Association between Dialysis Modality and Infectious Diseases: Peritoneal Dialysis versus Hemodialysis

Abstract

<b><i>Introduction:</i></b> For dialysis patients with end-stage kidney disease, infectious diseases (IDs) are the most common causes of hospitalization and death. However, the association between dialysis modality and IDs remains unclear. We aimed to determine the association between the dialysis modality and IDs. <b><i>Methods:</i></b> This retrospective observational cohort study compared the emergency hospitalization and mortality for IDs between peritoneal dialysis (PD) and hemodialysis (HD) patients. After propensity score matching, the risk factors were evaluated by the Cox proportional hazard regression models. <b><i>Results:</i></b> A total of 260 patients were compared – 130 of 135 PD and 130 of 706 HD patients. When the modality-specific ID (PD-catheter ID/peritonitis- and vascular access-related ID) was excluded, no significant differences in emergency hospitalization and mortality rates for overall IDs were observed between the PD and HD groups. Serum ferritin (HR, 2.17; CI, 1.06–4.43; <i>p</i> = 0.03) and Charlson Comorbidity Index (CCI) (HR, 1.24; CI, 1.01–1.52; <i>p</i> = 0.04) were significant predictors of emergency hospitalization for IDs, whereas age (HR, 1.12; CI, 1.05–1.19; <i>p</i> &#x3c; 0.001), male (HR, 3.38; CI, 1.01–11.3; <i>p</i> = 0.048), serum alkaline phosphatase (ALP) (HR, 6.87; CI, 2.18–21.7; <i>p</i> = 0.001), C-reactive protein (CRP) (HR, 10.7; CI, 3.55–32.1; <i>p</i> &#x3c; 0.001), and CCI (HR, 1.79; CI, 1.27–2.52; <i>p</i> &#x3c; 0.001) were significant predictors of ID mortality. When modality-specific ID was included, the emergency hospitalization rate for overall IDs was higher in the PD groups, and PD was a significant predictor of emergency hospitalization for IDs, whereas no significant difference in mortality rate for overall IDs was found between the PD and HD groups. <b><i>Conclusions:</i></b> ID events were not associated with dialysis modality when modality-specific ID was excluded, whereas the risk of modality-specific IDs was higher in PD than HD. Serum ferritin and ALP as well as age, male sex, CRP, and CCI were the risk factors for ID events.