Correlation between gastrointestinal diseases and peritoneal dialysis-associated peritonitis

Objective To investigate the incidence of gastrointestinal symptoms and diseases in peritoneal dialysis (PD) patients, and explore their associations with PD-associated peritonitis. Methods PD patients who were followed up in PD center of the First Affiliated Hospital of Sun Yat-sen University from March 1, 2016 to December 31, 2017 were prospectively enrolled and followed up until withdrew from PD or until December 31, 2019. Gastrointestinal symptoms, gastrointestinal diseases and peritonitis episodes were collected during the study period. The severity of gastrointestinal symptoms was assessed by the Gastrointestinal Symptoms Rating Scale. The demographic and clinical data were compared between patients with and without gastrointestinal diseases. The influencing factors of peritonitis were analyzed by Poisson regression model. Results A total of 471 PD patients were included. Among them, 387(82.2%) patients had at least one gastrointestinal symptom, and 142(30.2%) patients had gastrointestinal diseases. The incidence of peritonitis was 0.094 episodes per patient year, 0.034 episodes per patient year for gram-positive bacteria peritonitis and 0.027 episodes per patient year for gram-negative bacteria peritonitis. The multi-factor Poisson regression model showed that gastrointestinal disease was an independent influencing factor for the occurrence of total peritonitis and gram-negative bacteria peritonitis (OR=1.852, 95%CI 1.252-6.369, P=0.002; OR=3.324, 95%CI 1.616-6.836, P=0.001, respectively), and higher score of diarrheal symptoms was an independent influencing factor for the occurrence of gram-negative bacterial peritonitis (OR=2.832, 95%CI 1.616-4.963, P＜0.001). Conclusions The incidence of gastrointestinal diseases in PD patients is 30.2%. Gastrointestinal disease is an independent influencing factor for the occurrence of total peritonitis and gram-negative bacteria peritonitis, and diarrhea symptom is an independent influencing factor for the occurrence of gram-negative bacteria peritonitis.