Risk factors for adverse outcomes after peritonitis-related technique failure

Abstract

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.