Reduced residual renal function is a risk of peritonitis in continuous ambulatory peritoneal dialysis patients.
BACKGROUND
Loss of residual renal function (RRF) contributes to anaemia, inflammation and malnutrition and is also a strong predictor of mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. However, the role of RRF on peritonitis is not yet clearly established. This study aimed to evaluate the effect of RRF on the development of peritonitis.


METHODS
Study subjects were 204 end-stage renal disease (ESRD) patients who started PD from January 2000 to December 2005. Biochemical and clinical data within 1 month of PD commencement were considered as baseline. To determine risk factors for peritonitis, multivariate Cox regression was performed. Kaplan-Meier analysis and log-rank test were used to examine the difference of peritonitis-free period according to the presence of diabetes and RRF.


RESULTS
On univariate analysis based on baseline data in first peritonitis, diabetes was less prevalent and RRF (6.7+/-2.6 vs 4.0+/-2.3 ml/min/1.73 m2, P<0.01), haemoglobin (10.9+/-1.2 vs 10.6+/-1.2 g/dl, P<0.05) and serum albumin level (3.6+/-0.4 vs 3.4+/-0.4 g/dl, P<0.01) were significantly higher in the peritonitis-free group. Kaplan-Meier analysis showed that time to first PD peritonitis episode was significantly longer in the non-diabetic patients (P<0.001) and in patients with higher residual GFR (P<0.001). Multivariate analysis showed that diabetes [hazard ratio(HR) 1.64, P<0.05] and RRF (per 1 ml/min/1.73 m2 increase, HR 0.81, P<0.01) were independent risk factors.


CONCLUSIONS
Our study revealed that RRF and diabetes were risk factors for peritonitis. These results suggest that preservation of RRF should be viewed as a protective strategy to reduce peritonitis.
Han
Seung Hyeok
SH
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Lee
Sang Choel
SC
Ahn
Song Vogue
SV
Lee
Jung Eun
JE
Kim
Dong Ki
DK
Lee
Tae Hee
TH
Moon
Sung Jin
SJ
Kim
Beom Seok
BS
Kang
Shin-Wook
SW
Choi
Kyu Hun
KH
Lee
Ho Yung
HY
Han
Dae-Suk
DS
D003710:Demography; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D010538:Peritonitis / Q000382:microbiology / Q000503:physiopathology*; D016016:Proportional Hazards Models; D012307:Risk Factors