Skip to main content

Main menu

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • ASN Meeting Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
    • Reprint Information
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Reprint Information
    • Subscriptions
    • Feedback
  • ASN Kidney News
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
American Society of Nephrology
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Advertisement
American Society of Nephrology

Advanced Search

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • ASN Meeting Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
    • Reprint Information
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Reprint Information
    • Subscriptions
    • Feedback
  • ASN Kidney News
  • Visit ASN on Facebook
  • Follow CJASN on Twitter
  • CJASN RSS
  • Community Forum
Original ArticlesDialysis
You have accessRestricted Access

Geographic and Educational Factors and Risk of the First Peritonitis Episode in Brazilian Peritoneal Dialysis Study (BRAZPD) Patients

Luis C. Martin, Jacqueline C.T. Caramori, Natalia Fernandes, Jose C. Divino-Filho, Roberto Pecoits-Filho and Pasqual Barretti
CJASN August 2011, 6 (8) 1944-1951; DOI: https://doi.org/10.2215/CJN.11431210
Luis C. Martin
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jacqueline C.T. Caramori
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Natalia Fernandes
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jose C. Divino-Filho
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Roberto Pecoits-Filho
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Pasqual Barretti
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data Supps
  • Info & Metrics
  • View PDF
Loading

Abstract

Background and objectives Peritonitis remains as the most frequent cause of peritoneal dialysis (PD) failure, impairing patient's outcome. No large multicenter study has addressed socioeconomic, educational, and geographic issues as peritonitis risk factors in countries with a large geographic area and diverse socioeconomic conditions, such as Brazil.

Design, setting, participants, & measurements Incident PD patients recruited from 114 dialysis centers and reporting to BRAZPD, a multicenter observational study, from December 2004 through October 2007 were included. Clinical, dialysis-related, demographic, and socioeconomic variables were analyzed. Patients were followed up until their first peritonitis. Cox proportional model was used to determine independent factors associated with peritonitis.

Results In a cumulative follow-up of 2032 patients during 22.026 patient-months, 474 (23.3%) presented a first peritonitis episode. In contrast to earlier findings, PD modality, previous hemodialysis, diabetes, gender, age, and family income were not risk predictors. Factors independently associated with increased hazard risk were lower educational level, non-white race, region where patients live, shorter distance from dialysis center, and lower number of patients per center.

Conclusions Educational level and geographic factors as well as race and center size are associated with risk for the first peritonitis, independent of socioeconomic status, PD modality, and comorbidities.

Introduction

Peritonitis continues to be the most frequent cause of peritoneal dialysis (PD) failure, with significant effect on patient morbidity and mortality, despite the strong reduction of its incidence observed over the past decades (1). A clustered distribution of patients with higher incidence of peritonitis has been consistently described; in addition, differences in peritonitis rate between centers and regions have been observed (2). These observations suggest that patient characteristics, as well as factors related to the therapy and the environment, may influence peritonitis risk.

Among patient-related factors, black race (3,4), diabetes (3,4), and advanced age (3) are the most frequently reported peritonitis predictors, although conflicting results are observed in different studies (5,6). Obesity (7), malnutrition (8), chronic inflammation (9), reduced residual renal function (10), and previous peritonitis have also been described as risk factors (3). In addition, there are conflicting results regarding the comparison between continuous ambulatory PD (CAPD) and automated PD (APD) (3,11,12). The effect of other comorbid conditions has not been emphasized until the present.

Moreover, peritonitis rates can be influenced by other factors, such as educational level, geographic region, distance from the PD center, or by socioeconomic status. In a previous study, patients living far from the nearest dialysis center presented significantly higher chance of being prescribed PD (13), and therefore the distance from the center could potentially influence PD outcome and peritonitis rate (14,15); however, this hypothesis has not been evaluated in detail. Socioeconomic condition has also been described as a factor determining peritonitis risk (16), although isolated analysis of the effect of income has not been studied in depth.

Because there is a lack of large multicenter studies analyzing peritonitis risk factors in countries with large geographic area and social disparities addressing socioeconomic, educational, and geographic issues, the objective of this study was to identify factors that are associated with first peritonitis in a large Brazilian PD cohort.

Materials and Methods

Patient Population

The study included patients from 114 centers reporting monthly to the BRAZPD (17), a Brazilian cohort study. Monthly data were obtained using software specifically designed to collect data, which were transferred to a central database. The database includes prospectively collected information on incident and prevalent patients recruited in the study from December 2004 through October 2007, totaling 6198 patients (3439 incident and 2759 prevalent patients). Out of a total of 3439 incident patients, 2032 patients 18 years or older who remained at least 90 days on PD were eligible for the study, whereas 867 were excluded for not completing 90 days on PD, 239 were pediatric patients, and 301 did not have information about peritonitis. This study was performed in accordance with the Declaration of Helsinki and all participants provided written informed consent before enrollment.

During the follow-up period, patients were evaluated monthly by nephrologists and nurses at the PD clinic and data was collected, including age (years), gender, race, cause of end-stage renal disease (ESRD), previous hemodialysis (HD), PD modality (CAPD or APD), body mass index (kg/m2), blood pressure (BP) (mmHg), serum albumin (g/dl), hemoglobin levels (g/dl), PD indication (medical, patient's option, or only option), previous nephrology referral, family income (minimum wages [MW] per month: 0 to 2, 3 to 5, >5), education level (illiteracy, elementary, secondary, and higher), distance from dialysis center (<25, 25 to 50, >50 km), region where patients live and its Human Development Index (HDI) (18), number of patients per dialysis center (in quintiles), microbiological characteristics of peritonitis, and total follow-up period (months). The presence of comorbid conditions (collagenosis, malignancy, cardiopathy, left ventricular hypertrophy, and diabetes) was registered as present or absent.

To define the three levels of family income, we considered the concept of Ethical Poverty Line (EPL) (19), the Brazilian Gross Domestic Product (GDP) per capita, and the mean Brazilian MW in the period of study, which was $150.42 US dollars (USD) ($4.94/d) (20). The International Poverty Centre suggests $2.70 USD per person per day as the EPL (19) and considering that 3.2 is the average number of individuals per family living in private dwellings (21), 2 MW of monthly family income ($3.08 USD per person per day) is the closest to the corresponding EPL in Brazil. The monthly income of 5 MW ($7.71 USD per person per day) was considered as a reference for Brazilian GDP per capita that was $7.87 USD per person per day (22). More detailed information on the family income characterization were described by Bastos et al. (23), which covers family income effect on survival of the BRAZPD population.

Definition of Peritonitis

The definition of peritonitis followed the recommendations of the International Society for Peritoneal Dialysis guidelines (24). Prescription of antibiotics was based on the patient's clinical conditions according to each center's protocol. Patients were hospitalized whenever necessary.

Statistical Analyses

Patients were followed up until the primary end point, namely, the first peritonitis; those with end of follow-up before reaching end point were censored. Clinical, demographic, dialysis-related, geographic, and socioeconomic variables were included in peritonitis risk analysis. Univariate analyses using Cox proportional hazard regression were performed to select variables to the final model and the elimination criterion for them was P > 0.10. Multivariate analysis using Cox proportional hazards regression model was used to determine independent factors associated with the primary end point. Collinearity among variables was tested and if statistically significant interactions were presented, one of them was excluded. Peritonitis-free survival curve was constructed according to the Kaplan–Meier method. The chi-squared test was used when appropriate. Statistical significance was defined as P < 0.05. All statistical analyses were performed using SPSS 16.0 (SPSS Inc.) software.

Results

The study population consisted of 2032 incident adult PD patients, who were followed for a median of 12.2 months (range 1 to 32 months). Patient characteristics at baseline are summarized in Table 1. Four hundred seventy-four (23.3%) patients presented at least one episode of peritonitis during a cumulative follow-up period of 22026 patient-months, whereas the remaining 1558 patients had no peritonitis. The overall peritonitis rate was one episode per 34.6 patient-months, the median peritonitis-free time was 26 months, and the cumulative peritonitis-free survival was 44% in 32 months (Figure 1).

View this table:
  • View inline
  • View popup
Table 1.

Summary of patient characteristics at baseline (n = 2032)

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

Peritonitis-free survival of 2032 incident peritoneal dialysis patients of BRAZPD Registry from December 2004 to October 2007.

Microbiological information was not reported in 33 episodes and negative culture was observed in 181 (38.1%). Of the 260 cases with etiologic definition, 161 (61.9%) were due to gram-positive agents, 90 (34.6%) to gram negatives, and nine (3.5%) to fungi. Among gram positive, the most frequent was Staphylococcus aureus (50.9%), followed by coagulase-negative staphylococci (37.3%), Enterococcus spp (6.2%), Streptococcus spp (5%), and Corinebacterium spp (0.6%). Escherichia coli was the main gram-negative germ causing 26.7% of the cases, followed by Pseudomonas aeruginosa (24.4%), Klebsiella spp (13.3%), Acinetobacter spp (11.1%), and Enterobacter (8.9%). Other Enterobacteriaccea were identified in 11.1% and other nonfermentative gram-negative bacilli in 3.4% of the cases. Neisseria spp caused one episode (1.1%). There were significant differences in proportion of episodes by etiology throughout regions (P = 0.65).

The frequency of peritonitis episodes and the median time to the first peritonitis according to demographic, dialysis-related, clinical, geographic, and socioeconomic variables are expressed in Tables 2 and 3. Age, race, educational level, distance from dialysis center, region where patients live, systolic BP (SBP), dialysis indication, number of patients per center, and presence of diabetes were associated with risk for the first episode of peritonitis in the univariate analysis (Tables 2 and 3) and therefore were included in the multivariate Cox proportional hazard model. The regional HDI were as follows: Northeast = 0.749, North = 0.786, West Center = 0.838, Southeast = 0.847, and South = 0.85. The cause of ESRD was excluded because of collinearity between diabetic nephropathy and presence of diabetes, whereas the association between HDI and outcome was not analyzed because of its strict association with regions. No significant interaction was found between other variables.

View this table:
  • View inline
  • View popup
Table 2.

Frequency and median time to the first peritonitis episode according to demographic factors

View this table:
  • View inline
  • View popup
Table 3.

Frequency and median time to the first peritonitis episode according to clinical factors

The multivariate analysis demonstrated that factors independently associated with increased hazard risk (HR) for the first peritonitis were as follows: educational level (illiteracy versus higher: HR = 1.75, 95% confidence interval [CI] = 1.04 to 2.92, P = 0.03; elementary versus higher: HR = 1.64, 95% CI = 1.06 to 2.54, P = 0.02; and secondary versus higher: HR = 1.57, 95% CI = 0.99 to 2.49, P = 0.05), race (non-white versus white race: HR = 1.26, 95% CI = 1.003 to 1.58, P = 0.04), region where patients live (Northeast versus South: HR = 1.77, 95% CI = 1.23 to 2.55, P = 0.002), distance from dialysis center (≤25 km versus >50 km: HR = 1.40, 95% CI = 1.07 to 1.83, P = 0.01), and number of patients per dialysis center (<40 versus 157 to 226: HR = 1.49, 95% CI = 1.02 to 2.18, P = 0.03, P = 0.03) (Figure 2). The other variables had no statistically significant association with the primary end point (Figure 2).

Figure 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2.

Cox proportional hazards regression model (n = 474 episodes in 2032 patients). CI, confidence interval; HR, hazard ratio; SBP, systolic blood pressure.

Discussion

Peritonitis remains a major problem for the wide utilization of PD because it is associated with high morbidity and technique failure (1,25). Identification of risk factors in large prospective cohorts, particularly analyzing incident patients, may help to identify populations at high risk.

This prospective cohort study of incident patients showed that predictors of peritonitis include non-white race, lower educational level, region where the patient lives, shorter distance from the dialysis center, and a lower number of patients per center.

Only few large cohort studies tried to identify risk factors for peritonitis. Oo et al. (3) studied variables associated with peritonitis using the US Renal Data System (USRDS) including 11,975 patients who were on PD from 1994 to 1997 and identified that the peritonitis risk was lower for CAPD than for APD. Other significant risk factors included age, black race, diabetes, peritonitis in the early period of PD, and congestive heart failure. The ANZDATA analysis, which included data on 3162 patients who started PD from 1999 to 2003, identified Aboriginal race, obesity, and older age as predictors of peritonitis (26). Moreover, in a Canadian study (27) of 4247 incident patients from 25 centers between January 1996 and September 2005, independent predictors of peritonitis included age, black race, diabetes among women, and transfer from HD to PD, whereas CAPD and APD had similar risk. Unfortunately, these studies did not address socioeconomic, educational, and geographic issues and their results were not adjusted for important comorbidities such as collagenosis, malignancies, and cardiac disturbances.

In contrast to the aforementioned studies, age, diabetes, and PD modality did not influence the peritonitis risk in this study. Data on age and diabetes have been conflicting; although the majority of authors have reported that older age and presence of diabetes are associated with higher peritonitis risk, the USRDS results (3) showed that older age was not a predictor of risk whereas in the ANZDATA analysis (26) presence of diabetes was not associated with peritonitis rate. Regarding socioeconomic status, Chow et al. (16) showed in a single-center retrospective cohort of 102 incident patients that the need for social security assistance and illiteracy were the only statistically significant factors associated with time to the first peritonitis, after adjustment for age and medical factors, such as diabetes and serum albumin.

Regarding PD modality, some studies found that APD is associated with a lower peritonitis risk (11,12); however, our results showing no differences between APD and CAPD are in agreement with more recent and larger studies (3,27).

Non-white race was associated with a higher peritonitis rate, confirming data from previous reports. Black race was identified several times as a peritonitis risk factor (3,4) and Aboriginal race was an independent predictor for peritonitis in the ANZDATA cohort (26). It is important to notice that non-white race in Brazil comprises not only black but also brown, yellow, and indigenous races. White race was associated with a lower peritonitis risk adjusted to confounding factors such as educational level or family income; however, the influence of other social factors such as sanitary conditions cannot be excluded. It is difficult to explain the association between shorter distance from the dialysis center and higher peritonitis risk observed in cohort. We can speculate that a greater availability of diagnosis resources associated with dialysis center proximity could in part explain this observation. However, it is possible that patients residing closer to the dialysis center could in fact represent an urban population with poorer conditions of hygiene compared with those living in more distant sites. In line with our findings, Tonelli et al. (14) reported that Canadian patients living >300 km from a dialysis center had a significantly lower risk of technique failure compared with those living closer (50 km). In contrast, Lim et al. (15) recently reported in a large Australian PD population that patients residing in a nonmetropolitan location, especially remote indigenous, have a greater peritonitis risk. Further studies will need to be designed to particularly address this issue.

Interestingly, educational level was negatively and independently associated with the risk of the first episode of peritonitis. This result is in agreement with those published by Chow et al. (16), one of the first to report a strong relationship between social factors and the risk of dialysis-related peritonitis. A similar result has not been previously reported in large cohort studies of incident PD patients. The influence of educational level on peritonitis risk was observed after adjustment for socioeconomic and demographic characteristics as well as relevant coexisting medical factors and comorbidities, showing the strong influence of this variable on peritonitis risk.

The influence of PD program size on technique survival and peritonitis risk has been previously reported; although centers with a higher number of patients have presented lower risk to technique failure (28), the effect of this variable on peritonitis risk has not been properly addressed until the present time. Davenport (1) reported that there was no significant correlation between size center and peritonitis rate in dialysis units of the London region. Similar results were reported by Kavanagh et al. (29) in Scottish units. In contrast, center size correlated with infectious complications rate in a large American cohort (30). Our results showed a significant effect of center size on the peritonitis risk, reinforcing the hypothesis that center experience may have a positive effect on the outcome of PD patients.

Finally, we observed a significant difference on peritonitis risk among country regions. The Northeast was significantly associated with a higher risk after adjustment for different confounding variables. Brazilian territory is large and reaches across several latitudes. Consequently, different types of climate are observed. A Korean study (31), analyzing a wide range of temperature and humidity showed correlation between peritonitis rate and climatic factors, with peak incidence during the warm humid months. A similar result has been reported in a study performed in Hong Kong (32). Northeast is the warmest Brazilian region; thus, it is possible to attribute our result to climatic conditions. In addition, social disparities could also influence peritonitis risk; in fact, Northeast has a lowest HDI among Brazilian regions, whereas South has the highest, which can be correlated with better infrastructural and living conditions, explaining, at least in part, the regional differences in peritonitis risk. Another possibility would be the fact that Northeast presents the highest incidence of diarrhea (33); however, the effect of this condition may be blunted in the present analysis of adult patients because children present four times higher incidence of this problem than adults (33), who were excluded from the analysis. Interestingly, the frequency of peritonitis etiologies was similar among regions, without higher proportion of episodes by intestinal germs in Northeast.

This study has several limitations. First, our data set did not include data on individual patient's training (according to different educational level and domiciliary conditions such as water supply), dedicated space to dialysis procedure, exit site catheter care, appropriate dialysis procedure, private nurse support, and residual renal function, all factors that could represent peritonitis risk factors. However, Borras et al. (34) found no relation between educational level and training period time. Also, in this study there was a high proportion of culture-negative episodes, which makes difficult the analysis of peritonitis risk according to different etiologies. These results should stimulate the review of laboratory methods currently utilized and generate new protocols to improve the results in the country. It is also noticeable that there was in this study a high percentage of patients originating from HD. Possibly this is a consequence of late referral because approximately 45% of patients were not monitored by nephrologists during the predialysis period. Data from a large retrospective Brazilian single-center cohort (35) showed that the number of incident PD patients originating from HD increased threefold over the last 25 years.

The main strength of this study is the fact that it is a large multicenter cohort analysis of incident PD patients, incorporating several potentially important demographic, geographic, socioeconomic, and educational factors beyond relevant clinical pre-existent conditions. Moreover, this is the first Latin American study designed to address whether these factors are predictors of peritonitis risk. Our results reinforce that illiteracy is a strong predictor of risk, in agreement with findings of Chow et al. (16). Indeed, this is the first report showing that poverty is not an independent predictor of peritonitis risk, corroborating the results of Bastos et al. (23), which demonstrated that economic status, based on family income, is not independently associated with outcomes in patients of the same cohort (BRAZPD). Taken together, these studies suggest strongly that low economic status should not be considered a limiting factor to PD indication.

Conclusions

The present study has identified educational level as a strong risk predictor for the first peritonitis episode, independent of socioeconomic status, PD modality, and comorbidities. In addition, we identified non-white race, PD center size, and geographic aspects such as the region where patients live and the distance from dialysis center as independent predictors of the peritonitis risk. In contrast to previous studies, socioeconomic status, gender, age, diabetes, and PD modality did not have an effect on peritonitis risk. Our results may be helpful in identifying the patients starting dialysis treatment who are at the highest risk for peritonitis, particularly in countries with heterogeneous geographic and socioeconomic characteristics where PD may be an interesting alternative to increase access to renal replacement therapy. These results reinforce the need for further studies looking at factors that influence peritonitis incidence, including those which are considered nonmodifiable today, to identify intervention alternatives and thereby improve PD outcomes.

Disclosures

Jose Carolino Divino Filho is a full-time employee of Baxter Healthcare.

Acknowledgments

The authors thank the statistician Marcia Olandowski for her support. This study was financed by Baxter Healthcare, Brazil.

Footnotes

  • Published online ahead of print. Publication date available at www.cjasn.org.

  • Received December 26, 2010.
  • Accepted April 27, 2011.
  • Copyright © 2011 by the American Society of Nephrology

References

  1. 1.↵
    1. Davenport A
    : Peritonitis remains the major clinical complication of peritoneal dialysis: The London UK, Peritonitis Audit 2002–2003. Perit Dial Int 29: 297–302, 2009
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Stinghen AE,
    2. Barretti P,
    3. Pecoits-Filho R
    : Factors contributing to the differences in peritonitis rates between centers and regions. Perit Dial Int 27 [Suppl 2]: S281–S285, 2007
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Oo TN,
    2. Roberts TL,
    3. Collins AJ
    : A comparison of peritonitis rates from the United States Renal Data System database: CAPD versus continuous cycling peritoneal dialysis patients. Am J Kidney Dis 45: 372–380, 2005
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Chow KM,
    2. Szeto CC,
    3. Leung CB,
    4. Kwan BC,
    5. Law MC,
    6. Li PK
    : A risk analysis of continuous ambulatory peritoneal dialysis-related peritonitis. Perit Dial Int 25: 374–379, 2005
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Nessim SJ,
    2. Bargman JM,
    3. Austin PC,
    4. Story K,
    5. Jassal SV
    : Impact of age on peritonitis risk in peritoneal dialysis patients: An era effect. Clin J Am Soc Nephrol 4: 135–141, 2009
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Barretti P,
    2. Bastos KA,
    3. Dominguez J,
    4. Caramori JC
    : Peritonitis in Latin America. Perit Dial Int 27: 332–339, 2007
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    1. McDonald SP,
    2. Collins JF,
    3. Rumpsfeld M,
    4. Johnson DW
    : Obesity is a risk factor for peritonitis in the Australian and New Zealand peritoneal dialysis patient populations. Perit Dial Int 24: 340–346, 2004
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    1. Prasad N,
    2. Gupta A,
    3. Sharma RK,
    4. Sinha A,
    5. Kumar R
    : Impact of nutritional status on peritonitis in CAPD patients. Perit Dial Int 27: 42–47, 2007
    OpenUrlAbstract/FREE Full Text
  9. 9.↵
    1. Wang Q,
    2. Bernardini J,
    3. Piraino B,
    4. Fried L
    : Albumin at the start of peritoneal dialysis predicts the development of peritonitis. Am J Kidney Dis 41: 664–669, 2003
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Han SH,
    2. Lee SC,
    3. Ahn SV,
    4. Lee JE,
    5. Kim DK,
    6. Lee TH,
    7. Moon SJ,
    8. Kim BS,
    9. Kang SW,
    10. Choi KH,
    11. Lee HY,
    12. Han DS
    : Reduced residual renal function is a risk of peritonitis in continuous ambulatory peritoneal dialysis patients. Nephrol Dial Transplant 22: 2653–2658, 2007
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. de Fijter CW,
    2. Oe LP,
    3. Nauta JJ,
    4. van der Meulen J,
    5. Verbrugh HA,
    6. Verhoef J,
    7. Donker AJ
    : Clinical efficacy and morbidity associated with continuous cyclic compared with continuous ambulatory peritoneal dialysis. Ann Intern Med 120: 264–271, 1994
    OpenUrlCrossRefPubMed
  12. 12.↵
    1. Sanchez AR,
    2. Madonia C,
    3. Rascon-Pacheco RA
    : Improved patient/technique survival and peritonitis rates in patients treated with automated peritoneal dialysis when compared to continuous ambulatory peritoneal dialysis in a Mexican PD center. Kidney Int Suppl 108: S76–S80, 2008
    OpenUrlPubMed
  13. 13.↵
    1. Miskulin DC,
    2. Meyer KB,
    3. Athienites NV,
    4. Martin AA,
    5. Terrin N,
    6. Marsh JV,
    7. Fink NE,
    8. Coresh J,
    9. Powe NR,
    10. Klag MJ,
    11. Levey AS
    : Comorbidity and other factors associated with modality selection in incident dialysis patients: The CHOICE Study. Choices for Healthy Outcomes in Caring for End-Stage Renal Disease. Am J Kidney Dis 39: 324–336, 2002
    OpenUrlCrossRefPubMed
  14. 14.↵
    1. Tonelli M,
    2. Hemmelgarn B,
    3. Culleton B,
    4. Klarenbach S,
    5. Gill JS,
    6. Wiebe N,
    7. Manns B
    : Mortality of Canadians treated by peritoneal dialysis in remote locations. Kidney Int 72: 1023–1028, 2007
    OpenUrlCrossRefPubMed
  15. 15.↵
    1. Lim WH,
    2. Boudville N,
    3. McDonald SP,
    4. Gorham G,
    5. Johnson DW,
    6. Jose M
    . Remote indigenous peritoneal dialysis patients have higher risk of peritonitis, technique failure, all-cause and peritonitis-related mortality. Nephrol Dial Transplant. 2011 [Epub ahead of print].
  16. 16.↵
    1. Chow KM,
    2. Szeto CC,
    3. Leung CB,
    4. Law MC,
    5. Li PK
    : Impact of social factors on patients on peritoneal dialysis. Nephrol Dial Transplant 20: 2504–2510, 2005
    OpenUrlCrossRefPubMed
  17. 17.↵
    1. Fernandes N,
    2. Bastos MG,
    3. Cassi HV,
    4. Machado NL,
    5. Ribeiro JA,
    6. Martins G,
    7. Mourão O,
    8. Bastos K,
    9. Ferreira Filho SR,
    10. Lemos VM,
    11. Abdo M,
    12. Vannuchi MT,
    13. Mocelin A,
    14. Bettoni SL,
    15. Valenzuela RV,
    16. Lima MM,
    17. Pinto SW,
    18. Riella MC,
    19. Qureshi AR,
    20. Divino Filho JC,
    21. Pecoits-Filho R
    ; Brazilian Peritoneal Dialysis Multicenter Study. The Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD): Characterization of the cohort. Kidney Int Suppl 108: S145–S151, 2008
    OpenUrlPubMed
  18. 18.↵
    Banco Central do Brasil, http://www.bcb.gov.br/pec/boletimregional/port/2009/01/br200901b1p.pdf. Accessed March 2, 2011
  19. 19.↵
    1. Edward P
    : The Ethical Poverty Line: A moral definition of absolute poverty. Third World Quarterly 27: 377–393, 2006
    OpenUrlCrossRef
  20. 20.↵
    Banco Central do Brasil, http://www4.bcb.gov.br/pec/taxas/ingl/ptaxnpesq.asp?id=quotations&id=quotations, 2009. Accessed April 2, 2011
  21. 21.↵
    Instituto Brasileiro de Geografia e Estatistica, http://www.ibge.gov.br/home/estatistica/populacao/trabalhoerendimento/pnad2006/sintesepnad2006.pdf. Accessed February 2, 2011
  22. 22.↵
    International Monetary Fund, http://www.imf.org/external/pubs/ft/weo/2008/01/weodata/weorept.aspx?pr.x=68&pr.y=10&sy=2005&ey=2007&scsm=1&ssd=1&sort=country&ds=.&br=1&c=223&s=NGDPRPC&grp=0&a=. Accessed February 2, 2011
  23. 23.↵
    1. Bastos HA,
    2. Qureshi AR,
    3. Lopes AA,
    4. Fernandes N,
    5. Barbosa LLM,
    6. Pecoits-Filho R,
    7. Divino Filho JC
    . The impact of family income on survival in incident Brazilian peritoneal dialysis patients (BRAZPD): Is it time to revisit a myth? Clin J Am Soc Nephrol 6: 1676–1683, 2011
    OpenUrlAbstract/FREE Full Text
  24. 24.↵
    1. Li PK,
    2. Szeto CC,
    3. Piraino B,
    4. Bernardini J,
    5. Figueiredo AE,
    6. Gupta A,
    7. Johnson DW,
    8. Kuijper EJ,
    9. Lye WC,
    10. Salzer W,
    11. Schaefer F,
    12. Struijk DG
    . Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 30: 393–423, 2010
    OpenUrlFREE Full Text
  25. 25.↵
    1. Perez Fontan M,
    2. Rodriguez-Carmona A,
    3. Garcia-Naveiro R,
    4. Rosales M,
    5. Villaverde P,
    6. Valdes F
    . Peritonitis-related mortality in patients undergoing chronic peritoneal dialysis. Perit Dial Int 25: 274–284, 2005
    OpenUrlAbstract/FREE Full Text
  26. 26.↵
    1. Lim WH,
    2. Johnson DW,
    3. McDonald SP
    : Higher rate and earlier peritonitis in Aboriginal patients compared to non-Aboriginal patients with end-stage renal failure maintained on peritoneal dialysis in Australia: Analysis of ANZDATA. Nephrology (Carlton) 10: 192–197, 2005
    OpenUrlCrossRefPubMed
  27. 27.↵
    1. Nessim SJ,
    2. Bargman JM,
    3. Austin PC,
    4. Nisenbaum R,
    5. Jassal SV
    : Predictors of peritonitis in patients on peritoneal dialysis: Results of a large, prospective Canadian database. Clin J Am Soc Nephrol 4: 1195–1200, 2009
    OpenUrlAbstract/FREE Full Text
  28. 28.↵
    1. Huisman RM,
    2. Nieuwenhuizen MGM,
    3. de Charro FT
    : Patient related and centre related factors influencing technique survival of peritoneal dialysis in The Netherlands. Nephrol Dial Transplant 17: 1655–1660, 2002
    OpenUrlCrossRefPubMed
  29. 29.↵
    1. Kavanagh D,
    2. Prescott GJ,
    3. Mactier RA
    on behalf of the Scottish Renal Registry. Peritoneal dialysis-associated peritonitis in Scotland (1999–2002). Nephrol Dial Transplant 19: 2584–2591, 2004
    OpenUrlCrossRefPubMed
  30. 30.↵
    1. Mujais S
    : Microbiology and outcomes of peritonitis in North America. Kidney Int 70: S55–S62, 2006
    OpenUrl
  31. 31.↵
    1. Kim MJ,
    2. Song JH,
    3. Park YJ,
    4. Kim GA,
    5. Lee SW
    . The influence of seasonal factors on the incidence of peritonitis in continuous ambulatory peritoneal dialysis in the temperate zone. Adv Perit Dial 16:243–247, 2000
    OpenUrlPubMed
  32. 32.↵
    1. Szeto CC,
    2. Chow KM,
    3. Wong TY,
    4. Leung CB,
    5. Li PK
    : Influence of climate on the incidence of peritoneal dialysis-related peritonitis. Perit Dial Int 23: 580–586, 2003
    OpenUrlAbstract/FREE Full Text
  33. 33.↵
    Governo do Rio de Janeiro-Brasil, http://portal.saude.rj.gov.br/Docs/agua_alimentos/epidemiologiamdda.pdf. Accessed February 2, 2011
  34. 34.↵
    1. Borras M,
    2. Sorolla C,
    3. Carrera D,
    4. Martín M,
    5. Villagrassa E,
    6. Fernández E
    : Patients with learning difficulties: Outcome on peritoneal dialysis. Adv Perit Dial 22: 116–118, 2006
    OpenUrlPubMed
  35. 35.↵
    1. Moraes TP,
    2. Pecoits-Filho R,
    3. Ribeiro SC,
    4. Rigo M,
    5. Silva MM,
    6. Teixeira PS,
    7. Pasqual DD,
    8. Fuerbringer R,
    9. Riella MC
    : Peritoneal dialysis in Brazil: Twenty-five years of experience in a single center. Perit Dial Int 29: 492–498, 2009
    OpenUrlAbstract/FREE Full Text
View Abstract
PreviousNext
Back to top

In this issue

Clinical Journal of the American Society of Nephrology: 6 (8)
Clinical Journal of the American Society of Nephrology
Vol. 6, Issue 8
1 Aug 2011
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
View Selected Citations (0)
Print
Download PDF
Sign up for Alerts
Email Article
Thank you for your help in sharing the high-quality science in CJASN.
Enter multiple addresses on separate lines or separate them with commas.
Geographic and Educational Factors and Risk of the First Peritonitis Episode in Brazilian Peritoneal Dialysis Study (BRAZPD) Patients
(Your Name) has sent you a message from American Society of Nephrology
(Your Name) thought you would like to see the American Society of Nephrology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Geographic and Educational Factors and Risk of the First Peritonitis Episode in Brazilian Peritoneal Dialysis Study (BRAZPD) Patients
Luis C. Martin, Jacqueline C.T. Caramori, Natalia Fernandes, Jose C. Divino-Filho, Roberto Pecoits-Filho, Pasqual Barretti
CJASN Aug 2011, 6 (8) 1944-1951; DOI: 10.2215/CJN.11431210

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Request Permissions
Share
Geographic and Educational Factors and Risk of the First Peritonitis Episode in Brazilian Peritoneal Dialysis Study (BRAZPD) Patients
Luis C. Martin, Jacqueline C.T. Caramori, Natalia Fernandes, Jose C. Divino-Filho, Roberto Pecoits-Filho, Pasqual Barretti
CJASN Aug 2011, 6 (8) 1944-1951; DOI: 10.2215/CJN.11431210
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Abstract
    • Introduction
    • Materials and Methods
    • Results
    • Discussion
    • Conclusions
    • Disclosures
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data Supps
  • Info & Metrics
  • View PDF

More in this TOC Section

Original Articles

  • Trends in Discard of Kidneys from Hepatitis C Viremic Donors in the United States
  • Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide
  • Zolpidem Versus Trazodone Initiation and the Risk of Fall-Related Fractures among Individuals Receiving Maintenance Hemodialysis
Show more Original Articles

Dialysis

  • Cardiac Geometry in Children Receiving Chronic Peritoneal Dialysis: Findings from the International Pediatric Peritoneal Dialysis Network (IPPN) Registry
  • Defining Left Ventricular Hypertrophy in Children on Peritoneal Dialysis
Show more Dialysis

Cited By...

  • Risk Factors And Prevention of Peritoneal Dialysis-Related Peritonitis
  • 'Educational Deprivation is Associated with PD Peritonitis
  • Barriers to Increasing Use of Peritoneal Dialysis in Bangladesh: A Survey of Patients and Providers
  • Risk of Peritoneal Dialysis-Related Peritonitis in a Multi-Racial Asian Population
  • The Current State of Peritoneal Dialysis
  • Social Determinants of Racial Disparities in CKD
  • The Association of Individual and Regional Socioeconomic Status on Initial Peritonitis and Outcomes in Peritoneal Dialysis Patients: A Propensity Score-Matched Cohort Study
  • Socio-Economic Status and Peritonitis in Australian Non-Indigenous Peritoneal Dialysis Patients
  • Correlation Between Glycemic Control and the Incidence of Peritoneal and Catheter Tunnel and Exit-Site Infections in Diabetic Patients Undergoing Peritoneal Dialysis
  • The Association between Peritoneal Dialysis Modality and Peritonitis
  • 32 Years' Experience of Peritoneal Dialysis-Related Peritonitis in a University Hospital
  • Longitudinal Changes in Health-Related Quality of Life Scores in Brazilian Incident Peritoneal Dialysis Patients (BRAZPD): Socio-economic Status Not a Barrier
  • Is Female Sex Really a Risk Factor for Infectious Death in Peritoneal Dialysis?
  • Lower Education Level Is a Major Risk Factor for Peritonitis Incidence in Chronic Peritoneal Dialysis Patients: A Retrospective Cohort Study with 12-Year Follow-Up
  • Effects of Climatic Region on Peritonitis Risk, Microbiology, Treatment, and Outcomes: a Multicenter Registry Study
  • Association of Smoking with Cardiovascular and Infection-Related Morbidity and Mortality in Chronic Hemodialysis
  • Google Scholar

Similar Articles

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Articles

  • Current Issue
  • Early Access
  • Subject Collections
  • Article Archive
  • ASN Meeting Abstracts

Information for Authors

  • Submit a Manuscript
  • Trainee of the Year
  • Author Resources
  • ASN Journal Policies
  • Reuse/Reprint Policy

About

  • CJASN
  • ASN
  • ASN Journals
  • ASN Kidney News

Journal Information

  • About CJASN
  • CJASN Email Alerts
  • CJASN Key Impact Information
  • CJASN Podcasts
  • CJASN RSS Feeds
  • Editorial Board

More Information

  • Advertise
  • ASN Podcasts
  • ASN Publications
  • Become an ASN Member
  • Feedback
  • Follow on Twitter
  • Password/Email Address Changes
  • Subscribe

© 2021 American Society of Nephrology

Print ISSN - 1555-9041 Online ISSN - 1555-905X

Powered by HighWire