Risk factors for peritoneal dialysis-associated peritonitis: the role of oral active vitamin d.
BACKGROUND
Peritonitis is a major complication of peritoneal dialysis (PD), being associated with hospitalization, catheter loss, technique failure, and increased mortality. Data on various risk factors for peritonitis are inconsistent, and no association with concomitant therapy has been shown. ♢


METHODS
We performed a retrospective analysis of all incident and prevalent PD patients (n = 55) treated in Innsbruck, Austria, between 2000 and 2007. Data consisted of 1291 patient-months and 55 episodes of peritonitis. Patient demographic data, comorbidities, concomitant medication, laboratory parameters, and microbiology results were obtained from the medical records and from the hospital's electronic database. ♢


RESULTS
The mean peritonitis incidence rate was 0.51 episodes/patient-year (range: 0.24 - 0.73 episodes/patient-year) or 1 episode every 23.5 months (range: 16 - 50 months). In a primary analysis including demographic characteristics, comorbidities, laboratory parameters, and concomitant medication, only treatment with oral active vitamin D was associated with a significantly lower risk of peritonitis. Adjusted for time on PD and baseline serum albumin, oral active vitamin D therapy was associated with an 80% reduced relative risk of peritonitis [hazard ratio (HR): 0.20; 95% confidence interval (CI): 0.06 to 0.64; p = 0.007)]. The risk reduction was comparable in patients who received 0.25 μg or more of vitamin D daily (HR: 0.18; 95% CI: 0.05 to 0.65; p = 0.008) and in those who received less than 0.25 μg vitamin D daily (HR: 0.21; 95% CI: 0.06 to 0.77; p = 0.018). ♢


CONCLUSIONS
Treatment with oral active vitamin D might be associated with a lower risk of peritonitis in PD patients.
Department of Internal Medicine IV-Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria. michael.rudnicki@i-med.ac.at
Michael
M
Rudnicki
Julia
J
Kerschbaum
Johann
J
Hausdorfer
Gert
G
Mayer
Paul
P
König
D000284:Administration, Oral; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001317:Austria; D002408:Catheters, Indwelling / Q000009:adverse effects*; D015331:Cohort Studies; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D010538:Peritonitis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage*
D014807:Vitamin D