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Risk factors for adverse outcomes after peritonitis-related technique failure

Authors
 Sung Jin Moon  ;  Seung Hyeok Han  ;  Dong Ki Kim  ;  Jung Eun Lee  ;  Beom Seok Kim  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Ho Yung Lee  ;  Dae-Suk Han 
Citation
 PERITONEAL DIALYSIS INTERNATIONAL, Vol.28(4) : 352-360, 2008 
Journal Title
 PERITONEAL DIALYSIS INTERNATIONAL 
ISSN
 0896-8608 
Issue Date
2008
MeSH
Adult ; Age Factors ; C-Reactive Protein/analysis ; C-Reactive Protein/metabolism* ; Catheters, Indwelling/adverse effects* ; Female ; Humans ; Kidney Failure, Chronic/complications* ; Kidney Failure, Chronic/metabolism ; Male ; Middle Aged ; Multivariate Analysis ; Peritoneal Dialysis/adverse effects* ; Peritoneal Dialysis/instrumentation ; Peritonitis/blood ; Peritonitis/etiology* ; Peritonitis/metabolism ; Peritonitis/pathology ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Treatment Outcome
Keywords
Adult ; Age Factors ; C-Reactive Protein/analysis ; C-Reactive Protein/metabolism* ; Catheters, Indwelling/adverse effects* ; Female ; Humans ; Kidney Failure, Chronic/complications* ; Kidney Failure, Chronic/metabolism ; Male ; Middle Aged ; Multivariate Analysis ; Peritoneal Dialysis/adverse effects* ; Peritoneal Dialysis/instrumentation ; Peritonitis/blood ; Peritonitis/etiology* ; Peritonitis/metabolism ; Peritonitis/pathology ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Treatment Outcome
Abstract
BACKGROUND: Peritonitis is the leading cause of technique failure in peritoneal dialysis (PD) patients. Some patients experience recurrent ascites, encapsulating peritoneal sclerosis (EPS), and even death after catheter removal. Little is known, however, about the risk factors for such complications. METHODS: The study subjects were 117 patients that had their PD catheter removed due to peritonitis between January 2000 and June 2006. Biochemical and clinical data were reviewed retrospectively. Serum C-reactive protein (CRP) and blood and effluent white blood cell counts (WBC) were measured at baseline and at 72 hours of peritonitis. Based on adverse outcomes, patients were classified into 4 groups: non-complication (NC; n = 73), recurrent ascites (A; n = 26), EPS (E; n = 10), and death directly related to peritonitis (D; n = 8). RESULTS: Age at PD catheter removal was significantly higher in D group compared to NC group (62.0 +/- 10.6 vs 51.2 +/- 11.5 years, p < 0.05). In addition, mean PD duration was significantly longer in E group compared to NC and A groups (130.5 +/- 48.1 vs 58.8 +/- 42.4 vs 74.8 +/- 47.4 months, p < 0.01). Compared to baseline, effluent WBC was significantly decreased in NC group after 72 hours of peritonitis. In addition, serum CRP level was significantly decreased in NC and A groups, whereas it was significantly increased in D group. Multivariate analyses adjusted for age, PD duration, blood and effluent WBC, serum CRP, and micro-organisms revealed that serum CRP level at 72 hours predicted significantly the development of EPS [odds ratio (OR) 1.15, p < 0.05] and peritonitis-related death (OR 1.18, p < 0.01). In addition, PD duration (per 1 month increase: OR 1.03, p < 0.05) and age at PD catheter removal (per 1 year increase: OR 1.11, p < 0.05) were identified as significant determinants of EPS and peritonitis-related death respectively. Only effluent WBC at 72 hours was significantly associated with the development of ascites (OR 1.27, p < 0.05). CONCLUSION: Older patients with long PD duration and those with persistently elevated serum CRP levels were likely to develop complications after peritonitis-related technique failure. Our study suggests that serial measurement of CRP may be helpful in predicting the development of complications after PD catheter removal.
Files in This Item:
T200800500.pdf Download
DOI
18556377
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kim, Dong Ki(김동기)
Kim, Beom Seok(김범석) ORCID logo https://orcid.org/0000-0002-5732-2583
Moon, Sung Jin(문성진)
Lee, Jung Eun(이정은) ORCID logo https://orcid.org/0000-0003-0917-2872
Lee, Ho Yung(이호영)
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Dae Suk(한대석)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/106681
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