| OBJECTIVE:The multicenter clinical data of patients with peritoneal dialysis-associated peritonitis(PDAP)in Jilin Province were retrospectively analyzed.Comparing the clinical characteristics and prognosis between early-onset peritoneal dialysis-associated peritonitis(EOP)and late peritoneal dialysis-associated peritonitis(LOP),we provided theoretical basis for clinical treatment of peritoneal dialysis-associated peritonitis.METHODS:This study recruited the patients with end-stage renal disease(ESRD)who had occured PDAP at least once in four peritoneal dialysis centers of Jilin Province (including The Second Hospital of Jilin University,The First Bethune Hospital of Jilin University,Jilin Central Hospital,The Fourth Hospital of Jilin University)from 2013 to 2018.The end points of follow-up is one of following events: death, hemodialysis,kidney transplant,or by December 31,2019.This study is divided into three parts with different population,the whole population,the elderly and the diabetes in the whole population,respectively.The EOP was defined as the dialysis time ?12 months from PD onset.Three parts study population were divided into EOP group and LOP group respectively,and the general information,laboratory findings,treatment outcome and prognosis of patients were compared.RESULT:1.Overall population:(1)A total of 575 patients with 314 patients in the EOP group and 261 patients in the LOP group were included.Except for the significant differences in serum albumin before dialysis and hemoglobin of the first PDAP,There were no significant differences in general information and laboratory findings between two groups(P>0.05).(2)The proportion of coagulase-negative Staphylococcus,Staphylococcus aureus,and Enterococcus cultured in the dialysate of EOP group was significantly higher than that of LOP group,while Streptococcus and G+ bacteria were lower than those of LOP group(P <0.05).(3)The initial treatment efficiency and subsequent treatment cure rate of the EOP group were significantly higher than those of the LOP group,while the catheter removal rate of subsequent treatment was lower than that of the LOP group(P <0.05).(4)The Kaplan-Meier survival curve showed that the survival rate of patients in the EOP group was lower than that in the LOP group,while the rates of technical failure,occurrence of PDAP(n?2),and composite endpoint(technical failure and all-cause death)were significantly higher than those in the LOP group P ?0.001).(5)After correcting for confounding factors by multivariate Cox proportional hazard regression,the risk of all-cause death,technical failure,recurrence of PDAP and the composite endpoint in EOP group was 2.623 times,2.530 times,2.019 times,2.475 times the LOP group,respectively(P<0.05).2.The elderly in the whole population(1)A total of 194 patients with an average age of 72.91 years(female,58.7%)were included.85 patients were in the EOP group with an average age of 71.85 years(female,71.8%).Except for the significant differences in serum albumin before dialysis and estimated glomerular filtration ratee(eGFR)of the first PDAP,there was no significant differences in general information and laboratory findings between two groups in the eldly(P>0.05).(2)The percentage of Acinetobacter and negative-culture cultured in the dialysate of the EOP group was significantly higher than that in the LOP group(P<0.05).(3)There were no significant differences in the initial treatment efficiency and subsequent treatment outcome(including the cure rate,catheter removal rate,recurrence rate,and peritonitis-related mortality)between the two groups(P>0.05).(4)The Kaplan-Meier survival curve showed that the survival rate of patients in the EOP group was lower than that in the LOP group,while the rates of technical failure,occurrence of PDAP(n? 2),and entering composite endpoints(technical failure and all-cause death)were significantly higher than those in the LOP group(P ?0.006).(5)After correcting for confounding factors by multivariate Cox proportional hazard regression,the risk of all-cause death,technical failure,recurrence of PDAP and the composite endpoint in EOP group was 2.223 times,2.784 times,3.438 times,2.676 times the LOP group respectively,but the risk of technical failure was not statistically significant(P>0.05).3.The diabetic patients in the whole population(1)A total of 202 patients with 112 patients in the EOP group and 90 patients in the LOP group were included.Except for the significant differences in the rate of sex and eGFR of the first PDAP,there were no significant differences in general information and laboratory findings between two groups in diabetic patients(P>0.05).(2)The proportion of Streptococcus and Monas cultured in the dialysate of the EOP group was significantly lower than that of the LOP group(P<0.05).(3)The PDAP-related mortality rate of the follow-up treatment in the EOP group was lower than that in the LOP group(P = 0.015).There was no statistical difference in the initial treatment efficiency,cure rate,catheter removal rate,and recurrence rate between the two groups(P> 0.05)(4)The Kaplan-Meier survival curve showed that the survival rate of patients in the EOP group was lower than that in the LOP group,while the rates of technical failure,occurrence of PDAP(n?2),and entering composite endpoints(technical failure and all-cause death)were significantly higher than those in the LOP group(P?0.019).(5)After correcting for confounding factors by multivariate Cox proportional hazard regression,the risk of all-cause death,technical failure,recurrence of PDAP and the composite endpoint in EOP group was 3.093 times,6.373 times,4.203 times,4.338 times the LOP group respectively(P<0.05).CONCLUSION:EOP is an independent predictor of the risk of PDAP(n?2),all-cause death,all-cause death,technical failure,and compound endpoint events in the general population and patients with diabetes;EOP is the risk of PDAP(n?2),all-cause death in elderly patients And an independent predictor of the risk of a composite endpoint event,rather than an independent predictor of the risk of technical failure in old age. |
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