Risk factors of infectious peritonitis of CAPD patients in Rajavithi Hospital.

OBJECTIVE

Continuous ambulatory peritoneal dialysis (CAPD) is a renal replacement therapy for end stage renal disease (ESRD) patients. Peritoneal infection, peritonitis is a major cause of death and technical failure in ESRD patients receiving CAPD treatment. Previous studies demonstrated that lower serum albumin, higher body mass index, and diabetic kidney disease were associated with increase in incidence of peritonitis. However the demographics of the patients in the Rajavithi hospital such as race, gender, age, socioeconomic status and various other factors were different from the patients in the previous studies. The present study was conducted to investigate the risk factors of peritonitis, causative organisms, and route of infection among CAPD patients in Rajavithi Hospital.

MATERIAL AND METHOD: This is a retrospective descriptive study. All patients in the present study are ESRD patients who received CAPD treatment during March 2009 to February 2011 and adhered with the treatment for at least 1 year. The patients were divided into two groups 1) the patients who got infectious peritonitis within 1 year after catheter implantation and 2) the patients who did not get or got infectious peritonitis after 1 years. The medical records were reviewed and the data were analyzed to identify the risk factors of peritonitis, frequency of causative organisms, and the route of infection.

RESULTS

Of 27 patients, 16 patients (59.3%) had peritonitis within the first year, and 11 patients (40.7%) had no peritonitis or had peritonitis after the first year. The risk factors associated with peritonitis were diabetes (62.5 % in patients with peritonitis within first year vs. 18.2% in the patients who had no peritonitis or had peritonitis after the first year, p = 0.047) and higher blood sugar level (139.5 +/- 34.6 mg/dl in patients with peritonitis within first year vs. 115.9 +/- 23.4 mg/dl 18.2% in the patients who had no peritonitis or had peritonitis after the first year, p = 0.011). Transluminal peritoneal catheter route was the route of infection in every subject in the present study. The major causative agents were gram-positive bacteria.

CONCLUSION

Diabetic kidney disease and high fasting blood sugar were the risk factors of peritonitis and trans-luminal peritoneal catheter are the major route of infection in the present study. Therefore, good blood sugar control and strict adherence with sterile technique for peritoneal dialysis would decrease the incidence of peritonitis in CAPD patients.