Infections may be deadly for many dialysis patients

Highlights

• An infection called peritonitis commonly arises in the weeks before many patients on peritoneal dialysis die.
• More studies are needed to determine whether peritonitis causes premature death in dialysis patients.

10% to 20% of dialysis patients receive peritoneal dialysis.

Washington, DC (May 24, 2012) — An infection called peritonitis commonly arises in the weeks before many dialysis patients die, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings suggest that peritonitis may be a deadly condition for some kidney failure patients.

Most kidney failure patients on dialysis get their treatments at a clinic, through hemodialysis. But about 10% to 20% receive treatments at home through peritoneal dialysis, where fluids are first pumped into the abdominal cavity to collect wastes from the blood and are later removed from the body. Unfortunately this fluid can become infected, causing a condition called peritonitis. This occurs as commonly as twice a year to once every five or six years.

Neil Boudville (University of Western Australia, in Perth) and his colleagues evaluated whether peritonitis affects the survival of patients on peritoneal dialysis. They looked at information from all kidney failure patients (1,316 individuals) who received dialysis in Australia and New Zealand from May 2004 through December 2009 and who died while undergoing treatment or soon after.

Compared with the rest of the year, patients were more likely to develop peritonitis during the 120 days prior to their death, and even more so during the final month before their death. Specifically, they were six times as likely to develop peritonitis during the 30 days prior to their death compared with six months earlier.

"We have therefore proposed a potential new definition for a cause of death—"peritonitis-associated death"—being any death within 30 days of an episode of peritonitis," said Prof Boudville.

Study co-authors include Anna Kemp, PhD, Philip Clayton, Wai Lim, PhD, Sunil Badve, Carmel Hawley, Stephen McDonald PhD, Kathryn Wiggins, MD, Kym Bannister, MD, Fiona Brown PhD.

Disclosures: Neil Boudville has previously received research funds from Roche, travel grants from Roche, Amgen and Jansen Cilag, and speaking honoraria from Roche. Wai Lim is on the Advisory Board for Novartis, Genzyme, Bristol Myer Squibb and Pfizer, he has also received research grants from Novartis, Genzyme and Pfizer, plus speaking honoraria from Novartis and Genzyme. David Johnson is a consultant for Baxter Healthcare Pty Ltd and Fresenius Medical Care and has previously received research funds from Baxter. He has also received speakers' honoraria and research grants from Fresenius Medical Care and Baxter. Kym Bannister is a consultant for Baxter Healthcare Pty Ltd, on their Clinical Advisory Board and received speaking honoraria. Fiona Brown is a consultant for Baxter and Fresenius and has received travel grants from Amgen and Roche. Stephen McDonald has received speaking honoraria from AMGEN Australia, Fresenius Australia and Solvay Pharmaceuticals and travel grants from AMGEN Australia, Genzyme Australia and Jansen-Cilag. The remaining authors have no competing financial interests to declare.

The article, entitled "Recent Peritonitis Associates with Mortality Among Patients Treated with Peritoneal Dialysis," will appear online at http://jasn.asnjournals.org/ on May 24, 2012, doi: 10.1681/ASN.2011121135.

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