Survival and prognostic factors of mortality in patients with peritoneal dialysis-related peritonitis

Introduction: Peritonitis is one of the major complications of peritoneal dialysis (PD). The median survival time and survival rate in PD patient has been studied extensively globally and varies from one country to another. However, the median survival time and survival rate of PD related peritonitis data is scarcely studied both locally and globally. Objective: This study aimed to to determine the survival time and prognostic factors of PD related peritonitis. Method: This study was a retrospective cohort study that used secondary data from the National Renal Registry from 2010 until 2015 located in Hospital Kuala Lumpur. Five main group variables were studied comprising of socio-demographic, clinical parameters, biochemical parameters, PD regime and medications. The outcome studied was the survival time which was calculated from the first peritonitis episode until the outcome of death. The primary event was all-cause mortality and censored outcome included patient still alive at end of study, changed to heamodialysis and loss to follow-up. Kaplan Meier estimate and lifetable analysis were used for univariable and Cox Proportional Hazard Regression was used for multivariable analysis. Results: Overall the study included a total of 2,002 patients. This study observed 40% of the patient had death as outcome. Overall, the mean age of the patients were 59 (standard deviation) 17.4 and 50.2% of the patients were woman. The median survival time for PD related peritontis was 46.3 months (95% confidence interval (CI): 42.2, 56.7). The one-, two- and three year survival rates of PD related peritonitis were 75.6 (95% CI: 73.7,77.5), 64.6% (95% CI: 62.5, 66.7) and 55.6% (95% CI: 53.3,57.8) respectively. Five prognostic factors were identified in this study affecting survival of PD related peritonitis patients which were age (Adjusted hazard ratio (AHR): 1.04; 95% CI: 1.03,104), serum albumin (AHR: 1.37; 95% CI: 1.20, 1.57), onset of peritonitis (AHR: 1.24; 95% CI: 1.08,1.43), angiotensin receptor blocker medication (AHR: 1.37: 95% CI: 1.11, 1.60) and peritonitis episode (AHR: 0.36; 95% CI: 0.27, 0.46). Conclusions: Multiple Cox Proportional Hazard Regression revealed older age, hypoalbuminemia, not on angiotensin receptor blocker, increase peritonitis episode and late onset peritonitis were significant prognostic factors of mortality. These findings provide evidence based information for clinicians and policy makers in planning preventive measures and interventional programs for peritonitis in PD patients