Center-specific factors associated with peritonitis risk—a multi-center registry analysis

Nadeau-Fredette, Annie-Claire, Johnson, David W., Hawley, Carmel M., Pascoe, Elaine M., Cho, Yeoungjee, Clayton, Philip A., Borlace, Monique, Badve, Sunil V., Sud, Kamal, Boudville, Neil and McDonald, Stephen P. (2016) Center-specific factors associated with peritonitis risk—a multi-center registry analysis. Peritoneal Dialysis International, 36 5: 509-518. doi:10.3747/pdi.2015.00146


Author Nadeau-Fredette, Annie-Claire
Johnson, David W.
Hawley, Carmel M.
Pascoe, Elaine M.
Cho, Yeoungjee
Clayton, Philip A.
Borlace, Monique
Badve, Sunil V.
Sud, Kamal
Boudville, Neil
McDonald, Stephen P.
Title Center-specific factors associated with peritonitis risk—a multi-center registry analysis
Journal name Peritoneal Dialysis International   Check publisher's open access policy
ISSN 1718-4304
0896-8608
Publication date 2016-09-01
Sub-type Article (original research)
DOI 10.3747/pdi.2015.00146
Open Access Status Not yet assessed
Volume 36
Issue 5
Start page 509
End page 518
Total pages 10
Place of publication Milton, ON, Canada
Publisher Multimed
Language eng
Abstract

Previous studies have reported significant variation in peritonitis rates across dialysis centers. Limited evidence is available to explain this variability. The aim of this study was to assess center-level predictors of peritonitis and their relationship with peritonitis rate variations. ♦

All incident peritoneal dialysis (PD) patients treated in Australia between October 2003 and December 2013 were included. Data were accessed through the Australia and New Zealand Dialysis and Transplant Registry. The primary outcome was peritonitis rate, evaluated in a mixed effects negative binomial regression model. Peritonitis-free survival was assessed as a secondary outcome in a Cox proportional hazards model. ♦

Overall, 8,711 incident PD patients from 51 dialysis centers were included in the study. Center-level predictors of lower peritonitis rates included smaller center size, high proportion of PD, low peritoneal equilibration test use at PD start, and low proportion of hospitalization for peritonitis. In contrast, a low proportion of automated PD exposure, high icodextrin exposure and low or high use of antifungal prophylaxis at the time of peritonitis were associated with a higher peritonitis rate. Similar results were obtained for peritonitis-free survival. Overall, accounting for center-level characteristics appreciably decreased peritonitis variability among dialysis centers (p = 0.02). ♦

This study identified specific center-level characteristics associated with the variation in peritonitis risk. Whether these factors are directly related to peritonitis risk or surrogate markers for other center characteristics is uncertain and should be validated in further studies.
Formatted abstract
Background: Previous studies have reported significant variation in peritonitis rates across dialysis centers. Limited evidence is available to explain this variability. The aim of this study was to assess center-level predictors of peritonitis and their relationship with peritonitis rate variations.

Methods: All incident peritoneal dialysis (PD) patients treated in Australia between October 2003 and December 2013 were included. Data were accessed through the Australia and New Zealand Dialysis and Transplant Registry. The primary outcome was peritonitis rate, evaluated in a mixed effects negative binomial regression model. Peritonitis-free survival was assessed as a secondary outcome in a Cox proportional hazards model.

Results: Overall, 8,711 incident PD patients from 51 dialysis centers were included in the study. Center-level predictors of lower peritonitis rates included smaller center size, high proportion of PD, low peritoneal equilibration test use at PD start, and low proportion of hospitalization for peritonitis. In contrast, a low proportion of automated PD exposure, high icodextrin exposure and low or high use of antifungal prophylaxis at the time of peritonitis were associated with a higher peritonitis rate. Similar results were obtained for peritonitis-free survival. Overall, accounting for center-level characteristics appreciably decreased peritonitis variability among dialysis centers (p = 0.02).

Conclusion: This study identified specific center-level characteristics associated with the variation in peritonitis risk. Whether these factors are directly related to peritonitis risk or surrogate markers for other center characteristics is uncertain and should be validated in further studies.
Keyword ANZDATA
Center
Mixed effects
Peritoneal dialysis
Peritonitis
Predictors
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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