Center Effects and Peritoneal Dialysis Peritonitis Outcomes: Analysis of a National Registry

Htay Htay, Yeoungjee Cho, Elaine M. Pascoe, Darsy Darssan, Annie Claire Nadeau-Fredette, Carmel Hawley, Philip A. Clayton, Monique Borlace, Sunil V. Badve, Kamal Sud, Neil Boudville, Stephen P. McDonald, David W. Johnson

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Background: Peritonitis is a common cause of technique failure in peritoneal dialysis (PD). Dialysis center−level characteristics may influence PD peritonitis outcomes independent of patient-level characteristics. Study Design: Retrospective cohort study. Setting & Participants: Using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data, all incident Australian PD patients who had peritonitis from 2004 through 2014 were included. Predictors: Patient- (including demographic data, causal organisms, and comorbid conditions) and center- (including center size, proportion of patients treated with PD, and summary measures related to type, cause, and outcome of peritonitis episodes) level predictors. Outcomes & Measurement: The primary outcome was cure of peritonitis with antibiotics. Secondary outcomes were peritonitis-related catheter removal, hemodialysis therapy transfer, peritonitis relapse/recurrence, hospitalization, and mortality. Outcomes were analyzed using multilevel mixed logistic regression. Results: The study included 9,100 episodes of peritonitis among 4,428 patients across 51 centers. Cure with antibiotics was achieved in 6,285 (69%) peritonitis episodes and varied between 38% and 86% across centers. Centers with higher proportions of dialysis patients treated with PD (>29%) had significantly higher odds of peritonitis cure (adjusted OR, 1.21; 95% CI, 1.04-1.40) and lower odds of catheter removal (OR, 0.78; 95% CI, 0.62-0.97), hemodialysis therapy transfer (OR, 0.78; 95% CI, 0.62-0.97), and peritonitis relapse/recurrence (OR, 0.68; 95% CI, 0.48-0.98). Centers with higher proportions of peritonitis episodes receiving empirical antibiotics covering both Gram-positive and Gram-negative organisms had higher odds of cure with antibiotics (OR, 1.22; 95% CI, 1.06-1.42). Patient-level characteristics associated with higher odds of cure were younger age and less virulent causative organisms (coagulase-negative staphylococci, streptococci, and culture negative). The variation in odds of cure across centers was 9% higher after adjustment for patient-level characteristics, but 66% lower after adjustment for center-level characteristics. Limitations: Retrospective study design using registry data. Conclusions: These results suggest that center effects contribute substantially to the appreciable variation in PD peritonitis outcomes that exist across PD centers within Australia.

Original languageEnglish
Pages (from-to)814-821
Number of pages8
JournalAmerican Journal of Kidney Diseases
Issue number6
Publication statusPublished or Issued - Jun 2018
Externally publishedYes


  • Catheter removal
  • center effect
  • center size
  • center-level characteristics
  • cure
  • dialysis modality
  • health facility size
  • mortality
  • outcomes
  • peritoneal dialysis (PD)
  • peritonitis
  • predictors
  • registries
  • renal replacement therapy (RRT)
  • technique failure
  • transfer to haemodialysis
  • treatment failure

ASJC Scopus subject areas

  • Nephrology

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