A.T.N. van Diepen
- Infections in peritoneal dialysis patients: Incidence, determinants and the association with peritoneal transport
- Award date
- 20 February 2015
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
The research reported in this thesis aimed to contribute to the knowledge about the epidemiology of infections in peritoneal dialysis (PD) patients and its subsequent impact on peritoneal transport.
Incidence: This thesis provides evidence that PD patients carry a higher baseline risk of infections when compared to HD patients. A large proportion of the infections in PD patients were related to the PD technique, whereas this was different for HD patients.
Determinants: Protein-energy wasting was associated with a 40% increased infection rate in both HD and PD patients. Therefore, our study underlines that routine screening of nutritional status is important in all dialysis patients. In addition, we have shown a strong temporal association between a recent exit site infection and the development of subsequent peritonitis. However, only an association and no causal relationship could be attributed after a qualitative assessment of the literature using the Bradford Hill criteria. Furthermore, no association between glucose exposure and the time to subsequent peritonitis is present in PD patients.
Peritoneal transport: Patients with a very first peritonitis remained at an initial faster transport state, whereas patients without a first peritonitis episode showed a stabilization of peritoneal transport parameters presented by a slight decrease of the transport status. Patients who survived three years on PD and experienced frequent peritonitis episodes showed an increasing trend in small solute transport and a decreasing trend in transcapillary ultrafiltration, whereas the contrary was true in patients without peritonitis or with one or two episodes.
- Research conducted at: Universiteit van Amsterdam
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