Assessment of risk factors in continuous ambulatory peritoneal dialysis-related peritonitis attacks

Abstract number: 1733_754

Yilmaz G.R., Ozturk R., Bulut C., Parpucu H., Irmak H., Kinikli S., Duranay M., Demiroz A.P.

Objectives: Peritonitis is a common clinical problem that occurs in patients with end stage renal disease and treated by peritoneal dialysis. The aim of this study was to evaluate the potential risk factors for continuous ambulatory peritoneal dialysis (CAPD) related peritonitis

Methods: The study included a study group and a control group. CAPD related peritonitis patients treated in Infectious Diseases and Clinical Microbiology Department between February 2006 and July 2006 formed the study group. And the control group included CADP patients without peritonitis. Demographic characteristics of patients and control group were recorded. Complete blood count, serum protein, albumin, procalcitonine (PCT) and C-reactive protein (CRP) levels were tested in both groups. Cloudiness of the peritoneal dialysis fluid with or without abdominal pain was considered as a suggestive finding of peritonitis and was confirmed by cell count and culture. Patients with more than 100 white blood cells/mL in their dialysate fluid were accepted as having peritonitis. SPPS 13.0 for Windows was used for statistical analysis.

Results: There were 50 patients in the study group and 50 patients in the control group. The mean age of the patients was 48.4 years (range 18–83 years) and 44.8 years (range 19–79 years) in the study and control groups, respectively. The median peritoneal dialysate fluid white blood cell count was 1,275/mm³ (170–17,900) in study group. There were 56 episodes of peritonitis in 50 patients.

Age, gender, education, living in rural area and profession have not been found as risk factors for peritonitis attacks. However, ESR, CRP, PCT, anaemia, hypoalbuminaemia, and hypoproteinaemia were found as risk factors for attacks (p < 0.05). Serum CRP level was found high in 88% of study and 26% of control group (p < 0.05). Serum PCT level was found high in 42% of patient and 16% of control group (p < 0.05). Serum CRP level greater than 5 mg/mL and serum PCT level greater than 2 ng/mL were found to have 100% positive predictive value for the diagnosis of CAPD related peritonitis.

Conclusion: In several previous studies, high serum CRP and PCT levels were reported in CAPD patients without peritonitis. In follow up period of CAPD patients with anaemia, hypoalbuminaemia, and/or hypoproteinaemia, high serum CRP and/or PCT level may imply peritonitis.