Changes before and after COVID-19 pandemic on the personal hygiene behaviors and incidence of peritonitis in peritoneal-dialysis patients: a multi-center retrospective study.

BACKGROUND: The impact of Coronavirus disease (COVID-19) pandemic and its influence on personal hygiene behaviors and peritonitis rate in peritoneal-dialysis patients is unknown. METHODS: A multi-center retrospective study was conducted. We reviewed all the cases of peritoneal-dialysis (PD) patients from four major PD centers in Wuhan before and after COVID-19. There were 567 patients enrolled in total. Information was collected on personal hygiene behaviors, basic clinical characteristics, lab results, peritonitis details. We used Chi-square analysis to compare the personal hygiene behaviors, and used Chi-square goodness-of-fit analysis to compare the peritonitis rates before and after COVID-19. Multivariate logistic regression analysis was used to analyze the risk factors for peritonitis rate. RESULTS: There were no significant differences on peritonitis rates in six-month period before and after COVID-19 (p = 0.0756, Fig. 2 and Table 3). But Gram-positive infections decreased dramatically (p = 0.0041, Table 4). Personal hygiene behaviors such as length of time for washing hands when performing PD treatment, the frequency of washing hands before PD treatment and six general behaviors had significant differences (P < 0.05 Table 2). The multivariate logistic regression analysis showed never washing hands before PD treatment and serum albumin level were the risk factors of peritonitis during COVID-19 (OR 14.408, 95%CI 3.930 -52.821, P = 0.0002; OR 4.681, 95% CI 1.755 -12.485, P = 0.002, Table 5). CONCLUSIONS: The COVID-19 pandemic had a significant positive influence on personal hygiene behaviors. Peritonitis rate did not significantly decrease but Gram-positive infections dramatically decreased. Never hand washing before PD treatment and serum albumin were the risk factors for peritonitis. We should emphasize hand washing before PD treatment in training and re-training program.

Baseline serum triglyceride predicts early-onset peritonitis and prognosis in incident CAPD patients.

ABSTRACT: We aimed to investigate the hypothesis that serum triglyceride (TG) may be an independent predictor of early-onset peritonitis and prognosis in incident continuous ambulatory peritoneal dialysis (CAPD) patients.In this retrospective, observational study, we screened 291 adults admitted to the PD center of the Wuhan No. 1 hospital from August 1, 2013 to November 31, 2017. All biochemical data were collected at the first 1 to 3 months after the initiation of CAPD. Early-onset peritonitis was defined as peritonitis occurring within 6 months after the initiation of PD. All of PD patients were followed up to July 31, 2018. The primary endpoint was the incidence of early-onset peritonitis while the second endpoints included overall mortality and technical failure.A total of 38 patients occurred early-onset PD peritonitis and the Lasso logistic regression selected TG and age in the final model for early-onset peritonitis. We divided patients into two groups based on the median baseline TG levels: TG ≥ 1.4mmo/L group (n = 143) and TG < 1.4mmol/L group (n = 148). There were 34 (11.7%) patients died and 33 (11.3%) patients transferred to hemodialysis during the follow-up, Moreover, a level of TG ≥ 1.4mmol/L at the initiation of CAPD was associated with a significantly increased probability of technical failure (hazard ratio, HR, 1.30; 95% confidence interval, 95% CI, 1.09 to 2.19, P = .043) and overall mortality (HR, 2.33; 95% CI, 1.16-4.72, P = .018).Serum TG levels measured at the initiation of PD therapy is an independent predictor of early-onset peritonitis and prognosis of CAPD patients.

Association between medical insurance type and survival in patients undergoing peritoneal dialysis.

BACKGROUND: Socioeconomic characteristics may affect the outcomes of patients treated with peritoneal dialysis (PD). There are two major medical insurances in China: the New Cooperative Medical Scheme (NCMS), mainly for rural residents, and the Urban Employees' Medical Insurance (UEMI). The aim of the present study was to assess the effect of medical insurance type on survival of patient undergoing PD. METHOD: This was a prospective study in adult patients who underwent PD at the Wuhan No.1 Hospital between January 2008 and December 2013. Patients had received continuous ambulatory PD for >3 months. Patients were divided according to their medical insurance. Demographic and socioeconomic data, biochemical parameters and primary clinical outcomes including all-cause mortality, switch to hemodialysis and kidney transplantation were analyzed. RESULT: There were 415 patients with UEMI and 149 with NCMS. Compared with UEMI, patients with NCMS were younger, and had shorter dialysis duration, smaller proportion of diabetic nephropathy, more severe anemia, and more frequent hyperphosphatemia and hyperuricemia. Total Kt/V, creatinine clearance and residual renal function were not different. There was no difference in technique survival (P > 0.05) between the two groups, but rural patients showed lower overall survival (P < 0.05). Multivariate analysis showed that NCMS was independently associated with lower survival (RR = 1.49; 95% CI = 1.04-2.15). CONCLUSIONS: Medical insurance model is independently associated with PD patient survival.