Risk Factors of Catheter Loss Following Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis

Korean Journal of Nephrology 2010;29(3):357-365.

Mihyun Jang, M.D.1, Eunah Hwang, M.D.1, Jungeun Kim, M.D.1, Go Choi, M.D.1, Seungyeup Han, M.D.1, Sungbae Park, M.D.1

Department of Internal Medicine, Keimyung University School of Medicine, Kidney Institute¹
Hemodialysis Unit²
Dongsan Medical Center

원저 : 복막투석 환자에서 복막염으로 인한 투석도관 제거와 관련된 위험인자

장미현1 , 황은아1 , 김정은1 , 최 고1 , 한승엽1 , 박성배1 , 홍윤수2 , 이금희2 , 김현철1

계명대학교 의과대학 내과학교실, 신장연구소1 , 동산병원 인공신장실2

Abstract

Purpose : Peritoneal dialysis (PD) catheter removal is regarded as an important index of patient morbidity. The aim of this study was to evaluate factors influencing catheter loss following peritonitis in PD patients. Methods : We retrospectively reviewed 917 episodes of peritonitis in 621 new CAPD patients from Jan 2001 to Feb. 2009 in Dongsan Medical center. Episodes requiring PD catheter removal were compared by both univariate and multivariate analyses with those in which PD catheters were preserved. Results : When peritonitis episodes requiring PD catheter removal (n=80) were compared to catheter preserved peritonitis episodes (n=837), the incidence of PD catheter loss increased as the duration on PD preceding the peritonitis were longer (p<0.000). Also, PD catheter removal was more likely to occur after peritonitis episodes with low serum albumin level (p=0.009) and high serum CRP level (p<0.000), those with long duration of PD effluent leukocyte count remaining above 100/mm3 (p<0.000), those with concomitant exit site/tunnel infection (p=0.043), and those with presence of abdominal pathology (p<0.000). The microbiological determinants of PD catheter loss included two or more bacteria cultured (p=0.002) and fungi (p<0.000). In multivariate analysis, the duration of PD effluent leukocyte count remaining above 100/mL and the number of organism cultured were independent risk factors of PD catheter removal in peritonitis episodes. Conclusion : Duration of PD effluent leukocyte count remaining above 100/mm3, and the number of organisms cultured were independent risk factors for catheter removal following peritonitis.

Key Words: Peritoneal dialysis, Peritonitis, Device removal