Effect of gastric acid suppressants and prokinetics on peritoneal dialysis-related peritonitis

Table 1 Clinical characteristics of the included patients n (%)

Variables	Peritonitis group (n = 61)	No peritonitis group (n = 59)	P value
Age (yr), [median (range)]	51 (27-79)	49 (24-77)	0.653
Sex (male)	55 (52.9)	81 (56.6)	0.558
Height (cm)	162.09 ± 6.94	163.21 ± 8.45	0.435
Bwt (kg)	57.68 ± 8.41	59.49 ± 11.24	0.332
BMI [m/(kg)2]	21.98 ± 2.73	22.26 ± 3.48	0.628
Cause of ESRD
Glomerulonephritis	19 (31.1)	20 (33.9)	0.153
DM	21 (34.4)	12 (20.3)
HTN	5 (8.2)	1 (1.7)
Polycystic kidney disease	1 (1.6)	2 (3.4)
Unknown/idiopathic	11 (18.0)	17 (28.8)
Other cause	4 (6.6)	7 (11.9)
HTN	50 (82.0)	53 (89.8)	0.217
DM	23 (37.7)	17 (28.8)	0.302
Diverticulosis	1 (2.3)	3 (6.7)	0.616
PD modality (CAPD)	51 (83.6)	47 (79.7)	0.577
Initial serum Albumin (mg/dL)	3.51 ± 0.47	3.60 ± 0.48	0.336
Peritonitis free time (d),
[median (range)]	762 (31-3918)	1302 (100-4234)	0.070

Data presented as mean ± SD, unless otherwise stated. Bwt: Body weight; BMI: Body mass index; ESRD: End stage renal disease; DM: Diabetes mellitus; HTN: Hypertension; LC: Liver cirrhosis; PD: Peritoneal dialysis; CAPD: Continuous ambulatory peritoneal dialysis.

Table 2 Acid-suppressive therapy and other medications in peritonitis group and no peritonitis group n (%)

	Peritonitis group	No peritonitis group	P value
	(n = 61)	(n = 59)
Use of PPIs	6 (9.8)	10 (16.9)	0.252
≤ 7 d	5 (8.2)	4 (6.8)	0.691
8-30 d	0 (0.0)	1 (1.7)
> 30 d-1 yr	1 (1.6)	5 (8.5)
No use	55 (90.2)	49 (83.1)
Use of H2Bs	15 (24.6)	4 (6.8)	0.011
≤ 7 d	7 (11.5)	3 (5.1)	0.041
8-30 d	1 (1.6)	0 (0.0)
> 30 d-1 yr	7 (11.5)	1 (1.7)
No use	46 (75.4)	55 (93.2)
Use of other antacids	4 (6.6)	3 (5.1)	1.000
≤ 7 d	3 (1.9)	1 (1.7)	0.472
8-30 d	1 (0.0)	1 (1.7)
> 30 d-1 yr	0 (1.9)	1 (1.7)
No use	57 (96.2)	56 (94.9)
Use of prokinetics	20 (32.8)	18 (30.5)	0.789
≤ 7 d	11 (18.0)	10 (16.9)	0.712
8-30 d	2 (3.3)	0 (0.0)
> 30 d-1 yr	7 (11.5)	8 (13.6)
No use	41 (67.2)	41 (69.5)
Use of immunosuppressants	4 (6.6)	3 (5.1)	1.000
≤ 7 d	2 (3.3)	1 (1.7)	0.610
8-30 d	0 (0.0)	0 (0.7)
> 30 d-1 yr	2 (3.3)	2 (3.4)
No use	57 (93.4)	56 (94.9)

PPIs: Proton pump inhibitors; H2B: H2-blockers.

Table 3 Multivariate analysis of potential risk factors for the development of peritoneal dialysis related peritonitis

	Odds ratio	95%CI	P value
Initial serum albumin level	0.50	0.20-1.25	0.139
Use of Immunosuppressants	1.85	0.28-12.40	0.527
Use of PPIs	0.50	0.20-1.25	0.364
Use of H2Bs	6.55	1.64-26.26	0.008
Use of other Antacids	1.47	0.21-10.29	0.696
Use of prokinetics	1.70	0.67-4.33	0.269

PPIs: Proton pump inhibitors; H2Bs: H2-blockers.

Table 4 Clinical characteristics of peritonitis patients by the causative pathogen n (%)

Variables	Included peritonitis episode (n = 81)
	Enteric peritonitis	Non-enteric peritonitis	P value
	(n = 26)	(n = 55)
Age (yr) [median (range)]	51.5 (29-69)	51.0 (27-79)	0.990
Sex (male)	16 (61.5)	27 (49.1)	0.295
Height (cm)	162.34 ± 7.88	162.21 ± 6.82	0.943
Bwt (kg)	56.93 ± 7.88	57.95 ± 8.50	0.610
BMI [m/(kg)2]	21.61 ± 2.68	22.05 ± 2.81	0.504
Cause of ESRD
Glomerulonephritis	12 (46.2)	17 (30.9)	0.250
DM	7 (26.9)	20 (36.4)
HTN	3 (11.5)	3 (5.5)
Polycystic kidney disease	0 (0.0)	1 (1.8)
Unknown/idiopathic	3 (11.5)	11 (20.0)
Other cause	1 (3.8)	3 (5.5)
HTN	21 (80.8)	43 (78.2)	0.789
DM	8 (30.8)	25 (45.5)	0.209
Diverticulosis	0 (0.0)	0 (0.0)
PD modality (CAPD)	23 (88.5)	46 (83.6)	0.743
Initial serum Albumin (mg/dL)	3.52 ± 0.45	3.47 ± 0.43	0.687
Peritonitis free time (d)
[median (range)]	692 (31–3696)	1064 (31-5383)	0.380

Data presented as mean ± SD, unless otherwise stated. Bwt: Body weight; BMI: Body mass index; ESRD: End stage renal disease; DM: Diabetes mellitus; HTN: Hypertension; LC: Liver cirrhosis; PD: Peritoneal dialysis; CAPD: Continuous ambulatory peritoneal dialysis.

Table 5 Isolated microorganisms of the peritonitis episodes by the peritoneal dialysis effluent culture

Causative organism	Peritonitis episodes (n = 81)	Percentage (%)
Escherichia coli	9	11.1
Klebsiella species	4	4.9
Acinetobacter species	3	3.7
Enterococcus species	1	1.2
Enterobacter species	0	0
Bacillus species	4	4.9
Pseudomonas species	0	0
Staphylococcus aureus	0	0
Other staphylococcus species (CoNS, etc.)	9	11.1
Streptococcus species	14	17.3
Corynebacterium species	1	1.2
Micrococcus species	1	1.2
Candida species	2	2.5
Other	3	3.7
Polymicrobial	10	12.3
No growth	20	24.7

CoNS: Coagulase negative staphylococcus.

Table 6 Acid-suppressive therapy and other medications in enteric peritonitis group and non-enteric peritonitis group n (%)

		Included peritonitis episode (n = 81)
		Enteric peritonitis (n = 26)	Non-enteric peritonitis (n = 55)	P value
Sterile peritonitis included in NEP group	Use of PPIs	3 (11.5)	8 (14.5)	1.000
	Use of H2Bs	6 (23.1)	15 (27.3)	0.687
	Use of other antacids	1 (3.8)	5 (9.1)	0.658
	Use of prokinetics	5 (19.2)	18 (32.7)	0.209
	Use of immunosuppressants	2 (7.7)	7 (12.7)	0.501
Sterile peritonitis excluded in NEP group	Use of PPIs	3 (11.5)	5 (14.3)	1.000
	Use of H2Bs	6 (23.1)	9 (25.7)	0.818
	Use of other antacids	1 (3.8)	3 (8.6)	0.629
	Use of prokinetics	5 (19.2)	13 (37.1)	0.129
	Use of immunosuppressants	2 (7.7)	5 (14.3)	0.688

PPIs: Proton pump inhibitors; H2Bs: H2-blockers. NEP: Non-enteric peritonitis.