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International Society for Peritoneal Dialysis (ISPD) guidelines recommend catheter removal in refractory peritonitis in patients with peritoneal dialysis with the purpose to prevent irreversible damage to the peritoneal membrane and death, with re-insertion of a new catheter at least two weeks after the removal and resolution of the peritonitis.
A retrospective cohort study was conducted with patients with peritoneal dialysis. Clinical and biochemical variables were measured and patients were classified based whether they presented with or without a refractory peritonitis.
A total of 291 patients were included, mean age 35.5 (27-59) years, 51% male and 49% women, with 51% of the patients in continuous ambulatory peritoneal dialysis. Of the 291 patients, 147 (50.5%) were diagnosed with refractory peritonitis. Patients with refractory peritonitis had a higher incidence of hypertension (27.08% vs 94.5%, p = < .0001), higher incidence of diabetes mellitus (20.8% vs 30.6%, p= <.045), and higher incidence of previous peritonitis (24.3% vs 69.4%, p= < .0001).
Death occurred more frequently in those who presented with refractory peritonitis (31.3%) versus those without refractory peritonitis (18.7%) with a significative statistical p analysis (p = < .021). Causes of death in patients with refractory peritonitis and those without refractory peritonitis are presented in table 1. Mean time to death in patients with refractory peritonitis was 4 days (1-11) after diagnosis, and 3 months after change of modality to hemodialysis.
Survival rate in our population with refractory peritonitis was lower to those reported in international reports. Compared with patients without refractory peritonitis, those who changed of modality to hemodialysis presented higher mortality. Survival was 4 months (1-11) months after a case of refractory peritonitis.