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CONTINUOUS AMBULATORY PERITONEAL DIALYSIS IN PATIENTS WITH HEPATITIS B LIVER DISEASE

Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China

Correspondence to: C.C. Szeto, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
ccszeto{at}cuhk.edu.hk

• Objective: We hypothesized that patients with hepatitis B virus infection and cirrhosis are more susceptible to peritonitis as a complication of peritoneal dialysis (PD).
  
• Methods: A retrospective study was carried out to compare peritonitis rates between cirrhotic and non-cirrhotic patients with hepatitis B virus infection.
  
• Results: Between 1994 and 2004, 25 PD patients with hepatitis B cirrhosis and 36 patients with hepatitis B without cirrhosis were included for analysis. Mean follow-up duration was 52 months. Subjects with hepatitis B cirrhosis consisted of more males and had higher total body weight. No cirrhotic patients (20 of them being Child-Pugh class A, 2 class B, and 3 class C) had undergone portosystemic shunting or liver transplantation. Cirrhotic patients had slightly higher bilirubin concentration than the non-cirrhotic group (22 ± 50 vs 9 ± 4 µmol/L, p = 0.16). There was no difference in median peritonitis-free survival between cirrhotic and non-cirrhotic patients (40 vs 37 months, p = 0.64 by log-rank test). The average peritonitis rate was 1 episode every 19.2 patient-months in the cirrhotic group and 1 episode every 20.5 patient-months in the non-cirrhotic group. Time to first peritonitis did not differ between the two groups with respect to gram-negative organisms (p = 0.88) or gram-positive organisms (p = 0.52). Cirrhotic patients had more frequent Streptococcus species peritonitis, which accounted for 13% of all peritonitis episodes, as opposed to 2% among the non-cirrhotic patients (p = 0.01). Overall treatment response rate and outcome did not differ between patients with and patients without cirrhosis.
  
• Conclusions: Peritonitis-free survival of cirrhosis patients infected by hepatitis B virus compares favorably with that in patients without cirrhosis. The presence of liver cirrhosis does not appear to compromise PD outcome.
  

KEY WORDS: Hepatitis B; peritonitis; Streptococcus; cirrhosis.

Received 4 October 2004; accepted 22 July 2005.

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