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Tuberculous peritonitis in chronic renal failure managed by continuous ambulatory peritoneal dialysis
Abstract:
Continuous ambulatory peritoneal dialysis (CAPD) is being increasingly used to treat chronic renal failure in New Zealand. Peritonitis due in particular to gram positive organisms remains the major complication. Three of 92 CAPD patients trained in the Wellington Renal Unit had tuberculous peritonitis, a previously rarely reported complication. Gram positive or Gram negative bacterial infections preceded or followed isolation of Mycobacterium tuberculosis. Differential peritoneal fluid leucocyte counts were not predictive of tuberculous infection and total leucocyte counts remained elevated in tuberculous patients treated for other concurrent bacterial peritonitides. Systemic toxicity was not encountered in these patients, symptoms being confined almost entirely to the peritoneum. CAPD was continued during treatment with anti-tuberculous therapy, in all three patients. However, peritoneal pain on dialysis fluid in-flow necessitated temporary hemodialysis management in two. Anti-tuberculous chemoprophylaxis may be prudent in the at-risk Polynesian patient with chronic renal failure who is being considered for CAPD management.
Insights
Tuberculous peritonitis is a rare complication of continuous ambulatory peritoneal dialysis (CAPD). This study found it occurred in 3 of 92 patients, with symptoms localized to the peritoneum.
Area of Science:
- Nephrology
- Infectious Diseases
- Public Health
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a growing treatment for chronic renal failure in New Zealand.
- Peritonitis, particularly from Gram-positive organisms, is the primary complication of CAPD.
Observation:
- Three out of 92 CAPD patients at Wellington Renal Unit developed tuberculous peritonitis.
- Tuberculous peritonitis cases were preceded or followed by bacterial peritonitis (Gram-positive or Gram-negative).
Findings:
- Peritoneal fluid leucocyte counts were not predictive of tuberculous infection.
- Total leucocyte counts remained elevated even when treating concurrent bacterial peritonitis.
- Symptoms were primarily peritoneal, with no systemic toxicity observed.
Implications:
- CAPD can be continued during anti-tuberculous therapy, though temporary hemodialysis may be needed for inflow pain.
- Anti-tuberculous chemoprophylaxis might be advisable for at-risk Polynesian patients with chronic renal failure undergoing CAPD.
- This highlights the importance of considering tuberculosis in CAPD peritonitis, especially in specific populations.