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Abstract: SU-OR21

Variation in Peritoneal Dialysis-Related Peritonitis Outcomes and Treatment Practices: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Al sahlawi, Muthana, Division of Nephrology, St. Michael’s Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada, Toronto, Canada
  • McCullough, Keith, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Fuller, Douglas S., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Zhao, Junhui, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Boudville, Neil, Medical School, University of Western Australia, Perth, Australia, Perth, Western Australia, Australia
  • Ito, Yasuhiko, Aichi Medical University, Nagakute, Japan, Nagakute, Japan
  • Kanjanabuch, Talerngsak, Center of Excellence in Kidney Metabolic Disorders and Division of Nephrology, Department of Internal Medicine, Chulalongkorn University, Bangkok, Thailand, Bangkok, Thailand
  • Nessim, Sharon, Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Canada, Montreal, Quebec, Canada
  • Piraino, Beth M., University of Pittsburgh, Pittsburgh, PA, United States, Pittsburgh, Pennsylvania, United States
  • Teitelbaum, Isaac, University of Colorado, Aurora, CO, United States, Aurora, Colorado, United States
  • Johnson, David W., Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia, Brisbane, Queensland, Australia
  • Woodrow, Graham, Renal Unit, St James’s University Hospital, Leeds, United Kingdom, Leeds, United Kingdom
  • Perl, Jeffrey, Division of Nephrology, St. Michael’s Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada, Toronto, Ontario, Canada
Background

Peritoneal dialysis (PD)-associated peritonitis is a leading cause of technique failure and transition to hemodialysis. In the Optimizing Peritonitis Prevention in The United States (OPPUS) study, we explored the impact of various patient, facility and treatment factors on the likelihood of cure following a peritonitis episode.

Methods

Using Peritoneal Dialysis Outcomes and Practice Patterns Study phase 1 (2014-2017) data from Australia and New Zealand, Canada, Japan, Thailand, the UK, and the US, cure was defined as the absence of a peritonitis relapse or recurrence, PD catheter removal, transition to hemodialysis or death during the 50 days following a peritonitis episode. Multivariable logistic regression was used to test associations between cure and patient, facility, and treatment characteristics.

Results

We identified 1677 peritonitis episodes in 1190 patients across 126 facilities. Overall, 63% of episodes resulted in a cure. Cure was associated with APD (OR v. CAPD=1.35, 95% CI 1.02-1.80), higher serum albumin (OR=1.04 per 0.1 g/dL, 95% CI=1.01, 1.06), facility icodextrin use (OR=1.06 per 10% greater icodextrin use, 95% CI = 1.01-1.12), and aminoglycoside use for Gram-negative peritonitis (OR v. ceftazidime=3.10, 95% CI=1.02, 9.36). Prior peritonitis (OR v. no prior peritonitis episodes during follow-up=0.84, 95% CI=0.74, 0.97) and concomitant exit-site infection (OR= 0.42, 95% CI=0.28, 0.63) were associated with lower cure odds. Higher odds of peritonitis relapse were seen among patients with greater residual urine volume (OR= 1.14 per 200 ml, 95% CI=1.07, 1.22).

Conclusion

Different characteristics and management practices can impact the likelihood of cure following a peritonitis episode. Our findings can inform future guidelines in addressing the effect of different modifiable patient, facility, and treatment factors on reducing morbidity associated with PD peritonitis.

Funding

  • Other NIH Support