Around three million people in the UK have kidney disease

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Peritonitis

What is it?

Peritonitis is an infection of the peritoneum – the membrane covering your internal organs which lines a space in your body called the peritoneal (or abdominal) cavity.

If the lining becomes infected the internal organs it covers can also be damaged. Left untreated, peritonitis can become life-threatening.

Although peritonitis can have other causes (as a complication of appendicitis for example), this information is about peritonitis as a common complication for people who are receiving peritoneal dialysis.

What are the causes

In continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD)the peritoneum is used to filter out waste products and excess fluid from the blood –  a job which would normally be done by the kidneys.

But peritonitis can occur if bacteria enter the abdomen from outside the body through the dialysis catheter and infect the peritoneum.

How can this happen?

Peritonitis can occur if:

  • dialysis equipment isn't kept clean (but sometimes infections can happen even if every care is taken over hygiene)
  • the open ends of the catheter are touched during a bag change, allowing bacteria to enter the catheter
  • there is an infection around the exit site of the catheter
  • there is an infection in the large intestine (bowel), e.g. diverticulitis.

Symptoms

Signs and symptoms of peritonitis can include:

  • abdominal pain
  • a high temperature  (38C or above)
  • feeling and being sick
  • a rapid heartbeat
  • a swollen stomach
  • experiencing severe shivering accompanied by a feeling of coldness (known medically as rigors)
  • cloudy used dialysis fluid or visible white flecks in the fluid.

Contact your dialysis unit immediately if you develop any of these symptoms – or call the NHS 111 non-emergency medical helpline.

Possible consequences

People on peritoneal dialysis usually average less than one case of peritonitis a year – some may never get it. But repeated bouts of infection can damage the peritoneum and cause thickening of the tissue (sclerosis).

If thickening becomes severe or widespread it can prevent peritoneal dialysis from working properly and some people may have to transfer to haemodialysis instead.

Diagnosis

A small sample of your ‘used’ dialysis fluid may be examined microscopically to look for the presence of white blood cells. High numbers of these cells would indicate an infection.

If the white cell count is raised, your dialysis fluid will also be ‘cultured’ (grown in a petri dish) to see which organisms (bugs) are causing the infection and sensitivity tests on the organisms will determine which antibiotic treatments will be best for you.

  • Two common types of bacteria are Staphylococcus epidermidis and Staphylococcus aureus (known as Staff infections) but many other bacteria can cause peritonitis, and occasionally infection can be caused by a fungus (usually Candida).

Treatment

Peritonitis is normally treated with antibiotics. Treatment is often started quickly, so the drugs can get to work while diagnostic tests are completed. Once the test results are known the antibiotic treatment can be adjusted, if necessary.

  • Antibiotics can be added to new dialysis fluid, taken as tablets or injected into a vein via a cannula.
  • Some people are able to do this treatment themselves at home; while others can be treated at their local outpatients department.
  • In severe cases you may need to stay in hospital for several days and receive antibiotics intravenously via a drip.
  • If you have severe or repeated peritonitis, it may be necessary to remove the dialysis catheter and ‘rest’ your abdomen for several weeks. During this time you will need to have haemodialysis until you are ready to return to peritoneal dialysis, and oral or intravenous antibiotic treatment will need to continue until it is certain that the infection has cleared up.
  •  For a few people, haemodialysis may become the long-term treatment option.

Help with eating while in hospital

Peritonitis can make it hard for you to digest food so a feeding tube might be passed into your stomach through your nose, or placed inside your stomach using keyhole surgery.

If a feeding tube can't be used, liquid nutrients can be given directly into one of your veins.

Possible surgery

Sometimes it may become necessary to remove your catheter, depending on the severity frequency and cause of your infection. But a replacement can often be fitted later.

If part of your peritoneum has been seriously damaged by infection you may need surgery to remove it.

Prevention

The best way to try and prevent peritonitis is to keep your dialysis equipment clean. You can do this by:

  • strictly following the training given by your dialysis nurse, around exchange procedure and exit site care
  • always making sure that the room where you have your dialysis sessions is clean
  • having good personal hygiene before, during and after bag changes

Help for you

  • Don’t hesitate to speak to your PD nurse or kidney specialist if you have any concerns about contracting peritonitis – or if you need help with your dialysis or any other aspects of your condition.

You can also find lots of helpful tips, advice and information about exercise, diet, mental wellbeing and peer support in our How can I help myself? section.

Reviewed April 2019

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Why we need more research

Over the last 20 years there have been major improvements in the design of the tubing and connections used to deliver peritoneal dialysis fluid, but we still need better ways to prevent bacteria getting into the peritoneal cavity during PD exchanges.

Kidney Research UK has a long history of supporting researchers with an interest in improving dialysis for people with kidney disease. Professor Edwina Brown is one such researcher, who has helped us devise resources to help patients make informed choices about their treatment.

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Join our Kidney Voices for Research network and get involved in the latest research into the causes and treatments of kidney disease.

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