Outcome of patients who develop early-onset peritonitis

Although advances have been made in the treatment and prevention of peritoneal dialysis (PD) peritonitis, these infections are still a significant source of technique failure, morbidity, and mortality in the end-stage renal disease population. Currently, it is unclear whether PD patients who experience an episode of peritonitis early in the course of their therapy are more vulnerable to the complications of peritonitis. Using retrospective data collected at the Toronto General Hospital Home Peritoneal Dialysis Unit between January 1, 1998, and December 31, 2004, we compared technique and patient outcomes between PD patients developing "early-onset" peritonitis and a matched control group of PD patients. "Early-onset" peritonitis was defined as peritonitis occurring within 3 months of PD catheter insertion. Outcomes included survival on PD or the combined endpoint of technique failure (transfer to hemodialysis) or death. The early-onset cohort was younger than the control group and had a higher peritonitis rate (1.18 episodes vs. 0.28 episodes per patient-year). Gram-positive micro-organisms, particularly coagulase-negative staphylococci, were the most common cause of peritonitis. At the conclusion of the study, 8 patients (38.1%) in the early-onset cohort had transferred to hemodialysis, 2 patients (9.5%) had died of cardiac complications, and 11 patients (52.4%) remained on PD. The combined rate of technique failure and death in the early-onset group was almost twice as high as that in the control group (0.282 vs. 0.175 per patient-year). Time to the composite end-point of technique failure or death did not significantly differ between the two groups (p = 0.26). In summary, there is an important trend toward increased death and technique failure in PD patients who develop peritonitis early in the course of their PD therapy.