The Incidence And Risk Factors Of Peritoneal Dialysis Peritonitis In Cities And Countrysides Of Hunan Province

Background:Most end-stage renal disease(end-stage renal disease, ESRD) patients have hemodialysis treatment in hemodialysis(hemodialysis, HD) center, and peritoneal dialysis(peritoneal dialysis, PD) is dominant in the home dialysis therapy. By 2012, the global number of PD patients accounted for 11% of all the dialysis patients.At the end of 2011, China has 2.7 million patients of peritoneal dialysis, and in the end of 2012, the number of peritoneal dialysis patients reached 3.8 million, accounting for 13% of the total number of dialysis. PD has been accepted by more and more people PD because of its features and advantages, such as the device is simple, easy to operate required;Less impact on blood volume without increasing heart load;protection of residual renal function.Peritoneal dialysis-related peritonitis is one of the most common and serious complication of peritoneal dialysis patients,it is also the main reason for exiting peritoneal dialysis. Meanwhile, the incidence of peritonitis affect peritoneal function and survival in peritoneal dialysis patients. In addition, the incidence of peritonitis increase the economic burden on patients and have a serious impact on the quality of patients’ life. In recent years, with the improvement of dialysis tubing,dialysate,and the technology matures dialysis, peritoneal dialysis-related peritonitis incidence decreased significantly, but it is still the main cause of hospitalization and PD technical failure.At present, China is in the primary stage of socialism and uneven development of urban and rural, there is a difference in education, household sanitation, personal hygiene, the actual operation of sterile between urban and rural peritoneal dialysis patients, the peritonitis incidence of urban-rural may be different. By investigating the incidence of peritonitis in urban and rural peritoneal dialysis patients,finding out whether there is a clear distinction, and explore the possible factors influencing the occurrence of peritonitis, prevention against the relevant factors, to reduce the occurrence of peritonitis, peritoneal dialysis patients to improve the quality of patients’ life. Objective:Survey the incidence of peritonitis in urban-rural peritoneal dialysis patients in Hunan Province,to finding out whether there is a difference and analyze the relationship between these factors and peritoneal dialysis-related peritonitis. Method:From January 2013 to December 2014,823 patients in the People’s Hospital of Hunan Provincial, The Third Xiangya Hospital Of Central South University and Shaoyang Central Hospital were selected.According to the patient long-term residence, patients divided into urban groups(city, county) and rural groups(towns, rural areas). Calculate the incidence of urban and rural peritonitis in various dialysis centers, analyze whether there are differences between the two. Through face to face questionnaire the peritoneal dialysis patients in the People’s Hospital of Hunan Provincial, recording CAPD patients with general information(gender, age, place of residence, education level, etc.), primary disease, the operating conditions, personal health situation, diarrhea and constipation, and so on. According to the criterion of peritonitis, divide into peritonitis and never peritonitis groups. Analyze the relationship between these factors and the occurrence of peritonitis. Result: 1.There is no statistically significant between urban and rural groups in age and gender(p>0.05).The incidence and risk factors of peritoneal dialysis peritonitis in cities and countrysides of Hunan Province,there is a difference.City peritonitis incidence is 0.19 times / patient-years(1/62 patients months), the rural peritonitis rate was 0.28 times / patient year(1/42 patients),Patients in rural towns have a higher incidence than patients in urban. 2. Analysis on general data:There is a statistically difference between peritonitis group and non- peritonitis group in the long-term residence(p<0.05), but in gender, age, height, weight, body mass index, education level, the difference is not statistically significant(p> 0.05). 3.Analysis on pathogen: There is a statistically difference between peritonitis group and non- peritonitis group in whether patients complicating diabetes(p <0.05). 4.Analysis on operations:the occurrence of peritonitis have a relationship with liquid exchange chamber,wash hands before the operation, wearing masks, tunnel care, iodine cap, UV lamp(p <0.05). 5.Analysis on personal hygiene habits: There is a statistically difference between peritonitis group and non- peritonitis group in the frequency of hand washing, brushing, bathing in summer(p<0.05), but in the frequency of changing toothbrushes,washing bedding drying, comparison on nails, onychomycosis or tinea,, the difference is not statistically significant(p> 0.05). 6.Analysis on intestinal function:There is a statistically difference between peritonitis group and non- peritonitis group in the diarrhea, constipation(p<0.05). 7. Logistic regression analysis: The risk of peritonitis occurred in rural patients is 5.876 times than the urban patients, the risk of peritonitis occurred in patients who wash their hands three to five times is 5.961 times than up to ten times, the risk of peritonitis occurred in patients who brush once or less is 3.947 times than brush twice or more, the risk of peritonitis occurred in patients who have diarrhea is 5.744 times than without diarrhea, the risk of peritonitis occurred in patients who have constipation is 2.021 times than without constipation. 8.Factors that may affect the differences between urban and rural peritonitis rates: There is a statistically difference between urban and rural groups in education level,the frequency of hand washing, brushing(p<0.05), but in the primary disease,whether patients complicating diabetes, diarrhea, constipation,the difference is not statistically significant(p> 0.05). Conclusion: 1.There is a difference on the incidence of peritonitis between urban and rural peritoneal dialysis patients in Hunan Province,The city peritonitis incidence is 0.19 times / patient-years(1/62 patients months), the rural peritonitis rate was 0.28 times / patient year(1/42 patients),and the risk is 5.876 times. 2.The occurrence of peritonitis have a relationship with whether complicating diabetes, dialysis operations, personal hygiene,diarrhea and constipation. 3.The differences between urban and rural peritonitis rates may have a relationship with education level,the frequency of hand washing, brushing.