Prevalence, microbiology, and outcome of peritonitis in peritoneal dialysis patients in vietnam: a multicenter study

Abstract

Background

Chronic kidney disease (CKD) is a substantial contributor to global mortality, requiring interventions like kidney transplantation and dialysis. Peritoneal dialysis (PD) has emerged as an effective dialytic modality despite the susceptibility to peritonitis. The study aimed to determine the prevalence of peritonitis among PD patients, elucidating pivotal factors affecting its occurrence, causative bacterial agents, and treatment outcomes (mortality rates, removal of the Tenckhoff catheter, and switch to hemodialysis).

Methods

A retrospective cohort study was conducted, which included patients who underwent PD between January 2019 and December 2021 at nine dialysis centers in Vietnam. The prevalence rate of peritonitis was estimated as the quotient of total peritonitis episodes and cumulative patient-years. The association of peritonitis with factors such as age, care (self-care or helper-assisted PD), comorbidities, education level was analyzed using regression analysis. Peritonitis outcomes including mortality rate, Tenckhoff catheter removal, and transitions to hemodialysis were evaluated. PD-related infections were assessed. Additionally, the causative bacterial agents and the negative culture rate were determined.

Results

A total of 691 PD patients from nine centers from the south of Vietnam were recruited for the study. Peritonitis was reported in 32.42% of the patients during the study period of 2019–2021. An increase in the number of patients reporting peritonitis was observed over the years. A significant association (p = 0.01) between peritonitis rate and level of literacy was found. The mortality rate among patients who underwent PD was 2.68%. About 16.18% of patients with peritonitis had to have the Tenckhoff catheter removed and needed to be switched to hemodialysis. Around 46.98% of the peritonitis cases were culture-positive.

Conclusion

The prevalence of peritonitis among PD patients in Vietnam increased from 2019 to 2021. Lower literacy positively correlated with peritonitis, regardless of the type of PD. The high prevalence of culture-negative peritonitis cases indicated gaps in diagnostic procedures or the presence of unusual pathogens. These outcomes highlight the need for improved education, diagnostic practices, and interventions to reduce peritonitis risks and enhance patient care in PD programs in Vietnam.