Peritoneal Dialysis–Associated Peritonitis Rates and Outcomes in a National Cohort are not Improving in the Post-Millennium (2000 – 2007)

Abstract

Background

Peritoneal dialysis (PD)–related peritonitis remains the leading cause of technique failure and a significant cause of morbidity among PD patients. Rates in the literature vary, reflecting differences in study design and in populations. The objective of the present study was to determine peritonitis incidence and outcomes in Scotland and to compare them with national guidelines.

Methods

All 10 adult renal units in Scotland prospectively collect data relating to peritonitis for all PD patients in Scotland. Complete audit data between 1 January 2000 and 31 December 2007 were analyzed for the study.

Results

The 1918 peritonitis episodes in 38 106 PD treatment months yielded a national rate of 1 episode every 19.9 months. The UK Renal Association standard was met every year, but is not consistently improving. The median peritonitis-free survival was 526 days (95% confidence interval: 463 to 589 days). The spectrum of causative organisms reflected those in previous reports, with a culture- negative rate of 19.4%. Nationally, the cure rate was 74.6%, the refractory rate was 22.6%, and the death rate was 2.8%. Outcome varied by organism. Recurrences represented 9.3% of episodes, and technique failure occurred in 14.9%. The peritonitis rate was higher for continuous ambulatory PD patients than for automated PD patients (1 episode every 17.6 months vs 1 episode every 22.3 months, p < 0.001, relative risk: 1.27). There were significant differences between renal units.

Conclusions

This large national PD cohort met targets for peritonitis rates every year during the 8 years covered by the present report, but showed no consistent trend for improvement. Peritonitis remains the main cause of technique failure in Scotland. Peritonitis rates varied widely between the units, which suggests that we should look to the units and countries with lower peritonitis rates to see if we can adopt successful elements of their practice before resigning ourselves to our ongoing peritonitis burden.