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Abstract

Peritonitis is an important cause of morbidity and mortality in patients receiving peritoneal dialysis (PD). However, there are no data about the comparison of the incidence of peritonitis among PD solution types. The aim of the present study was to compare the incidence of peritonitis among PD solutions in PD patients treated either with Nutrineal or with Extraneal or with conventional glucose solutions. A total of 147 patients (60 female and 87 male) who underwent PD were included in the study. Of these patients, 47 used only glucose solutions (group I), 79 used glucose solutions combined with Extraneal (group II) and 21 used glucose solutions combined with Nutrineal (group III). The laboratory values and demographics of the patients were noted. There was no significant difference in the frequency of peritonitis among the three groups. Peritonitis occurred in 14 of 47 patients (29.8%) in group I, in 28 of 79 patients (35.4%) in group II and in 6 of 21 patients (28.6%) in group III. Patients with serum albumin levels below 3 g/dl had a significantly higher peritonitis rate than patients with serum albumin levels above 3 g/dl (p < 0.05). We have shown that a low serum albumin level is an important risk factor for the development of peritonitis in CAPD patients. The PD solution does not appear to be a risk factor for the development of peritonitis in CAPD patients, although this question should be studied further with larger numbers. Copyright 2007 S. Karger AG, Basel.

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Albumin at the start of peritoneal dialysis predicts the development of peritonitis.

Beth Piraino, Linda F. Fried, Qin Wang … (2003)

Both peritonitis and serum albumin level are associated with morbidity and mortality in peritoneal dialysis (PD) patients. Severe cases of peritonitis result in hypoalbuminemia. However, it is not clear whether hypoalbuminemia predicts the development of peritonitis. We performed a retrospective analysis of a prospectively collected database from six centers in western Pennsylvania and West Virginia. Incident PD patients with a Charlson Comorbidity Index (CCI) score at the start of PD therapy and serum albumin level measured within 30 days of initiation were selected. Poisson regression was used to analyze predictors of peritonitis. Three hundred ninety-three patients had a CCI score and serum albumin level measured at the start of PD therapy. Overall peritonitis rate was 0.65 episodes/dialysis-year. Significant univariate predictors were albumin level (rate ratio [RR], 0.79 per 1-g/dL [10-g/L] increase; 95% confidence interval [CI], 0.65 to 0.95; P = 0.015), male sex (P = 0.003), and being dialyzed in the Veterans Administration (RR, 1.97; 95% CI, 1.48 to 2.62; P < 0.001) or other center (RR, 1.68; 95% CI, 1.92 to 5.62; P < 0.001). Although CCI score correlated inversely with albumin level (r = -0.305; P < 0.001), CCI score was only marginally predictive of peritonitis (P = 0.068). In multivariate analysis, predictors were albumin level (RR, 0.74; 95% CI, 0.31 to 1.75; P = 0.002) and race (RR, 1.36; P = 0.024). Patients with an initial serum albumin level less than 2.9 g/dL (29 g/L) had a peritonitis rate of 1.5 episodes/dialysis-year compared with 0.6 episodes/dialysis-year for patients with an initial serum albumin level of 2.9 g/dL or greater (P < 0.001). Hypoalbuminemia at the start of PD therapy is an independent predictor of subsequent peritonitis. Intervention studies to decrease peritonitis risk in this high-risk subset of patients are needed. Copyright 2003 by the National Kidney Foundation, Inc.