Membrane transport status does not predict peritonitis risk in patients on peritoneal dialysis. Issue 7 (24th July 2018) - So, Sarah
Abstract: Aim: The aim of this study is to determine whether peritoneal membrane transport status (MTS) is associated with peritonitis or poor peritoneal dialysis‐related outcomes. Methods: This retrospective cohort study analysed data of incident adult patients on peritoneal dialysis in Western Sydney between 1 October 2003 and 31 December 2012. Only patients who underwent peritoneal equilibration and adequacy tests within 6 months of commencement were included. Kaplan–Meier survival curves for time until first peritonitis and time until composite endpoint of peritonitis, death or technique failure, censored for transplant, were constructed. Results: About 397 patients, mean age 58.8(+/−2SD29) years, body mass index (BMI) 26.6(+/−5) kg/m 2 and serum albumin 35.4(+/−5) g/L were included. About 59.2% had high/high‐average peritoneal MTS; 45.8% were past and current smokers; 51.9% developed at least one episode of peritonitis; 7.6% changed to haemodialysis; 6.3% underwent transplantation; 8.8% died; and 25.4% remained free of the aforementioned events over a mean follow‐up period of 22.5 months (range 0–115 months). Peritoneal MTS was not associated with time to first peritonitis ( p = 0.67) or composite endpoint of peritonitis, death or technique failure ( p = 0.12). Smoking and hypoalbuminaemia independently predicted time to first peritonitis. Past and current smokers had a hazard ratio of 1.38 (95% CI 1.03–1.86) for shorter time to first peritonitis, significant after adjustment for serum albumin ( p = 0.033). Serum albumin <32 g/L had a hazard ratio of 1.74 (95% CI 1.13–2.67) for shorter time to first peritonitis, significant after adjusting for smoking ( p = 0.012). Conclusion: Smoking and hypoalbuminaemia, but not MTS, were associated with shorter time to first peritonitis and composite endpoint of peritonitis, death and technique failure. Summary at a Glance: This study is a retrospective cohort analysis of 397 patients in Australia, describing technique failure and associations with peritonitis. Smoking status was a factor associated with a higher incidence of shorter time to first episode of peritonitis, but not membrane transport status.