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Updated: Nov 11, 2025
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Published on: May 23, 2025
Time until treatment initiation is associated with catheter survival in peritoneal dialysis-related peritonitis
Rikako Oki1, Shiho Tsuji1, Yoshifumi Hamasaki2
1Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Insights
Prompt antibiotic treatment for peritoneal dialysis (PD) peritonitis is crucial. Delayed treatment (≥24 hours) significantly increases PD catheter removal rates and peritonitis recurrence.
Area of Science:
- Nephrology
- Infectious Diseases
Background:
- Peritonitis is a serious complication of peritoneal dialysis (PD).
- Timely treatment initiation is critical for managing PD-related peritonitis and preventing complications.
Purpose of the Study:
- To investigate the relationship between the time from PD effluent abnormalities to antibiotic treatment (ST time) and PD catheter removal.
- To identify factors associated with delayed ST time and catheter removal in PD patients.
Main Methods:
- Retrospective analysis of 109 PD-related peritonitis cases in 62 PD patients.
- Univariate and multivariate analyses were used to examine ST time and PD catheter removal.
- Patient data included PD duration, peritonitis episodes, tunnel infections, and treatment timing.
Main Results:
- A higher catheter removal rate was observed in the delayed ST time group (≥24 hours) compared to the early ST time group (<24 hours) (38% vs. 16%, p=0.02).
- Concomitant tunnel infection and delayed ST time were significantly associated with catheter removal.
- Delayed ST time was also linked to higher rates of catheter removal and peritonitis recurrence within one month.
Conclusions:
- Significant association found between PD catheter removal and treatment initiation >24 hours after abnormal effluent.
- Peritoneal dialysis duration and first peritonitis episode were associated with delayed ST time.
- Patient education on prompt medical attention for peritonitis symptoms, especially in long-term PD patients, may improve outcomes.
Abstract:
For peritonitis, a serious complication of peritoneal dialysis (PD), we investigated the relation between duration from the sign (PD effluent abnormalities) to treatment with appropriate antibiotics (ST time) and catheter removal. For 62 PD hospital patients, data of PD-related peritonitis (n = 109) were collected retrospectively. We examined ST time and PD catheter removal times using univariate and multivariate analyses. The catheter removal rate in the delayed ST time group (≥ 24 h) was higher than that in early ST time group (< 24 h) (38 vs. 16%, p = 0.02). Concomitant tunnel infection and delayed ST time were associated with catheter removal (OR [95% CI] 32.3 [3.15-329] and 3.52 [1.11-11.1]). Rates of catheter removal and re-development of peritonitis within 1 month after starting treatment were higher in the delayed ST time group (p = 0.02). PD duration at peritonitis and the first peritonitis episode were associated with delayed ST time (1.02 [1.00-1.04] and 3.42 [1.09-10.7]). Significant association was found between PD catheter removal and the start of treatment more than 24 h after appearance of abnormal effluent. Education for patients about prompt visitation at the onset of peritonitis with long PD duration might improve outcomes.
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