Continuous Ambulatory Peritoneal Dialysis (CAPD) is a life-saving therapy for patients with kidney failure, but one of its most common and serious complications is peritonitis — an infection within the peritoneal cavity. Recognising the signs early and seeking prompt treatment is crucial to prevent long-term damage and ensure continued dialysis success.
What Is Peritonitis?
Peritonitis is an infection or inflammation of the peritoneum, the thin membrane lining the abdominal cavity and covering the internal organs.
In CAPD patients, the catheter and exit site serve as a direct link between the inner peritoneal cavity and the outside environment. This connection can allow bacteria or fungi from the skin, clothes, or air to enter the peritoneum, leading to infection.
During an episode of peritonitis, immediate antibiotic treatment is essential. Patients also require adequate calorie and protein intake to meet the body’s increased nutritional demands during infection and recovery.
Common Causes of Peritonitis in CAPD
Several factors can contribute to the development of peritonitis in CAPD patients, including:
- Contamination of the catheter adapter or connector through touching, sneezing, or coughing
- Exit site infection that spreads inward to the peritoneum
- Constipation, which can cause bacteria from the intestines to migrate into the peritoneal cavity
- Systemic infections in other parts of the body that spread through the bloodstream
- Holes, cracks, or damage in the catheter
Maintaining strict hygiene during dialysis exchanges and ensuring catheter integrity are key preventive measures.
Recognizing the Symptoms of Peritonitis
Early detection is vital. Common symptoms of peritonitis in CAPD patients include:
- Abdominal pain or tenderness
- Cloudy or poor catheter flow
- Fever or chills
- Nausea, vomiting, and general malaise
If any of these symptoms occur, contact your healthcare team immediately for evaluation and treatment.
Nutritional Impact
Peritonitis not only affects the peritoneum but also disrupts a patient’s nutritional status. The infection increases the body’s energy and protein requirements and can lead to:
- Increased protein loss during dialysis exchanges
- Loss of other essential nutrients
- Inflammation-related metabolic stress
- Ultrafiltration failure, affecting fluid balance
During and after infection, a high-protein, high-calorie diet under the guidance of a renal dietitian is recommended to support healing and maintain overall health.
Exit Site Infection: A Common Precursor to Peritonitis
The exit site, where the PD catheter passes through the skin, is another potential source of infection.
Common causes include:
- Improper or delayed catheter dressing changes
- Moist or wet dressings
- Physical trauma to the exit site
If not treated promptly, exit site infections can progress to tunnel infections or peritonitis, leading to catheter malfunction and interruption of dialysis therapy. Regular cleaning, proper dressing techniques, and early medical attention can help prevent such complications.
