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Peritoneal Dialysis Associated Peritonitis Rate – Validation of a Simplified Formula

Peritonitis is the most important therapy-related complication of peritoneal dialysis (PD). Unfortunately, many PD centers around the world do not accurately record peritonitis rate, mainly because they cannot ascertain PD patient time-at-risk from “patient flow” data - that is, calculating PD patient-days from dates when patients start and finish PD. We propose a simplified method of calculating PD peritonitis rate using PD patient time-at-risk from “patient stock” data - - that is, calculating PD patient-days from the number of prevalent PD patients at the center at the start of the year and the corresponding number at the end. We compared gold-standard measurements of annual PD peritonitis rates with simplified ones in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) / New Zealand (NZ) PD Registry, and Le Registre de Dialyse Péritonéale de Langue Française et hémodialyse à domicile (the RDPLF). A total of 268 centers from 9 countries with 4311 center-years and 110,185 patient-years of follow-up were modelled. Overall agreement was excellent with a concordance correlation coefficient of 0.978 (95% confidence interval [CI] 0.975-0.980) in ANZDATA / NZ PD Registry, and 0.978 (0.977-0.980) in the RDPLF. There was statistically significant lower agreement for smaller centers in the registries at 0.972 (0.966-0.976) and 0.973 (0.970-0.976) respectively, although the performance of the simplified formula remains clinically sound in even these centers. The simplified method of calculating PD peritonitis rate is accurate, and will allow more centers around the world to measure, report, and work on reducing PD peritonitis rates.