Surgical Outcome of Peritoneal Dialysis in Elderly Patients

Peritoneal dialysis-related infections in elderly patients

This review outlines the epidemiology, characteristics, risk factors, and prognosis of peritoneal dialysis (PD)-related peritonitis, PD catheter-related infections, and the effects of assisted PD in elderly patients from the Japanese perspective. Based on the literature, the incidence of peritonitis is likely to be higher in elderly patients than in younger patients. The most frequent causative bacteria in elderly patients are Gram-positive bacteria, as in adult PD patients, most commonly due to transcatheter infection. However, elderly patients may have difficulty recognizing cloudy drainage fluid due to decreased visual acuity. Hypokalemia, the use of gastric acid suppressants, prophylactic antibiotic use before endoscopy, biocompatible fluids and hypoalbuminemia considered modifiable risk factors for peritonitis. However, the mechanism by which treatment of hypokalemia prevents peritonitis is unknown. Currently, the relationship between gastric acid suppression therapy and peritonitis in elderly patients is debatable, with no evidence to strongly recommend uniform discontinuation of gastric acid suppression therapy. Exit-site infection (ESI) is a major risk factor for the development of peritonitis, and appropriate prevention and management of ESI may reduce infection-related hospitalizations in PD patients. Currently, no randomized, controlled trials have verified the effectiveness of antibiotic application for ESI in Japan, but results from other countries are awaited. In assisted PD, it is extremely important that family members, caregivers, and nurses who support the procedure receive sufficient education and training from medical professionals familiar with PD. Early detection and treatment of PD-related infections are required because the risk of death increases in elderly patients.

Poorer clinical outcomes of early-onset peritonitis in elderly peritoneal dialysis patients: A longitudinal and multicenter study

INTRODUCTION

Early-onset peritonitis (EOP) is a risk factor for mortality in peritoneal dialysis (PD) patients. This study investigates the clinical features and outcomes of EOP in elderly patients.

METHODS

This multicenter retrospective study evaluated 433 elderly PD patients with end-stage renal disease. The cohort was divided into nonperitonitis group (n = 239), EOP group (≤12 months, n = 109) and late-onset peritonitis (LOP) group (>12 months, n = 85). Clinical data, treatment results, and outcomes were compared between the groups.

RESULTS

Compared with LOP group, there were no significant intergroup differences in the rate of primary recovery, complete cure, relapse, catheter removal, or death from PDAP (p >0.05) in the most recent PDAP episode. However, Kaplan-Meier analysis showed that patients in the EOP group were likely to have multiple episodes of PD-associated peritonitis (PDAP), technique failure, all-cause death, and composite endpoint in the long-term prognostic outcomes (p <0.001).

CONCLUSIONS

EOP is significantly associated with poorer clinical outcomes in older PD patients.

Effects of age and diabetes mellitus on clinical outcomes in patients with peritoneal dialysis-related peritonitis

BACKGROUND

Peritoneal dialysis (PD)-related peritonitis is the most common complication and the leading cause of technique failure for patients on PD therapy. The aim of this study was to review the episodes and outcomes of PD-related peritonitis, with special reference to the effects of age and diabetes status.

METHODS

The study comprised 204 consecutive peritonitis episodes between January 2001 and June 2011 from our registry database. Factors associated with treatment failure and mortality were analyzed with multi-variable logistic regression modeling.

RESULTS

The overall peritonitis rate was one episode per 65 patient-months or 0.187 episodes/patient-year. Older patients had lower probability of remaining free of peritonitis (log rank, p<0.001). Elderly patients and diabetic subjects had a higher risk of peritonitis-related dropout. Age (odds ratio [OR], 1.37; p=0.041), diabetes mellitus (OR, 3.64; p=0.005), and gram-negative peritonitis (OR, 3.55; p=0.011) were independent determinants of catheter removal. Age (OR, 1.93; p=0.026) and diabetes (OR, 5.98; p=0.015) were the only predictors of death from peritonitis.

CONCLUSIONS

Old age and diabetes mellitus are two major risk factors for adverse outcomes of PD-related peritonitis. Although they are not contraindications to PD, our results suggest that these patients need meticulous care when peritonitis occurs.