K HEPBURN1, K LAMBERT2, J MULLAN2, B MCALISTER2, M LONERGAN1, H HASSAN1
1Department of Renal Medicine, Wollongong Hospital, Wollongong, Australia, 2Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, Australia
Aim: To examine peritonitis as a risk factor for cardiovascular events (CVE) in patients undertaking peritoneal dialysis (PD).
Background: Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in PD. There is a documented association between infection and an increase in CVE. However, no studies have examined the association between peritonitis and CVE in the PD population.
Methods: All adult patients undertaking PD for more than 3 months in one NSW health district from 2001-2015 were included in this retrospective cohort analysis. Patients, baseline characteristics and peritonitis events were obtained from the ANZDATA Registry. CVE data using ICD10 coding was obtained and data linkage was facilitated by the Centre for Health Research Illawarra Shoalhaven Population (CHRISP). Time-dependent covariate analysis using Cox-proportional models were used to determine hazard ratios.
Results: 212 patients were included; median age was 66 years (IQR 54.3-74.4) and 63.7% were male. Glomerulonephritis was the most common underlying renal disease (29.2%). 128 patients (60%) experienced peritonitis, and 64 (30.2%) experienced CVE. Risk factors for CVE were cerebrovascular disease (HR 2.74, 95%CI 1.37-5.51, p=0.005), diabetes (HR 2.29, 95%CI 1.39-3.77, p=0.001), CVD (HR 1.73, 95%CI 1.04-2.87, p=0.04) and age (HR 1.04, 95%CI 1.02-1.06, p=0.01). Risk of CVE from peritonitis was 1.33 (95%CI 0.79-2.25, p=0.28), even when accounting for covariates (HR 1.33, 95%CI 0.78-2.26, p=0.29).
Conclusions: This is the first study to quantify risk of CVE in PD patients who develop peritonitis. We found that peritonitis increases the risk of CVE by 33%. Statistical significance was not reached in this study, possibly due to a low event rate and relatively small sample size. Larger studies to explore this important association are warranted.
Dr Kirsten Hepburn is a second year Nephrology Advanced Trainee in the East Coast Renal Network, Sydney, NSW. Her other degrees include BSc (Psych) and MPH.