Spectrum of infectious complications in continuous ambulatory peritoneal dialysis and the role of metabolic derangement to infections.

BACKGROUND

Metabolic derangement is related to increased morbidity and mortality in the general population, but its implications for dialysis patients remain unclear. This study aimed to examine the spectrum of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

MATERIALS AND

METHODS

100 cases of perforation peritonitis over a period of 1 year were studied retrospectively in terms of microbial infectious causes, co-morbidity, and postoperative biochemical characteristics. Special attention was given to identifying metabolic distress associated with peritonitis in patients who had undergone CAPD.

RESULTS

Clinical evaluation and biochemical assessment showed hyperthyroidism, hyperphosphatemia, hypocalcemia, hypoalbuminemia, and hypervitaminosis D in 99%, 90%, 79%, 71%, and 61% of the patients, respectively. Metabolisms such as uric acid, K+, ferritin, and C-reactive protein were within normal. Comorbidity was significantly higher in peritonitis patients (p < 0.008) than in non-peritonitis patients. CAPD patients with peritonitis required surgical insertion of a CAPD catheter (p < 0.005) rather than a medical method. Bacterial infections within the examined population exhibited significant variation (p < 0.001), which was uniformly caused by Gram-positive and Gram-negative bacteria. Multivariate analysis showed that albumin (p < 0.04), potassium (p < 0.002), sugar (p < 0.02), phosphate (p < 0.002), and vitamin D (p < 0.006) levels were strong independent predictors of CAPD associated with peritonitis.

CONCLUSION

Patients with peritonitis and CAPD in Iraq have a mixed spectrum with respect to metabolism. E. coli pathogen peritonitis was the most dominant in the population. Comorbidity in patients with peritonitis was independent of sex.