A det a.,

uy'lufiglufluu Original Article

o, v i A d i t v q, erl w l[...---!---gilo ilg rdg s l, o { n t r A o rB o rE o U rio { ri o { 0 n t fl u 1, o { q| U ? u a l { l9l Yl'l.l uo il Yl o il

lultsilururafl?irr{il:vtrYnd ffwrisrunrd?rrrf

Risk Factor of Peritonitis in CAPD Patients in Sawanpracharak Hospital

Nakhon Sawan Province

Yufi rfisatrqrufio n.u. Rutchanee Chieochanthanakii M.D.

n{usruorq:R::tt Department of Medicine

I:susruraoa::rfiJ:vttYnd sawanpracharak Hospital

ff.ru5oun:aa::r{ Nakhon Sawan

da v dfl?::nillvx'l:RUl2xdl: Sawanpracharak Medical ]ournal

Vol. z No. r january-April zoroani -iilfi z qiluil I tJR:1nil-ltlulul{ 2553

vflJltfiouov , d A a. h d a 4 d--.-r- --y--y-.-^. ,--.rr^.^:^:^\ .-.4-Tnoiltsaffi : nfiafintrnailEnr:runr:hotfratEaqda.,:rta.,:antau @eritonitis) ttflsn1?notta---1-------- -'- - q

& q d & rfria.,:nr.oaanviof,'xlrr (exit site infection) :rrurT',:qu6nr:aho',:t7aria[:n

1ta c 6 n ur fl o {fl r d EJ.] ? a.: n I : t fi or p e ri to n i ti s'[u {rh er fi r.:t n m r t d a',: fr a.:

(continuous ambulatory peritoneal dialysis : CAPD)

florildf;nul : mrirulnrfiuu l:',tt,tururaae::6il:strind o'',:m{olun:aa::d'

tilttuunr:?ffu : n1:finu1ttuu case-controllt

ndufraodr,r : {rha CAPD dtf,riunr:inur ott-:uri 1 n:n01nil 2550 6'-: 31 4a1nsJqq

2ss2 druru 122 A\

?f;nr:f,nut : :?1t:?ilflailaflflt?t:sLfiauta.:{rJau il:snaudraflo4adugru lfiuriSS

s ia. u I r - Y -alEl tl tFI l:afir{luartm4zo.:tmela l:nturm?1u dru6',: uavillufn

. oA 9 \ t I \rY , - ij u Yil:vr? nr:dr.,:lnntda.-:fr a.:'Ld uri iufr t5ru CAP D :sEls?\ fl 11 o{ (break-in)

fia-{n1T'[dyiafir.,:1m {uiirfin peritonitis mta exit site infection uu, d,rial:n ,.lan:?aLdao lfirrri serum creatinine, serum albumin, hemoglobin,

HBsAg, anti-HBs ttflr anti-HCV4ri{an"lrflRu't : {rJra CAeD 122 a\ fiornrrunr:inr*r t,290.5 rdau rntarvirriu to.o

ffiaurianu :yttsL?a1fl1afi or peritonitis n#.-:u:n fi ritadaMrriu t z.oz rdau

a-n:r nr:ufi o peritonitis rvir riu 1 B. 1 8 udau oia n#.,:n6o o.oo r,{o rir,lo-m:rnr:rfin exit site infection ivirriu 18.44 rdaurion#.,: ntaryirn-uo.os o'#oriufll rd'a stapnytococcus coagutase negative riluarumnratperitonitis Saaas zo.g ,,arr{a staphylococcus aureus rfluarrmEto.:exit site infection iaaar sg.o :vriudnqfi u'[u rda or r{lufloo-r]rdu{rat

aAAtvu6nr:6orrtarEourio.,:fra.,:o-nrau'lu{rhuf,r.,:lnnr.,:daor1o.,: Inafirirnmrurden

#ud'nrf (odds ratio) rvirniu a.ro ,ri..t tgsr Cr 1.89-7.86, p = 0.003)L--.-ol- Y A r - I u ,z{ u d ad u6r?uu0aflau1 rtu alEJ [:nru1m?1u nzilrueanra :vnrun5tofrfru :cot]u

nmur{ruflurdankjvrurilurJoo-EJrdu.:2a.,:nr:finrdardauziatyia.,: :sEJsrrnrvYq6lrrqvd-"

lrnria.,:md'.-:n'rdldriafir.,:'[orrilurJo{afla.-:riura.,:nr:ufior peritonitis Inufirirnrrrurfiata=rullTvrii urir#u 0.44 Ln:' (95o/o cr 0.17-L11, p = o.o4o)

I To study the incidenc density of peritonitis and exit site infection,

causative organism and risk factor of peritonitis in cApD patients.

I Renal Diatysis Unit, Department of Medicine, sawanpracharak hospital.

I Case-control study.

: 122 CAPD patients from July 1,2OOT to October 91, 2OO9

I Medical records and dialysis records were reviewed. The following

data age, gender, cause of renal failure, underlying disease, diabetes

mellitus, weight and height, were retreived date of start dialysis,

break-in, date of peritonitis, date of exit site infection, causativeorganism, and specific blood chemistry results; serum creatinine,serum albumin, hemoglobin, HBsAg, anti-HBs and anti_HCV.

: 1,290.5 patient-months or 10.6 months per patients were follow up.

Time to first peritonitis is 17.2 months. Rate of peritonitis is 1g.1g

month or 0.66 per year. Rate of exit site infection is 19.44 months or

!-- d I v a d o,..lor:atttavoqil : o'n:rnr:tfinnr: peritonitis tu{rjra cApD'lnfirda.,:niurnruq{firirmuorl{

lu peritoneal dialysis-related infections recommendations 2o0s n1:nFl

00vfitdlfiCI,q

o-trm nmrfi n peritonitis'[uft]r erareJr:nrirldor nnr:rfi ru:sriuo-aq fi ulurdaq- ---+ 4 J ' "*^-*]. --. -v-v-..A v \t , v: nlTFr Fr tU 0 tu auua.,lm a{ o fl t6lu tl oo a td'EJ.,t nmdr.,:1mmr.,:da,ovia.:

Abstract

Obiective

Setting

Design

Subiects

Method

Results

fl oi'er?0wo rn r:6erdor6o:piorfro rdnr eturo.rptJ.:trdr'lfl rrrriolrlo.r

a.r e ! 1ul:.rnoruraa::idil:cryrind{wdnrn:a.l::riUYl 7 AUufl 1 il.n'-til.El. 2553 Risk Factor of Peritonitis in CAPD Patients in sawmpmchrak Hospital, Nakhon Sawm province 3

Conclusion

0.65 per year. Staphylococcus coagulase negative was the causative

organism of peritonitis (20.8%), while Staphylococcus aureus was

found 59.6% in exit site infection. The baseline serum albumin is

important risk factor of peritonitis in CAPD patients (OR = 3.30; 95%

Cl 1.39-7.86; P = 0.003) but the other factors such as age, DM,

BMl, serum creatinine, hematocrit are not. Finally, break-in is preventive

factor of peritonitis. (OR = 0.44i 95"/" Cl 0.17 - 1.11; P = 0.049)

The rate of peritonitis from this study is closed to rate of peritonitis

from Peritoneal dialysis-related infections recommendations 2005.

lncrease serum alblumin.level can reduce the rate of peritonitis.

Peritonitis, Risk factor, CAPDKey words

uYtu-r

rl :c rm dln u fi lirh alnm EJ r{oi.r:s a c

qnfi1er(end stage relal Oisease) mnn,jrgo0 nuriail:szrn:ud,,:firunu ratafi rirharj:srutru 18,000-2o,o0o nu raurrr"r]rrn

4 a A Ayi 1tl jLflEJ.,:tililamsmnrfiilafr {ilralnararurnfifl ot

(1)

- Ayt , X vyv a vfl1T:nU1mruU?UnAilUAsLFt:U n=O nr::nr*rQq

drr-iornnumulm (renal reptacement therapy)

fi s ifr lfiud nT:v{anrdanfirurntotlnrfiaru

(hemodialysis : HD) nr:f,t.,:1nnr.,:ria.:fia.,:

(peritoneal dialysis : PD) lldafl1:rirriornlfielulm

(kidney transplantation : KT) a1n{aila Thai

Renal Replacement Therapy Registry (TRT)

fl esso {rh adtfiiu nr:inr*rdrfnn or unulndo &iloruruykfiilo 26,452 Au (419.9 nuria

' A e \evu:v{1ft:?1u{a1unu) LoTU HD 20,641 nu

(g27.s nurioil:ytrn:ud.-:f,ruau) pD

1,198 nu (19.0 nuriail:ymn:md.,:f,runu;

uas KT 3,618 Au (57.4 nurioil:szrn:vrd.,:

f,lunu;tzr

mrir flln rfi fl il I:.:ll EJlul n d?TTri'

rl:vtrfn r$ lfi rtl orlfru3n1:n1:in u1 uh rior

nnumuln z ifr 6a HD uny po Inarilunr:Y|,tvA1{ 1Flil1.:20{?10{ LLUU continuous ambulatory

peritoneal dialysis (CAPD) rrrir6ru HD

fi #ndrura.,:{rJrarurnn.i1 pD urimai'.,:orn

30 na1nil 2s5O igu1ail:ynlfiulauraCAPD f irst rirmfu (rh atum#nd:yri'uaznryl

firumrir(t) d.,: zun'lfr0-or:rdauza.o frdr u po

: HD ryirriu + : r d.,rrilu#ndaudrfirudu

adr.,::rnt5r

v44tYu tIo?sln Eilnod, v d

d?T:ntlTszl:fl 1*t??ld1T

fl ru mr ua sa r.l a:: n rir riru'lu nr :fir.:1rruq

mrmio.:fr o.: 6 a nT :fi pr rfi'a ufi audo.:fr a.r a-n lfl uq

. A d, i , i .i"(peritonitis) fr.: rfluar un nfi ylur-iaafi drrfi vir'[fr

frrhurfisfrin Saanv o.8-iaeras tz.s(o) yir'lfr{9i o cd, Y v U r I,Ju? UA1 rilU n A{}1 U Ft fl 1:A1{ LFlnl{tA{r A{qq

Ituuyhr tHr1ru? Fr:1? $asn1?T(technical fai Iu re)

a N A a X -J ooy^Q1 fl fl 1:Fr Fl ttoyt:u Lt:{fi :a tTa:{{{?11 tfi tn Ft

IJJ

n'r:tfi a il? 4.,: rE alda.rfr a.,: (mem brain fai lu re)q

ao'q-Aa1 fl fl 1:FIfl 1*1 LU Fr1{U:vtYt F[?\U?1ilAA gTt

^'jtfirunrmrutfiH.r?a{n1:tAor peritonitis lfiruri

n?1sJd?u l:nlnornru'rfi?'ru (diabetic kidney

disease) unv:soiudaqfi u'lurdan (baseline

serum albumin)(a) ruoifrarya'luil:vtmntmuq

q1n n1:dnu1?ra{u1EJ rryrm fri uava rus(u)

n #uyr u'irrJoq-ufi rfi s., nrr u rd a.:r a{ n1:rA ndd

peritonitis eJt?\U{ hypoalbuminemia utas

anemia

%daqqU n n1:6uto{ nITLR n periton itis uarnT :fi Br rd'aI

do.:mr.,:aanviafiT .,:1n (exit site infection)&%d&riqvj

T?rJn{au rln1:6u11 o{ttana tTn ttas ilaafl r6tu{

za{ peritonitis'lufrilra CAPD

a44?fifl1iflflu1

aFlnwl$ltu case-control study flfltJ

u I uly t v n c X v vn?afl1{ [nun ilil']u[Ft?1u[To:{TyuudFtytlElqqAyauov\yaaylt?1lu fl1::fl 1*1u']1.t FtTtFt ttytu Ln n ? H ? fr

aCAPD rl-.:rroi 1 nrng1nil 2550 au6.,l 91

na1 nil 2552 fl o.,il:.lyr u1u1nd?::ri'rhsminriq

o'.,:n{nru n:ar::d' .fru: \ 1 22 nu rni.,: rirh aqdt t a A yn Aa-

luu 2 nail flailflnu1 n0 zuil?flytilan:1fl1:qqq

AXaa-,sAafl 1:Flfl 1*1UA.tl.r? n nilTvd{n tTta Fln:41

Y\rAdaoBafir.:lmdu rial lu rti or r6a Brzm'Luri, s1 fir.i1n

9

peritonitis riaan'jT mtaryirniu o.o7 nf{daflqiruru 79 nu Ina'Lfirnruq4'fi ritnuorti'luperitoneal dialysis-related infections

jo 6recommendations 2005 YlnlfiUntntufl

lJlnrgluza{n1:rnn peritonitisl{fi r nf.:'[uraar 1B rdauraia 0.67 nf.:riafl(u)

I d 9nT? U T? 3J?tO 3J A Q1fl !? {:stlt EtUl A{ r.,rJ ? El{q

t v u 3 lv1l:vflOUFr?flzA3JAy{Ufr',tU LnUn AlEl tyrFIqdqsia.l:nfi uflual rfi n?ra.rlrt?1 fl I:n ru'rfi ?1u

q

,Ya,%e\tyd?ud.o msu1fi un il:vtrtnr:6r.1 Lrtnfi?ia.lyta.l{ve , - J^'lffurri iufirSilCAPD :suvv(nfra.:(break-in)

mn-.:nr:'ldyiafir.:1n {ufi rfi nperitonitis ytaX 'i a

exit site infection LLasttaflaLTn r.lnn:?ataaFr

lfiuri serum creatinine, serum albumin,

hemoglobin, HBsAg, anti-HBs Uns anti-HCV

nT :ifiqda peritonitis tl:vnaufirsadrtfiaa z fla rirrialud ftorfia.:riarlru'r

sJlnn'jl 1oo Lf,ad/Qnulnd'fia6rrun: uns

adr.:riafl5aflas so rilu potymorphonuclear

teukocytes mta nurd'aa1nn1:frasJfirtaav

nlTty,rlvLiioza.,:ilr srfrr.:1m(6)AAV

nlTTfraau exit site infetion rrt-i.,:Flrru

nlTdlLLunaor: Twardowski lotuarriaarnr:

LraBo'rfl1:udFt.,lrflil O #nuruy 6o perfect,

good, equivocal, acute infection, chronic

infection and cuff infection without exit

i nf ection Inr ai fi o dEl'ir fi nr :fi nr rda ri.,: uri acrte

infection dulrln,

i rn:rsffla runln a'Lfil'rhun:ru ritSonlqgo-edr,jyti

ult6lua?arJatuunln?13Jn :8flas mlaaEtq

tfiot peritonitis rurnn'ir 0.67 n#.,rriatl qiruru rardrurfiu{ruuulm:fi.1u rritsurfielu{oila43 nu n{runruqru 6a airtradfidm:rnr:rfin :sfi.j1{ndilInu'lfi Jn, .orure test ulsqqqq

fl oflsr?arrolnr:onrdor6orpio.rdorri'nrarcJo{pXi:0dr,:'lnmr{siordol

A.; v ) 1ul:snelruaar::rirliysrfnd,i',:lj;nun:d?::riUm 7 ALUYI 1 N.n.-tlJ.cl. 2553 Risk Factor of Peritonitis in CAPD Patients in Sawmprachrak Hospital, Nakhon Sawm province 5

aa"r*"", --*-r"--r*peritonitis LLds exit site infection luflut:n uay g nu 6nrfluiauay t.Z l,lutriAriudnrAufiun 2 za{n1:Flnu1 fi1ilaauL6lu{dsJyrytfi?a{

n"r:Lnn peritonitis Iorant:mrri1 odds ratio

uasn n6au fie aaru nr:n n na H Lruuy,tl,lfl6tl

(anti-HCV positive) S nu aotr{lutapias +.s

ruarfi 4 fi {e.r ri'u oi atriaril #n raufi (anti-H Bs

positi;) * u, FrufluiaaaB so.g (nr:1{fi 1)

(multiple logistic regression) fi:srriunml,fiar't', ra.r'anjiflurfiuurvil'h.lnriru6nuruasneirunrunnqqqv:aEra8 95

4flafl1rflnu1

dru-orn n urnutrr dr aid cApD m.:milr a'[n rfi s ru

I:.:l'rfl rurnae::d'rl:vminri fi rflr rnruei"lu

nr:finr*rdfisiluruyf{fi Nn 122 nu finnrruu&

n1:TnulTt'.:?13JFl 1,290.5 r6aumtarviT ri'u t0.6 rdaurianu(patient-months)

firlrerrfisfiin 22 AuilarfluSotray ra.o lortr"- o oo uyd't tfi 4?a{nlTralEjt? Ft Ln ttn n1TLnfl peritonitis

11 nu fir,rttuiosas so.o flfluriu 2 nu

6nr{lufaeras 9.1 vr-r'lorra Lrnyml{rAu

flaamva'nraufiorrd'a adr.lay t nu 6prr{lu

Saanv 4.s finnrrunr:fnr*rhiae,rtrrdrua 4 nu

6orrfluiaHav 1a.2 unytrim:rud.rri4qdAAdtyv

nr:rriEjzlm 3 nu horrfluiaaas 13.6 ridra,ivo

rilfi erunT :inu1a1fl CAeD lrlitu hemodiatysis

siruru 6 nu IorEJfiarrfinqrn peritonitis4'av,^dn [].rnaljduannanm?fl 1*lFt?8u1il08.:Uy 3 nU+- 6t Y

-- - a a A O r yna[uu:auas 50.0 rnofl1:FtptLua:.I luta{Tta,3

h e rn i a) ua s r.r-t fi n'[uda.,: fr a t q u u fi nr rir"L fi a n m-uq

(intestinal obstruction) aeir.:nr t nu 6orr{lu

Saerav to.z- v

"|vei'nurusyTrlrhar frrh u 01 fl rad ugq

(fungal peritonitis) l#rdaufizTmfiu(inguinat finrrflufasaa 2o.B rasrfllyr{a'lejdu zo r'{.,:

nuiT #nuruvvi'elrh a.: da{ n 6i il'lri fi nrT ruq

urr n rir.,: riu uril lu'jT n ri ru n-r a drt fi ar rn ntnm a3-",qtTA:{41fl[U1?1?1U LLnB n1 baseline serum

v i u 3 - Aq -- v{d r aln rr a ria f.:fi ldiu nr :fn u1 atbumin riaan'ir g nfsJlrnfifi rt: il1nn.j1n6isJ

n?unil adr.:firiarirn"rynrtafifi (P = 0.004

Lrne o.oo3) (n1fl{fi 1)

:sElst?a1fl1:rfiot peritonitis n#.:u:nd, A I ufrrirrqdEJryirfi'u 17.67 rdau a-n:rn1:LfiFr

peritonitis [ri1n-r-.r 1 8.1 I rdauriani&.,: mta

0.66 n#.: ri afl lor s F nludrt u:n mY.: rui 6ru nmdnm

1 n:n01nsJ 2550-30 niuarau Zsst finr:rfinUa

peritonitis 21 n:.,1 Lu:sEls[?a1n1:nnnltJ-Y,

n1 :in r*ryj'., ?1 sJ Ft g2 1 . 0 mr^ au 6 or r{lu a"'n:r nr :a{tva'&avFlnrfla[m1flu 15.29 tFtauFlErFt:{ rfiE]unu

'[u:ct]s L?a1 1 na1nil 25s1-g1 nalneJ 2s52avU3J :s Er s [? n'l fl 1 : Fl n rll ]J n 1:Tfl 141 yhl fi N Fl 96 g. 5

Gaufint:rfior peritonitis 50 n{.: 6rrrf,luan:.ra&tvd,A

fl1:FlnLtaLillnu 1 9.39 LAAUF|An:\:

n1:rfin peritonitis rYoru, zt nf.,:

fl.1FlT?0tl11st{AA1U?U 67 n:\: yluITO&

Staphylococcus coagulase negative 14 Fri.,:

Ad'y)nnlilu:aflnv 38.7 (n1:'1.:fl 2)

d'm:tnr:rfior exit site infectiona,&a&

ryirnu 18.44 r6aurianf.: rEa 0.65 nirriatlIor EJ 6 nlu?ir.r ul:n rls.: uri Gar nr:fi nt*r 1 n:n4 1 n il2550-30'fiuultlu 2551 fi exit site infection46.0fi2.6 tl rnnmfr.,: 69 nu firrr{luiacray 56.6

22 u#o turrrsmnrnr:fi nnrrunr:inur-Y-----da6,uo3thlfi8JFt 321.0 rFtau nnriluon:rnr:frnrfra

I u a , A d uotYt1fl u 1 4.59 tFtounan:.t tfr uunulu:sgsteat

1 naln;J 2s51 6.0#uannr:6nr*r'[ui'ufi

31 nalntJ 2552 fi:yeryrratnlTAnFl-lilt-An1Tfnu1yi.,lfieJn 969.s rdau fi exit site

infection 48 n{.,: 6Bru{lufrr:rnr:fi orrd'atua'A

rm1flu 20.10 raouFtan:{

y{Un1:tfin exit site infection 70 nf{r. ! " & A6l{FlT?Qty'llytuaalu?u 57 FtT{ yrutz'a

Staphylococcus aureus g+ n{.,1 finr{lufaaas

59.6 (fl1?',trd S1

'lurrar ta rdaumta 0.67 nf.:riofl unsrfiarAd

url5uu tfr nutyrJs[? a1n1:rA o periton itisrd,va,A

Tvfi 'i1{tl Lr:n ri'uf,|fi aa.,:?a..:n1Tfi nu1 ylu.ir'[u4ri dv o & , UIIfr aat fi o=n:1 nlrA n rfr a ri a ni.:ur u n.j.r'[u

ilu:n +.t o rdau rdurdsrn-ufinulun1:rfi Fr

exit site infecrion tuttid aa.,: fi dm:r n.r:fi or rdo. & ,el d,riani.ourun'ir'luf,lu:n s.st l6au uant.ir

:ruun1:1fru3nr: CApD 6du ororfia{a1n4--- 4 vt &N fl 1:tFlTfl eJ ruil? u Ft{ tm naufl 1T.t1{6{1 U UA$4A.,1

n1:?1{61'tEJ iencfnofs catheter fi nr:lfiamrue ra% a ,j , y:tLasmTu0un n13J rnnxtn n1:rila uurir erur aret4A,aed'dr.:ln ua yfi n1 :il Ts rfi um d'.,1 n1:da u a u liu'la

jqu.ltfran n daufloo"u rfiEJ',t fir EJail nr: 'irfirJrauavri4ua{r-hfld1si1Tnnau'lrlyhtfi

6lAflAUy{4nrU ?yU.i1 baseline serum

albumin r{lurJoo'a r6iEj{?a{n1:rfi fl peritonitis

tu {rJ r crt nm a r{a fr fi in ur uh u-Br n n rfl utneadrd,deav6,,t?fl?0' cAPD tnailrirnrralrfra.od'ruylno

(odds ratio) 3.30 ryil (95% Ct 1.39-7.86,

P = o.oo3) dauflo{adu 1 lfiud alEJ

I:nrurmmu rirfiruennlEJ Tyniunirafifiu

tYOEJl\lnflnA{q

rd'a ri aI:nfi lrLr-i a afi antu nr:rfi n

peritonitis 6a stapnyococcus aureus uay

staphylococcus coagulase negative 6n:rru.-)-y-.y -- - A-4- !"-r 9 , Aurm1 nu:a fl av 29.3 {.,tn a rIu6{Fldaufr ua sn.irnr:6nr*r'luil:sun rtnyi'u n n fi ylu ru1 n n.i1

SaEJas so(t) yi.rdril:rcfndau?o{fl ,rrn:?ar'{uvvvau.

:sBtunmrut{u{urfian triviut{lurJoo-utda.,l cutture negative peritonitis d.:y{u61iaansta.,ln1?tfi n peritonitis uasri.,:nt,jrTs?ly[?a1

l r-n fr a.,: m #t n r :t d ri o f, r.,:1 n rfl u rJq o-er fl a.: riu

?I a.,r nr: rfi n periton itis Io u fi Fir nrr u rd a.,: #ru lt'n if(odds ratio) 0.44 ryil (95% ct 0.17-1.11,p = 0.043) (n1T1.,1fi 4)

Ad?o1:0r

se.zlunr:dnr*rd fiarilu#ordaudrurnrfiuc' io

rn 6u6lier1 or:g'tufi ri,ln u orl{,jrtri nr:rfi ufa aas

20(6) arorfio.,:a1n?Yunaunl:rfiu peritoneal

diatysate ftuid lriuaru1sdsJ r?iu hjlfitdluma& ia

ty'r1srfrofi fi ar mr:a d rrfir (hemocu Itu re

media) mta {rJralfiarrJfrflruvrurriaunr:rfiuperitoneal dialysate fluid d.,:rr:rq

a-n:rnr:rfin peritonitis'[u{rJaer :vd'ua-aqfiu.lurfian (basetineserumOAPD firirtvirn-u t8.t8 rfiourian{.,r rato arbumin) rilurlo,fr'flrdEJ..tflo{urdgJ?ra{n1*n,

0.66 n#triatl d{tnf,r6fltriurnru'}'ifirirfiuFr peritonitis fiylu'lun.r:6nr*rd d.,:nannfia.,:n1u

lfflu perltoneal dialysis-related infections nr:6nr*T firjruurza.:il:yrnnory{urtflLLasrecommendations 2005(6) idrirmunl{td r nf.,: {aryatur.J:yrmfl1mu lqsnu,irfil serum

fl oo'r,rfruwornr:6srdour^ouio.rri'o.rehraurlo,rpirhsdr.r'lnmxriordo.r

lul:,ruoruroae::riil:smYnd i'{fiiorn:cr::riflfi Z qUIUii .l iJ.n.-fsJ.tl. 2553 Risk Factor of Peritonitis in CAPD Patients in Sawanprachamk Hospirat, Nakhon Sawm province 7

albumin ana{nn t nie.rlrorfifin: avrfiiln?lsJq

Jufi er.,:z 0.,: nr: tfi n pe riton itis 5a H ac 27 -7 4P'4'7'e)

(leakage) totrir arf,r.,:da.:frat rfi a{a1 fl ur{a

Atfia.,:qrn serum albumin level r{luriauan6.,l

n1?umlntul n1T?a.,r rid? cJ d.t s{ n n:sytu Fioqt

immun response uanalndpi.ltJ.:'jrfi nrrsuremia t{lu:vusnalu.rurifl ufi qsdr nr:inury

^d - -_ - - & Ayu d u vFr?u?f, CAPD n{uunlTn{il?u3J:vFtuoauriuo d 3a ^ A q vtutaannla{tflFr peritonitis &J'1fl?u UoauJ,ua6u q uiu aru orlzfiruranra *as l:rrtmorn)q

rr'6,qviJtu111?1u LtJyru',tltlJU!AAU tdU.lf,.lLtFtfl Ft1{A1 n

do,vdinlTFlnul [Uu:s[nFInv?Ufl n('', AIAtUA{A1flYn O d A, a tY dvd

urun.urirfln'i1 23.0 fiIanirulmtrl{rr.tFt:'JvaLrnsFil ra6 a rr-'tfi rura nr a ryir fiu 21 .a+3.4

ty:?TJFI?EJ

roncnrdt{6{

1. Pongskul C, Sirivongs D, Keobounma T, Chanlertrith

Survival and technical failure in a large cohort

Assoc Thai 2006; 89 suppl 2: S98-S105.

ei{ fl ntil a fi n rir'lfr uda il r u rfr 'r dri a.,: fr a.: m r.,:q

periluminal route-&Fhluufll:anonT1n1:[nn peritonitis

'[u ririe u cApD d'rsn:n?i{fiIor a nr:rfi l:voiu{qaOdrou

anuSJu Lu[aa n Ltu n1T[tusu1 fl 't::u1l:sTr1u{I v o u u aua &

41fi 1: rflJ n1::fl l*'.lu1U FtTr Ft rrYtu LA Lfi r:??tul- { re a ILFI u L8J Fla{:a0u tn afl 1?syt [Ruu1 n1:a1 fl R1?E

d &o d a vd?lo{ t6{u n{ Lu taa n ltasn?: [?13J:sElvr?a1fl 1:

It'n fr a.,: m a'.: n 1 r'ldyi o ft .:ln'[u {rJ r a I n 6] n u fi

drurh cAPD,d:uI

ua€Aufrnr:run1:Lnn peritonitis LLns

q

exit site infection'lur.irha CAPD rvirriu O.OO

fiIanie.rlnr:T\:rruFr: nmdnfinar.lhilruirrflu Ltns 0.65 n#.:riafl d.:hirfiurnruvirurn:oluq-Ailooe*durzo{nmLnn peritonitis lunr:6nr*rd firirmuor lo'Ervlutd'a Staphylocoocr, *"n,-,i""A , d i, j ytfi.:si'ttornn'r:finr*rfiri1usJ1rfia{arn{rJaa negative t{luartm4zat peritonitis iaeras 20.8

dru'luqjtaElns 9g ra{n1:6nu1d finmrfin uasv{tlrda staphytococcus aureus riluatm4q

fla{ exit site infection taaav Sg.O flofurdat

:rEJs[?a1y{-nfra.,:m#.,:nr:'ldviafirtln flo{n1:tfiF] peritonitis dnuda fi:rniuo-aqfiu

rflurJao-e#fla.:niunmrfin peritonitis ry{r1sfl1r turfioorriaan'j1 g nirlnorfifin:

drurir cApD riufiaT qrfinrJrumrnr:irfiru

D, Promajuk P, Limwatananon C.

of Thai CAPD patients. J Med

7

B Yufi rduarrq;tufio d?::fi'il?y?,.rinr{Urtat:

2. The Nephrology Society of Thailand. Thai renal replacement therapy registry year

2007. nt.trytyrle: rfln6 riin; zsso. 141i1 3g.q

3. nrurigelumS. elfinrurigruumi rta.: ?u1EJAnBil:dEJrf{drstnmsr{ai.,:?saydnfilg1Ou'Lu:suura'nrj:rnnqtn.ryluyi.:m6.

1a.:{ufi go qa1nil 25s0).

4. McDonald SP, collins JF, Rumpsfeld M, Johnson DW. obesity is a risk factor

for peritonitis in Australian and New Zealand peritoneal dialysis patient populations.

Perit Dial lnt 2004; 24: 840-6.

5. sirivongs D, Pongskul c, Keobounma T, chunlertrith D, sritaso K, Jeff J. Risk

factors of first peritonitis episode in Thai CAPD patients. J med Assoc Thai 2006;

89 suppl 2: 5138-545.

6. Piraino B, Bailie GR, Bernardini J, Boeschoten E, Gupta A, Holmes c, et al.

Peritoneal dialysis-related infections recommendations: 2005 update. perit Dial lnt

2OO5;25: 107-31.

7. Twardowski ZJ, Prowant BF. Classification of normal and diseased exit sites. perit

Dial lnt 1996; 16 supp3: S32-S50.

8. Saklayen MG. CAPD peritonitis: incidence, pathogen, diagnosis, and management.

Med Clin North Am 1990;14(4): 997-1010.

9. Wang Q, Bernardini J, Piraino B, Fried L. Albumin at the start of peritoneal

dialysis predicts the development of peritonitis. Am J Kidney Dis 2003; 41: 664-9.

1O.chow KM, szeto cc, Leung cB, Kwan BC, Law MC, Li pK. A risk analysis of

continuous ambulatory peritoneal dialysis-related peritonitis. perit Dial lnt 2005;

25: 374-9.

fl 06'utdo.tcrornr:sr'qrdortrooqriolfrordnrarcJo{rXilrudrl'lqrtlriolflot

lul:ruoruraa':::riil:smYnd 6'.rlr5orn:aa::ri-.) - )ilyl 7 AU1Jil 1 ,J.n.-til.E. 2553 Risk Factor of Peritonitis in CAPD Patients in Sawmpmchmk Hospital, Nakhon Sawm Province I

n1r1{d t n-nuruvrirtrlta.ofrrha CAPDq

#nururvTr}l

frrhaq

thl14tJn

^}{J,enlTnnt{0tua!{4.:fl4{q

A,a,< 0.67 nT.lFloU > 0.67 n&riafl P value

sirurultauarl

si'ruru(taflar) drurulfaerar;

d'ruru{rJru

a1q

riaan'j, oo tld,A

60 1jil:Ail1nn?1

[ltl F[

{'tEl

m€.:

I:nfir{luarrm4lnma

rlt1?1?',ru (DN)*

rr:rilriuTafimd{ (HT).truA-[nanrduu5a:n (CGN).

ta uq{ulLuLFl (ADPKD).

Obstructive uropathy

GouVurate nephropathy

trir:rrarrrnI:nrummu

HBsAg positive (N = 111)

Anti-HBs positive (N = 110)

Anti-HCV positive (N = 111)

d'ufiruranT a (BMl).(kg/m2)

BMI < 23 kglmz

BMI > 23 kglm2

:ruc?t'nfra.r (break-in) (N =

Yes

No

122(10O)

1 10(e0.2)

12(e.8)

53(43.4)

6e(56.6)

42(34.4)

16(13.2)

2O(16.4)

1(0.8)

7(5.7)

1(0.8)

35(28.7)

42(34.4)

B(7.2)

34(30.e)

5(4.5)

Bev2.1)

34(27.9)

121)

91(75.2)

30(24.8)

7e(64.7)

74(93.7)

5(6.3)

33(41.8)

46(58.2)

23(29.1)

15(1e.0)

17(21.5)

0

5(6.3)

1(1.3)

18(22.8)

23(29.1)

5(6.e)

23(32.4)

3(4.2)

55(6e.6)

24(30.4)

63(Bo.B)

15(1e.2)

43(35.3)

36(83.7)

7(16.3)

20(46.5)

23(53.5)

1e(44.2)

1(2.3)

3(7.0)

1(2.3)

2(4.7)

0

17(3e.5)

1e(44.2)

3(7.7)

11(28.2)

2(5.1)

33(76.7)

1o(23.3)

28(65.1)

15(34.e)

o.077

0.376

o.oo4#

0.071

0.517

o.217

0.575

0.267

0.095

10 Yrfi riuamrsru6o d?:Td'ilBmindrata,r:

Fr1T1.,tfi 1 a-nurusyTrh.Jra.,r{rJra cApD (ria)

rirjru nr:6nrdaudauda.,:fro.:{q

n-nururyrtil il{fi'JFl s 0.67 nfruirfl > 0.67 n{.:riafl p vatue

Q1U?U o v

drria 'irurulSaaar; drurulfaaar;

Serum albumin

riaun'ir s g/dl 4j(ss.6) 1s(24.o) 2z(s1.2) o.oos#

3 g/dl uSorurnn'jr 81(66.4) 60(76.0) z1(48.s)

Serum creatinine(mgidL)

rioan'ir 15 mg/dl 69(56.6) 42(53.2) 27(62.8) 0.24215 mg/dl yiaalrnn,jr 53(43.4) 97(46.8) 16(s2.2)

Hemoglobin(g/dL)

riafln'ir 10 g/dl 114(9s.4) z4(ss.7) 40(93.0) 0.583

10 g/dl miarurnn'jr 8(6.6) 5(6.3) 3(7.0)

* DN=diabetic nephropathy, HT=hypertension, CGN=chronic glomerulonephritis, ADPKD=autosomal

dominant polycystic kidney disease, BMI=body mass index

* fiu-arirn"rgnr.rafifi p < o.o5

q-i -.{i t e elJii0ldrJ{10{n1:n6rror0o'lino{so{0nrduxo{4rJ2ua1{1nm1{ryo lrlo.t

a.) - ) 1u'l:.rnuuraar::rirl:crrinf i'{ilinua:a.l::riflfr Z ouIuff 1 N.a.-fU.E. 2553 Risk Factor of Peritonitis in CAPD Patienb in Sawmpmcharak Hospitalo Nakhon sawm province 1 1

A 3r Jor1:1.rfi 2 rfia1:nfirflud1rfiE?a{ peritonitis

Js )ar{0[:Flllruud1rfin

(causative organis;)

'&a1u?uFrT{

(peritonitis episodes)

ITAEJAg

Gram positive organisms

Staphylococcus coagulase negative

Staphylococcuc aureus

Bacillus spp

streptococcus spp

Entercocus spp

Gram negative organisms

Pseudomonas spp

Escherichia coli

Acinetobacter spp

Klepsiella pneumoniae

Fungus

Others

No growth

14

5

2

1

1

6

4

3

3

1

1

26

20.8

7.5

3.0

1.5

1.5

9.0

6.0

4.5

4.5

1.5

1.5

38.7

67 100.0

12 Yufi rfinauramufio 6x::riil:strindnzar:

i 3; )m1T1{fi 3 rfialhnfiriludlrfin?a.: exit site infection

rd'al:ni4rflud1rrrr

(causative organism)

Q1U?UnT{

(peritonitis episodes)?aflne

Gram positive organisms

Staphylococcuc aureus

Staphylococcus coagulase negative

Gram negative organisms

Pseudomonas spp

Acinetobacter spp

Other gram negative

Others

No growth

34

8

6

1

4

3

1

59.6

14.0

10.5

1.8

7.0

5.3

'1.8

57 100.0

A.1 vdvv6aFr1:1{?1 4 UAAUtdthl6tily{yt6 ?a{fl1:[Rn peritonitis

uaoutdu.l oR* 95% Cl. P value

altl > 60 tl

I:nrurmrru

d'rfiilrnnrfl (BMt). ) 28 kgtm2

Tvucfl-nfro.: (break-in)

Serumalbumin<3g/dl

Serum creatinine (mg/dl) ) tS mg/dl

Hemoglobin (g/dl) < 10 g/dl

2.88

1.93

0.69

0.44

3.30

0.67

0.90

0.72-12.23

0.83-4.48

0.26-1.74

0.17-1.11

1.39-7.86

0.29-1.53

0.1 7-6.1 0

o.o77

0.071

o.267

0.043#

o.oo3#

o.242

0.583

*BMl = body mass index, oR = odds ratio, cl = confidence interval* firiarirriqnl.:dfiA p < o.os