Peritoneal dialysis related peritonitis as a risk factor for cardiovascular events

Background Cardiovascular disease is the leading cause of mortality in peritoneal dialysis (PD) patients. Infection is known to increase the risk of cardiovascular events (CVE), however no studies have examined the association between PD peritonitis and CVE. Aim The aim of the study was to examine peritonitis as a risk factor for CVE in PD patients. Methods This retrospective cohort study included all adults undertaking PD for ≥ 3 months in one Australian health district from 2001‐2015. Baseline characteristics and peritonitis event information was obtained from the Australian and New Zealand Dialysis and Transplant Registry. The Centre for Health Research Illawarra Shoalhaven Population (CHRISP) facilitated data linkage using ICD10 coding to capture CVE information. Results A total of 211 patients were included with median age of 66 years [Interquartile range 54.49‐ 74.45], and 64% were male. Peritonitis occurred in 114 patients (54%), and 65 (30.8%) patients experienced a CVE. Identified risk factors for CVE included; Cerebrovascular disease (Hazard ratio [HR] 2.72, 95%CI 1.36‐5.47), diabetes (HR 2.41, 95%CI 1.47‐3.96), coronary artery disease (HR 1.67, 95%CI 1.01‐2.77) and age (HR 1.03, 95%CI 1.01‐1.06). There was no significant increase in risk of CVE following peritonitis (HR 1.37, 95%CI 0.81‐2.32, p=0.24), even when accounting for age, cerebrovascular disease, diabetes and existing coronary artery disease (HR 1.32, 95%CI 0.78‐2.23, p=0.30). Conclusions We did not find an increase in the risk of CVE following a peritonitis episode in PD patients. This result may be due to small sample size or rapid peritonitis treatment mitigating cardiovascular risk.