Abstract
Peritonitis is a major peritoneal dialysis complication. Despite a high cure rate, relapsing and repeat peritonitis is associated with Tenckhoff catheter biofilm and multiple episodes of peritoneal damage. In relapsing peritonitis, prompt catheter removal is mandatory; otherwise, in repeat peritonitis, there is not a clear indication for catheter removal. It is questionable if the approach to removal should be different. There are few recent data on repeat and relapsing peritonitis microbiology and clinical outcomes since most studies are from the past decade. This study evaluates the microbiology, clinical outcomes, and impact of relapsing and repeat peritonitis on technique survival and the impact of catheter removal in development of further peritonitis episodes by the same microorganism. We developed a single-center retrospective study from 1998 to 2019 that compared repeat and relapsing peritonitis with a control group in terms of causative microorganisms, cure rate, catheter removal, and permanent and temporary transfer to hemodialysis. We also compared repeat and relapsing peritonitis clinical outcomes when Tenckhoff catheter was not removed. Comparing to the control group, the repeat/relapsing group had a higher cure rate (80.4% versus 74.5%, p=0.01) and lower rate of hospitalization (10.9% versus 27.7%, p=0.01). Technique survival was superior in the repeat/relapsing group (log rank = 4.5, p=0.03). Gram-positive peritonitis was more common in the repeat/relapsing group especially Streptococci viridans (43.5% versus 21.3%, p=0.01) and Gram-negatives in the control group (26.6% vs 9.0%, p=0.02). When the Tenckhoff catheter was not removed after a repeat episode, 58.6% developed a new repeat/relapsing episode versus 60.0% in the relapsing group. Although repeat and relapsing peritonitis have a higher cure rate, it leads to further episodes of peritonitis and consequent morbidity. When Tenckhoff catheter was not removed, the probability of another peritonitis episode by the same microorganism is similar in repeat and relapsing peritonitis.
Highlights
Peritoneal dialysis- (PD-) related peritonitis is a major PD complication and an important cause of ultrafiltration failure and hemodialysis transfer [1, 2]
Repeat and relapsing episodes seem to have a high cure rate, they deserve special attention because there is a substantial risk of developing further episodes, which may perpetuate peritoneal membrane damage [3, 4]. ere is little evidence that supports a different approach to relapsing and repeat peritonitis once both are related to colonization of peritoneal catheter by a microorganism and are associated with multiple episodes of peritonitis [4,5,6,7]. ere are few recent data on repeat and relapsing peritonitis microbiology and clinical outcomes since most studies are from the past decade [4, 8]
All episodes of PD peritonitis in our unit from 1998 to 2019 were reviewed. e data included demographic information, primary kidney disease cause, comorbid conditions, PD modality, microbiology of peritonitis episodes, and cause of PD withdraw. e diagnosis of peritonitis was based on International Society of Peritoneal Dialysis (ISPD) recommendations and at least two of the following: abdominal pain and/or cloudy dialysis effluent; dialysis effluent white cell count >100/μL with >50% polymorphonuclear cells; and positive dialysis effluent culture
Summary
Peritoneal dialysis- (PD-) related peritonitis is a major PD complication and an important cause of ultrafiltration failure and hemodialysis transfer [1, 2]. Ere is little evidence that supports a different approach to relapsing and repeat peritonitis once both are related to colonization of peritoneal catheter by a microorganism and are associated with multiple episodes of peritonitis [4,5,6,7]. Ere are few recent data on repeat and relapsing peritonitis microbiology and clinical outcomes since most studies are from the past decade [4, 8]. There was a change on technique and microbiological policies, namely, exit-site antibiotic prophylaxis, so it is important to evaluate if the microorganisms and clinical outcomes of repeat and relapsing episodes remain the same. Is study evaluates the microbiology, clinical outcomes, and impact of relapsing and repeat peritonitis on technique survival and the impact of catheter removal in development of further peritonitis episodes by the same microorganism
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