Clinical characteristics and treatment outcomes of relapsing,recurrent and repeat peritoneal dialysis-associated peritonitis: a multicenter study

Objective To explore the clinical characteristics and treatment outcomes of different types of peritoneal dialysis-associated peritonitis (PDAP). Methods The clinical data of PDAP patients admitted to the Second Hospital of Jilin University, Second Part of the First Hospital of Jilin University, Jilin Central Hospital and Jilin First Automobile Work General Hospital in Jilin province from 2013 to 2019 were reviewed. According to the type of PDAP, the patients were divided into relapsing group, recurrent group, repeat group and control group, and the baseline data, pathogens culture and treatment outcomes among the four groups were compared. Results A total of 542 patients with PDAP were enrolled in the study, including 43 cases in relapsing group, 32 cases in recurrent group, 27 cases in repeat group and 440 cases in control group. The median follow-up time was 30.5 (16.0, 50.0) months. The rate of Gram-positive bacteria in repeat group was higher than that of control group (70.37% vs 42.95%, P=0.030); the rate of fungi in recurrence group was higher than that of control group (21.88% vs 3.86%, P=0.006). Compared with control group, relapsing group had a lower cure rate (67.44% vs 83.64%, P=0.048) and a higher relapse rate (23.26% vs 2.27%, P=0.002), and recurrent group had a higher catheter removal rate (28.13% vs 8.18%, P=0.012). Multivariate logistic regression showed that recurrence was an independent risk factor for catheter removal (OR=5.137, 95%CI 2.105-12.539, P＜0.001). The technical failure rates in relapsing group and recurrent group were both higher than those in control group (41.86% vs 17.05%, P=0.002; 46.88% vs 17.05%, P=0.002). Multivariate Cox regression showed that relapse and recurrence were both independent risk factors for technical failure (HR=2.587, 95%CI 1.525-4.389, P＜0.001; HR=3.571, 95%CI 2.022-6.306, P＜0.001), and also were independent risk factors for composite endpoint (HR=1.565, 95%CI 1.045-2.344, P=0.030; HR=2.004, 95%CI 1.269-3.164, P=0.003). Conclusion Compared with common PDAP, the therapeutic effects and prognosis of relapsing and recurrent PDAP are worse.