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
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