Prognostic factors and impact of peritoneal dialysis-related early peritonitis on mortality in Sardjito General Hospital, Yogyakarta, Indonesia

Background Peritonitis has been reported to be asso­ciated with high mortality. However, information on the impact of the first peritonitis episode on continu­ous ambulatory peritoneal dialysis (CAPD) patients is sparse. ObjectiveTo determine the association between peritoneal dialysis-related early peritonitis and mor­tality. To determine prognostic factors on mortality in peritonitis patients with peritoneal dialysis. Methods A retrospective observational cohort study was conducted over 5 years at a single PD unit in Sardjito Hospital. Inclusion criteria: First onset of peritonitis patients with peritoneal dialysis from 2013 -2017, age ≥ 18 years old. Exclusion criteria: Incomplete medical records. A total of 48 patients on CAPD with peritonitis was divided into the early onset of peritonitis (< 20 months) and late onset of peritonitis ( ≥ 20 months. Kaplan-Meier survival curve was used to display cumulative relative risk as a parameter of prognostic factors. Results A total of 48 patients (early onset of peritonitis, n = 31; late onset of peritonitis, n = 17) were analyzed in our study with a mean of age50.6 years consisted of males 64.6%. There was a significant difference in patients’ mortality between the early and late onset of peritoni­tis. The Kaplan-Meier analysis revealed that log-rank test, p<0.05 with a mean survival time of patients with early peritonitis and late peritonitis was 236 days (95% CI: 162-309 days) and 1702 days (95% CI: 1067-2338 days) consecutively. Compared to those who were nor­moweight, underweight or overweight patients had in­creased risk of mortality, (RR 1.14 and 1.15; p=0.003, respectively). There was a significant association be­tween diabetes mellitus and lower serum creatinine levels, and the risk of mortality (RR 1.43, p=0.03 and mean difference -6.01, p< 0.001, respectively). Conclusions Early peritonitis patients have a poor prognosis compared to the late peritonitis group. Pa­tients with shorter time to first peritonitis were prone to having a higher mortality rate. Diabetes mellitus, under­weight or overweight, and lower serum creatinine are prognostic factors of mortality in peritonitis patients.