Risk factors of peritonitis during early peritoneal dialysis in patients with ANCA-associated systemic vasculitis
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This study investigated the risk factors of peritonitis during early peritoneal dialysis for renal failure in patients with antineutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitis (AASV). This study enrolled hospitalized AASV patients with renal failure who underwent peritoneal dialysis at the Department of Nephrology of our hospital between 2008 and 2015. The primary aim of this study was to perform a retrospective analysis to characterize peritonitis during the early period (≤ 8 weeks) of dialysis, and to compare the differences in initial clinical manifestations, vasculitis activity, immunosuppressive therapies prior to the renal replacement therapy, and prognosis between patients with or without peritonitis. The secondary aim of this study was to conduct a literature review of peritoneal dialysis in patients with vasculitis. All 14 enrolled AASV patients had myeloperoxidase (MPO)-positive microscopic polyangiitis (MPA). Six patients (of whom 2 died) withdrew from peritoneal dialysis due to peritonitis caused by enteric bacteria during the early period of dialysis. Their mean Birmingham vasculitis activity score (BVAS) during the early AASV onset was 31.67 ± 3.98, with significant symptoms of gastrointestinal involvement. Also, their BVAS score, anti-MPO antibody titer, erythrocyte sedimentation rate, C-reactive protein level, serum ANCA level, and glucocorticoid dose were higher than the AASV patients without peritonitis (all p < 0.05). AASV patients with a higher level of vasculitis (BVAS score > 30) during onset as well as gastrointestinal symptoms had a higher risk for intestinal peritonitis. Therefore, peritoneal dialysis is not recommended as a first-choice renal replacement therapy for such patients.
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