Evaluation of the epidemiologic triad in the incidence of peritonitis among pediatric patients with chronic kidney disease undergoing peritoneal dialysis: a single-center study in Indonesia.

INTRODUCTION

Peritonitis is the most common and serious complication of Continuous Ambulatory Peritoneal Dialysis (CAPD) in children. Understanding the interaction of host, agent, and environmental factors-based on the epidemiologic triad-may help reduce its incidence in pediatric populations, especially in resource-limited settings. This study aimed to evaluate host and environmental factors associated with peritonitis among pediatric CAPD patients while descriptively characterizing the causative microorganisms involved.

METHODS

This retrospective study included 35 pediatric patients receiving CAPD from 2019 to 2024. Clinical, socioeconomic, nutritional, and environmental data were collected. Peritonitis diagnosis followed ISPD criteria. Peritonitis incidence and peritonitis-free survival were analyzed using Kaplan-Meier curves and bivariate statistical tests.

RESULTS

Eleven patients (31.4%) developed peritonitis, with an overall rate of 4.5 episodes per 100 person-months. Low dietary diversity, well water consumption, and low paternal education or labor/driver occupations were associated with higher peritonitis occurence (p < 0.05). Kaplan-Meier analysis showed that low dietary diversity significantly reduced peritonitis-free survival (p = 0.021). Trends were observed for water source and occupation.

CONCLUSION

Peritonitis in pediatric CAPD patients results from a multifactorial interplay of nutritional, environmental, and socioeconomic factors. Addressing these determinants through dietary support, hygiene education, and socioeconomic assistance may help reduce peritonitis risk and support better outcomes.