title: Risk factors for drainage-requiring ascites after refractory peritonitis in peritoneal dialysis patients.
abstract: OBJECTIVE
  Refractory peritonitis remains a thorny issue for patients with chronic peritoneal dialysis (PD). Shortly after catheter removal, some patients develop persistent peritoneal inflammation and ascites formation, which require percutaneous drainage for symptom relief. Our study aimed at finding the risk factors for this kind of event.
  
  
  METHODS
  A total of 47 PD patients complicated with refractory peritonitis who underwent catheter removal between January 2009 and December 2011 were enrolled in this study. Data were compared between patients with and without the development of symptomatic ascites requiring drainage during hospitalization.
  
  
  RESULTS
  Among the 47 refractory peritonitis patients, 15 patients developed symptomatic ascites that needed further drainage shortly after catheter removal during hospitalization. The following factors were associated with an increased risk: longer dialysis duration, higher peritoneal Kt/V urea, and a significant rise in serum C-reactive protein (CRP) level after catheter removal. These patients had a prolonged hospital stay (62 vs 21 days, P < 0.001) and a significantly higher risk of recurrent loculated ascites during subsequent 6 months of follow-up (33.3 vs 6.2 %, P = 0.022) compared with patients who did not develop ascites requiring drainage during hospitalization.
  
  
  CONCLUSIONS
  A significant portion of patients with refractory PD peritonitis experienced ascites requiring drainage shortly after catheter removal, which led to a prolonged hospitalization. Whether routine drain placement at the time of catheter removal for this high-risk group would be of benefit warrants further prospective studies.
authors: Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
authors: Cheng-Chia
authors: CC
authors: Lee
authors: Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
authors: Kun-Hua
authors: KH
authors: Tu
authors: Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Hsiao-Hui
authors: HH
authors: Chen
authors: Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Ming-Yang
authors: MY
authors: Chang
authors: Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. cchung9651@yahoo.com.|Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan. cchung9651@yahoo.com.
authors: Cheng-Chieh
authors: CC
authors: Hung
mesh_terms: D000328:Adult; D001201:Ascites / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D002097:C-Reactive Protein / Q000032:analysis; D002408:Catheters, Indwelling / Q000009:adverse effects; D004322:Drainage / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D010538:Peritonitis / Q000175:diagnosis / Q000209:etiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D002097:C-Reactive Protein
keywords: Ascites; C-reactive protein; Drainage; Outcome assessment; Peritonitis