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Peritoneal dialysis (PD) is a medical process that removes waste products and excess fluid from the body using the peritoneal membrane as a natural filter.Peritoneal Dialysis MethodsSeveral methods can be used for peritoneal dialysis, including Acute Intermittent Peritoneal Dialysis, Continuous Ambulatory Peritoneal Dialysis, and Automated Peritoneal Dialysis, also known as Continuous Cyclic Peritoneal Dialysis.Acute Intermittent Peritoneal Dialysis (AIPD) is used for patients with uremic...
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Updated: Nov 21, 2025

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Variability in Culture-Negative Peritonitis Rates in Pediatric Peritoneal Dialysis Programs in the United States.

T Keefe Davis1, Kristina A Bryant2, Jonathan Rodean3

  • 1Department of Pediatrics, Division of Pedatric Nephrology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Clinical Journal of the American Society of Nephrology : CJASN
|January 19, 2021
PubMed
Summary

Culture-negative peritonitis is common in pediatric peritoneal dialysis. Practices like catheter exit site placement and patient self-dialysis varied between low- and high-rate centers, but no single technique explained the differences in culture-negative peritonitis rates.

Keywords:
pediatric nephrologyperitoneal dialysis

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Area of Science:

  • Pediatric Nephrology
  • Dialysis Technology
  • Infectious Disease Management

Background:

  • International guidelines recommend a culture-negative peritonitis rate below 15% for long-term peritoneal dialysis patients.
  • Significant variability in culture-negative peritonitis rates exists among pediatric dialysis centers.
  • The study aimed to identify practices associated with this variability.

Purpose of the Study:

  • To evaluate specific clinical practices and patient characteristics associated with varying culture-negative peritonitis rates in pediatric peritoneal dialysis centers.
  • To compare practices between centers with low (≤20%) and high (>20%) culture-negative peritonitis rates.
  • To investigate the impact of peritoneal dialysis effluent culture techniques on peritonitis rates.

Main Methods:

  • A prospective study involving 32 pediatric dialysis centers over 5.5 years.
  • Comparison of clinical practices and patient characteristics between low- and high-culture-negative peritonitis rate centers.
  • A survey assessing center-specific peritoneal dialysis effluent culture techniques.

Main Results:

  • Over 19,025 patient-months, 27% of peritonitis episodes had negative cultures.
  • Low-rate centers more frequently used catheters with downward-facing exit sites and two cuffs.
  • High-rate centers had more patients performing self-dialysis; effluent culture techniques varied widely with no clear differentiating factor.

Conclusions:

  • Culture-negative peritonitis is a frequent complication in pediatric maintenance peritoneal dialysis.
  • Despite recommendations, significant variability exists in dialysis effluent culture techniques and procedures across centers.
  • No consistent practice or technique was identified to differentiate centers with low versus high culture-negative peritonitis rates.