Abstract: TH-PO869

Poor Early Exit Site Condition Was Associated with Subsequent Exit Site Infection and Catheter Loss of Peritoneal Dialysis

Session Information

  • Peritoneal Dialysis - I
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Uehara, Masaki, Department of Nephrology, National Hospital Organization Chiba-East Hospital, Chiba, Japan
  • Yamakawa, Takafumi, Department of Nephrology, National Hospital Organization Chiba-East Hospital, Chiba, Japan
  • Kawaguchi, Takehiko, Department of Nephrology, National Hospital Organization Chiba-East Hospital, Chiba, Japan
  • Imasawa, Toshiyuki, Department of Nephrology, National Hospital Organization Chiba-East Hospital, Chiba, Japan
  • Kadomura, Moritoshi, Department of Nephrology, National Hospital Organization Chiba-East Hospital, Chiba, Japan
Background

Exit site infection (ESI) is a common complication for peritoneal dialysis (PD) patients. A previous study reported that the first ESI before eight month post-implant period was a higher risk of PD related infections. However, it is unclear whether an early condition of exit site after PD initiation is associated with subsequent ESI and PD catheter loss.

Methods

We retrospectively examined 46 patients who started PD from 2010 to 2015 at Chiba East Hospital in Japan. The patients were divided into two groups, good or poor exit site condition group (G or P group), according to ISPD exit site scoring system. We defined the poor exit site as the score more than 2 points on the first outpatient visit after PD initiation, or the worse score on the second visit. We compared episodes of ESI more than twice (E), peritonitis (P) and catheter loss (L) between the groups. Cox regression was used to estimate hazard ratios (HRs) adjusting for age and diabetes as primary disease.

Results

The patients were mostly male (69.6%), with a mean age of 61.0 years, and 50% of patients had diabetes. There were no statistical differences in baseline characteristics between the two groups. During the median follow-up of 719 days, we observed 13 of Es, 15 of Ps, and 13 of Ls. In unadjusted analyses, we found no statistical difference in P free survival rates, but E and L free survival rates were significantly lower in P group than in G group (Figure). In multivariable analyses, the adjusted HRs (95% CI) for E, P, and L in P group were 29.5 (2.62-331.61), 1.90 (0.61-5.94), and 3.00 (1.01-8.95), respectively.

Conclusion

Poor early exit site conditions were associated with subsequent ESIs and PD catheter losses. It may be crucial to keep good exit conditions after PD initiation. Further studies are needed to verify that early screening and interventions for poor exit sites can improve the outcomes.