Peritoneal Dialysis Complications and Management

Peritoneal dialysis (PD) offers a versatile home-based modality for renal replacement, but its success is tempered by a spectrum of complications. Infectious peritonitis remains the most formidable challenge, driven by entry-site colonisation, biofilm formation on catheters and compromised host defences. Bacterial profiles have shifted from predominantly Gram-positive organisms to a rising incidence of Gram-negative and, more rarely, fungal pathogens, each demanding tailored antimicrobial regimens. Non-infectious issues such as catheter malfunction, dialysate leaks, herniation and ultrafiltration failure further threaten technique longevity. Metabolic perturbations—including glucose absorption, sodium loss and protein depletion—add to the clinical burden. Effective management hinges on meticulous catheter care, regular exit-site inspection, patient education in aseptic technique and judicious use of prophylactic measures during invasive procedures. Emerging strategies encompass early risk stratification, predictive scoring, microbiological surveillance and antibiotic de-escalation guided by susceptibility patterns. Together, these advances aim to preserve peritoneal membrane function, reduce morbidity and enhance technique survival on a global scale.

Research from Nature Portfolio

Recent studies have introduced a clinical risk prediction tool that accurately stratifies the probability of treatment failure following peritonitis episodes in PD patients. The model integrates patient-specific factors such as diabetes status, systolic blood pressure on presentation and dialysate leukocyte counts at defined intervals. With high discrimination and calibration, this scoring scheme facilitates early identification of high-risk cases, informing decisions on catheter removal, escalation to haemodialysis or intensified antimicrobial therapy, and holds promise for harmonising care pathways across diverse practice settings.

Peritoneal Dialysis Complications and Management publication trend

The graph below shows the total number of articles in peritoneal dialysis complications and management across all publications each year (not limited to Nature Index journals).

Technical terms

Peritonitis: Inflammation of the peritoneal membrane, typically due to microbial infection in PD.

Empirical antibiotic therapy: Initial antimicrobial treatment begun before specific culture results are available, guided by likely pathogens.

De-escalation: The practice of narrowing antibiotic spectrum or reducing number of agents based on confirmed microbial susceptibility to minimise resistance and toxicity.

Ultrafiltration failure: Inadequate removal of fluid from the peritoneal cavity due to transport alterations, leading to volume overload.

References

1. A rare case of successful treatment of peritoneal dialysis patient with Serratia marcescens peritonitis without catheter removal: case report and literature review. Frontiers in Cellular and Infection Microbiology (2024).
2. Best Practice of Peritoneal Dialysis-Associated Gram-Negative Peritonitis in Children: Insights From the International Pediatric Peritoneal Dialysis Network Registry. Kidney International Reports (2024).
3. A Clinical Risk Prediction Tool for Peritonitis-Associated Treatment Failure in Peritoneal Dialysis Patients. Scientific Reports (2018).