CAPD Peritonitis: Causes, Management

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In most cases, considerable clinical improvement occurs within 48 hours of starting therapy

 

Peritonitis is a frequent complication of continuous ambulatory peritoneal dialysis (CAPD) and the most common cause of CAPD failure. About 60% of patients receiving CAPD will have at least one episode of peritonitis during the first year of this mode of dialysis, according to Ram Gokal, MD, Consultant Nephrologist and Honorary Lecturer at the University of Manchester in the United Kingdom. CAPD peritonitis is associated with catheter loss, adhesions, increased protein loss, return to hemodialysis, and considerable morbidity.1

 

Dr. Gokal spoke about CAPD peritonitis at the National Kidney Foundation's 2007 Clinical Meetings in Orlando.

 

Most episodes of CAPD peritonitis are caused by contamination of the dialysis tubing or extension of catheter exit site or tunnel infections. Peritonitis in patients receiving CAPD usually occurs within 48 hours of contamination. CAPD peritonitis risk is influenced by comorbidities, hypoalbuminemia, nutritional status, and patient race, income, and education level.2



 

An accurate diagnosis of CAPD peritonitis is based on both clinical and laboratory findings. The most common sign of CAPD peritonitis is cloudy effluent in the dialysate bag upon exchange. Characteristic features of CAPD peritonitis include abdominal pain or tenderness, fever, nausea, cloudy dialysate effluent containing more than 100 WBC/mm3, and the isolation of microorganisms from the dialysate.

 

All episodes of CAPD peritonitis are potentially serious. The severity of CAPD peritonitis may be influenced by etiology, causative organism, and duration of infection. Indications for catheter removal in patients with CAPD peritonitis include catheter or tunnel infection, fungal, tuberculous, persistent or relapsing peritonitis, bowel perforations, cuff erosion and protrusion, and post-transplant peritonitis.

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