Severe peritonitis in patients treated with peritoneal dialysis: a case series study

Severe peritonitis causing death and/or technique termination (catheter explanted) is one of the most devastating complications of peritoneal dialysis (PD). The aim of this case series study was to reveal the predictors of risk and clinical characteristics of these cases. We included 38 patients with either peritonitis causing death (18 patients, 47%) or catheter removal (20 patients, 53%) in the period 1996-2006. Their last clinical, laboratory and peritoneal equilibration test data before the peritonitis episode and hospitalization data after the start of peritonitis were reviewed. Their median (range) age was 66 (25-85) years, 61% were male, and the median PD duration was 60 (1-144) months. Baseline C-reactive protein (17.5 ± 19.1 mg/L) was substantially higher than in contemporary stable controls from our unit (3.5 ± 4.2 mg/L, P = 0.002). For 14 patients (37%), this was their first episode, with a significantly lower mortality of 14% as opposed to 47% across the whole group (P = 0.002). Almost half the patients (42%) had a causative abdominal condition identified, such as diverticulitis or cholecystitis. Clinical and laboratory data at presentation were variable and not different according to survival. Non-surviving cases had a significantly larger proportion of fast transporters (83 vs. 45%, P = 0.03), a significantly lower estimate of daily protein intake (0.72 vs. 0.88 g/kg/day, P = 0.007), and a significantly higher proportion of non-Gram-positive causative microorganisms (72 vs. 40%, P = 0.019). The patients with severe peritonitis were characterized as older with a longer PD duration, and a higher baseline C-reactive protein. Fast peritoneal transport, lower normalized protein catabolic rate, and non-Gram-positive causative bacteria were associated with mortality.