ALTERAÇÕES CLIMÁTICAS E SEU IMPACTO EM INFECÇÃO ASSOCIADA À DIÁLISE PERITONEAL

INTRODUCTION: Peritonitis is the main non-fatal complication in patients undergoing chronic peritoneal dialysis. Seasonal variations in peritonitis rates may be related to climatological variables such as humidity and temperature, particularly due to their potential impact on personal hygiene AIMS: To assess the association between climatic variables, such as temperature and humidity in the patient’s city, and the peritonitis rate associated with peritoneal dialysis MATERIALS AND METHODS: A multicentric cohort study was conducted using clinical and laboratory data from peritoneal dialysis clinics across Brazil. Daily climate data were obtained from INMET, and cities lacking complete information were excluded. Monthly averages for temperature and humidity were calculated. Statistical analysis included multilevel modeling and Poisson regression to assess the association between climate variables and peritonitis. Risk factors were adjusted using a backward stepwise multivariate model. Polynomial terms were added to capture non-linear effects. An ordinal variable was created to compare visually distinguishable climate categories. Finally, the study was approved by the ethics committees of all participating centers. RESULTS: We included 3,931 patients from the BRAZPD cohort, totalling 67,940 monthly observations across 46 Brazilian cities, over 87 centers. The overall peritonitis rate was 1 episode every 21.6 months (95% CI, 20.6–22.7), with 1,352 episodes recorded. Among 1,327 episodes with culture data, 236 were due to Gram-negative bacteria, 452 to Gram-positive, 597 had negative cultures, 40 were fungal, and 2 were polymicrobial. A significant inverse association was found between humidity and peritonitis risk. Humidity levels below 50% were associated with a 74% increased risk compared to the reference range of 70–80%, with no association observed for temperature. These findings were adjusted for relevant clinical and demographic confounders. When stratified by microorganism, the association persisted only for Gram-negative infections, with no significant correlation found for Gram-positive or culture-negative episodes. FINAL CONSIDERATIONS: Climatological variability appears to be associated with an increased risk of peritonitis, particularly in relation to humidity. Interventional studies are needed to determine whether this association can be at least partially mitigated.

KEYWORDS: Peritoneal dialysis-associated peritonitis; Climate; Humidity; Temperature; Season.