Early Initiation of Icodextrin Reduces Peritoneal Dialysis-Associated Peritonitis Risk: A Retrospective Cohort Study.

IF 2.2 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2024-12-06 DOI:10.1159/000542326

Ryunosuke Mitsuno, Takashin Nakayama, Kohkichi Morimoto, Kiyotaka Uchiyama, Naoki Washida, Ei Kusahana, Eriko Yoshida Hama, Shun Tonomura, Norifumi Yoshimoto, Akihito Hishikawa, Aika Hagiwara, Tatsuhiko Azegami, Jun Yoshino, Toshiaki Monkawa, Tadashi Yoshida, Shintaro Yamaguchi, Kaori Hayashi

{"title":"Early Initiation of Icodextrin Reduces Peritoneal Dialysis-Associated Peritonitis Risk: A Retrospective Cohort Study.","authors":"Ryunosuke Mitsuno, Takashin Nakayama, Kohkichi Morimoto, Kiyotaka Uchiyama, Naoki Washida, Ei Kusahana, Eriko Yoshida Hama, Shun Tonomura, Norifumi Yoshimoto, Akihito Hishikawa, Aika Hagiwara, Tatsuhiko Azegami, Jun Yoshino, Toshiaki Monkawa, Tadashi Yoshida, Shintaro Yamaguchi, Kaori Hayashi","doi":"10.1159/000542326","DOIUrl":null,"url":null,"abstract":"Introduction: Peritonitis is a common and serious complication of peritoneal dialysis (PD) that leads to its discontinuation and death. Icodextrin (ICO) improves peritoneal ultrafiltration and its early use reduces mortality. However, its effectiveness in reducing PD-associated infections remains to be elucidated.Methods: This retrospective observational study enrolled patients who underwent PD between September 2011 and March 2020. The patients were classified into two groups: those who received ICO at the initiation of PD therapy (early ICO) and those who received ICO later or not at all (late/no ICO) and were followed up from PD induction until PD cessation, death, or 3 years had passed.Results: Of the 82 patients (age, 61 [53-72] years), 21 received early ICO. During follow-up (36 [14-36] months), the incidence of PD-associated peritonitis was 0.17 episodes per patient-year. Log-rank tests indicated that PD-associated peritonitis and tunnel infection (TI)-free survival rates were significantly better with the early use of ICO than with late/no ICO (p = 0.02 and p = 0.01, respectively). The early use of ICO remained significantly associated with decreased incidence of both peritonitis and TI (hazard ratio [HR], 0.19; 95% confidence interval [CI], 0.06-0.69 and HR, 0.10; 95% CI, 0.01-0.78, respectively) using Cox regression analysis adjusted for potential confounders.Conclusion: Beginning ICO administration at the initiation of PD shows promise for mitigating the risks of PD-associated peritonitis and TI.","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-10"},"PeriodicalIF":2.2000,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Blood Purification","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000542326","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEMATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: Peritonitis is a common and serious complication of peritoneal dialysis (PD) that leads to its discontinuation and death. Icodextrin (ICO) improves peritoneal ultrafiltration and its early use reduces mortality. However, its effectiveness in reducing PD-associated infections remains to be elucidated.

Methods: This retrospective observational study enrolled patients who underwent PD between September 2011 and March 2020. The patients were classified into two groups: those who received ICO at the initiation of PD therapy (early ICO) and those who received ICO later or not at all (late/no ICO) and were followed up from PD induction until PD cessation, death, or 3 years had passed.

Results: Of the 82 patients (age, 61 [53-72] years), 21 received early ICO. During follow-up (36 [14-36] months), the incidence of PD-associated peritonitis was 0.17 episodes per patient-year. Log-rank tests indicated that PD-associated peritonitis and tunnel infection (TI)-free survival rates were significantly better with the early use of ICO than with late/no ICO (p = 0.02 and p = 0.01, respectively). The early use of ICO remained significantly associated with decreased incidence of both peritonitis and TI (hazard ratio [HR], 0.19; 95% confidence interval [CI], 0.06-0.69 and HR, 0.10; 95% CI, 0.01-0.78, respectively) using Cox regression analysis adjusted for potential confounders.

Conclusion: Beginning ICO administration at the initiation of PD shows promise for mitigating the risks of PD-associated peritonitis and TI.

查看原文本刊更多论文

早期使用醋酸糊精可降低腹膜透析相关腹膜炎的风险：一项回顾性队列研究。

腹膜炎是腹膜透析（PD）常见且严重的并发症，可导致腹膜透析终止和死亡。Icodextrin （ICO）改善腹膜超滤，早期使用可降低死亡率。然而，它在减少pd相关感染方面的有效性仍有待阐明。方法：这项回顾性观察性研究纳入了2011年9月至2020年3月期间接受PD治疗的患者。患者被分为两组：在PD治疗开始时接受ICO的患者（早期ICO）和较晚或根本没有接受ICO的患者（晚期/无ICO），并从PD诱导随访至PD停止，死亡或三年过去。结果：82例患者（年龄61[53-72]岁）中，21例患者接受早期ICO。在随访期间（36[14-36]个月），pd相关性腹膜炎的发生率为0.17次/患者年。Log-rank检验显示，早期使用ICO的pd相关性腹膜炎和隧道感染（TI）无生存率显著高于晚期或未使用ICO的患者（P = 0.02和P = 0.01）。早期使用ICO仍与腹膜炎和TI发生率的降低显著相关(风险比[HR]， 0.19；95%置信区间[CI]为0.06 ~ 0.69，比差为0.10；95% CI，分别为0.01-0.78)，采用Cox回归分析校正潜在混杂因素。结论：在PD开始时开始使用ICO可以降低PD相关腹膜炎和TI的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.