Managing Peritoneal Dialysis-Related Peritonitis: A Patient's Journey

Q: Managing Peritoneal Dialysis-Related Peritonitis: A Patient's Journey

Hello： The biggest enemy of peritoneal dialysis (PD) is peritonitis. <br>Generally, it can be resolved with antibiotic infusion treatment; however, there are certain situations where catheter removal and conversion to hemodialysis (HD) are necessary. <br>For instance, in cases of

Peritoneal dialysis-associated peritonitis

Hello Dr.
Yang,
About six years ago, I started peritoneal dialysis due to chronic kidney failure.
The past six years have gone quite smoothly, and I have been very attentive to cleanliness and hygiene.
However, at the end of last year, I experienced abdominal pain and cloudy dialysis fluid, which led me to seek emergency care at the Veterans General Hospital.
Initially, the doctors suspected it was just a case of simple peritonitis and treated me with antibiotics infused into the dialysis fluid.
They were also concerned that the dialysis catheter might cause a more severe infection, so they removed the peritoneal catheter and switched me to hemodialysis via a catheter placed near my clavicle.
However, my inflammatory markers did not decrease, and I continued to experience unexplained fevers.
My peritoneum became hardened, and bacterial cultures did not yield any results, making it impossible to determine the cause of my symptoms.
Consequently, the doctors resorted to various antibiotics, and there was even a suspicion of tuberculosis, leading to a two-week course of anti-tuberculosis medication, which proved ineffective.

Later, I underwent an endoscopic procedure, which revealed that it was not tuberculosis, but there might have been some blood clots formed due to surgical mishaps.
I had another surgery to remove these clots and ended up hospitalized for over four months.
Eventually, I stopped having fevers, and my inflammatory markers decreased, allowing me to be discharged.
Currently, I am still on hemodialysis, but I really hope to return to peritoneal dialysis.
However, my peritoneum remains hardened, and hemodialysis is quite inconvenient for my daily life.
The doctors mentioned that the hemodialysis catheter near my clavicle cannot be maintained for too long.
Since I am still young and need to work, I would like to ask if there are any methods to restore my peritoneum for peritoneal dialysis.
I hope to receive a detailed response from you.

Qiao Qiao, 30~39 year old female. Ask Date: 2009/07/22

Dr. Yang Zhongwei reply Internal Medicine

Hello: The biggest enemy of peritoneal dialysis (PD) is peritonitis.
Generally, it can be resolved with antibiotic infusion treatment; however, there are certain situations where catheter removal and conversion to hemodialysis (HD) are necessary.
For instance, in cases of fungal infections, PD is usually abandoned in favor of HD.
Additionally, infections caused by Staphylococcus aureus and Pseudomonas aeruginosa often compel us to discontinue PD as well.
The condition you described may indicate that your peritoneum has lost its function after some inflammatory responses.
This is likely why the physician at the Veterans General Hospital suggested transitioning to HD.
If long-term HD is required, it is preferable to establish an arteriovenous fistula in the arm, as subclavian catheters can lead to blockage and infection issues and are not suitable for prolonged use.
I believe you are still young, and maintaining both physical and mental health while waiting for a kidney transplant should be a good choice.
If you do need to rely on HD in the future, don't find it too troublesome; with some adjustments to your schedule, you can still work.
Wishing you smooth dialysis in the future!

Reply Date: 2009/07/22

More Info

Managing peritoneal dialysis-related peritonitis can be a complex and challenging journey, especially for patients who have been on dialysis for an extended period. In your case, it appears that you have faced significant complications, including persistent abdominal pain, cloudy dialysis fluid, and a prolonged hospitalization due to infection and inflammation.
Peritoneal dialysis (PD) is a treatment for chronic kidney disease that involves the use of the peritoneum in the abdomen as a membrane across which fluids and dissolved substances are exchanged from the blood. While PD can be an effective and convenient option for many patients, it is not without risks, including peritonitis, which is an infection of the peritoneal cavity.
The management of peritonitis typically involves the use of antibiotics, either administered through the dialysis fluid or systemically. In your case, it seems that the initial treatment did not yield the expected results, leading to the removal of the PD catheter and a switch to hemodialysis. This step is often taken to prevent further complications, especially if there is concern about the integrity of the catheter or the risk of systemic infection.

The fact that your inflammatory markers remained elevated and you experienced persistent fever suggests that the infection was not responding to standard treatment protocols. The decision to explore for potential causes through surgical intervention, such as laparoscopy, was a prudent one, especially given the suspicion of complications like abscess formation or other underlying issues.
It is encouraging to hear that after a prolonged hospitalization and multiple interventions, your inflammatory markers have decreased, and you are no longer experiencing fever. However, the desire to return to peritoneal dialysis is understandable, especially considering the lifestyle limitations imposed by hemodialysis.
To assess whether you can safely return to peritoneal dialysis, several factors need to be considered:
1. Resolution of Infection: It is crucial to ensure that any underlying infection has been fully resolved. This may involve follow-up imaging studies or laboratory tests to confirm that there are no residual abscesses or sources of infection.

2. Condition of the Peritoneum: The health of your peritoneum is essential for successful PD. If the peritoneum remains thickened or fibrotic, it may not function effectively for dialysis. A thorough evaluation by your nephrologist or a specialist in peritoneal dialysis is necessary to determine the viability of resuming PD.

3. Patient Education and Training: If you are cleared to return to PD, it is vital to ensure that you are well-educated on the importance of aseptic technique and hygiene to minimize the risk of future infections. This includes proper catheter care and recognizing early signs of peritonitis.

4. Regular Monitoring: Once you resume PD, regular follow-up appointments will be essential to monitor your condition closely. This includes checking for any signs of infection, assessing the effectiveness of dialysis, and ensuring that your peritoneum remains healthy.

5. Alternative Options: If returning to PD is not feasible, discuss with your healthcare team about other dialysis modalities or potential kidney transplant options, if applicable.

In conclusion, while the journey back to peritoneal dialysis may be challenging, it is not impossible. Close collaboration with your healthcare team, including nephrologists and possibly infectious disease specialists, will be key to navigating this process. They can provide tailored recommendations based on your specific situation, ensuring that you receive the best possible care moving forward.

Similar Q&A

Understanding Complications from Diabetes: A Case Study on Peritoneal Dialysis

I would like to inquire about the complications arising from diabetes. My mother was hospitalized on Lunar New Year's Eve due to symptoms of drowsiness, which led us to the emergency room. Blood tests and cultures revealed she had peritonitis and a urinary tract infection, l...

Dr. Xiao Yongxun reply Internal Medicine
Hello, In response to your question, long-term diabetes can lead to chronic complications, including nephropathy, heart disease, cerebrovascular disease, retinopathy, neuropathy, circulatory system disorders, and periodontal disease. Almost every part of the body that is nouris...

Understanding Nutritional Challenges in Dialysis Patients: A Caregiver's Guide

Hello: My mother-in-law has been on peritoneal dialysis for 6 years. Due to her not eating or drinking and being inactive, she has developed malnutrition and dehydration. Recently, she was urgently hospitalized and a nasogastric tube was inserted for feeding with glucose. A CT sc...

Dr. Zhong Weisheng reply Internal Medicine
Regarding your question about how long a patient can sustain themselves after discharge without intravenous fluids, only taking oral medications for feeding (considering they have diabetes and complications from dialysis), it is difficult to determine solely from online informati...

Managing Symptoms of Nausea and Fatigue in Peritoneal Dialysis Patients

Dear Dr. Wu, My mother has a history of hypertension for over 30 years. In January of this year, she was hospitalized for treatment due to renal failure and is currently undergoing peritoneal dialysis. Prior to starting treatment, there was a delay, during which she experienced ...

Dr. Wu Jiyu reply Internal Medicine
1. Based on your description, I infer that your mother has been undergoing peritoneal dialysis for about 10 months. Theoretically, you should have a certain level of familiarity with the peritoneal dialysis nurse. You can discuss or clarify the symptoms you described with your mo...

Understanding Peritonitis Treatment: What to Expect in Critical Care

My sister was admitted to Kaohsiung Chang Gung Memorial Hospital two days ago due to abdominal pain. She is currently in the surgical intensive care unit. The physician diagnosed her with peritonitis. The attending physician has been administering antibiotics through an IV. Howev...

Dr. Huang Zhihui reply Surgery
It appears that the patient is exhibiting signs of sepsis, which is associated with a decrease in blood pressure. There are many potential causes of sepsis, and a definitive diagnosis requires correlating clinical manifestations with various tests. Sometimes, the initial symptoms...