Clinical analysis of peritonitis in peritoneal dialysis patients

Abstract

Introduction/Objective. Peritoneal dialysis is a method of treating patients in the terminal phase of renal failure (end-stage renal disease). Peritonitis represents most severe and most common complication of peritoneal dialysis. The most common peritonitis causes are Gram negative microorganisms: Staphylococcus-coagulase-negative, Staphylococcus aureus, Streptococcus sp, Neisseria sp. Gram negative microorganisms are: Pseudomonas sp, Enterococcus, Klebsiella sp, Proteus sp, Acinetobacter sp. The aim of the study was to examine the incidence of peritonitis and to determine the differences between patients with and without peritonitis and catheter infection. Other goals of the work were: the most frequent causes of peritonitis, the outcome of treatment, the influence of the length of treatment on the development of peritonitis, the influence of the peritoneal dialysis adequacy on the development of peritonitis, the influence of anemia, nutritional status, iron status, secondary hyperparathyroidism (Ca, P, CaxPO4, parathormone), protein status ? albumin and the effect of acid uricum on the development of peritonitis. Methods. Retrospectively, 84 patients were analyzed of peritoneal dialysis (2012?2016) at the Kragujevac Center for Nephrology and Dialysis of Clinical Center. The diagnosis of peritonitis was based on clinical picture, biochemical analyses, leukocyte in sediment of dialysis, findings of peritoneal-culture, signs of inflammation (C-reactive protein, leukocytes). The analysis included: the most common causes, the outcome of treatment, the influence of the length of treatment, the influence of the peritoneal dialysis adequacy, the influence of anemia, the influence of iron status, the influence of secondary hyperparathyroidism, the influence of protein status - albumin, and the effect of acid uricum on the development of peritonitis. Results. In total, 22 patients had one, six patients had two, six patients had three, six patients more than three episodes of peritonitis. The difference in mean values of the number of erythrocytes, hemoglobin, hematocrit, iron, albumin, diastolic pressure, systolic pressure between patients with peritonitis, and those without it, were statistically significant (p < 0.05). The difference in mean values of calcium (Ca), phosphor (P), CaxPO4, uricum value, parathormone, peritoneal dialysis adequacy, systolic pressure was not statistically significant (p > 0.05). The incidence of peritonitis and death were not associated (p = 1.000). Conclusion, Peritonitis is severe complication of peritoneal dialysis. Anemia and nutritional status are risk factors that affect the development of peritonitis in patients on peritoneal dialysis.