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ORIGINAL ARTICLES |
Division of Nephrology,1 Department of Medicine, Taipei Veterans General Hospital; School of Medicine,2 National Yang-Ming University; Division of Nephrology,3 Department of Medicine, Taipei Medical University Hospital, Taipei, Taiwan
Correspondence to: J.Y. Chen, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan. jychen{at}vghtpe.gov.tw
Background: Few patients are able to resume peritoneal
dialysis (PD) therapy after an episode of peritonitis that requires catheter
removal. PD catheter loss is therefore regarded as an important index of
patient morbidity. The aim of the present study was to evaluate factors
influencing catheter loss in patients suffering from continuous ambulatory PD
(CAPD) peritonitis. Patients and Methods: We retrospectively reviewed 579
episodes of CAPD peritonitis from 1999 to 2006 in a tertiary-care referral
hospital. Demographic, biochemical, and microbiological characteristics were
recorded. Episodes resulting in PD catheter removal (n = 68; 12%)
were compared by both univariate and multivariate analyses with those in which
PD catheters were preserved. Results: The incidence of PD catheter loss increased as
the number of organisms cultured increased (p = 0.001). Also, PD
catheter removal was more likely to occur after peritonitis episodes with low
serum albumin level (p = 0.004), those with long duration of PD
effluent leukocyte count remaining above 100/µL (p < 0.001),
those with concomitant tunnel infection (p < 0.001), those with
concomitant exit-site infection (p = 0.005), and those with presence
of catastrophic intra-abdominal visceral events (p < 0.001).
Duration on PD preceding the peritonitis episode was of borderline
significance (p = 0.080). On the contrary, initial PD effluent
leukocyte count and serum level of C-reactive protein were not predictive of
PD catheter loss. Micro-organisms of the Enterobacteriaceae family were the
major pathogens responsible for PD catheter loss following polymicrobial
peritonitis. Furthermore, we found that there was no association between
polymicrobial peritonitis and the catastrophic intra-abdominal visceral event,
although both resulted in a greater incidence of PD catheter loss. Among the
single-organism group in our population, the microbiological determinants of
PD catheter loss included fungi (p < 0.001), anaerobes (p
= 0.018), and Pseudomonas sp (borderline significance: p =
0.095). Conclusion: PD catheter loss as a consequence of
peritonitis is related primarily to hypoalbuminemia, longer duration of PD
effluent leukocyte count remaining above 100/µL, the etiologic source of
the infection, and the organism causing the infection. Peritonitis associated
with concomitant tunnel or exit-site infections and abdominal catastrophes
were more likely to proceed to PD catheter loss. The microbiological
determinants of PD catheter loss in the present study included polymicrobial
infections caused by Enterobacteriaceae as well as monomicrobial pseudomonal,
anaerobic, and fungal infections.
KEY WORDS: Peritoneal dialysis catheter loss; peritonitis; CAPD; microbiology.
Received 9 October 2007; accepted 3 March 2008.
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