Peritonitis rates fell from 2009 to 2018 for patients starting peritoneal dialysis
Key takeaways:
- The yearly incident peritoneal dialysis cohort size grew 160% during 9 years, data show.
- The unadjusted rate of combined peritonitis events dropped from 58.1 per 100 patient-years to 30.7 during the study.
Peritonitis rates among Medicare patients initiating peritoneal dialysis in outpatient and hospital settings fell between 2009 and 2018, data show.
“Peritonitis is a leading cause of morbidity for peritoneal dialysis (PD) patients, with 10% to 20% of events leading to PD cessation,” Christopher Knapp, MD, MPH, an internal medicine specialist and nephrologist at the University of Minnesota, Minneapolis, wrote with colleagues. Still, “it is unclear if this trend toward improved peritonitis hospitalization rates has been matched by improvements in outpatient peritonitis rates or has occurred partially as a result of shifting peritonitis treatment to the outpatient setting.”
Researchers used U.S. Renal Data System data from 2009 to 2018 to identify 40,059 patients who started peritoneal dialysis during the study with Medicare fee-for-service insurance. Average age was 64 years; 19% of patients were Black and 65% were white. Overall, 77% of patients lived in urban areas.
Researchers tagged peritonitis events as independent if these started more than 4 weeks after the start of prior event and 7 days after the end of the previous event.
Hospitalization was defined as an admission with a claim for peritonitis in any diagnosis position. Outpatient events were identified through dialysis facility claims for antibiotics.
Knapp and colleagues followed patients for up to 2 years after the start of dialysis, until death, transplant, kidney function recovery, conversion to hemodialysis or Medicare disenrollment. Median follow-up was 523 days.
The yearly incident peritoneal dialysis cohort size grew 160% during 9 years. The unadjusted rate of combined peritonitis events dropped from 58.1 per 100 patient-years to 30.7 per 100 patient-years during the study.
Hospitalization and outpatient peritonitis rates each improved, with adjusted rate ratios showing an 11% decrease in hospitalization rates per 2-year period (RR = 0.89; 95% CI, 0.87-0.90), comparable to the rate decrease in the ratio for outpatient peritonitis (RR = 0.88; 95% CI, 0.87-0.89) and the ratio for the combined outcome (RR = 0.88; 95% CI, 0.87-0.89).
Knapp and colleagues wrote that peritonitis rates improved regardless of setting: “This improvement is notable in light of the rapid increase in the PD population during the study period,” they wrote in the study.
“It is possible that more widespread use of prophylactic topical antibiotics or increased use of automated PD instead of continuous ambulatory PD in this period were partially responsible for this improvement,” according to the researchers, but “PD technology and techniques were otherwise largely unchanged over this time, so the divergence of peritonitis and technique survival outcomes is surprising and merits further study.”
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