Peritonitis in peritoneal dialysis patients: an overview.

The incidence of peritonitis in peritoneal dialysis (PD) patients has decreased as a result of improvements in PD technology. Nevertheless, peritonitis remains a major problem in PD, with a substantial percent of patients developing persistent or relapsing infections. Current treatment guidelines emphasize the use of intraperitoneal antibiotics and once-a-day administration of aminoglycosides and provide indications for removal of the peritoneal catheter. Further clinical studies testing these guidelines are needed. In addition, guidelines for patients on PD treatment modalities other than standard continuous ambulatory peritoneal dialysis (CAPD) need to be developed. Peritonitis may lead to extensive adhesion formation, peritoneal fibrosis of varying severity, permanent loss of peritoneal ultrafiltration, severe malnutrition, sepsis, and death. Special forms of peritonitis requiring great care and further study include those caused by fungi, mycobacteria, and multiple microorganisms, and those developing in HIV-positive PD patients.