Risk factors for adverse outcomes after peritonitis-related technique failure

Sung Jin Moon, Seung Hyeok Han, Dong Ki Kim, Jung Eun Lee, Beom Seok Kim, Shin Wook Kang, Kyu Hun Choi, Ho Yung Lee, Dae Suk Han

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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.

Original languageEnglish
Pages (from-to)352-360
Number of pages9
JournalPeritoneal Dialysis International
Volume28
Issue number4
Publication statusPublished - 2008 Jul 1

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Peritoneal Dialysis
Peritonitis
Peritoneal Fibrosis
C-Reactive Protein
Blood Proteins
Leukocyte Count
Catheters
Odds Ratio
Ascites
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Moon, S. J., Han, S. H., Kim, D. K., Lee, J. E., Kim, B. S., Kang, S. W., ... Han, D. S. (2008). Risk factors for adverse outcomes after peritonitis-related technique failure. Peritoneal Dialysis International, 28(4), 352-360.
Moon, Sung Jin ; Han, Seung Hyeok ; Kim, Dong Ki ; Lee, Jung Eun ; Kim, Beom Seok ; Kang, Shin Wook ; Choi, Kyu Hun ; Lee, Ho Yung ; Han, Dae Suk. / Risk factors for adverse outcomes after peritonitis-related technique failure. In: Peritoneal Dialysis International. 2008 ; Vol. 28, No. 4. pp. 352-360.
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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.",
author = "Moon, {Sung Jin} and Han, {Seung Hyeok} and Kim, {Dong Ki} and Lee, {Jung Eun} and Kim, {Beom Seok} and Kang, {Shin Wook} and Choi, {Kyu Hun} and Lee, {Ho Yung} and Han, {Dae Suk}",
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Moon, SJ, Han, SH, Kim, DK, Lee, JE, Kim, BS, Kang, SW, Choi, KH, Lee, HY & Han, DS 2008, 'Risk factors for adverse outcomes after peritonitis-related technique failure', Peritoneal Dialysis International, vol. 28, no. 4, pp. 352-360.

Risk factors for adverse outcomes after peritonitis-related technique failure. / Moon, Sung Jin; Han, Seung Hyeok; Kim, Dong Ki; Lee, Jung Eun; Kim, Beom Seok; Kang, Shin Wook; Choi, Kyu Hun; Lee, Ho Yung; Han, Dae Suk.

In: Peritoneal Dialysis International, Vol. 28, No. 4, 01.07.2008, p. 352-360.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk factors for adverse outcomes after peritonitis-related technique failure

AU - Moon, Sung Jin

AU - Han, Seung Hyeok

AU - Kim, Dong Ki

AU - Lee, Jung Eun

AU - Kim, Beom Seok

AU - Kang, Shin Wook

AU - Choi, Kyu Hun

AU - Lee, Ho Yung

AU - Han, Dae Suk

PY - 2008/7/1

Y1 - 2008/7/1

N2 - ◆ 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.

AB - ◆ 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.

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