Impact of diuresis and number of exchanges on Continuous Ambulatory Peritoneal Dialysis related peritonitis risk in RDPLF registry.

Authors

  • Clément vachey Nephrology, dialysis et transplantation department, University Hospital of Besançon https://orcid.org/0000-0003-1359-8358
  • Caroline Roubiou Nephrology, dialysis et transplantation department, University Hospital of Besançon
  • Catherine Bresson-Vautrin Nephrology, dialysis et transplantation department, University Hospital of Besançon
  • Cécile Courivaud Nephrology, dialysis et transplantation department, University Hospital of Besançon https://orcid.org/0000-0002-6533-6774

DOI:

https://doi.org/10.25796/bdd.v3i2.55153

Keywords:

peritoneal dialysis, glucose exposure, residual duresis, peritonitis

Abstract

Introduction

Peritonitis is still a frequent complication among patients undergoing peritoneal dialysis (PD) and it’s associated with a significant morbimortality. The aim of our study was to investigate the impact of diuresis volume and number of exchanges (NE) on continuous ambulatory peritoneal dialysis (CAPD) related peritonitis risk.

Methods

This study was performed with data from the French peritoneal dialysis registry (RDPLF). We included every incident patient in the registry from January 2010 to November 2019 who had at least an adequacy evaluation. Peritonitis risk was assessed firstly by estimating a peritonitis rate per year undergoing PD and secondly by focusing on time to first peritonitis, taking into account competing risks (kidney transplantation, switch to hemodialysis, PD withdrawal whatever the cause or death). Patients whose diuresis was <500mL/24 hours were considered oliguric.

Results

We included 620 patients in our analysis. The mean age was 72,9 (standard deviation (SD)=15,1). Two hundred and six (39,55%) had at least one peritonitis episode. No difference was observed between oliguric patients and the others. However, we noticed an increased risk in patients with a NE≥22 per week (HR=1,55, P=0,0005 and HR=1,47, P=0,02 considering competing risks). We also observed a lower risk in diabetic patients HR=0,74, p=0,02 and HR=0,77, p=0,0497).

Conclusion

We didn’t find any impact of diuresis volume on peritonitis risk. Whereas, the NE seems to be a considerable risk factor, especially when it’s superior to 22 per week.

References

Davenport A. Peritonitis remains the major clinical complication of peritoneal dialysis: the London, UK, peritonitis audit 2002-2003. Perit Dial Int J Int Soc Perit Dial. 2009 Jun;29(3):297–302.

Boudville N, Kemp A, Clayton P, Lim W, Badve SV, Hawley CM, et al. Recent peritonitis associates with mortality among patients treated with peritoneal dialysis. J Am Soc Nephrol JASN. 2012 Aug;23(8):1398–405.

Tian Y, Xie X, Xiang S, Yang X, Zhang X, Shou Z, et al. Risk factors and outcomes of high peritonitis rate in continuous ambulatory peritoneal dialysis patients: A retrospective study. Medicine (Baltimore). 2016 Dec;95(49):e5569.

Salzer WL. Peritoneal dialysis-related peritonitis: challenges and solutions. Int J Nephrol Renov Dis. 2018;11:173–86.

Gadola L, Poggi C, Dominguez P, Poggio MV, Lungo E, Cardozo C. Risk Factors And Prevention of Peritoneal Dialysis-Related Peritonitis. Perit Dial Int J Int Soc Perit Dial. 2019 Apr;39(2):119–25.

Kerschbaum J, König P, Rudnicki M. Risk factors associated with peritoneal-dialysis-related peritonitis. Int J Nephrol. 2012;2012:483250.

Han SH, Lee SC, Ahn SV, Lee JE, Kim DK, Lee TH, et al. Reduced residual renal function is a risk of peritonitis in continuous ambulatory peritoneal dialysis patients. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2007 Sep;22(9):2653–8.

John MM, Gupta A, Sharma RK, Kaul A. Impact of residual renal function on clinical outcome and quality of life in patients on peritoneal dialysis. Saudi J Kidney Dis Transplant Off Publ Saudi Cent Organ Transplant Saudi Arab. 2017 Feb;28(1):30–5.

Chen CH, Perl J, Teitelbaum I. Prescribing high-quality peritoneal dialysis: The role of preserving residual kidney function. Perit Dial Int J Int Soc Perit Dial. 2020 May;40(3):274–81.

Wang AY-M, Woo J, Wang M, Sea MM-M, Sanderson JE, Lui S-F, et al. Important differentiation of factors that predict outcome in peritoneal dialysis patients with different degrees of residual renal function. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2005 Feb;20(2):396–403.

Pecoits-Filho R, Heimbürger O, Bárány P, Suliman M, Fehrman-Ekholm I, Lindholm B, et al. Associations between circulating inflammatory markers and residual renal function in CRF patients. Am J Kidney Dis Off J Natl Kidney Found. 2003 Jun;41(6):1212–8.

Wang AY-M, Wang M, Woo J, Law M-C, Chow K-M, Li PK-T, et al. A novel association between residual renal function and left ventricular hypertrophy in peritoneal dialysis patients. Kidney Int. 2002 Aug;62(2):639–47.

Ateş K, Nergizoğlu G, Keven K, Sen A, Kutlay S, Ertürk S, et al. Effect of fluid and sodium removal on mortality in peritoneal dialysis patients. Kidney Int. 2001 Aug;60(2):767–76.

RDPLF (Registre de Dialyse Péritonéale de Langue Française) registry: available on http://WWW.RDPLF.org/.

Verger C, Ryckelynck J-P, Duman M, Veniez G, Lobbedez T, Boulanger E, et al. French peritoneal dialysis registry (RDPLF): outline and main results. Kidney Int Suppl. 2006 Nov;(103):S12–20.

Austin PC, Lee DS, Fine JP. Introduction to the Analysis of Survival Data in the Presence of Competing Risks. Circulation. 2016 Feb 9;133(6):601–9.

Fine JP, Gray RJ. A Proportional Hazards Model for the Subdistribution of a Competing Risk. J Am Stat Assoc. 1999;94(446):496–509.

Uiterwijk H, Franssen CFM, Kuipers J, Westerhuis R, Nauta FL. Glucose Exposure in Peritoneal Dialysis Is a Significant Factor Predicting Peritonitis. Am J Nephrol. 2020;51(3):237–43.

van Diepen ATN, van Esch S, Struijk DG, Krediet RT. The Association Between Glucose Exposure and the Risk of Peritonitis in Peritoneal Dialysis Patients. Perit Dial Int J Int Soc Perit Dial. 2016 10;36(5):533–9.

Nataatmadja M, Cho Y, Pascoe EM, Darssan D, Hawley CM, Johnson DW. Association between Peritoneal Glucose Exposure and Peritonitis in Peritoneal Dialysis Patients: The Bal ANZ Trial. Perit Dial Int J Int Soc Perit Dial. 2017 Jul;37(4):407–13.

Benabed A, Bechade C, Ficheux M, Verger C, Lobbedez T. Effect of assistance on peritonitis risk in diabetic patients treated by peritoneal dialysis: report from the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant. 2016 Apr;31(4):656–62.

Oo TN, Roberts TL, Collins AJ. A comparison of peritonitis rates from the United States Renal Data System database: CAPD versus continuous cycling peritoneal dialysis patients. Am J Kidney Dis. 2005 Feb;45(2):372–80.

Nessim SJ, Bargman JM, Austin PC, Nisenbaum R, Jassal SV. Predictors of Peritonitis in Patients on Peritoneal Dialysis: Results of a Large, Prospective Canadian Database. Clin J Am Soc Nephrol. 2009 Jul;4(7):1195–200.

Ueda R, Nakao M, Maruyama Y, Nakashima A, Yamamoto I, Matsuo N, et al. Effect of diabetes on incidence of peritoneal dialysis-associated peritonitis. PloS One. 2019;14(12):e0225316.

Published

2020-06-15

How to Cite

1.
vachey C, Roubiou C, Bresson-Vautrin C, Courivaud C. Impact of diuresis and number of exchanges on Continuous Ambulatory Peritoneal Dialysis related peritonitis risk in RDPLF registry. Bull Dial Domic [Internet]. 2020 Jun. 15 [cited 2024 Dec. 22];3(2):83-92. Available from: https://bdd.rdplf.org/index.php/bdd/article/view/55153