Peritonitis is a major cause of morbidity and technique failure in patients receiving peritoneal dialysis. Complicated peritonitis that manifests as multiple or unresolving episodes is classified as refractory, recurrent, relapsing, or repeat peritonitis, and often possesses higher risk of technique failure and mortality as well as lower complete cure rates than primary or uncomplicated episodes. While these peritonitis subtypes affect a considerable portion of PD patients, details regarding their epidemiology, pathogenesis, diagnosis, clinical sequelae, and management have not yet been fully elucidated. Improved clinical awareness and understanding of complicated peritonitis subtypes is crucial to ensure optimal management for these patients; thus, we consolidate and report the pertinent findings of recent literature on these four entities.

Peritoneal dialysis (PD) is one of the most preferred kidney replacement therapies in children. However, it has an important complication such as peritonitis. This study was planned to investigate the causes and frequency of peritonitis in children with PD.

The demographic features, peritonitis episodes and microbiological characteristics of PD patients followed up for 5 years.

Fifty pediatric PD patients who met the study criteria in a 5-year period were included in the study. Consanguineous marriage was 64% and 44% of the mothers was illiterate. Nineteen patients had no peritonitis episode and a total of 54 peritonitis episode were experienced. The overall peritonitis rate was one episode per 24.4 patient-months. Culture negativity rate was 44%.

Even though factors such as the education level of the parents, the number of people or rooms in the house, dialysis modality were thought to influence peritonitis episodes, they could not be shown statistically. This article is protected by copyright. All rights reserved.

We report a case of a 2-year-old-boy with end stage renal disease (ESRD) secondary to posterior urethral valves (PUV) on peritoneal dialysis (PD). Our patient developed multiple episodes of peritonitis, refractory anemia and feeding intolerance over a 12-month-period. He was treated with multiple courses of intraperitoneal antibiotics. Despite being on high-calorie formula, he was slowly thriving. The feeding intolerance was attributed to past history of prematurity, gastro-esophageal reflux disease and ESRD co-morbidities. He had anemia resistant to erythrocyte stimulating agents and iron supplementation. His family received re-training and mastered the PD techniques. They reported no breach of the aseptic techniques. His workup which included multiple AP abdominal XR-plain films were read as unremarkable and showed the gastrostomy tube (GT) and the PD catheter in good position. He completed his antibiotic courses as prescribed after each peritonitis episode, peritoneal fluid cultures repeated after each treatment completion showed no growth. During the last peritonitis episode, our patient developed ultrafiltration failure. A cross-table abdominal XR was obtained to evaluate the peritoneal catheter position and showed an intra-abdominal foreign body. During surgery, a needle was laparoscopically removed from the ileum and the PD catheter was replaced. Subsequently, our patient's feeding intolerance and resistant anemia resolved. Finally PD was successfully resumed.