Aim: We investigated the association of peritoneal glucose exposure and dialysis exchange number with peritonitis outcome in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods: The first episodes of bacterial peritonitis were retrospectively analyzed in 187 CAPD patients. Peritoneal glucose exposure was calculated based on PD prescription at the onset of peritonitis. Results: Patients with peritoneal glucose exposure ≤140 g/day showed a higher and complete cure rate of peritonitis (66 vs. 51.7%, p = 0.047), lower occurrence of relapsing/recurrent peritonitis (10.0 vs. 21.8%, p = 0.026) and catheter removal (14.0 vs. 26.4%, p = 0.033). Patients who exchanged more than three times every day demonstrated marginally higher catheter removal rate (24.1 vs. 13.0%, p = 0.085). Logistic analysis indicated that peritoneal glucose exposure >140 g/day was an independent predictor for relapsing/recurrent peritonitis (RR: 1.959, p = 0.042). Conclusion: High peritoneal glucose exposure is associated with increased incidence of relapsing/recurrent peritonitis in CAPD patients.

1.
Li PK, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A, Johnson DW, Kuijper EJ, Lye WC, Salzer W, Schaefer F, Struijk DG; International Society for Peritoneal Dialysis: Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 2010;30:393-423.
2.
Boudville N, Kemp A, Clayton P, Lim W, Badve SV, Hawley CM, McDonald SP, Wiggins KJ, Bannister KM, Brown FG, Johnson DW: Recent peritonitis associates with mortality among patients treated with peritoneal dialysis. J Am Soc Nephrol 2012;23:1398-1405.
3.
Brown F, Gulyani A, McDonald S, Hurst K: 35th Annual Report 2012: Australia and New Zealand Dialysis and Transplant Registry. South Australia, Adelaide, 2013.
4.
Pajek J, Hutchison AJ, Bhutani S, Brenchley PE, Hurst H, Perme MP, Summers AM, Vardhan A: Outcomes of peritoneal dialysis patients and switching to hemodialysis: a competing risks analysis. Perit Dial Int 2014;34:289-298.
5.
Yung S, Chan TM: Pathophysiological changes to the peritoneal membrane during PD-related peritonitis: the role of mesothelial cells. Mediators Inflamm 2012;2012:484167.
6.
Mortier S, De Vriese AS, McLoughlin RM, Topley N, Schaub TP, Passlick-Deetjen J, Lameire NH: Effects of conventional and new peritoneal dialysis fluids on leukocyte recruitment in the rat peritoneal membrane. J Am Soc Nephrol 2003;14:1296-1306.
7.
Witowski J, Wisniewska J, Korybalska K, Bender TO, Breborowicz A, Gahl GM, Frei U, Passlick-Deetjen J, Jörres A: Prolonged exposure to glucose degradation products impairs viability and function of human peritoneal mesothelial cells. J Am Soc Nephrol 2001;12:2434-2441.
8.
Posthuma N, ter Wee P, Donker AJ, Dekker HA, Oe PL, Verbrugh HA: Peritoneal defense using icodextrin or glucose for daytime dwell in CCPD patients. Perit Dial Int 1999;19:334-342.
9.
Cho Y, Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville N, Bannister KM, Clayton PA, Johnson DW: Association of biocompatible peritoneal dialysis solutions with peritonitis risk, treatment, and outcomes. Clin J Am Soc Nephrol 2013;8:1556-1563.
10.
Johnson DW, Brown FG, Clarke M, Boudville N, Elias TJ, Foo MW, Jones B, Kulkarni H, Langham R, Ranganathan D, Schollum J, Suranyi M, Tan SH, Voss D; balANZ Trial Investigators: Effects of biocompatible versus standard fluid on peritoneal dialysis outcomes. J Am Soc Nephrol 2012;23:1097-1107.
11.
Montenegro J, Saracho R, Gallardo I, Martínez I, Muñoz R, Quintanilla N: Use of pure bicarbonate-buffered peritoneal dialysis fluid reduces the incidence of CAPD peritonitis. Nephrol Dial Transplant 2007;22:1703-1708.
12.
Lam D, Bargman JM: Peritonitis in the patient on peritoneal dialysis: does the composition of the dialysis fluid make a difference? Clin J Am Soc Nephrol 2013;8:1471-1473.
13.
Tobudic S, Kratzer C, Poeppl W, Vychytil A, Burgmann H: Impact of various peritoneal dialysis solutions on the growth of common bacterial and yeast pathogens. Perit Dial Int 2011;31:688-692.
14.
Morton AR, Evans G, Shannon A, Zoutman D: Growth of coagulase negative staphylococci in peritoneal dialysate fluid. Effect of calcium concentration. ASAIO J 1994;40:M431-M434.
15.
McDonald WA, Watts J, Bowmer MI: Factors affecting Staphylococcus epidermidis growth in peritoneal dialysis solutions. J Clin Microbiol 1986;24:104-107.
16.
Tuomanen E, Cozens R, Tosch W, Zak O, Tomasz A: The rate of killing of Escherichia coli by beta-lactam antibiotics is strictly proportional to the rate of bacterial growth. J Gen Microbiol 1986;132:1297-1304.
17.
Hermsen ED, Hovde LB, Hotchkiss JR, Rotschafer JC: Increased killing of staphylococci and streptococci by daptomycin compared with cefazolin and vancomycin in an in vitro peritoneal dialysate model. Antimicrob Agents Chemother 2003;47:3764-3767.
18.
Zelenitsky S, Franczuk C, Fine A, Ariano R, Harding G: Antibiotic tolerance of peritoneal bacterial isolates in dialysis fluids. J Antimicrob Chemother 2002;49:863-866.
19.
Li PK, Chow KM: Infectious complications in dialysis - epidemiology and outcomes. Nat Rev Nephrol 2011;8:77-88.
20.
Davies SJ, Phillips L, Naish PF, Russell GI: Peritoneal glucose exposure and changes in membrane solute transport with time on peritoneal dialysis. J Am Soc Nephrol 2001;12:1046-1051.
21.
Jiang N, Qian J, Lin A, Lindholm B, Axelsson J, Yao Q: Initiation of glucose-based peritoneal dialysis is associated with increased prevalence of metabolic syndrome in non-diabetic patients with end-stage renal disease. Blood Purif 2008;26:423-428.
22.
Mehrotra R, de Boer IH, Himmelfarb J: Adverse effects of systemic glucose absorption with peritoneal dialysis: how good is the evidence? Curr Opin Nephrol Hypertens 2013;22:663-668.
23.
Johnson DW, Brown FG, Clarke M, Boudville N, Elias TJ, Foo MW, Jones B, Kulkarni H, Langham R, Ranganathan D, Schollum J, Suranyi MG, Tan SH, Voss D; balANZ Trial Investigators: The effects of biocompatible compared with standard peritoneal dialysis solutions on peritonitis microbiology, treatment, and outcomes: the balANZ trial. Perit Dial Int 2012;32:497-506.
24.
Liu YL, Huang CC, Kao MT: Residual renal function predicts outcome of fungal peritonitis in peritoneal dialysis patients. Perit Dial Int 2006;26:407-409.
25.
Panichi V, Migliori M, De Pietro S, Taccola D, Bianchi AM, Giovannini L, Norpoth M, Metelli MR, Cristofani R, Bertelli AA, Sbragia G, Tetta C, Palla R, Colombo R: C-reactive protein and interleukin-6 levels are related to renal function in predialytic chronic renal failure. Nephron 2002;91:594-600.
26.
Moon SJ, Han SH, Kim DK, Lee JE, Kim BS, Kang SW, Choi KH, Lee HY, Han DS: Risk factors for adverse outcomes after peritonitis-related technique failure. Perit Dial Int 2008;28:352-360.
27.
Chow KM, Szeto CC, Kwan BC, Pang WF, Ma T, Leung CB, Law MC, Li PK: Randomized controlled study of icodextrin on the treatment of peritoneal dialysis patients during acute peritonitis. Nephrol Dial Transplant 2014;29:1438-1443.
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