Related Experiment Videos
Impaired outcome of continuous ambulatory peritoneal dialysis in immunosuppressed patients
P A Andrews1, K J Warr, J A Hicks
1Department of Nephrology, Guy's Hospital, London, UK.
Background:
Although immunodeficiency predisposes to CAPD peritonitis with fungal or unusual organisms, the role of immunosuppression as a predisposing factor for CAPD peritonitis, as well as the outcome of such episodes, remains uncertain.
Methods:
The incidence, spectrum of infectious organisms, and outcome of CAPD peritonitis was retrospectively reviewed in 39 immunosuppressed and 146 non-immunosuppressed patients treated with CAPD over the calendar year 1993.
Results:
Immunosuppressed patients were younger (mean 44 vs 57 years, P<0.001) and had an increased incidence of previous transplantation, glomerulonephritis, systemic lupus erythematosus, and vasculitis. Immunosuppressed patients had more episodes of peritonitis (69/29 patients vs 99/147, P<0.001), required more frequent hospital admission (25/39 vs 33/146, P<0.001), had more days off CAPD (331 vs 242, P<0.001), and required more laparotomies to remove infected CAPD catheters (11/39 vs 14/146, P<0. 01). Immunosuppression was associated with increased infection due to S.aureus and fungi, which may have contributed towards increased morbidity in this group. Current immunosuppression or a recent history of immunosuppression appeared to be equally potent risk factors for infection. There was a trend for the incidence of infection to parallel the aggressiveness of immunosuppression.
Conclusions:
Immunosuppression is an important risk factor for CAPD peritonitis. A high index of suspicion for infection and aggressive chemotherapy are mandatory. CAPD may not be the initial therapy of choice in this high-risk group.
Insights
Immunosuppression significantly increases the risk of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients, leading to more frequent infections and complications. Aggressive treatment and careful consideration of alternative therapies are crucial for this high-risk group.
Area of Science:
- Nephrology
- Infectious Diseases
- Immunology
Background:
- Immunodeficiency is known to predispose to unusual organisms in CAPD peritonitis.
- The specific role of immunosuppression as a risk factor and its impact on CAPD peritonitis outcomes remain unclear.
Purpose of the Study:
- To investigate the incidence, spectrum of organisms, and outcomes of CAPD peritonitis in immunosuppressed versus non-immunosuppressed patients.
- To determine if immunosuppression is a significant risk factor for CAPD peritonitis.
Main Methods:
- Retrospective review of 185 patients (39 immunosuppressed, 146 non-immunosuppressed) undergoing CAPD in 1993.
- Analysis of peritonitis episodes, causative organisms, hospitalization rates, CAPD downtime, and surgical interventions.
Main Results:
- Immunosuppressed patients experienced a higher incidence of peritonitis (P<0.001) and required more hospital admissions (P<0.001) and CAPD catheter removals (P<0.01).
- Increased infections with Staphylococcus aureus and fungi were observed in the immunosuppressed group, correlating with higher morbidity.
- Both current and recent immunosuppression were identified as potent risk factors, with infection incidence potentially paralleling immunosuppression intensity.
Conclusions:
- Immunosuppression is a critical risk factor for CAPD peritonitis.
- A high index of suspicion and aggressive management are essential for infected immunosuppressed CAPD patients.
- CAPD might not be the optimal initial treatment for this high-risk population.