Información de la revista
Vol. 31. Núm. 4.Julio 2011
Páginas 379-504
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 31. Núm. 4.Julio 2011
Páginas 379-504
DOI: 10.3265/Nefrologia.pre2011.Apr.10796
Acceso a texto completo
Remisión obligatoria y otros factores relacionados con la peritonitis en pacientes en diálisis peritoneal
Obligatory referral among other factors associated with peritonitis in peritoneal dialysis patients
Visitas
6128
, D.D.. Oygarb, A.S.. Yalinb, M.R.. Altiparmakb, R.. Atamanb, K.. Serdengectib
b Department of Nephrology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey,
Este artículo ha recibido
6128
Visitas
Información del artículo

Objetivo: La peritonitis es una de las principales comorbilidades que presentan los pacientes en diálisis peritoneal (DP). El objetivo de este estudio es centrarnos en los posibles factores de riesgo, incluidos los de más reciente estudio entre los ya clásicos factores de la peritonitis en pacientes en DP. Materiales y métodos: Analizamos 109 pacientes (H/M = 67/42) sometidos a seguimiento durante al menos tres meses en un único centro, un hospital terciario con una tasa de 360,1 años-paciente. En este trabajo, concebido como un estudio de cohorte retrospectivo, se registraron las características demográficas, las condiciones que llevaron a la DP, tipo de DP, pruebas químicas y episodios de peritonitis. Esta información se extrajo de los historiales. Resultados: Se descubrió que la tasa de peritonitis era de 0,22 episodios/años-paciente y 22 (20,18%) pacientes habían padecido más de un episodio. Veintisiete (24,8%) de los pacientes recibían DP por obligación. Gracias al análisis de regresión múltiple, se descubrió que los factores relacionados eran el tipo de llegada al tratamiento (obligatoria frente a voluntaria) (p = 0,04; RR = 2,6), los niveles de albúmina sérica (p = 0,05; RR = 1,2), y la positividad para anticuerpos contra el virus de hepatitis C (p = 0,03; RR = 1,6). La frecuencia de pacientes mujeres era significativamente mayor en el grupo que había padecido múltiples episodios (p = 0,01). Conclusión: La remisión obligatoria, que puede ser un indicio de la falta de motivación por los procedimientos de DP, es un importante factor de riesgo de peritonitis en los pacientes en DP y merece ser objeto de estudio. Como era de esperar, los pacientes con múltiples episodios presentaron una mayor frecuencia de remisión obligatoria y además, el número de mujeres era mayor en comparación con el grupo que había padecido un único episodio.

Palabras clave:
Factores de riesgo
Palabras clave:
Diálisis peritoneal
Palabras clave:
Peritonitis

Aim: Peritonitis is one of the major comorbidities of peritoneal dialysis (PD) patients. The aim of this study was to concentrate on potential risk factors, including more recently studied ones among the classical ones for peritonitis, in PD patients. Materials and methods: We analysed 109 patients (F/M = 42/67) followed up at least for 3 months in a single centre, a tertiary referral hospital for 360.1 patient years. In the study which is designed as a retrospective cohort study, demographic characteristics, conditions for choosing PD, type of PD treatment, some chemical tests and peritonitis episodes were recorded from the files of the patients. Results: The rate of peritonitis was found to be 0.22 episode/patient year and 22 (20.18%) of the patients had more than one episode. Twenty seven (24.8%) of the patients were allocated to PD due to obligatory reasons. According to multiple regression analysis, the assosciated factors were found to be PD allocation type (obligatory versus voluntary) (p = 0.04; RR = 2.6), serum albumin level (p = 0.05; RR = 1.2), and anti-hepatitis C Virus Antibody positivity (p = 0.03; RR = 1.6). Frequency of female patients were significantly higher in the group who had multiple episodes (p = 0.01). Conclusion: Obligatory referral which can be an indication of loss of motivation for peritoneal dialysis procedures, is thought to be a strong risk factor for peritonitis in PD patients and should be further studied. Patients with multiple episodes had a higher frequency of obligatory referral as expected and additionally, they were higher in number of females when compared to the ones with single episode.

Keywords:
Risk factors
Keywords:
Peritoneal dialysis
Keywords:
Peritonitis
El Texto completo está disponible en PDF
Bibliografía
[1]
Strippoli GF, Tong A, Johnson D, Schena FP, Craig JC. Catheter-related interventions to prevent peritonitis in peritoneal dialysis: a systematic review of randomized, controlled trials. J Am Soc Nephrol 2004;15:2735-46. [Pubmed]
[2]
Mallorca R, Cancarini GC, Zubani RR,??Camerini C, Manili L, Brunori G, et al. CAPD viability: a long-term comparison with hemodialysis. Perit Dial Int 1996;16:276-87. [Pubmed]
[3]
Woodrow G, Turney JH, Brownjohn AM. Technique failure in peritoneal dialysis and its impact on patient survival. Perit Dial Int 1997;17:360-4. [Pubmed]
[4]
Jaar BG, Plantinga LC, Crews DC, Fink NE, Hebah N, Coresh J,??et al. Timing, causes, predictors and prognosis of switching from peritoneal dialysis to hemodialysis: a prospective study. BMC Nephrol 2009;6(10):3.
[5]
Nodaira Y, Ikeda N, Kobayashi K, Watanabe Y, Inoue T, Gen S,??et al. Risk factors and cause of removal of peritoneal dialysis catheter in patients on continuous ambulatory peritoneal dialysis. Adv Perit Dial 2008;24:65-8. [Pubmed]
[6]
Chow KM, Szeto CC, Leung CB, Kwan BC, Law MC, Li PK. A risk analysis of continous ambulatory peritoneal dialysis related peritonitis. Perit Dial Int 2005;25(4):374-9. [Pubmed]
[7]
Wang Q, Bernardini J, Piraino B, Fried L. Albumin at the start of peritoneal dialysis predicts the development of peritonitis. Am J Kidney Dis 2003;41:664-9. [Pubmed]
[8]
Golper TA, Bries ME, Bunke M, Schreiber MJ, Bartlett DK, Hamilton RW,??et al. Risk factors for peritonitis in long term peritoneal dialysis: the Network 9 peritonitis and catheter survival studies. Academic Subcommittee of the Steering Committee of the Network 9 Peritonitis and Catheter Survival Studies. Am J Kidney Dis 1996;28:428-36.
[9]
Holley JL, Bernardini J, Perlmutter JL, Piraino B. Acomparison of infection rates among older and younger patients on continous peritoneal dialysis. Perit Dial Int 1994;14:66-9. [Pubmed]
[10]
Huang JW, Hung KJ, Yen CJ, Wu KD, Tsai TJ. Comparison of infectious complications in peritoneal dialysis patients using either a twin-bag system or automated peritoneal dialysis. Nephrol Dial Transplant 2001;16:604-7. [Pubmed]
[11]
Locatelli AJ, Marcos GM, G??mez MG, ??lvarez SA, De Benedetti LC. Comparing peritonitis in continuous ambulatory peritoneal dialysis patients versus automated peritoneal dialysis patients. Adv Perit Dial 1999;15:193-6. [Pubmed]
[12]
Portol??s J, Del Peso G, Fern??ndez-Reyes MJ, Bajo MA, L??pez-S??nchez P. GCDP. Previous comorbidity and lack of patient free choice of technique predict early mortality in peritoneal dialysis.??Perit Dial Int 2009;29(2):150-7.?? [Pubmed]
[13]
Nessim SJ, Bargman JM, Austin PC, Nisenbaum R, Jassal SV. Predictors of peritonitis in patients??on peritoneal dialysis: results of a large, prospective canadian database. Clin J Am Soc Nephrol 2009;4(7):1195-200. [Pubmed]
[14]
Fried L, Piraino B. Peritonitis. In:??Khanna R,??Krediet R??(eds.). Nolph and Gokal??s Textbook of Peritoneal Dialysis. Chapter 19; 3rd edn. New York: Springer Science and Business Media, 2009;543-70.
[15]
Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML. A simple comorbidity scale predicts clinical outcomes and costs in comorbidity scale predicts clinical outcomes and costs in dialysis patients. Am J Med 2000;108:609-13. [Pubmed]
[16]
Naz H, Sahin G, Serbest S, Yal??in AU. Peritonitis related to peritoneal dialysis: evaluation of 179 attacks. Mikrobiyol Bul 2008;42(2):265-72. [Pubmed]
[17]
Bulut C, Ozt??rk R, Yilmaz GR, Parpucu H, Irmak H, Kinikli S, et al.??Evaluation of the epidemiological, clinical and laboratory findings in continuous ambulatory peritoneal dialysis related peritonitis attacks. Mikrobiyol Bul 2008;42(2):255-64. [Pubmed]
[18]
Dombros N, Dratwa M, Feriani M, Gokal R, Heimburger O, Krediet R,??et al. EBPG Expert Group on Peritoneal Dialysis. European Best Practice Guidelines for Peritoneal Dialysis. 3 Peritoneal Access. Nephrol Dial Transplant 2005;20(9):8-12.
[19]
19.??Li PK, Szeto CC, Piraino B. ISPD Guidelines/Recommendations. Peritoneal Related Infections Recommendations: 2010 Update. Perit Dial Int 2010;30:393-423. [Pubmed]
[20]
Miguel A, Garc??a-Ram??n R, P??rez-Contreras J,??S??nchez J, Rivera F, Olivares J, et al.; Levante PD Multicenter group. Comorbidity and mortality in peritoneal dialysis: a comparative study of type 1 and 2 diabetes versus nondiabetic patients. Peritoneal dialysis and diabetes. Nephron 2002;90(3):290-6.
[21]
Prasad N, Gupta A, Sinha A, Sharma RK, Kumar A, Kumar R, et al. A comparison of outcomes between the diabetic and nondiabetic CAPD patients in India. Perit Dial Int 2008;28(5):468-76. [Pubmed]
[22]
Cueto Manzano AM. Hypoalbuminemia in dialysis. Is it a marker for malnutrition or inflammatiion. Rev Invest Clin 2001;53(2):152-8. [Pubmed]
[23]
Prasad N, Gupta N, Sharma RK, Sinha A, Kumar R. Impact of nutritional status on peritonitis in CAPD patients. Perit Dial Int 2007;27(1):42-7. [Pubmed]
[24]
Sirivongs D, Pongskul C, Keobounma T, Chunlertrith D, Sritaso K, Johns J. Risk factors for first peritonitis attack in Thai CAPD patients. J Med Assoc Thai 2006;89(2):138-45.
[25]
Davenport A. Peritonitis remains the major clinical complication of peritoneal dialysis: the London, UK, peritonitis audit 2002-2003. Perit Dial Int 2009;29(3):297-302.
[26]
S??nchez AR, Madonia C, Rasc??n-Pacheco RA. Improved patient/technique survival and peritonitis rates in patients treated with automated peritoneal dialysis when compared to continous ambulotatory peritoneal dialysis in Mexican PD center. Kidney Int Suppl 2008;108:76-80.
[27]
Rabindranath KS, Adams J, Ali TZ, MacLeod AM, Vale L, Cody J, et al. Continous ambulatory peritoneal dialysis versus automated peritoneal dialysis for end-stage renal disease (Review). Cochrane Database Syst Rev 2007;18(2):CD006515.
[28]
Troidle LK, Gorban-Brennan N, Kliger AS, Finkelstein FO. Continous cycler therapy, manual peritoneal dialysis therapy and peritonitis. Adv Perit Dial 1998;14:137-41. [Pubmed]
[29]
G??rriz JL, Miguel A, Garc??a-Ram??n R, G??mez-Rold??n C, Olivares J, P??rez-Contreras J, et al. Absence of seroconversion to hepatitis C virus infection in CAPD patients. Nephrol Dial Transplant 1997;12(2):373-4. [Pubmed]
[30]
Akpolat T, Dilek M, Yavuz M, Utas C, Ozener C, Karayaylali I, et al. Turkish Multicenter PD Study Group. Low seroconversion rates in CAPD patients compared to hemodialysis patients: potential advantages for transplant candidates. Perit Dial Int 2002;22(4):520-3.
[31]
Kotsanas D, Polkinghorne KR, Korman TM, Atkins RC, Brown F. Risk factors for peritoneal dialysis related peritonitis: can we reduce the incidence and improve patient selection? Nephrology (Carlton) 2007;12(3):239-45.
Idiomas
Nefrología

Suscríbase a la newsletter

Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.