title: Albumin at the start of peritoneal dialysis predicts the development of peritonitis.
abstract: BACKGROUND
  Both peritonitis and serum albumin level are associated with morbidity and mortality in peritoneal dialysis (PD) patients. Severe cases of peritonitis result in hypoalbuminemia. However, it is not clear whether hypoalbuminemia predicts the development of peritonitis.
  
  
  METHODS
  We performed a retrospective analysis of a prospectively collected database from six centers in western Pennsylvania and West Virginia. Incident PD patients with a Charlson Comorbidity Index (CCI) score at the start of PD therapy and serum albumin level measured within 30 days of initiation were selected. Poisson regression was used to analyze predictors of peritonitis.
  
  
  RESULTS
  Three hundred ninety-three patients had a CCI score and serum albumin level measured at the start of PD therapy. Overall peritonitis rate was 0.65 episodes/dialysis-year. Significant univariate predictors were albumin level (rate ratio [RR], 0.79 per 1-g/dL [10-g/L] increase; 95% confidence interval [CI], 0.65 to 0.95; P = 0.015), male sex (P = 0.003), and being dialyzed in the Veterans Administration (RR, 1.97; 95% CI, 1.48 to 2.62; P < 0.001) or other center (RR, 1.68; 95% CI, 1.92 to 5.62; P < 0.001). Although CCI score correlated inversely with albumin level (r = -0.305; P < 0.001), CCI score was only marginally predictive of peritonitis (P = 0.068). In multivariate analysis, predictors were albumin level (RR, 0.74; 95% CI, 0.31 to 1.75; P = 0.002) and race (RR, 1.36; P = 0.024). Patients with an initial serum albumin level less than 2.9 g/dL (29 g/L) had a peritonitis rate of 1.5 episodes/dialysis-year compared with 0.6 episodes/dialysis-year for patients with an initial serum albumin level of 2.9 g/dL or greater (P < 0.001).
  
  
  CONCLUSIONS
  Hypoalbuminemia at the start of PD therapy is an independent predictor of subsequent peritonitis. Intervention studies to decrease peritonitis risk in this high-risk subset of patients are needed.
authors.affiliation: Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Qin
authors.initials: Q
authors.lastname: Wang
authors.forename: Judith
authors.initials: J
authors.lastname: Bernardini
authors.forename: Beth
authors.initials: B
authors.lastname: Piraino
authors.forename: Linda
authors.initials: L
authors.lastname: Fried
mesh_terms: D000328:Adult; D000368:Aged; D000418:Albumins / Q000378:metabolism*; D015897:Comorbidity / Q000639:trends; D019992:Databases as Topic; D005260:Female; D005544:Forecasting / Q000379:methods; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D010530:Peritoneal Dialysis / Q000379:methods*; D010538:Peritonitis / Q000097:blood* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D044469:Racial Groups; D012189:Retrospective Studies; D017678:Sex Distribution; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D014903:West Virginia / Q000453:epidemiology
chemical_list: D000418:Albumins