Impact of peritonitis on long-term survival of peritoneal dialysis patients

Background: The impact of each episode of peritonitis on long-term survival of peritoneal dialysis (PD) patients has yet to be defined. Objectives: To determine the risk that each episode of peritonitis poses for patient survival and for the PD technique. Patients: 1515 patients included in the Levante registry from 1 January 1993 to 31 December 2005. Methods: Retrospective analysis of a multicentre registry using Cox regression for time-dependent variables. Results: We analysed 1609 episodes of peritonitis in 716 patients (47.2%). In the univariate analysis, each case of peritonitis treated in the outpatient unit was associated with an increase in mortality (hazard ratio [HR] 1.99, P<.001), which was greater for episodes that required hospitalisation (HR 3.62, P<.001). Mortality increased with each successive episode in the same patient. Multivariate analysis confirmed the association of each case of peritonitis with lower longterm survival (HR 2.01, P<.001), with a different risk for episodes due to gram-positive, gram-negative bacteria and fungi (HR 1.73, 2.43 and 5.71, respectively; P9.001). Other variables associated with mortality were age, low residual renal function, absence of vascular access and comorbidity. Peritonitis was the only independent variable associated with technique failure (HR 1.29, P<.001), with a different risk for episodes due to gram-positive and gram-negative bacteria and fungi (HR 1.73, 2.43 and 5.71, respectively; P<.001). Conclusions: Episodes of peritonitis negatively influence long-term survival of patients on PD.