin University,Jilin Central Hospital,and Jilin Province FAW General Hospital,according to the type of PDAP,it is divided into four groups: relapsing group(first relapsing peritonitis),recurrent group(first recurrent peritonitis),repeat group(first repeat peritonitis),and control group(first peritonitis without relapse or recurrence or repeat).Analyzing general data,laboratory indicators,exudate pathogens,treatment outcomes,and the effects of PDAP types on outcomes in four groups of patients,to summarize clinical features and treatment prognosis of relapsing,recurrent and repeat peritonitis.Results:1.Research subjects: The ratio of relapsing,recurrent and repeat PDAP to the total number of PDAP cases is significantly lower than that of 10-25 years ago;542 patients with PDAP are enrolled,including 43 cases in relapsing group,32 cases in recurrent group,27 cases in repeat group and 440 cases in control group.2.Baseline data: There is no statistical difference in gender,age,primary disease,combined disease,disease severity score,with diarrhea or constipation and laboratory indicators compared with any two groups(P’ >0.05);the dialysis age of repeat group is higher than that of control group(P’<0.05).(P’ represents the level of significance between groups)3.Exudate pathogenic bacteria: The ratios of Gram-positive bacteria cultured in repeat group is higher than that in control group(P’<0.05),and the rate of fungus cultured in recurrent group is higher than that in control group(P’<0.05).(P’ represents the level of significance between groups)4.Treatment evaluation: The initial treatment effectiveness rate of recurrent group is lower than that of control group and relapsing group(P’<0.05);the cure rate of relapsing group is lower than of control group(P’<0.05),and the relapse rate is higher than of control group(P’<0.05),the catheter removal rate of recurrent group is higher than of control group(P’<0.05),there is no statistical difference in peritonitis-related mortality among four groups of patients(P>0.05).(P and P’ represent the level of significance for overall and between groups,respectively)5.Logistic regression analysis: Recurrence is an independent risk factor for patient’s current PDAP catheter removal(P<0.05),however,neither relapse nor repeat is an independent risk factor for patient’s current PDAP catheter removal(P>0.05);the type of PDAP is not an independent risk factor for peritonitis-related death in patients(P>0.05).6.Outcome events and survival analysis: The maintenance peritoneal dialysis rate of relapsing group is lower than that of control group and repeat group(P’<0.05),the technical failure rate of relapsing group and recurrent group are higher than that of control group(P’<0.05),there is no significant difference in all-cause mortality among four groups of patients(P>0.05).The median survival time of technical failure in relapsing group and recurrent group are shorter than that in control group(P’<0.05);there is no statistical difference in the median survival time of death among four groups of patients(P> 0.05);the median survival time of the composite endpoint in recurrent group is shorter than that in control group(P’<0.05).(P and P’ represent the level of significance for overall and between groups,respectively)7.Cox regression analysis: Relapse and recurrence are not only independent risk factors for technical failure(HR=2.587,95%CI: 1.525-4.389;HR=3.571,95%CI: 2.022-6.306;P<0.001),but also independent risk factors for the composite endpoint(HR=1.565,95%CI: 1.045-2.344;HR=2.004,95%CI: 1.269-3.164;P<0.05);PDAP type is not an independent risk factor for all-cause death in patients(P>0.05).Conclusion:1.The ratio of relapsing,recurrent and repeat PDAP to the total number of PDAP cases are decreased significantly compared with 10-25 years ago.2.The cure rate of relapsing group is lower than that of control group,and the relapse rate is higher than that of control group,the catheter removal rate of recurrent group is higher than that of control group,there are no significant difference in peritonitis-related mortality among four groups of patients.3.Recurrence is an independent risk factor for patient’s current PDAP catheter removal;PDAP type is not an independent risk factor for peritonitis-related death in patients.4.The rate of maintenance peritoneal dialysis in relapsing group is shorter than that in control group and repeat group;the rate of technical failure in relapsing and recurrent group are higher than that in control group;there is no significant differences in all-cause mortality among four groups of patients.5.Relapse and recurrence are independent risk factors for technical failure and composite endpoint;PDAP type is not an independent risk factor for all-cause death in patients.