{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:19:43Z","timestamp":1790108383792,"version":"4.0.1"},"reference-count":30,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004704","name":"National Research Council of Thailand","doi-asserted-by":"publisher","award":["58-056"],"award-info":[{"award-number":["58-056"]}],"id":[{"id":"10.13039\/501100004704","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002842","name":"Chiang Mai University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002842","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background\/Objectives: Although peritoneal dialysis (PD) practices have improved over the past decades, limited evidence exists on all-cause mortality and cardiovascular death following PD-associated peritonitis. This study aimed to investigate the association between PD-associated peritonitis and the risk of all-cause mortality and cardiovascular death. Methods: This multicenter, retrospective cohort study included adult patients who newly initiated PD between 1 January 2006 and 31 December 2020, with follow-up through 30 September 2022. Patients were matched 1:1 by time from PD initiation to index date (the occurrence date of PD-associated peritonitis for the exposure group and the corresponding matched time on PD for the non-exposure group [individuals without any peritonitis event]), age, and sex. Multivariable Cox proportional hazards models with shared frailty correction and competing risk models were used to estimate hazard ratio (HR) and subdistribution hazard ratio (SHR), respectively. Subgroup analyses were conducted by age, sex, PD modality, and comorbid conditions. Results: The cohort included 1510 matched pairs (total sample, 3020; mean age [SD], 58.6 [14.2] years; 1618 males [53.6%]), with a median follow-up of 5.6 years. After adjusting for sociodemographic, PD, and clinical characteristics and laboratory profiles, patients with any PD-associated peritonitis episode had significantly higher risk of all-cause mortality (HR, 2.17 [1.78\u20132.66], p &lt; 0.001; SHR, 2.00 [1.74\u20132.29], p &lt; 0.001) and cardiovascular death (HR, 2.90 [2.05\u20134.59], p &lt; 0.001; SHR, 2.25 [1.66\u20133.05], p &lt; 0.001) compared to those without PD-associated peritonitis. Subgroup analyses revealed no significant interactions (all p values for interaction &gt; 0.05). Conclusions: PD-associated peritonitis was independently associated with substantially increased risk of all-cause and cardiovascular mortality among patients undergoing PD. These findings support the need for targeted interventions and clinical strategies aimed at reducing adverse outcomes following PD-associated peritonitis.<\/jats:p>","DOI":"10.3390\/medsci13040249","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T02:48:28Z","timestamp":1761878908000},"page":"249","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Association Between Peritoneal Dialysis-Associated Peritonitis and the Risk of All-Cause Mortality and Cardiovascular Death: A Time-Matched Retrospective Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1100-7171","authenticated-orcid":false,"given":"Surapon","family":"Nochaiwong","sequence":"first","affiliation":[{"name":"Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5783-8766","authenticated-orcid":false,"given":"Kajohnsak","family":"Noppakun","sequence":"additional","affiliation":[{"name":"Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish M.","family":"Sood","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada"},{"name":"Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, ON K1Y 4E9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4738-8447","authenticated-orcid":false,"given":"Kednapa","family":"Thavorn","sequence":"additional","affiliation":[{"name":"Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, ON K1Y 4E9, Canada"},{"name":"Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON K1H 8L6, Canada"},{"name":"School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg A.","family":"Knoll","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada"},{"name":"Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, ON K1Y 4E9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chidchanok","family":"Ruengorn","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7913-2799","authenticated-orcid":false,"given":"Apichat","family":"Tantraworasin","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Clinical Surgical Research Center, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1038\/s41581-022-00623-7","article-title":"Epidemiology of peritoneal dialysis outcomes","volume":"18","author":"Bello","year":"2022","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"ii18","DOI":"10.1093\/ndt\/gfae130","article-title":"Global structures, practices, and tools for provision of chronic peritoneal dialysis","volume":"39","author":"Cho","year":"2024","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1001\/jama.2024.16338","article-title":"Dialysis for Chronic Kidney Failure: A Review","volume":"332","author":"Flythe","year":"2024","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"641","DOI":"10.2215\/CJN.0000000000000280","article-title":"Peritoneal Dialysis-Related Infections","volume":"19","author":"Cho","year":"2024","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e2237580","DOI":"10.1001\/jamanetworkopen.2022.37580","article-title":"Association Between Pretransplant Dialysis Modality and Kidney Transplant Outcomes: A Systematic Review and Meta-analysis","volume":"5","author":"Ngamvichchukorn","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1053\/j.ajkd.2019.09.017","article-title":"Establishing a Core Outcome Set for Peritoneal Dialysis: Report of the SONG-PD (Standardized Outcomes in Nephrology-Peritoneal Dialysis) Consensus Workshop","volume":"75","author":"Manera","year":"2020","journal-title":"Am. J. Kidney Dis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Nochaiwong, S., Ruengorn, C., Koyratkoson, K., Thavorn, K., Awiphan, R., Chaisai, C., Phatthanasobhon, S., Noppakun, K., Suteeka, Y., and Panyathong, S. (2018). A Clinical Risk Prediction Tool for Peritonitis-Associated Treatment Failure in Peritoneal Dialysis Patients. Sci. Rep., 8.","DOI":"10.1038\/s41598-018-33196-2"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1177\/08968608221080586","article-title":"ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment","volume":"42","author":"Li","year":"2022","journal-title":"Perit. Dial. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.2215\/CJN.14631218","article-title":"Peritoneal Dialysis-Associated Peritonitis","volume":"14","author":"Szeto","year":"2019","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/nep.12986","article-title":"Peritonitis as a risk factor for long-term cardiovascular mortality in peritoneal dialysis patients: The case of a friendly fire?","volume":"23","author":"Yabumoto","year":"2018","journal-title":"Nephrology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2388","DOI":"10.1016\/j.ekir.2022.08.008","article-title":"Association of Peritonitis With Cardiovascular Mortality Over Time in the Peritoneal Dialysis Population: An Australia and New Zealand Dialysis and Transplant Registry Study","volume":"7","author":"Murali","year":"2022","journal-title":"Kidney Int. Rep."},{"key":"ref_12","unstructured":"United States Renal Data System (2025, August 30). 2024 Annual Report: End Stage Renal Disease: Chapter 1\u2014Incidence, Prevalence, Patient Characteristics, and Treatment Modalities, Available online: https:\/\/usrds-adr.niddk.nih.gov\/2024\/end-stage-renal-disease\/1-incidence-prevalence-patient-characteristics-and-treatment-modalities."},{"key":"ref_13","unstructured":"United States Renal Data System (2025, August 30). 2024 Annual Report: End Stage Renal Disease: Chapter 6\u2014Mortality, Available online: https:\/\/usrds-adr.niddk.nih.gov\/2024\/end-stage-renal-disease\/6-mortality."},{"key":"ref_14","unstructured":"ANZDATA Registry (2025, January 22). 44th Report: Chapter 3\u2014Mortality in Kidney Failure with Replacement Therapy (Australia and New Zealand Dialysis and Transplant Registry. Available online: http:\/\/www.anzdata.org.au."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1177\/08968608231172740","article-title":"ISPD Catheter-related Infection Recommendations: 2023 Update","volume":"43","author":"Chow","year":"2023","journal-title":"Perit. Dial. Int."},{"key":"ref_16","first-page":"CD004679","article-title":"Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients","volume":"4","author":"Campbell","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_17","first-page":"CD012478","article-title":"Catheter insertion techniques for improving catheter function and clinical outcomes in peritoneal dialysis patients","volume":"2","author":"Briggs","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_18","first-page":"723","article-title":"Impact of peritonitis on long-term survival of peritoneal dialysis patients","volume":"31","author":"Olivares","year":"2011","journal-title":"Nefrologia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1681\/ASN.2011121135","article-title":"Recent peritonitis associates with mortality among patients treated with peritoneal dialysis","volume":"23","author":"Boudville","year":"2012","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ye, H., Zhou, Q., Fan, L., Guo, Q., Mao, H., Huang, F., Yu, X., and Yang, X. (2017). The impact of peritoneal dialysis-related peritonitis on mortality in peritoneal dialysis patients. BMC Nephrol., 18.","DOI":"10.1186\/s12882-017-0588-4"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1007\/s40620-020-00716-1","article-title":"Changes in serum albumin concentrations during transition to dialysis and subsequent risk of peritonitis after peritoneal dialysis initiation: A retrospective cohort study","volume":"33","author":"Noppakun","year":"2020","journal-title":"J. Nephrol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1080\/07853890.2021.1889023","article-title":"Comparative effectiveness of lactulose and sennosides for the prevention of peritoneal dialysis-related peritonitis: An open-label, randomized, active-controlled trial","volume":"53","author":"Noppakun","year":"2021","journal-title":"Ann. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1080\/08898489509525394","article-title":"Correlated individual frailty: An advantageous approach to survival analysis of bivariate data","volume":"5","author":"Yashin","year":"1995","journal-title":"Math. Popul. Stud."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3424","DOI":"10.1177\/0962280220921889","article-title":"A tutorial on frailty models","volume":"29","author":"Balan","year":"2020","journal-title":"Stat. Methods Med. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A Proportional Hazards Model for the Subdistribution of a Competing Risk","volume":"94","author":"Fine","year":"1999","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.jclinepi.2012.09.017","article-title":"A competing risks analysis should report results on all cause-specific hazards and cumulative incidence functions","volume":"66","author":"Latouche","year":"2013","journal-title":"J. Clin. Epidemiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity Analysis in Observational Research: Introducing the E-Value","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1038\/nrneph.2013.43","article-title":"The peritoneal-renal syndrome","volume":"9","author":"Nessim","year":"2013","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1681\/ASN.2013030314","article-title":"Independent effects of systemic and peritoneal inflammation on peritoneal dialysis survival","volume":"24","author":"Lambie","year":"2013","journal-title":"J. Am. Soc. Nephrol."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/13\/4\/249\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T05:16:48Z","timestamp":1761974208000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/13\/4\/249"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,30]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["medsci13040249"],"URL":"https:\/\/doi.org\/10.3390\/medsci13040249","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,30]]}}}