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NDT Advance Access originally published online on May 21, 2007
Nephrology Dialysis Transplantation 2007 22(9):2653-2658; doi:10.1093/ndt/gfm242
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© The Author [2007].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Reduced residual renal function is a risk of peritonitis in continuous ambulatory peritoneal dialysis patients

Seung Hyeok Han1, Sang Choel Lee2, Song Vogue Ahn3, Jung Eun Lee1, Dong Ki Kim1, Tae Hee Lee1, Sung Jin Moon1, Beom Seok Kim1, Shin-Wook Kang1, Kyu Hun Choi1, Ho Yung Lee1 and Dae-Suk Han1

1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, 2Department of Internal Medicine, Kwandong Universtiy, Koyang, Kyungki-do, Korea and 3Department of Preventive Medicine,Yonsei University College of Medicine, Seoul

Correspondence and offprint requests to: Dae-Suk Han, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, 134 Shinchon-dong Seodaemun-gu, Seoul, Korea, 120-752. Email: dshan{at}yumc.yonsei.ac.kr



  Abstract

Background. Loss of residual renal function (RRF) contributes to anaemia, inflammation and malnutrition and is also a strong predictor of mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. However, the role of RRF on peritonitis is not yet clearly established. This study aimed to evaluate the effect of RRF on the development of peritonitis.

Methods. Study subjects were 204 end-stage renal disease (ESRD) patients who started PD from January 2000 to December 2005. Biochemical and clinical data within 1 month of PD commencement were considered as baseline. To determine risk factors for peritonitis, multivariate Cox regression was performed. Kaplan–Meier analysis and log-rank test were used to examine the difference of peritonitis-free period according to the presence of diabetes and RRF.

Results. On univariate analysis based on baseline data in first peritonitis, diabetes was less prevalent and RRF (6.7 ± 2.6 vs 4.0 ± 2.3 ml/min/1.73 m2, P < 0.01), haemoglobin (10.9 ± 1.2 vs 10.6 ± 1.2 g/dl, P < 0.05) and serum albumin level (3.6 ± 0.4 vs 3.4 ± 0.4 g/dl, P < 0.01) were significantly higher in the peritonitis-free group. Kaplan–Meier analysis showed that time to first PD peritonitis episode was significantly longer in the non-diabetic patients (P < 0.001) and in patients with higher residual GFR (P < 0.001). Multivariate analysis showed that diabetes [hazard ratio(HR) 1.64, P < 0.05] and RRF (per 1 ml/min/1.73 m2 increase, HR 0.81, P < 0.01) were independent risk factors.

Conclusion. Our study revealed that RRF and diabetes were risk factors for peritonitis. These results suggest that preservation of RRF should be viewed as a protective strategy to reduce peritonitis.

Keywords: peritonitis; residual renal function; diabetes

Received for publication: 24.10.06
Accepted in revised form: 29. 3.07


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