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Open Access Research article

The effects of living distantly from peritoneal dialysis units on peritonitis risk, microbiology, treatment and outcomes: a multi-centre registry study

Yeoungjee Cho12, Sunil V Badve12, Carmel M Hawley12, Stephen P McDonald13, Fiona G Brown14, Neil Boudville M15, Kathryn J Wiggins16, Kym M Bannister17, Philip Clayton18 and David W Johnson129*

Author Affiliations

1 Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia

2 Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia

3 Department of Nephrology & Transplantation Services, University of Adelaide at the Queen Elizabeth Hospital, Adelaide, Australia

4 Department of Nephrology, Monash Medical Center, Melbourne, Australia

5 School of Medicine and Pharmacology, University of Western Australia, Perth, Australia

6 Department of Renal Medicine,, Royal Melbourne Hospital,, Melbourne, Australia

7 Department of Nephrology, Royal Adelaide Hospital, Adelaide, Australia

8 Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia

9 Department of Nephrology, Level 2, ARTS Building, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, 4102, AUSTRALIA

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BMC Nephrology 2012, 13:41  doi:10.1186/1471-2369-13-41

Published: 15 June 2012

Abstract

Background

The aim of the study was to determine whether distance between residence and peritoneal dialysis (PD) unit influenced peritonitis occurrence, microbiology, treatment and outcomes.

Methods

The study included all patients receiving PD between 1/10/2003 and 31/12/2008, using ANZDATA Registry data.

Results

365 (6%) patients lived ≥100 km from their nearest PD unit (distant group), while 6183 (94%) lived <100 km (local group). Median time to first peritonitis in distant patients (1.34 years, 95% CI 1.07-1.61) was significantly shorter than in local patients (1.68 years, 95% CI 1.59-1.77, p = 0.001), whilst overall peritonitis rates were higher in distant patients (incidence rate ratio 1.32, 95% CI 1.20-1.46). Living ≥100 km away from a PD unit was independently associated with a higher risk of S. aureus peritonitis (adjusted odds ratio [OR] 1.64, 95% CI 1.09-2.47). Distant patients with first peritonitis episodes were less likely to be hospitalised (64% vs 73%, p = 0.008) and receive antifungal prophylaxis (4% vs 10%, p = 0.01), but more likely to receive vancomycin-based antibiotic regimens (52% vs 42%, p < 0.001). Using multivariable logistic regression analysis of peritonitis outcomes, distant patients were more likely to be cured with antibiotics alone (OR 1.55, 95% CI 1.03-2.24). All other outcomes were comparable between the two groups.

Conclusions

Living ≥100 km away from a PD unit was associated with increased risk of S. aureus peritonitis, modified approaches to peritonitis treatment and peritonitis outcomes that were comparable to, or better than patients living closer to a PD unit. Staphylococcal decolonisation should receive particular consideration in remote living patients.

Keywords:
Antibiotics; Bacteria; Fungus; Microbiology; Peritoneal Dialysis; Peritonitis; Outcomes; Relapse; Remoteness