Risk Factors And Prognosis Of Early-onset Peritoneal Dialysis-associated Peritonitis

Objective:The purpose of this study was to analyze the risk factors and prognosis of early-onset peritoneal dialysis associated peritonitis(PDAP).Methods:We selected 116 patients with PDAP from Shengjing Hospital of China Medical University from January 2008 to June 2016,and divided them into the arly-onset PDAP group(n=32)and late-onset PDAP group(n=84)based on the first onset time.We collected the clinical data,laboratory results and bacterial culture results.We recorded their outcomes and survival time obtained from a follow-up that ended on the date of death or ended by March 2017 or by the time that the peritoneal dialysis was superseded by long-term hemodialysis.Results:The rates of violation of aseptic manipulation and living in bungalow in the early-onset PDAP group were much higher than those of the late-onset PDAP group(P<0.05).The differences in terms of peritoneal dialysis operators between the two groups were significant(P<0.05).The average hemoglobin and albumin levels of the early-onset PDAP group were obviously lower than those of the late-onset PDAP group(P<0.05).Of the 82 cases underwent bacterial culture of peritoneal dialysis fluid,59 (72.0%)had positive results,including 14 of early-onset PDAP and 45 of late-onset PDAP.The distribution of pathogens in the two groups showed no significant differences(x~2=0.982,P=0.612).Binary Logistic regression analysis revealed that violation of aseptic manipulation[OR=0.242,95%CI(0.079,0.739)],living in bungalow [OR=0.209,95%CI(0.063,0.692)],decreased hemoglobin levels[OR=0.947,95%CI(0.917,0.978)]and decreased albumin levels[OR=0.890,95%CI(0.799,0.978)]were the risk factors of early-onset PDAP(P<0.05).There were no significant differences in treatment outcomes between the two groups(x~2=1.488,P=0.475).Kaplan-Meier analysis showed that by the end of the follow-up,the median survival time of the early-onset PDAP group was shorter than that of the late-onset PDAP group[24.0(11.2,36.8)months vs 40.0(34.4,45.6)months,(x~2=7.221,P=0.007)].Conclusion:This study found that patients with early-onset PDAP often have shorter survival time.Violation of aseptic manipulation,living in bungalow,decreased hemoglobin and albumin were the independent risk factors of early-onset PDAP.It is necessary to take effective measures to prevent and decrease the incidence of early-onset PDAP and prolong the survival of such patients.