Skip to main content

A 10-year retrospective cohort study on the risk factors for peritoneal dialysis-related peritonitis: a single-center study at Tokai University Hospital

Clinical and Experimental Nephrology volume 18, pages 649–654 (2014)Cite this article

Abstract

Background

Common outcomes of peritoneal dialysis (PD)-related peritonitis include catheter removal and transition to hemodialysis (HD). According to recent data, the incidence of PD-related peritonitis in Japan is not low, and peritonitis is the most common cause of withdrawal from PD. Against this backdrop, the purpose of this study is to determine the incidence of PD-related peritonitis at the Outpatient Nephrology Clinic of Tokai University Hospital (hereafter “the Clinic”) and to examine causative bacteria and the risk factors related to the development of peritonitis.

Methods

We investigated all PD-related peritonitis episodes of 192 PD patients who visited the Clinic during the period from April 1, 2001 to March 31, 2011 and established the incidence of PD-related peritonitis, along with culture-negative peritonitis rates. Regarding the risk factors that are associated with the development of peritonitis, we examined patient backgrounds, whether an automated peritoneal dialysis (APD) device was used, and which type of connection system was employed.

Results

The incidence of peritonitis was one episode per 64.5 patient-months, and the culture-negative peritonitis rate was 16.4 %. Of the cultured bacterial isolates 71.3 % were Gram-positive cocci, including 25.0 % of coagulase-negative staphylococci, 13.2 % of methicillin-susceptible Staphylococcus aureus (MSSA), and 6.6 % of methicillin-resistant Staphylococcus aureus (MRSA). Gram-negative rods were 19.1 %. Risk factors associated with the development of peritonitis included age at the start of PD [odds ratio 1.042, 95 % confidence interval (CI) 1.016–1.069, p value = 0.001], diabetes mellitus nephropathy (DMN) (odds ratio 22.003, 95 % CI 2.101–230.452, p value = 0.010), and the use of a sterile tubing welder device (STWD) (odds ratio 2.399, 95 % CI 1.043–5.521, p value = 0.040).

Conclusions

Regarding the situation of peritonitis at a single center during the 10-year period of this study, risk factors associated with the development of peritonitis included age at the start of PD, DMN, and the use of an STWD.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Nakai S, Iseki K, Itami N, Ogata S, Kazama JJ, Kimata N, Shigemats T, Shinoda T, Shoji T, Suzuki K, Taniguchi M, Tsuchida K, Nakamoto H, Nishi H, Hashimoto S, Hasegawa T, Hanafusa N, Hamano T, Fujii N, Masakane I, Marubayashi S, Morita O, Yamagata K, Wakai K, Wada A, Watanabe Y, Tsubakihara Y; Committee of Renal Data Registry; Japanese Society for Dialysis Therapy, Tokyo Japan. An overview of regular dialysis treatment in Japan (as of Dec 31, 2010). Ther Apher Dial 2012; 16:483–521.

    Google Scholar 

  2. Kawanishi H, Kawaguchi Y, Fukui H, Hara S, Imada A, Kubo H, Kin M, Nakamoto M, Ohira S, Shoji T, for the Long-Term Peritoneal Dialysis Study Group. Encapsulating peritoneal sclerosis in Japan: a prospective, controlled, multicenter study. Am J Kidney Dis. 2004;44:729–37.

    Google Scholar 

  3. Imada A, Kawaguchi Y, Kumano K, Nomoto Y, for the CAPD-related peritonitis study group in Japan. A multicenter study of CAPD-related peritonitis in Japan. J Jpn Soc Ther. 2001;34:1157–62.

    Google Scholar 

  4. Mizuno M, Ito Y, Tanaka A, Suzuki Y, Hiramatsu H, Watanabe M, Tsuruta Y, Matsuoka T, Ito I, Tamai H, Kasuga H, Shimizu H, Kurata H, Inaguma D, Hiramatsu T, Horie M, Naruse T, Maruyama S, Imai E, Yuzawa Y, Matsuo S. Peritonitis still an important factor for withdrawal from peritoneal dialysis therapy in the Tokai area of Japan. Clin Exp Nephrol. 2011;15:727–37.

    PubMed  Article  Google Scholar 

  5. Li PK, Szeto CC, Beth Piraino B, Bernardini J, Figueiredo AE, Gupta A, Johnson DW, Kuijper EJ, Lye WC, Salzer W, Schaefer F, Struijk DG. ISPD guidelines/Recommendations. Peritoneal dialysis-related infections recommendations: 2010 update. Perito Dail Int. 2010;30:393–423.

  6. Choi P, Nemati E, Banerjee A, Preston E, Levy J, Brown E. Peritoneal dialysis catheter removal for acute peritonitis: a retrospective analysis of factors associated with catheter removal and prolonged postoperative hospitalization. Am J Kidney Dis. 2004;43:103–11.

    PubMed  Article  Google Scholar 

  7. Piraino B. Peritonitis as a complication of peritoneal dialysis. J Am Soc Nephrol. 1998;9:1956–64.

    CAS  PubMed  Google Scholar 

  8. Ghali JR, Bannister KM, Brown FG, Rosman JB, Wiggins KJ, Johnson DW, McDonald SP. Microbiology and outcomes of peritonitis in Australian peritoneal dialysis patients. Perit Dial Int. 2011;31:651–62.

    PubMed  Article  Google Scholar 

  9. Brown MC, Simpson K, Kerssens JJ, Mactier RA. Peritoneal dialysis-associated peritonitis rates and outcomes in a national cohort are not improving in the post-millennium (2000–2007). Perit Dial Int. 2011;31:639–50.

    PubMed  Article  Google Scholar 

  10. Kofteridis DP, Valachis A, Perakis K, Maraki S, Daphnis E, Samonis G. Peritoneal dialysis-associated peritonitis: clinical features and predictors of outcome. Int J Inf Dis. 2010;14:489–93.

    Article  Google Scholar 

  11. Chow KM, Szeto CC, Leung CB, Kwan BC, Law MC, Li PK. A risk analysis of continuous ambulatory peritoneal dialysis-related peritonitis. Perit Dial Int. 2005;25:374–9.

    PubMed  Google Scholar 

  12. Lobo JVD, Villar KR, de Andrade Júnior MP, Bastos KdeA. Predictor factors of peritoneal dialysis-related peritonitis. J Bras Nephrol. 2010;32:156–164.

  13. Kotsanas D, Polkinghorne KR, Korman TM, Atkins RC, Brown F. Risk factors for peritoneal dialysis-related peritonitis: can we reduce the incidence and improve patient selection? Nephrology. 2007;12:239–45.

    PubMed  Article  Google Scholar 

  14. Vecchi AFD, Maccario M, Braga M, Scalamogna A, Castelnovo C, Ponticelli C. Peritoneal dialysis in nondiabetic patients older than 70 years: comparison with patients age 40–60 years. Am J Kidney Dis. 1998:31:479–90.

    Google Scholar 

  15. Okayama M, Inoue T, Nodaira Y, Kimura Y, Nobe K, Seto T, Sueyoshi K, Takane H, Takenaka T, Okada H, Suzuki H. Aging is an important risk factor for peritoneal dialysis-associated peritonitis. Adv Perit Dial. 2012;28:50–4.

    PubMed  Google Scholar 

  16. Lim WH, Dogra GK, McDonald SP, Brown FG, Johnson DW. Compared with younger peritoneal patients, elderly patients have similar peritonitis-free survival and lower risk of technique failure, but higher risk of peritonitis-related mortality. Perit Dial Int. 2010;31:663–71.

    Article  Google Scholar 

  17. Nessim SJ, Bargman JM, Austin PC, Story K, Jassal SV. Impact of age on peritonitis risk in peritoneal dialysis patients: an era effect. Clin J Am Soc Nephrol. 2009;4:135–41.

    PubMed  PubMed Central  Article  Google Scholar 

  18. Oo TN, Roberts TL, Collins AJ. A comparison of peritonitis rates from the United States Renal Data System Database: CAPD versus continuous cycling peritoneal dialysis patients. Am J Kidney Dis. 2005;45:372–80.

    PubMed  Article  Google Scholar 

  19. McDonald SP, Collins JF, Rumpsfeld M, Johnson DW. Obesity is risk factor for peritonitis in the Australian and New Zealand peritoneal dialysis patient population. Perit Dial Int. 2003;24:340–6.

    Google Scholar 

  20. Strippoli GFM, Tong A, Johnson D, Schena FP, Craig JC. Catheter-related interventions to prevent peritonitis in peritoneal dialysis: a systematic review of randomized controlled trials. J Am Soc Nephrol. 2004;15:2735–46.

    Google Scholar 

Download references

Conflict of interest

The authors have declared that no conflict of interest exists.

Author information

Affiliations

  1. Division of General Internal Medicine, Department of Internal Medicine, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193, Japan

    Makoto Nishina, Hidetaka Yanagi & Atsushi Takagi

  2. Division of Nephrology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193, Japan

    Takatoshi Kakuta, Masayuki Endoh & Masafumi Fukagawa

Authors
  1. Makoto Nishina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hidetaka Yanagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takatoshi Kakuta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masayuki Endoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masafumi Fukagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Atsushi Takagi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Makoto Nishina.

About this article

Cite this article

Nishina, M., Yanagi, H., Kakuta, T. et al. A 10-year retrospective cohort study on the risk factors for peritoneal dialysis-related peritonitis: a single-center study at Tokai University Hospital. Clin Exp Nephrol 18, 649–654 (2014). https://doi.org/10.1007/s10157-013-0872-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-013-0872-y

Keywords

  • Peritoneal dialysis
  • Peritonitis
  • Risk factors
  • Age