Kidney Week

Abstract: TH-PO410

Exit-Site Infection Associated with Baseline Body Mass Index in Patients Initiating Peritoneal Dialysis

Session Information

• Dialysis: Peritoneal Dialysis - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 703 Dialysis: Peritoneal Dialysis

Authors

• Nakamura, Hironori, Sinonoi General Hospital, Nagano, Japan

Hironori Nakamura,

• Mariko, Anayama, Sinonoi General Hospital, Nagano, Japan

Anayama Mariko,

• Makino, Yasushi, Sinonoi General Hospital, Nagano, Japan

Yasushi Makino,

• Nagasawa, Masaki, Sinonoi General Hospital, Nagano, Japan

Masaki Nagasawa,

Background

The International Society for Peritoneal Dialysis (PD) guidelines recommend the monitoring of PD-related infections as well as the incidence of peritonitis. However, the incidence rate of PD-related infections or the associated clinical factors have not been well investigated.

Methods

Forty-seven patients who initiated PD between 2012 and 2017 were retrospectively reviewed. The clinical data were compared between the patients developing exit-site infection (ESI) and those who did not during the initial 60 days after initiating PD. Kaplan–Meier analysis and Cox proportional hazards model were used to identify the factors associated with ESIs using the time to initial ESI from data in the cohort. An ESI was defined as the presence of purulent drainage with positive culture results, and was counted as one occurrence when the infection lasted for <4 weeks.

Results

The number of annual ESI events and their annual incidence rates between 2012 and 2017 were 1, 6, 18, 32, 20, and 36 and 0.83, 0.86, 1.36, 1.09, and 1.59 (per patient-years), respectively. The body mass index (BMI) in patients who developed ESIs before the initial 60 days (25.9 ± 4.4 kg/m²) was significantly higher than that of patients who did not develop ESIs (21.7 ± 2.8 kg/m²); the occurrence of diabetes mellitus (DM) was also significantly higher (9/16 vs. 7/31) and the D/P Cr was significantly lower (0.57 ± 0.08 vs. 0.66 ± 0.10) in patients with ESIs than in those without ESIs. There were no significant differences in variables, such as age, sex, stepwise PD initiation, presence of caregiver, and serum albumin, between the two groups. Kaplan–Meier revealed that the high BMI group divided by the median value and the occurrence of DM indicated a higher rate of ESI (Log-Rank: p = 0.006 and 0.026, respectively) compared with the group with low BMI and that without DM. The Cox proportional hazards model revealed that ESI events during the 2 years were significantly affected by the patients’ BMI [hazard ratio (HR), 1.236; 95% confidence interval (95% CI), 1.07–1.41; p = 0.002] but not by the presence of DM (HR, 0.952; 95% CI, 0.29–3.03; p = 0.934).

Conclusion

Our findings suggest that ESIs are associated with baseline BMI of patients initiating PD in our study population. Body weight control at the time of PD initiation can potentially diminish the risk of ESI.