A Leading Cause Behind the Decline of Peritoneal Dialysis

Introduction Peritoneal dialysis (PD) was once a primary renal replacement therapy in Pakistan and many developing nations. However, its use has significantly declined, with peritonitis emerging as a leading cause. A retrospective study analyzed peritoneal dialysis patients to identify the prevalence and microbial causes of peritonitis.

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Understanding Peritonitis and Its Impact on PD Peritonitis, an infection of the peritoneal cavity, is a major complication of peritoneal dialysis. This study analyzed 42 PD patients, revealing that 35 (83.34%) had peritonitis episodes, contributing to a significant decline in PD usage. The most common site of infection was the intraperitoneal cavity (74.07%), followed by tunnel (14.83%) and exit site infections (11.4%).

Key Findings from the Study

• Microbial Causes:
  • Bacterial peritonitis: 80%
  • Fungal peritonitis: 11%
  • Tuberculosis-related peritonitis: 9%
• Culture Analysis:
  • 57 peritoneal fluid samples were analyzed.
  • 74% of samples were culture-positive, identifying Coagulase-negative Staphylococcus (CoNS), E. coli, Pseudomonas, and Candida among the main pathogens.
  • 26% of cases remained culture-negative, possibly due to prior antibiotic use or suboptimal culture techniques.

Clinical Implications and Global Perspective The high incidence of peritonitis led to the discontinuation of PD programs in Pakistan. However, countries like Taiwan, Guatemala, and Canada continue to use PD due to its cost-effectiveness and lower hemodynamic instability compared to hemodialysis. According to the International Society for Peritoneal Dialysis (ISPD), culture-negative peritonitis should be below 20% for effective management.

Read the Full Study For a detailed analysis of the study, visit: https://doi.com/10.29328/journal.jcn.1001028.

The Future of Peritoneal Dialysis With advancements in infection control and diagnostic techniques, peritoneal dialysis could be reintroduced in medical settings where it remains a viable option. Improved microbial detection and antibiotic stewardship are essential to prevent treatment failure and improve patient outcomes.

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