title: Prognostic impact of peritonitis in hemodialysis patients: A national-wide longitudinal study in Taiwan.
abstract: BACKGROUND
  Peritonitis has been independently associated with increased morbidity and mortality in peritoneal dialysis patients. However, there are few reports on peritonitis in hemodialysis patients. We aim at investigating both the risk profiles and prognostic impact of peritonitis in hemodialysis patients.
  
  
  METHODS
  This nation-wide longitudinal study uses claims data obtained from the Taiwan National Health Insurance Research Database. A total of 80,733 incident hemodialysis patients of age ≥ 20 years without a history of peritonitis were identified between January 1, 1998 and December 31, 2009. Predictors of peritonitis events were estimated using Cox proportional hazard models. Time-dependent Cox proportional hazard models were used to estimate hazard ratio for mortality attributed to peritonitis exposure.
  
  
  RESULTS
  Of 80,733 incident hemodialysis patients over a 13-year study period, peritonitis was diagnosed in 935 (1.16%), yielding an incidence rate of 2.91 per 1000 person-years. Female gender, liver cirrhosis and polycystic kidney disease were three of the most significant factors for peritonitis in both non-diabetic and diabetic hemodialysis patients. The cumulative survival rate of patients with peritonitis was 38.8% at 1 year and 10.1% at 5 years. A time-dependent Cox multivariate analysis showed that peritonitis had significantly increased hazard ratio for all cause mortality. Additionally, the risk of mortality remained significantly higher for non-diabetic hemodialysis patients that experienced peritonitis.
  
  
  CONCLUSIONS
  The risk of peritonitis in hemodialysis patients is higher in female gender, liver cirrhosis and polycystic kidney disease. Although peritonitis is a rare condition, it is associated with significantly poorer outcome in hemodialysis patients.
authors.affiliation: Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan.|Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yueh-An
authors.initials: YA
authors.lastname: Lu
authors.affiliation: Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan.|Department of Medicine, Chang Gung University, Taoyuan, Taiwan.|Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Kun-Hua
authors.initials: KH
authors.lastname: Tu
authors.affiliation: Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan.|Department of Medicine, Chang Gung University, Taoyuan, Taiwan.|Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Cheng-Chia
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Department of Radiology, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Wu
authors.affiliation: Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan.|Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan.|Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Tao-Yuan, Taiwan.|Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
authors.affiliation: Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan.|Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ya-Chung
authors.initials: YC
authors.lastname: Tian
authors.affiliation: Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan.|Department of Medicine, Chang Gung University, Taoyuan, Taiwan.|Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.|Healthcare Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.|Heart Failure Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
authors.forename: Pao-Hsien
authors.identifier: http://orcid.org/0000-0003-0361-6348
authors.initials: PH
authors.lastname: Chu
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000401:mortality / Q000503:physiopathology*; D006435:Renal Dialysis; D012307:Risk Factors; D013624:Taiwan