Analysis of factors related to peritoneal dialysis-associated peritonitis in patients with diabetic nephropathy and establishment of a risk model
10.3760/cma.j.cn341190-20241226-01749
- VernacularTitle:糖尿病肾病患者发生腹膜透析相关性腹膜炎的相关因素分析及风险模型建立
- Author:
Xuelian WANG
1
;
Yanxue ZHOU
1
Author Information
1. 义乌市中心医院肾内科，义乌 322000
- Publication Type:Journal Article
- Keywords:
Diabetic nephropathies;
Peritoneal dialysis;
Peritonitis;
Systemic inflammatory response syndrome;
Potassium;
Serum albumin;
Regression analysis
- From:
Chinese Journal of Primary Medicine and Pharmacy
2025;32(8):1152-1158
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the factors associated with the occurrence of peritoneal dialysis-associated peritonitis (PDAP) in patients with diabetic nephropathy and to establish a risk model.Methods:The clinical data of 90 patients with diabetic nephropathy who underwent peritoneal dialysis using Einkorn dextrin dialysate at Yiwu Central Hospital from January 2021 to December 2023 were analyzed retrospectively. Patients were classified into the PDAP group and the non-PDAP group based on the occurrence of PDAP as recorded in the medical records system. The clinical data and laboratory indicators of the two patient groups were collected and compared. Collinearity analysis was performed on the significantly different variables, and those without collinearity issues were included in a logistic regression model to identify factors associated with infection. The statistically significant variables from the regression analysis were used as predictors to construct a nomogram risk prediction model for the occurrence of infections in patients, and the model was subsequently validated.Results:Among the 90 patients, 21 (23.33%) developed PDAP and were included in the PDAP group, while the remaining 69 patients (76.67%) did not develop PDAP and were included in the non-PDAP group. The differences in baseline systemic inflammatory response index (SIRI), serum albumin (ALB), blood potassium levels, hemoglobin (Hb) levels, and dialysis duration between the two groups were statistically significant [(1.53 ± 0.45) vs. (1.31 ± 0.32), (28.67 ± 3.64) g/L vs. (34.61 ± 4.13) g/L, (3.13 ± 0.47) mmol/L vs. (3.97 ± 0.51) mmol/L, (90.83 ± 10.15) g/L vs. (107.27 ± 10.66) g/L, 43.00 (38.50, 48.00) months vs. 34.00 (32.00, 38.00) months, t/ Z = 3.17, 5.92, 6.72, 6.25, 7.03, all P < 0.05]. None of the indicators exhibited collinearity issues (variance inflation factor ≤ 10, tolerance ≥ 0.1), allowing for their inclusion in the logistic regression model. According to the logistic regression analysis, baseline SIRI ( OR = 5.816, 95% CI: 1.404-24.097) and dialysis duration ( OR = 1.412, 95% CI: 1.214-1.643) were identified as independent risk factors for the occurrence of PDAP in patients with diabetic nephropathy. In contrast, ALB ( OR = 0.653, 95% CI: 0.533-0.801), blood potassium levels ( OR = 0.025, 95% CI: 0.005-0.132), and Hb levels ( OR = 0.867, 95% CI: 0.811-0.926) were protective factors against the occurrence of PDAP. A prediction model incorporating these five predictors was established using logistic regression, and corresponding nomograms were plotted along with a decision curve and calibration curve. The net benefit rate of the prediction model within the threshold range was high, indicating that the accuracy of the model was good. Conclusions:Baseline SIRI, ALB, blood potassium levels, Hb levels, and dialysis duration in patients with diabetic nephropathy are all related risk factors for the occurrence of PDAP after peritoneal dialysis treatment. The nomogram model constructed based on these indicators can aid in the clinical screening of high-risk populations and provide a theoretical basis for the implementation of preventive and therapeutic measures.
