Mustafa KELEŞ, Ramazan ÇETİNKAYA, Fatma EROĞLU, Hamit ACEMOĞLU, M. Hamidullah UYANIK, Abdullah UYANIK

Peritoneal dialysis-related peritonitis: An analysis of risk factors in Northeast Anatolia

Amaç: Periton Diyalizi (PD), son dönem böbrek yetmezlikli hastaların tedavisinde kullanılan renal replasman tedavi seçeneklerinden biridir. Peritonit, PD’nin en sık görülen komplikasyonlarındandır. PD tedavisinde ve teknolojisinde sağlanan gelişmeler nedeni ile peritonit sıklığında azalma olmasına rağmen peritonit hâlâ sorun olmaya devam etmektedir. Bu çalışmada peritonit gelişmesinde etkili olan risk faktörlerinin araştırılması amaçlanmıştır. Yöntem ve gereç: Bu klinik kohortta, Atatürk Üniversitesi Tıp Fakültesi Nefroloji Bilim Dalı’nda Ocak 1998-Aralık 2007 tarihleri arasında Periton Diyalizi Ünitesi’nde takip edilen toplam 218 hastanın dosyaları retrospektif olarak incelendi. Hastaların demografik, klinik ve laboratuar sonuçları kaydedildi. Hastalar, hiç peritonit geçirmeyenler peritonitsiz grup ve en az bir veya daha fazla peritonit geçirenler peritonitli grup olmak üzere 2 gruba ayrıldı. Peritonitle ilgili risk faktörlerini saptamak için Cox regresyon analizi yapıldı, % 95 güven aralığında (GA) "hazard ratio" (HR: Zararlanma oranı) hesaplandı. Bulgular: Toplam 6304 periton diyaliz ayında 337 peritonit atağı gözlendi. Ortalama peritonit sıklığı 0.64 atak/yıl olarak bulundu. PD hastalarında ortalama albümin düzeyi artıkça peritonit riski 0.39 kat (% 95 GA 0,24 – 0,65; P < 0,001) azalmaktaydı. PD kataterinin cerrahi yöntemle takılması peritonit riskini 3,97 kat (% 95 GA 2,16 - 7,29; P < 0.001), hastalarda konstipasyon olması 2,22 kat (% 95 GA 1,26 - 3,92; P < 0.01), amiloidozun olması 1,81 kat (% 95 GA 0,93 - 3,50; P = 0,078) artırmaktaydı. Sonuç: Sonuç olarak, bu çalışmada hipoalbüminemi, konstipasyon, PD kateterinin cerrahi yöntemle takılması ve amiloidoz peritonit gelişimi için bir risk faktörü olarak tespit edilmiştir. Bu risk faktörleri hastaların takip edilmesinde göz önünde bulundurulmalıdır.

Periton diyalizi ile ilişkili peritonit: Kuzeydoğu Anadolu’da risk faktörlerinin analizi

Aim: Peritonitis is almost the most frequent complication of peritoneal dialysis (PD). Besides being the most frequent reason of hospitalization, peritonitis is also the most important determining factor of mortality-morbidity and technique survival among PD patients. In this study, it was aimed to identify the risk factors for peritonitis in these patients.Materials and methods: In this clinical cohort, records of 218 patients were collected between January 1998 and December 2007. The patients’ demographic, clinical, and laboratory parameters were recorded. Results were analyzed to compare patients who never had peritonitis and patients with at least one episode of peritonitis. Independent predictors of peritonitis were assessed using Cox regression, and the hazard ratio (HR) was determined using 95% confidence interval (95% CI).Results: Of over 6304 patient-months, 337 episodes of peritonitis were observed. The overall peritonitis rate was 0.64 attack/year. The risk of peritonitis was lower for PD patients with each 1 g/dL increase in mean albumin levels (HR, 0.39; 95% CI, 0.24-0.65; P < 0.001). Variables identified to be associated with an increased likelihood of peritonitis were: the placement of catheter via surgery (HR, 3.97; 95% CI, 2.16-7.29; P < 0.001), constipation (HR, 2.22; 95% CI, 1.26-3.92; P < 0.01), and amyloidosis (HR, 1.81; 95% CI, 0.93-3.50; P = 0.078). Conclusion: Hypoalbuminemia, constipation, the placement of catheter via surgery, and amyloidosis were found to increase the risk of peritonitis in the present study. Such risk factors should be kept in mind during follow-up of patients under PD.

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