Peritoneal-dialysis-related peritonitis: the art of rope-dancing

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Abstract
Although incidence rates of peritonitis have decreased substantially with the introduction of the flush‐before‐fill double‐bag principle, and the emergence of improved connection systems [1], peritonitis remains an Achilles tendon for peritoneal dialysis (PD) [2]. Mortality directly related to peritonitis is low, but peritonitis episodes cause psychosocial problems and are in the long run related to both technique failure and mortality [3]. Repetitive or protracted peritonitis episodes can also damage the peritoneal membrane [4]. Despite the overall decreasing incidence of peritonitis, mortality and technique failure attributable to it did not improve. This is due to the greater severity of infections caused by Gram‐negative and Staphylococcus aureus infections, two types of infections that are less related to connection systems, and the incidence of which has remained stable [5]. Although infection rates in haemodialysis are at least as high as those in PD [6], most nephrologists and many patients will point to the risk of peritonitis as one of the reasons not to perform PD. Because of all these arguments, prevention and treatment of peritonitis are still a matter of great concern.

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