title: Risk of Peritoneal Dialysis-Related Peritonitis in a Multi-Racial Asian Population.
abstract: ♦ BACKGROUND: Peritonitis is one of the most common complications of peritoneal dialysis (PD). Understanding the risk factors of peritonitis in a multi-racial Asian population may help to improve outcomes on PD. ♦ METHODS: We conducted a prospective observational study to identify risk factors for PD-related peritonitis over a 1-year period in 15 adult PD centers. All peritonitis episodes were independently adjudicated. ♦ RESULTS: A total of 1,603 participants with a mean age of 51.6 years comprising 52.7% females, 62.6% ethnic Malays, 27.0% Chinese, and 8.1% Indians were recruited. The overall peritonitis rate was 1 episode per 44.0 patient-months with 354 episodes recorded in 282 (17.6%) patients over 15,588 patient-months. Significant risk factors of peritonitis were severe obesity (incidence-rate ratio [IRR] 3.32, 95% confidence interval [CI]: 1.30, 8.45), hypoalbuminemia (IRR 1.61, 95% CI: 1.06, 2.46), Staphylococcus aureus nasal carriage (IRR 2.26, 95% CI: 1.46, 3.50), and use of Fresenius system (Fresenius Medical Care North America, Waltham, MA, USA) (IRR 2.49, 95% CI: 1.27, 4.89). The risk of peritonitis was lower in those on automated PD compared with standard PD (IRR 0.43, 95% CI: 0.25, 0.74), and in centers with a patient-staff ratio of 15 to 29.9 (IRR 0.67, 95% CI: 0.49, 0.90) and ≥ 30 (IRR 0.52, 95% CI: 0.34, 0.80). Prevalent patients and exit-site care with topical antibiotics were also protective against peritonitis. Peritonitis rates varied between racial groups. The IRRs of overall peritonitis and gram-positive peritonitis in Chinese versus other racial groups were 0.65 (95% CI: 0.46, 0.90) and 0.47 (95% CI: 0.24, 0.91), respectively. ♦ CONCLUSIONS: Multiple patient, center, and PD-system factors influence the risk of peritonitis. In the Asian population, there are racial differences in the risk of peritonitis.
authors.affiliation: Clinical Research Centre, Penang Hospital, Penang, Malaysia onglokemeng@gmail.com.
authors.forename: Loke Meng
authors.initials: LM
authors.lastname: Ong
authors.affiliation: Clinical Research Centre, Penang Hospital, Penang, Malaysia.
authors.forename: Chin Chin
authors.initials: CC
authors.lastname: Ch'ng
authors.affiliation: Clinical Research Centre, Penang Hospital, Penang, Malaysia.
authors.forename: Hong Chin
authors.initials: HC
authors.lastname: Wee
authors.affiliation: Clinical Research Centre, Sultanah Aminah Hospital, Johor, Malaysia.
authors.forename: Premaa
authors.initials: P
authors.lastname: Supramaniam
authors.affiliation: Clinical Research Centre, Penang Hospital, Penang, Malaysia.
authors.forename: Hadzlinda
authors.initials: H
authors.lastname: Zainal
authors.affiliation: Department of Nephrology, Serdang Hospital, Selangor, Malaysia.
authors.forename: Bak Leong
authors.initials: BL
authors.lastname: Goh
authors.affiliation: Department of Nephrology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
authors.forename: Sunita
authors.initials: S
authors.lastname: Bavanandan
authors.affiliation: Department of Nephrology, Tuanku Jaafar Hospital, Negeri Sembilan, Malaysia.
authors.forename: Lily
authors.initials: L
authors.lastname: Mushahar
authors.affiliation: Department of Nephrology, Sultanah Aminah Hospital, Johor, Malaysia.
authors.forename: Lai Seong
authors.initials: LS
authors.lastname: Hooi
authors.affiliation: Department of Nephrology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
authors.forename: Ghazali
authors.initials: G
authors.lastname: Ahmad
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D044466:Asian People / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D010538:Peritonitis / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D044469:Racial Groups; D018570:Risk Assessment; D015996:Survival Rate
keywords: Asian population; Peritoneal dialysis; center factors; patient factors; peritonitis; racial differences; risk factors; system factors