title: Peritonitis is still an important factor for withdrawal from peritoneal dialysis therapy in the Tokai area of Japan.
abstract: BACKGROUND
  In Japan, the population of patients on peritoneal dialysis (PD) is <4% of the total number of patients with end-stage renal disease. Few systemic analyses have examined why the number of PD patients has not increased in Japan. We organized a registry to analyze PD patients and retrospectively investigated 561 PD patients (about 5% of all Japanese PD patients) from 13 hospitals in the Tokai area for 3 years from 2005.
  
  
  METHODS
  We investigated background, physical status, laboratory data, status of PD therapy, and the occurrence of PD-related complications, and analyzed reasons for withdrawal from PD.
  
  
  RESULTS
  Nutrition did not change significantly during our observation. Urinary volume showed continued decreases after the introduction period. In contrast, PD fluid demand and ultrafiltration volume were significantly increased. For calcium metabolism, multiple phosphate binders were required after the second year of PD therapy. Early drop-out within 3 years after starting PD therapy comprised 50.9% of total withdrawals, with PD-related peritonitis as the most common reason, mainly caused by Gram-positive organisms. Incidence of peritonitis was 42.8 months/patient. Culture-negative results were obtained for 32% of peritonitis cultures. Diabetes affects the prognosis of PD therapy, but not the incidence of peritonitis.
  
  
  CONCLUSIONS
  We examined clinical status over 3 years in the Tokai area. The results suggest that the incidence of peritonitis needs to be decreased to prevent early withdrawal of PD patients. Education systems to decrease the incidence of peritonitis and techniques to decrease culture-negative results might be important for improving the prognosis of peritonitis.
authors.affiliation: Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya, Japan. mmizu@nagoya-u.ac.jp.|Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan. mmizu@nagoya-u.ac.jp.
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizuno
authors.affiliation: Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya, Japan.|Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Chubu Rosai Hospital, Nagoya, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Tanaka
authors.affiliation: Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya, Japan.|Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Hiramatsu
authors.affiliation: Handa City Hospital, Handa, Japan.
authors.forename: Midoriko
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Minami Seikyo Hospital, Nagoya, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Tsuruta
authors.affiliation: Ogaki Kita Clinic, Ogaki, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Matsuoka
authors.affiliation: Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.|Yokkaichi Municipal Hospital, Yokkaichi, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Ito
authors.affiliation: Anjo Kosei Hospital, Anjo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tamai
authors.affiliation: Nagoya Kyoritsu Hospital, Nagoya, Japan.
authors.forename: Hirotake
authors.initials: H
authors.lastname: Kasuga
authors.affiliation: Chubu Rosai Hospital, Nagoya, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Shimizu
authors.affiliation: Toyota Kosei Hospital, Toyota, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kurata
authors.affiliation: Tosei General Hospital, Seto, Japan.
authors.forename: Daijo
authors.initials: D
authors.lastname: Inaguma
authors.affiliation: Konan Kosei Hospital, Konan, Japan.
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Hiramatsu
authors.affiliation: Daiyukai Daiichi Hospital, Ichinomiya, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Horie
authors.affiliation: Kasugai Municipal Hospital, Kasugai, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Naruse
authors.affiliation: Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Maruyama
authors.affiliation: Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Enyu
authors.initials: E
authors.lastname: Imai
authors.affiliation: Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
authors.affiliation: Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
mesh_terms: D000368:Aged; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000209:etiology*; D010710:Phosphates / Q000097:blood; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D016312:Treatment Refusal
chemical_list: D010281:Parathyroid Hormone; D010710:Phosphates; D002118:Calcium