Risk factors of peritoneal dialysis-related peritonitis in the Japan Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS)

Abstract

Peritoneal dialysis (PD)-related peritonitis is a major complication of PD. Wide variations in peritonitis prevention, treatment strategies, and consequences are seen between countries. These between-country differences may result from modifiable risk factors and clinical practices. A total of 1225 Japanese PD patients were included and prospectively followed in the Peritoneal Dialysis Outcomes and Practice Patterns Study phase 1 (2014–2018) and phase 2 (2018–2022). Associations between PD-related peritonitis and various risk factors were assessed by Cox proportional hazards survival models. During follow-up (median 1.52 years), 539 peritonitis episodes were experienced by 364 patients. The country crude peritonitis rate was 0.27 episodes/patient-year. In the fully adjusted model, noticeable patient-level factors associated with experiencing any peritonitis included age (hazard ratio [HR], 1.07 per 5-year increase; 95% confidence interval [CI], 1.01–1.14), serum albumin level (HR, 0.63 per 1 g/dL higher; 95% CI, 0.48–0.82) and continuous ambulatory peritoneal dialysis (HR, 1.31 vs automated PD; 95% CI, 1.05–1.63). The adoption of antibiotic prophylaxis practice at the time of PD catheter insertion (HR, 0.63; 95% CI, 0.51–0.78), or when having complicated dental procedures (HR, 0.74; 95% CI, 0.57–0.95), or lower endoscopy (HR, 0.69; 95% CI, 0.54–0.89) were associated with lower hazards of any peritonitis while a routine facility practice of having more frequent regular medical visits was associated with a higher hazard. Identification of risk factors in Japan may be useful for developing future versions of guidelines and improving clinical practices in Japan. Investigation of country-level risk factors for PD-related peritonitis is useful for developing and implementing local peritonitis prevention and treatment strategies.