Infections in peritoneal dialysis patients: Incidence, determinants and the association with peritoneal transport

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.