title: Reduced residual renal function is a risk of peritonitis in continuous ambulatory peritoneal dialysis patients.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
authors.forename: Sang Choel
authors.initials: SC
authors.lastname: Lee
authors.forename: Song Vogue
authors.initials: SV
authors.lastname: Ahn
authors.forename: Jung Eun
authors.initials: JE
authors.lastname: Lee
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Kim
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Lee
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Moon
authors.forename: Beom Seok
authors.initials: BS
authors.lastname: Kim
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
authors.forename: Kyu Hun
authors.initials: KH
authors.lastname: Choi
authors.forename: Ho Yung
authors.initials: HY
authors.lastname: Lee
authors.forename: Dae-Suk
authors.initials: DS
authors.lastname: Han
mesh_terms: 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