Clinical Features,Influencing Factors And Prognosis Of Peritoneal Dialysis-Associated Peritonitis

Objective To investigate the clinical characteristics of peritoneal dialysis associated peritonitis(PDAP)in patients with persistent non-bed peritoneal dialysis(CAPD),and to analyze the influencing factors of PDAP in CAPD patients.The prognosis of patients with peritoneal dialysis(PD)was investigated and followed up,and the influencing factors of poor prognosis in PDAP patients were analyzed.Methods Patients with CAPD who received treatment and regular follow-up in the Department of Nephrology of the First Affiliated Hospital of Guangxi Medical University on January 1,2010 and December 31,2020 were selected.The prognostic event of follow-up was withdrawal from PD,and the remaining patients were followed up until December 31,2020.Patients were divided into PDAP group and non-PDAP group according to whether PDAP had ever occurred,and data differences between the two groups were compared.Patients were divided into positive group and negative group according to the pathogen status of PDAP for the first time,single group and multiple group according to the number of PDAP attacks,withdrawal group and maintenance group according to whether PDAP patients withdrew from PD,and the differences between the two groups were compared.Multivariate Logistic regression analysis was used to screen out risk factors,and then the receiver operating characteristic curve(ROC)was drawn to analyze the value of multivariate Logistic regression model in predicting the prognosis of PDAP.Results 584 CAPD patients were included in the study,with a mean age of47.42±13.66 years,a male-female ratio of 1.5:1,and a median age of 46 months.PDAP occurred in 114 patients(19.5%),with a age of 22-84 years,a male-female ratio of 1.42:1,and a mean age of 49.09±13.22.The median age of dialysis at first PDAP was 15 months.A total of 155 cases(26.5%)of 114 PDAP patients developed peritonitis,of which 90 CAPD patients developed PDAP only once(single: 90 cases),and the remaining 24 CAPD patients developed PDAP ≥2 times(multiple: 65 cases).At the first time of PDAP,pathogen strains were isolated from 36 patients by peritonal dialytic fluid culture,with a positive culture rate of 32.1% : 21 cases of Gram-positive bacteria(58.3%),11 cases of Gram-negative bacteria(30.6%),4 cases of fungi(11.1%),66 cases of negative culture,and the remaining 12 cases of mixed growth or contamination of multiple bacteria.Binary Logistic regression analysis suggested:Baseline hypoproteinemia(OR=2.263,95%CI 1.256-4.078,P=0.006)and PLT level(OR=1.005,95%CI 1.001-1.009,P=0.015)were independent risk factors for first PDAP.25(OH)D3 level(OR=0.978,95%CI 0.962-0.994,P=0.01)was a protective factor for PDAP.Etiological composition and body mass index(BMI)were independent risk factors for recurrent PDAP in PD patients(all P<0.05).Follow-up results of PDAP patients showed that 53 patients(46.5%)withdrew from PD,and 45 patients maintained PD.Binary Logistic regression analysis indicated that age,dialysis age at first PDAP and 25(OH)D3 deficiency were independent risk factors for withdrawal of PDAP patients(all P<0.05).Conclusion PDAP is a common complication in CAPD patients,and dialysate of more than half of PDAP patients has negative etiological culture.Hypoproteinemia,25(OH)D3 level and PLT level were the influencing factors for the occurrence of PDAP.Age,25(OH)D3 and the age of dialysis for the first PDAP were the influencing factors for the withdrawal of PDAP.