Relationship Between Serum 25(OH)D3 Deficiency And The Risk Of Peritoneal Dialysis Associated Peritonitis

Objective:To investigate the relationship between serum 25(OH)D3 deficiency and the risk of peritoneal dialysis associated peritonitis(PDAP).Methods:Baseline clinical data(before the peritoneal dialysis catheter placemented)of peritoneal dialysis patients treated with continuous ambulatory peritoneal dialysis(CAPD)in The First Affiliated Hospital of Guangxi Medical University from May 1,2013 to February 1,2016 were retrospective analyzed.All the patients were followed-up until July 31,2016.Patients were divided into two groups according to whether suffering peritonitis(patients with peritonitis,group A,patients free of peritonitis,group B).The baseline clinical data before the peritoneal dialysis catheter placemented of peritoneal dialysis patients were compared.According to the baseline serum 25(OH)D3 levels,patients were divided into deficiency group(25(OH)D3<15ng/ml)and non deficiency group(25(OH)D3?15ng/ml),the baseline clinical data of the two groups were also analyzed.Kaplan-Meier method was used to compare the time-to-peritonitis of two groups.COX proportional hazard model was used to analyze the relationship between the 25(OH)D3 deficiency and the risk of peritonitis.ROC curve was used to analyze the predictive value of baseline serum 25(OH)D3 for the risk of PDAP in peritoneal dialysis patients.Results:Compared with the group free of peritonitis,the age,weight and CPR were increased in the group with peritonitis,but the dialysis age,25(OH)D3 were reduced(P<0.05).Compared with the 25(OH)D3 non deficiency group,25(OH)D3 deficiency group had a significant increase incidence of peritonitis,high diastolic blood pressure and mean arterial pressure,but serum albumin,total serum protein decreased significantly(P<0.05).Kaplan-Meier survival analysis showed that,compared with 25(OH)D3 non deficiency group,the time-to-peritonitis episode of patients in 25(OH)D3 deficiency group were shorter(P<0.05).Cox proportional hazard model showed that after adjusting for age,sex,hemoglobin,serum albumin,C-reactive protein,total Kt/V,eGFR,diabetes or not,serum 25(OH)D3 deficiency is the independent risk factor of peritoneal dialysis associated peritonitis(HR 5.247,95%CI 1.180-23.340,P<0.05).ROC curve showed the area under the curve that baseline serum 25(OH)D3 deficiency predict the occurrence of PDAP is 0.714,and the best cut-Off point of baseline serum 25(OH)D3 is 11.35 ng/ml(sensitivity 75%,specificity 63%).Conclusions:Peritoneal dialysis associated peritonitis occurred earlier in peritoneal dialysis patients whose baseline serum 25(OH)D3 levels less than 15ng/ml.Baseline serum 25(OH)D3 deficiency(<15ng/ml)is the independent risk factor of peritoneal dialysis associated peritonitis,which can predict the incidence of peritoneal dialysis associated peritonitis.