Peritoneal tuberculosis in patients receiving continuous ambulatory peritoneal dialysis

Area of Science:

• Nephrology
• Infectious Diseases
• Public Health

Background:

• Patients with chronic renal failure face an elevated risk of tuberculosis (TB).
• TB incidence is highest within 12 months of starting dialysis, often presenting as extrapulmonary disease.
• Individuals from ethnic groups susceptible to TB, particularly from the Indian subcontinent, are at greater risk.

Purpose of the Study:

• To investigate the occurrence and characteristics of peritoneal tuberculosis (TB) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
• To analyze the clinical presentation, diagnosis, and outcomes of peritoneal TB in CAPD patients.

Main Methods:

• A retrospective analysis of all peritoneal TB cases in CAPD patients at a single institution over a 13-year period.
• Identification and review of patient demographics, clinical features, diagnostic methods, treatment, and outcomes.

Main Results:

• Eight cases of peritoneal TB were identified, with seven occurring in non-Caucasian patients.
• Most patients developed TB within 12 months of initiating CAPD, presenting with fever but symptoms mimicking bacterial peritonitis.
• Culture confirmed TB in six patients, while only two were smear-positive; three patients transitioned to hemodialysis, and three died, one from TB.

Conclusions:

• Peritoneal TB is an important, though relatively uncommon, manifestation in CAPD patients, typically developing early in the course of dialysis.
• The underlying reasons for the increased incidence of peritoneal TB in CAPD patients remain unclear and warrant further investigation.
• Early recognition and treatment are crucial, given the potential for severe outcomes including mortality.