Risk Factors of Infectious Peritonitis of CAPD Patients in Rajavithi Hospital
Sakarn Bunnag MD*, Prasert Thanakitcharu MD*, Udom Krairittichai MD*, Boonthum Jirajan MD*, Wanniya Meenune MD*, Chuleekorn Kanjanapanth MD**
Affiliation : * Staffs of Nephrologydivision, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand ** Resident of Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
Objective : Continuous ambulatory peritoneal dialysis (CAPD) is a renal replacement therapy for end stage renal disease
(ESRD) patients. Peritoneal infection, peritonitis is a major cause of death and technical failure in ESRD patients receiving
CAPD treatment. Previous studies demonstrated that lower serum albumin, higher body mass index, and diabetic kidney
disease were associated with increase in incidence of peritonitis. However, the demographics of the patients in the Rajavithi
hospital such as race, gender, age, socioeconomic status and various other factors were different from the patients in the
previous studies. The present study was conducted to investigate the risk factors of peritonitis, causative organisms, and
route of infection among CAPD patients in Rajavithi Hospital.
Material and Method: This is a retrospective descriptive study. All patients in the present study are ESRD patients who
received CAPD treatment during March 2009 to February 2011 and adhered with the treatment for at least 1 year. The
patients were divided into two groups 1) the patients who got infectious peritonitis within 1 year after catheter implantation
and 2) the patients who did not get or got infectious peritonitis after 1 years. The medical records were reviewed and the data
were analyzed to identify the risk factors of peritonitis, frequency of causative organisms, and the route of infection.
Results : Of 27 patients, 16 patients (59.3%) had peritonitis within the first year, and 11 patients (40.7%) had no peritonitis or
had peritonitis after the first year. The risk factors associated with peritonitis were diabetes (62.5 % in patients with peritonitis
within first year vs. 18.2% in the patients who had no peritonitis or had peritonitis after the first year, p = 0.047) and higher
blood sugar level (139.5 + 34.6 mg/dl in patients with peritonitis within first year vs. 115.9 + 23.4 mg/dl 18.2% in the patients
who had no peritonitis or had peritonitis after the first year, p = 0.011). Transluminal peritoneal catheter route was the route
of infection in every subject in the present study. The major causative agents were gram-positive bacteria.
Conclusion : Diabetic kidney disease and high fasting blood sugar were the risk factors of peritonitis and trans-luminal
peritoneal catheter are the major route of infection in the present study. Therefore, good blood sugar control and strict
adherence with sterile technique for peritoneal dialysis would decrease the incidence of peritonitis in CAPD patients.
Keywords : Continuous ambulatory peritoneal dialysis, CAPD, Infectious peritonitis, Risk factor
