The epidemiology of acute peritonitis in end-stage renal disease patients on peritoneal dialysis in Qatar: An 8-year follow-up study

Abstract

Acute peritonitis (AP) is a common and devastating complication in end-stage renal disease patients on peritoneal dialysis (PD). We are reporting an epidemiologic study of AP in Qatar over 8-year follow-up. We retrospectively reviewed medical records of all PD patients in Qatar from 2007 to 2014. The analysis was conducted to report epidemiology, outcome, and associated risk factors of AP. We had 318 AP episodes in 180 patients between 2007 and 2014. Six (3.3%) patients died as a result AP. Six cases of fungal peritonitis were reported. AP rate has decreased from 1 episode/29.7 PD-months in 2007 to 1/43.7 PD-months in 2014. Ninety-nine (55%) patients had single AP while 81 (45%) patients had 2 episodes or more (multiple AP). Patients on automated PD carried a higher risk of developing multiple AP [odds ratio (OR) = 1.46, 95% confidence interval (CI): 1.01–1.71]. The first episode of AP caused by Gram-positive cocci carried a significant risk of multiple AP (OR = 4.3, 95 % CI: 2.2–8.2). Negative-culture AP carried a significant protective role from multiple AP (OR = 0.35, 95% CI: 0.19–0.66). Most deaths occurred with the first episode of AP (4 out of 6). In this 8-year follow-up, epidemiologic study from Qatar, fungal peritonitis and mortality rate were very low, AP rate improved overall, multiple AP was prevalent (45%), and its risk increases with Gram-positive cocci infections. Our results signify the importance of implementing more efficient care bundles to prevent multiple AP.