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Risk factors for adverse outcomes after peritonitis-related technique failure

 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 
 Peritoneal Dialysis International, Vol.28(4) : 352-360, 2008 
Journal Title
 Peritoneal Dialysis International 
Issue Date
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
강신욱(Kang, Shin Wook) ORCID logo https://orcid.org/0000-0002-5677-4756
김동기(Kim, Dong Ki)
김범석(Kim, Beom Seok) ORCID logo https://orcid.org/0000-0002-5732-2583
문성진(Moon, Sung Jin)
이정은(Lee, Jung Eun) ORCID logo https://orcid.org/0000-0003-0917-2872
이호영(Lee, Ho Yung)
최규헌(Choi, Kyu Hun) ORCID logo https://orcid.org/0000-0003-0095-9011
한대석(Han, Dae Suk)
한승혁(Han, Seung Hyeok) ORCID logo https://orcid.org/0000-0001-7923-5635
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