Impaired outcome of continuous ambulatory peritoneal dialysis in immunosuppressed patients.
BACKGROUND
Although immunodeficiency predisposes to CAPD peritonitis with fungal or unusual organisms, the role of immunosuppression as a predisposing factor for CAPD peritonitis, as well as the outcome of such episodes, remains uncertain.


METHODS
The incidence, spectrum of infectious organisms, and outcome of CAPD peritonitis was retrospectively reviewed in 39 immunosuppressed and 146 non-immunosuppressed patients treated with CAPD over the calendar year 1993.


RESULTS
Immunosuppressed patients were younger (mean 44 vs 57 years, P<0.001) and had an increased incidence of previous transplantation, glomerulonephritis, systemic lupus erythematosus, and vasculitis. Immunosuppressed patients had more episodes of peritonitis (69/29 patients vs 99/147, P<0.001), required more frequent hospital admission (25/39 vs 33/146, P<0.001), had more days off CAPD (331 vs 242, P<0.001), and required more laparotomies to remove infected CAPD catheters (11/39 vs 14/146, P<0. 01). Immunosuppression was associated with increased infection due to S.aureus and fungi, which may have contributed towards increased morbidity in this group. Current immunosuppression or a recent history of immunosuppression appeared to be equally potent risk factors for infection. There was a trend for the incidence of infection to parallel the aggressiveness of immunosuppression.


CONCLUSIONS
Immunosuppression is an important risk factor for CAPD peritonitis. A high index of suspicion for infection and aggressive chemotherapy are mandatory. CAPD may not be the initial therapy of choice in this high-risk group.
Andrews
P A
PA
Department of Nephrology, Guy's Hospital, London, UK.
Warr
K J
KJ
Hicks
J A
JA
Cameron
J S
JS
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009181:Mycoses; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections; D017211:Treatment Failure