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Type: Journal article
Title: Center-specific factors associated with peritonitis risk-a multi-center registry analysis
Author: Nadeau-Fredette, A.
Johnson, D.
Hawley, C.
Pascoe, E.
Cho, Y.
Clayton, P.
Borlace, M.
Badve, S.
Sud, K.
Boudville, N.
McDonald, S.
Citation: Peritoneal Dialysis International, 2016; 36(5):509-518
Publisher: Multimed
Issue Date: 2016
ISSN: 0896-8608
Statement of
Annie-Claire Nadeau-Fredette, David W. Johnson, Carmel M. Hawley, Elaine M. Pascoe, Yeoungjee Cho, Philip A. Clayton, Monique Borlace, Sunil V. Badve, Kamal Sud, Neil Boudville and Stephen P. McDonald
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.
Keywords: ANZDATA; Peritoneal dialysis; center; mixed effects; peritonitis; predictors
Rights: Copyright © 2015 International Society for Peritoneal Dialysis
RMID: 0030055439
DOI: 10.3747/pdi.2015.00146
Appears in Collections:Medicine publications

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