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Type: Journal article
Title: Association of biocompatible peritoneal dialysis solutions with peritonitis risk, treatment, and outcomes
Author: Cho, Y.
Badve, S.
Hawley, C.
McDonald, S.
Brown, F.
Boudville, N.
Bannister, K.
Clayton, P.
Johnson, D.
Citation: Clinical Journal of the American Society of Nephrology, 2013; 8(9):1556-1563
Publisher: American Society of Nephrology
Issue Date: 2013
ISSN: 1555-9041
Statement of
Yeoungjee Cho, Sunil V. Badve, Carmel M. Hawley, Stephen P. McDonald, Fiona G. Brown, Neil Boudville, Kym M. Bannister, Philip A. Clayton, David W. Johnson
Abstract: <h4>Background and objectives</h4>The effect of biocompatible peritoneal dialysis (PD) solutions on PD-related peritonitis is unclear. This study sought to evaluate the relationship between use of biocompatible solutions and the probability of occurrence or clinical outcomes of peritonitis.<h4>Design, setting, participants, & measurements</h4>The study included all incident Australian patients receiving PD between January 1, 2007, and December 31, 2010, using Australia and New Zealand Dialysis and Transplant Registry data. All multicompartment PD solutions of neutral pH were categorized as biocompatible solutions. The independent predictors of peritonitis and the use of biocompatible solutions were determined by multivariable, multilevel mixed-effects Poisson and logistic regression analysis, respectively. Sensitivity analyses, including propensity score matching, were performed.<h4>Results</h4>Use of biocompatible solutions gradually declined (from 7.5% in 2007 to 4.2% in 2010), with preferential use among smaller units and among younger patients without diabetes mellitus. Treatment with biocompatible solution was associated with significantly greater overall rate of peritonitis (0.67 versus 0.47 episode per patient-year; incidence rate ratio, 1.49; 95% confidence interval [CI], 1.19 to 1.89) and with shorter time to first peritonitis (hazard ratio [HR], 1.48; 95% CI, 1.17 to 1.87), a finding replicated in propensity score-matched cohorts (HR, 1.36; 95% CI, 1.09 to 1.71).<h4>Conclusions</h4>In an observational registry study, use of biocompatible PD solutions was associated with higher overall peritonitis rates and shorter time to first peritonitis. Further randomized studies adequately powered for a primary peritonitis outcome are warranted.
Keywords: Humans
Biocompatible Materials
Dialysis Solutions
Disease-Free Survival
Treatment Outcome
Peritoneal Dialysis
Time Factors
Middle Aged
Rights: Copyright © 2013 by the American Society of Nephrology
DOI: 10.2215/CJN.12361212
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