title: Effect of assistance on peritonitis risk in diabetic patients treated by peritoneal dialysis: report from the French Language Peritoneal Dialysis Registry.
abstract: Diabetic patients treated by peritoneal dialysis (PD) have been reported to be at an increased risk of peritonitis. This has been attributed to impairment in host defense, visual impairment, disability and muscle wasting, which could compromise ability to safely perform catheter connections. This study aimed to evaluate whether assisted PD is associated with a lower risk of peritonitis in diabetic patients.
  
  
  
  This was a retrospective study based on data from the French Language Peritoneal Dialysis Registry. We included diabetic patients starting PD between 1 January 2002 and 31 December 2012. The end of the observation period was 31 December 2013. Using complementary regression analysis (Fine and Gray, Hurdle models), we assessed the relationship between peritonitis occurrence, peritonitis number over time and the type of assisted PD.
  
  
  
  Of the 3598 diabetic patients, there were 2040 patients on nurse-assisted PD. These patients were older, more comorbid and more frequently on continuous ambulatory peritoneal dialysis (CAPD). In the multivariate analysis, nurse assistance was associated with a reduced risk of peritonitis in the Fine and Gray [subdistribution hazard ratio: 0.78 (95% confidence interval, CI, 0.68-0.89)] and in the first component of the Hurdle models [rate ratio: 0.82 (95% CI 0.71-0.93)], but not a lower incidence of peritonitis after an initial episode [rate ratio: 0.82 (95% CI 0.95-1.38)]. Transplant failure, glomerulonephritis and CAPD were associated with an increased risk.
  
  
  
  In France, nurse-assisted PD is associated with a lower risk of peritonitis in diabetic patients treated by PD but not a lower incidence of peritonitis.
authors.affiliation: Néphrologie, CHU Côte de Nacre, CUMR, Caen, France.
authors.forename: Anais
authors.initials: A
authors.lastname: Benabed
authors.affiliation: Néphrologie, CHU Côte de Nacre, CUMR, Caen, France.
authors.forename: Clemence
authors.initials: C
authors.lastname: Bechade
authors.affiliation: Néphrologie, CHU Côte de Nacre, CUMR, Caen, France.
authors.forename: Maxence
authors.initials: M
authors.lastname: Ficheux
authors.affiliation: RDPLF, Pontoise, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Verger
authors.affiliation: Néphrologie, CHU Côte de Nacre, CUMR, Caen, France RDPLF, Pontoise, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lobbedez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005602:France / Q000453:epidemiology; D006701:Home Nursing / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects* / Q000451:nursing*; D010538:Peritonitis / Q000209:etiology / Q000517:prevention & control*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: diabetes mellitus; peritoneal dialysis; peritonitis