Strategies to Prevent Peritonitis after Procedures: Our Opinions

Peritoneal Dialysis (PD) patients are at increased risk of peritonitis following elective colonoscopy and other potentially invasive dental or gynecological procedures. The increased risk of iatrogenic peritonitis is attributed to procedure-related factors such as instrumentation, biopsies, tissue injury, and peri-procedural bacterial contamination. Also contributory are patient-related factors such as the effect of the immunocompromised status of end-stage renal disease and the presence of intraperitoneal dialysate on the disruption of natural host defense mechanisms. We propose the use of standard peri-procedure protocols, including procedure-specific prophylactic antibiotics, and discuss the enhanced defense rationale for a dry abdomen during and sometimes after procedures. Depending on the procedure and its inherent risk of causing peritonitis, as well as the patient's ability to withhold PD for up to 3 days, we sometimes increase the intensity of PD before the procedure. We conclude that it is imperative that proceduralists and nephrologists be aware of and proactive about how to mitigate postprocedure PD complications.