Clinical features and treatment outcomes of early-onset peritoneal dialysis-associated peritonitis: a multi-center retrospective study

Objective To explore the clinical characteristics and treatment outcomes of early-onset peritoneal dialysis-associated peritonitis (EOP). Methods Clinical data of patients with peritoneal dialysis-associated peritonitis (PDAP) from 2013 to 2018 in four tertiary hospitals of Jilin province were collected retrospectively. According to whether the dialysis time of the first PDAP was ≤12 months or not, the subjects were divided into EOP group (≤12 months) and late-onset PDAP (LOP) group (＞12 months) , and clinical data, pathogenic bacteria, treatment outcomes of PDAP and prognosis of two groups were compared. Results A total of 575 patients were included, including 314 patients in the EOP group, with age of (56.53±15.57) years and 152 females (48.4%), and 261 patients in the LOP group, with age of (56.61±14.42) years old and 144 females (55.2%). Compared with LOP group, the proportion of pathogenic bacteria culture-negative in EOP group was higher and the proportion of streptococcal infection was lower (both P＜0.05). The initial treatment efficiency and cure rate of EOP group were higher than that of LOP group, while the extubation rate was lower than that of LOP group (all P＜0.05). Multivariate logistic analysis indicated that the cure rate of EOP was 79% higher than that of LOP (OR=1.79, 95%CI 1.13-2.82, P=0.012), and the extubation rate of EOP was 68% lower than that of LOP (OR=0.32, 95%CI 0.15-0.66, P=0.002). Kaplan-Meier survival curve showed that the cumulative rates of multiple PDAP, technical failure, all-cause death, and composite end points (technical failure or all-cause death) in EOP group were higher than those in LOP group (P≤0.001). After correcting for confounding factors by multivariate Cox proportional hazard regression, the risk of multiple PDAP, technical failure, all-cause death, and composite endpoint (technical failure or all-cause death) in EOP group was 2.02 times (HR=2.02, 95%CI 1.26-3.24, P=0.004), 2.53 times (HR=2.53, 95%CI 1.58-4.05, P＜0.001), 2.66 times (HR=2.66, 95%CI 1.70-4.16, P＜0.001) and 2.48 times (HR=2.48, 95%CI 1.78-3.43, P＜0.001) of LOP group respectively. Conclusion The treatment outcome of the first PDAP of EOP patients is good, but the long-term prognosis is poor.