Outcome of Peritonitis in Automated Peritoneal Dialysis: A Cohort Study.

Rational & Objectives: Peritonitis is a serious complication of peritoneal dialysis (PD). Current treatment guidelines are directed toward patients receiving continuous ambulatory PD (CAPD), whereas the optimal treatment for those receiving automated PD (APD) is less clear. In this study, we compared the bacteriology and treatment outcomes of peritonitis episodes between patients receiving APD and CAPD and, for peritonitis episodes in patients receiving APD, we studied the difference in clinical outcomes between intermittent and continuous dosing of intraperitoneal antibiotics. Study Design: Single-center, retrospective cohort study. Setting & Participants: One hundred and seventy-six APD peritonitis episodes from 2007 to 2021 were compared to 352 CAPD episodes, matched for age, sex, and diabetes status. Exposures: Mode of PD; intermittent versus continuous dosing of intraperitoneal antibiotics. Outcomes: Primary outcome was the rate of complete cure. Analytical Approach: Groups were compared by χ2 test, Mann-Whitney U test, t test, or Fisher exact test. Results: The APD group had higher complete cure rates than the CAPD group (88% vs 81%, P = 0.033), but primary response rates were similar. Patients receiving nocturnal intermittent peritoneal dialysis had significantly higher primary response rates (91% vs 80%, P = 0.03) and complete cure rates (95% vs 79%, P < 0.001) than those receiving continuous cyclic peritoneal dialysis. Within the APD group, patients treated with intermittent dosing of intraperitoneal antibiotics demonstrated significantly better primary response rates (91% vs 69%, P < 0.001) and complete cure rates (93% vs 74%, P <0.001) than those converted to CAPD for a continuous regimen. Limitations: Retrospective study; small subgroup size. Conclusions: Peritonitis episodes in patients receiving APD had better treatment outcomes than those receiving CAPD. In the APD group, treatment with intermittent dosing of intraperitoneal antibiotics had better primary response rate and complete cure rate than those treated with continuous regimens.