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Clin J Am Soc Nephrol. 2017 Dec 7;12(12):2016-2022. doi: 10.2215/CJN.00630117. Epub 2017 Nov 7.

Residual Kidney Function and Peritoneal Dialysis-Associated Peritonitis Treatment Outcomes.

Author information

1
Laboratory Medicine Program, rachel.whitty@uhn.ca.
2
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; and.
3
Department of Medicine.
4
Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada.
5
Antimicrobial Stewardship Program, and.
6
Department of Pharmacy, University Health Network, Toronto, Ontario, Canada.

Abstract

BACKGROUND AND OBJECTIVES:

Residual kidney function contributes to the clearance of antibiotics excreted by the kidneys, lowering the antibiotic concentration, which may adversely affect the treatment of peritoneal dialysis-associated peritonitis. The objective of our study was to examine the relationship between residual kidneyfunction and peritonitis treatment outcomes.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

Our study included 181 participants who experienced 339 episodes of Gram-positive, Gram-negative, and culture-negative peritoneal dialysis-associated peritonitis at a single centerfrom 2003 to 2010. Episodes were categorized according to participants' urinary creatinine clearance (0, >0-5, and >5 ml/min). The data were analyzed using generalized estimating equation models to determine the covariate-adjusted association between urinary creatinine clearance and treatment failure (defined as relapse or recurrent peritonitis episodes, peritoneal catheter removal, or death from any cause during peritonitis treatment).

RESULTS:

Among episodes of peritonitis due to Gram-positive organisms or culture-negative infections, those experienced by participants with urinary creatinine clearance >5 ml/min had significantly higher odds of treatment failure than episodes experienced by anuric participants (27 of 80 versus 20 of 119 episodes resulting in treatment failure for creatinine clearance >5 versus 0 ml/min; odds ratio, 6.80; 95% confidence interval, 2.37 to 19.6). Episodes experienced by participants with creatinine clearance >0-5 ml/min also had significantly higher odds of treatment failure than episodes experienced by anuric participants (14 of 64 episodes resulting in treatment failure for creatinine clearance >0-5 ml/min; odds ratio, 2.87; 95% confidence interval, 1.12 to 7.35). The odds of relapse and recurrent peritonitis among participants with creatinine clearance >5 ml/min was also significantly higher compared with in anuric participants (17 of 80 versus 12 of 119 episodes resulting in relapse and recurrence for creatinine clearance >5 versus 0 ml/min; odds ratio, 6.76; 95% confidence interval, 1.90 to 23.8). Among participants with Gram-negative peritonitis, creatinine clearance was significantly associated with neither treatment failure nor relapse and recurrent peritonitis.

CONCLUSIONS:

Residual kidney function as measured by greater urinary creatinine clearance was associated with treatment failure among participants with Gram-positive and culture-negative peritonitis.

KEYWORDS:

Anti-Bacterial Agents; Recurrence; Treatment Failure; Treatment Outcome; antibiotic clearance; continuous ambulatory peritoneal dialysis; continuous cyclic peritoneal dialysis; creatinine; peritoneal dialysis; peritonitis; residual kidney function

PMID:
29114005
PMCID:
PMC5718262
[Available on 2018-12-07]
DOI:
10.2215/CJN.00630117
[Indexed for MEDLINE]

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