Global, Regional, and Country Incidence of Peritoneal Dialysis-Associated Peritonitis in the Contemporary Peritoneal Dialysis Practice: A Systematic Review and Meta-Analysis.

Background/

Objectives

Since peritoneal dialysis (PD) has been used in nephrology practice for several decades, contemporary evidence on global, regional, and country incidence rates of PD-associated peritonitis has not been comprehensively synthesized. We performed a systematic review and meta-analysis to estimate the incidence rates of PD-associated peritonitis worldwide in contemporary PD practice.

Methods

We systematically searched 6 electronic databases to identify all relevant English-language articles that reported rates of PD-associated peritonitis according to International Society for Peritoneal Dialysis (ISPD) criteria, regardless of age, sex, or PD modality, from 2011 to 2026. We used a random-effects meta-analysis to estimate the pooled incidence rate (episodes per patient-year), with corresponding 95% confidence intervals. We reported summary incidence rates of PD-associated peritonitis for the global estimation (overall rate), World Health Organization (WHO) region, and each country. We also estimated meta-syntheses by causative microorganism of PD-associated peritonitis.

Results

We identified 12,364 records, of which 153 unique study populations of PD patients fulfilled the study selection criteria. These included over 132,000 PD patients from 37 countries worldwide. Despite substantial heterogeneity, the global incidence rate estimate of PD-associated peritonitis was 0.31 (0.28-0.34) episodes per patient-year (total peritonitis episodes, 88,769; total patient-years at risk, 264,296.30). According to WHO region (p for difference between regions <0.001), the regional incidence rates of PD-associated peritonitis were 0.99 (0.68-1.45) for the African Region; 0.38 (0.31-0.45) for the Region of the Americas; 0.41 (0.35-0.48) for the South-East Asia Region; 0.37 (0.30-0.46) for the European Region; 0.39 (0.31-0.49) for the Eastern Mediterranean Region; and 0.21 (0.19-0.24) for the Western Pacific Region. Across 37 different countries, the top three highest incidence rates of PD-associated peritonitis were observed in South Africa, followed by Portugal and Sri Lanka. Meanwhile, the top three lowest incidence rates of PD-associated peritonitis were observed in South Korea, followed by mainland China and Japan. According to the ISPD benchmark, 10 of the 37 included countries had an overall PD-associated peritonitis rate > 0.40 episodes per patient-year. Regarding the causative microorganisms of PD-associated peritonitis, Gram-positive bacteria had the highest pooled incidence rate of PD-associated peritonitis (0.127 [0.113-0.142]), followed by culture-negative (0.073 [0.065-0.083]), Gram-negative bacteria (0.065 [0.058-0.073]), polymicrobial (0.017 [0.014-0.021]), fungus (0.009 [0.008-0.011]), and Mycobacterium (0.004 [0.003-0.006]).

Conclusions

These global estimates of PD-associated peritonitis incidence rates demonstrated variation across regions and countries. Given differences in healthcare systems across countries, sharing innovations and knowledge for continuous quality improvement and standardizing and harmonizing PD practice settings are warranted to improve quality indicators and patient well-being and reduce inequalities in PD management worldwide.