The effect of the pneumoperitoneum on the peritoneal defense mechanisms in diabetic rats

A Risk Analysis of Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis

Objective

We studied the clinical characteristics that influence the risk of dialysis-related peritonitis complication in incident Chinese patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

Methods

A single center, retrospective, observational cohort study was carried out to examine the risk factors of developing a first episode of dialysis-related peritonitis.

Results

Between 1995 and 2004, 246 incident CAPD patients were recruited for analysis. During the study period of 897.1 patient-years, 85 initial episodes of peritonitis were recorded. The median peritonitis-free time for diabetic subjects was significantly worse than for nondiabetic subjects (49.0 ± 10.5 vs 82.3 ± 12.6 months, p = 0.0019). The difference was due mainly to a higher likelihood of developing peritonitis with gram-negative organisms in patients with diabetes mellitus ( p = 0.038). Low serum albumin concentration was also associated with worse peritonitis-free survival. There was a nonsignificant trend toward an increased risk for peritonitis in the group of patients with cerebrovascular disease. According to multivariate Cox proportional hazards model for the analysis of time to first peritonitis episode, the two independent risk factors were presence of diabetes mellitus and initial serum albumin concentration. In particular, diabetes mellitus was associated with a hazard ratio of 1.50 and a 95% confidence interval of 1.05 – 2.40 ( p = 0.030) to develop an initial peritonitis. Lower serum albumin level at the start of CAPD was a significant predictor of peritonitis, with hazard ratio of 1.67 for every decrease of 10 g/L, and 95% confidence interval 1.08 – 2.60 ( p = 0.021).

Conclusions

Our results confirm the susceptibility of diabetic CAPD and hypoalbuminemic patients to peritonitis, and highlight the role of further studies in reducing this complication.