Treatment for peritoneal dialysis-associated peritonitis

Area of Science:

• Nephrology
• Infectious Diseases
• Clinical Trials

Background:

• Peritonitis is a frequent complication of peritoneal dialysis (PD), leading to significant morbidity and potential transfer to hemodialysis.
• Effective treatment of PD-associated peritonitis is crucial to reduce complications and recurrence rates.

Purpose of the Study:

• To evaluate the benefits and harms of various treatments for peritonitis in patients undergoing PD.
• To update previous reviews on PD-associated peritonitis treatments.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
• Inclusion of studies evaluating antibiotic administration routes, doses, schedules, regimens, fibrinolytic agents, peritoneal lavage, and catheter removal.

Main Results:

• Intraperitoneal (IP) antibiotic administration showed superiority over intravenous (IV) administration in reducing treatment failure.
• Glycopeptides demonstrated potential for complete cure, but evidence quality was low.
• Catheter removal and replacement appeared more effective than urokinase for relapsing or persistent peritonitis.

Conclusions:

• Current evidence for optimal PD-associated peritonitis treatment is limited due to small, poor-quality studies with inconsistent definitions.
• IP antibiotic administration is preferred over IV for PD peritonitis.
• Further high-quality research is needed to establish optimal antibiotic strategies and the role of interventions like peritoneal lavage.