Infections may be deadly for many dialysis patients

An infection called peritonitis commonly arises in the weeks before many dialysis patients die, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings suggest that peritonitis may be a deadly condition for some kidney failure patients.

Most kidney failure patients on dialysis get their treatments at a clinic, through hemodialysis. But about 10% to 20% receive treatments at home through peritoneal dialysis, where fluids are first pumped into the abdominal cavity to collect wastes from the blood and are later removed from the body. Unfortunately this fluid can become infected, causing a condition called peritonitis. This occurs as commonly as twice a year to once every five or six years.

Neil Boudville (University of Western Australia, in Perth) and his colleagues evaluated whether peritonitis affects the survival of patients on peritoneal dialysis. They looked at information from all kidney failure patients (1,316 individuals) who received dialysis in Australia and New Zealand from May 2004 through December 2009 and who died while undergoing treatment or soon after.

Compared with the rest of the year, patients were more likely to develop peritonitis during the 120 days prior to their death, and even more so during the final month before their death. Specifically, they were six times as likely to develop peritonitis during the 30 days prior to their death compared with six months earlier.

"We have therefore proposed a potential new definition for a cause of death—"peritonitis-associated death"—being any death within 30 days of an episode of peritonitis," said Prof Boudville.