Risk factors for adverse outcomes after peritonitis-related technique failure.
BACKGROUND
Peritonitis is the leading cause of technique failure in peritoneal dialysis (PD) patients. Some patients experience recurrent ascites, encapsulating peritoneal sclerosis (EPS), and even death after catheter removal. Little is known, however, about the risk factors for such complications.


METHODS
The study subjects were 117 patients that had their PD catheter removed due to peritonitis between January 2000 and June 2006. Biochemical and clinical data were reviewed retrospectively. Serum C-reactive protein (CRP) and blood and effluent white blood cell counts (WBC) were measured at baseline and at 72 hours of peritonitis. Based on adverse outcomes, patients were classified into 4 groups: non-complication (NC; n = 73), recurrent ascites (A; n = 26), EPS (E; n = 10), and death directly related to peritonitis (D; n = 8).


RESULTS
Age at PD catheter removal was significantly higher in D group compared to NC group (62.0 +/- 10.6 vs 51.2 +/- 11.5 years, p < 0.05). In addition, mean PD duration was significantly longer in E group compared to NC and A groups (130.5 +/- 48.1 vs 58.8 +/- 42.4 vs 74.8 +/- 47.4 months, p < 0.01). Compared to baseline, effluent WBC was significantly decreased in NC group after 72 hours of peritonitis. In addition, serum CRP level was significantly decreased in NC and A groups, whereas it was significantly increased in D group. Multivariate analyses adjusted for age, PD duration, blood and effluent WBC, serum CRP, and micro-organisms revealed that serum CRP level at 72 hours predicted significantly the development of EPS [odds ratio (OR) 1.15, p < 0.05] and peritonitis-related death (OR 1.18, p < 0.01). In addition, PD duration (per 1 month increase: OR 1.03, p < 0.05) and age at PD catheter removal (per 1 year increase: OR 1.11, p < 0.05) were identified as significant determinants of EPS and peritonitis-related death respectively. Only effluent WBC at 72 hours was significantly associated with the development of ascites (OR 1.27, p < 0.05).


CONCLUSIONS
Older patients with long PD duration and those with persistently elevated serum CRP levels were likely to develop complications after peritonitis-related technique failure. Our study suggests that serial measurement of CRP may be helpful in predicting the development of complications after PD catheter removal.
Moon
Sung Jin
SJ
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Han
Seung Hyeok
SH
Kim
Dong Ki
DK
Lee
Jung Eun
JE
Kim
Beom Seok
BS
Kang
Shin-Wook
SW
Choi
Kyu Hun
KH
Lee
Ho Yung
HY
Han
Dae-Suk
DS
D000328:Adult; D000367:Age Factors; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D010538:Peritonitis / Q000097:blood / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
D002097:C-Reactive Protein