title: Center-Specific Factors Associated with Peritonitis Risk-A Multi-Center Registry Analysis.
abstract: ♦
  
  
  BACKGROUND
  Previous studies have reported significant variation in peritonitis rates across dialysis centers. Limited evidence is available to explain this variability. The aim of this study was to assess center-level predictors of peritonitis and their relationship with peritonitis rate variations. ♦
  
  
  METHODS
  All incident peritoneal dialysis (PD) patients treated in Australia between October 2003 and December 2013 were included. Data were accessed through the Australia and New Zealand Dialysis and Transplant Registry. The primary outcome was peritonitis rate, evaluated in a mixed effects negative binomial regression model. Peritonitis-free survival was assessed as a secondary outcome in a Cox proportional hazards model. ♦
  
  
  RESULTS
  Overall, 8,711 incident PD patients from 51 dialysis centers were included in the study. Center-level predictors of lower peritonitis rates included smaller center size, high proportion of PD, low peritoneal equilibration test use at PD start, and low proportion of hospitalization for peritonitis. In contrast, a low proportion of automated PD exposure, high icodextrin exposure and low or high use of antifungal prophylaxis at the time of peritonitis were associated with a higher peritonitis rate. Similar results were obtained for peritonitis-free survival. Overall, accounting for center-level characteristics appreciably decreased peritonitis variability among dialysis centers (p = 0.02). ♦
  
  
  CONCLUSIONS
  This study identified specific center-level characteristics associated with the variation in peritonitis risk. Whether these factors are directly related to peritonitis risk or surrogate markers for other center characteristics is uncertain and should be validated in further studies.
authors.affiliation: Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada.
authors.forename: Annie-Claire
authors.initials: AC
authors.lastname: Nadeau-Fredette
authors.affiliation: Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia david.johnson2@health.qld.gov.au.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.affiliation: Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia.
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Pascoe
authors.affiliation: Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia.
authors.forename: Yeoungjee
authors.initials: Y
authors.lastname: Cho
authors.affiliation: Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Department of Nephrology, Prince of Wales Hospital, Sydney, Australia Faculty of Medicine, University of Sydney, Nepean Clinical School, Kingswood, Australia.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Clayton
authors.affiliation: Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Monique
authors.initials: M
authors.lastname: Borlace
authors.affiliation: Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Badve
authors.affiliation: Faculty of Medicine, University of Sydney, Nepean Clinical School, Kingswood, Australia Departments of Renal Medicine, Nepean and Westmead Hospitals, Sydney, Australia.
authors.forename: Kamal
authors.initials: K
authors.lastname: Sud
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Boudville
authors.affiliation: Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: McDonald
mesh_terms: D000368:Aged; D001315:Australia; D005260:Female; D006436:Hemodialysis Units, Hospital / Q000458:organization & administration*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D017063:Outcome Assessment, Health Care; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors
keywords: ANZDATA; Peritoneal dialysis; center; mixed effects; peritonitis; predictors