| Abstract [eng] |
Peritoneal dialysis (PD) is an important renal replacement therapy for patients with end-stage kidney disease; however, its long-term use is limited by infectious complications, particularly peritonitis. Peritonitis remains the leading cause of technique failure and transition to hemodialysis. Despite this, comprehensive analyses evaluating both risk factors and microbiology-based outcomes remain limited. The aim of this study was to evaluate risk factors of PD-associated peritonitis and clinical outcomes according to causative organisms using a systematic review and meta-analysis. A systematic literature search was conducted in PubMed/MEDLINE, Scopus, and Cochrane Library (2015–2025). Random-effects meta-analysis was performed. Observational studies reporting quantitative effect measures (HR, OR, RR with 95% CI) were included. The results showed that the most significant risk factors were hypoalbuminemia (effect size 1,74; 95 % PI 1,47–2,05; p<0,001; I²=0%) and older age (effect size 1,33; 95 % PI 1,01–1,76; p=0,044; I²=17,6%), whereas the association with diabetes mellitus was not statistically significant (effect size 0,95; 95 % PI 0,80–1,14; p=0,605; I²=27,5%). Hypoalbuminemia demonstrated a consistent association with increased peritonitis risk with low heterogeneity. Microbiological outcome analysis revealed that gram-positive peritonitis had the most favorable outcomes (cure rate 86,1 %; 95 % CI 82,7–89,2 %; I²=0 %), whereas gram-negative (cure rate 72,7 %; 95 % CI 58,8–84,7 %; I²=70,0 %), polymicrobial, and especially fungal infections (cure rate 15,3 %; 95 % PI 3,4–33,6 %; I²=48,1 %) were associated with worse prognosis, including higher catheter removal (73,2 %; 95 % PI 46,4–93,0 %) and transition to hemodialysis rates (34,90; 95 % PI 25,40–48,00; p<0,001). Conclusions: PD-associated peritonitis is multifactorial, with modifiable factors such as nutritional status playing a significant role. The causative organism is a key determinant of prognosis, highlighting the importance of early identification and targeted treatment. |
