Association of biocompatible peritoneal dialysis solutions with peritonitis risk, treatment, and outcomes.
OBJECTIVE
The effect of biocompatible peritoneal dialysis (PD) solutions on PD-related peritonitis is unclear. This study sought to evaluate the relationship between use of biocompatible solutions and the probability of occurrence or clinical outcomes of peritonitis.


METHODS
The study included all incident Australian patients receiving PD between January 1, 2007, and December 31, 2010, using Australia and New Zealand Dialysis and Transplant Registry data. All multicompartment PD solutions of neutral pH were categorized as biocompatible solutions. The independent predictors of peritonitis and the use of biocompatible solutions were determined by multivariable, multilevel mixed-effects Poisson and logistic regression analysis, respectively. Sensitivity analyses, including propensity score matching, were performed.


RESULTS
Use of biocompatible solutions gradually declined (from 7.5% in 2007 to 4.2% in 2010), with preferential use among smaller units and among younger patients without diabetes mellitus. Treatment with biocompatible solution was associated with significantly greater overall rate of peritonitis (0.67 versus 0.47 episode per patient-year; incidence rate ratio, 1.49; 95% confidence interval [CI], 1.19 to 1.89) and with shorter time to first peritonitis (hazard ratio [HR], 1.48; 95% CI, 1.17 to 1.87), a finding replicated in propensity score-matched cohorts (HR, 1.36; 95% CI, 1.09 to 1.71).


CONCLUSIONS
In an observational registry study, use of biocompatible PD solutions was associated with higher overall peritonitis rates and shorter time to first peritonitis. Further randomized studies adequately powered for a primary peritonitis outcome are warranted.
Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia.
Yeoungjee
Y
Cho
Sunil V
SV
Badve
Carmel M
CM
Hawley
Stephen P
SP
McDonald
Fiona G
FG
Brown
Neil
N
Boudville
Kym M
KM
Bannister
Philip A
PA
Clayton
David W
DW
Johnson
D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D001672:Biocompatible Materials / Q000009:adverse effects*; D015314:Dialysis Solutions / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000453:epidemiology* / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome
D001672:Biocompatible Materials; D015314:Dialysis Solutions