Hypertension is associated with an increased risk of peritoneal dialysis-associated peritonitis: a retrospective cohort study.

BACKGROUND

Peritoneal dialysis-associated peritonitis (PDAP) remains a major complication of peritoneal dialysis (PD) and is a leading cause of hospitalization, technique failure, and mortality. Hypertension is highly prevalent among PD patients; however, its association with PDAP risk has not been well defined.

METHODS

We conducted a retrospective cohort study including adult PD patients followed between January 1, 2007, and December 31, 2024. Clinical characteristics, laboratory parameters, dialysis-related features, and PDAP events were systematically collected. Hypertension was defined by a documented diagnosis, long-term use of antihypertensive medications, or repeated blood pressure measurements ≥140/90 mmHg at baseline. The cumulative incidence of PDAP was assessed using cumulative incidence function (CIF) curves and Gray's test. Independent associations were evaluated using Fine-Gray competing risk models and multivariable logistic regression analyses.

RESULTS

Among 352 PD patients, 194 (55.1%) had hypertension. During a mean follow-up of 46.1 months, hypertensive patients exhibited a significantly higher cumulative incidence of PDAP. After multivariable adjustment, hypertension remained independently associated with a higher risk of PDAP in both Fine-Gray competing risk models (HR = 4.46, 95% CI 2.49-7.99, P < 0.001) and logistic regression analyses (OR = 4.38, 95% CI 2.11-9.08, P < 0.001). In descriptive microbiological analyses, hypertensive patients showed a higher proportion of gram-negative organisms, whereas gram-positive organisms predominated in non-hypertensive patients.

CONCLUSION

Baseline hypertension was independently associated with a higher risk of PDAP in patients undergoing PD. These findings highlight the potential importance of blood pressure status in PDAP risk stratification and long-term PD management.