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Abstract: FR-PO534

International Variation in Outcomes After PD-Related Peritonitis

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Perl, Jeffrey, St. Michael's Hospital, Toronto, Ontario, Canada
  • Fuller, Douglas S., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Boudville, Neil, University of Western Australia, Nedlands, Western Australia, Australia
  • Ito, Yasuhiko, Aichi Medical University, Nagakute, Aichi, Japan
  • Kanjanabuch, Talerngsak, Chulalongkorn University, Bangkok, Thailand
  • Nessim, Sharon, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
  • Piraino, Beth M., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Teitelbaum, Isaac, University of Colorado, Aurora, Colorado, United States
  • Woodrow, Graham, St. James University Hospital, Leeds, United Kingdom
  • Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia

Group or Team Name

  • PDOPPS Infection Prevention and Management Workgroup
Background

Peritoneal dialysis (PD)-associated peritonitis is a major source of morbidity, mortality, and technique failure for patients receiving PD. We sought to understand if there were regional differences in peritonitis outcomes.

Methods

We used Peritoneal Dialysis Outcomes and Practice Patterns Study phase 1 (2014-2017) data from Australia and New Zealand (A/NZ), Canada (CA), Japan (JP), Thailand (TH), the UK, and the US to report variation in peritonitis outcomes (up to 50 days after peritonitis) by country and to estimate associations with organism type using logistic regressions adjusted for country, age, sex, diabetes, and serum albumin. Cure was defined as the lack of any outcome except hospitalization. Technique failure (TF) was defined as permanent transfer to hemodialysis or failure to resume PD within 12 weeks.

Results

We observed 2270 peritonitis episodes in 6949 patients during 7816 years of follow-up (crude rate: 0.29 episodes/year). Cure proportion was 64% (range by country: 54-68%), and death occurred in 6% (JP: 2%; TH: 16%, others: 4-5%). Hospitalization was common for both peritonitis-related causes (55%, range: 41-75%) and for any cause (72%; range: 59-91%), with >80% occurring within 14 days. Relapsing/recurrent peritonitis occurred in 9% (range: 7-14%), and concurrent exit-site infection occurred in 12% (JP, UK: 19-21%; TH: 6%; others: 9-10%). Catheter removal occurred in 21% (TH, JP, UK: 24-29%; others: 18-20%), and TF occurred in 16% (TH: 10%; others: 16-19%). Higher odds of death, TF, or catheter removal were seen for Gram-negative (OR=2.78, 95% CI=2.03, 3.8), culture negative (OR=1.3, 95% CI=0.92, 1.83), polymicrobial (OR=4.43, 95% CI=2.89, 6.79), and missing/unknown peritonitis (OR=2.64, 95% CI=1.89, 3.69), compared to Gram-positive peritonitis.

Conclusion

High proportions of peritonitis resulting in death (Thailand) and TF (all countries) suggest novel interventions to prevent peritonitis are needed. Emphasis on identification methods and development of organism-specific treatment strategies may help reduce morbidity associated with these episodes.

Funding

  • NIDDK Support