The relationship between peritoneal leukocyte count, fluid cultures, and clinical results in peritonitis among peritoneal dialysis patients: is there a geographic or ethnic difference?

ABSTRACT

We investigated peritoneal leukocyte count (PLC) and culture results for correlations with inflammation, nutrition, microbiologic parameters, and the effects of peritonitis on peritoneal equilibration tests (PETs) and clinical outcomes in peritoneal dialysis (PD) patients. The study group consisted of patients who had experienced peritonitis for the first time and who had been on PD for at least 6 months, with a PET performed both before and after the peritonitis episode. Only patients with an increased PLC were analyzed. In the 70 patients analyzed (35 men; mean age 45.1 +/- 13.5 years), 7 (10.0%) underwent PD catheter removal, 60 (85.7%) responded well to treatment, and 3 (4.3%) died. Cultures of peritoneal fluid were positive in 25 patients (35.7%), and these patients had a significantly higher PLC than did the culture-negative patients. After the peritonitis episode, C-reactive protein (CRP) increased significantly in affected patients. Residual urine declined after peritonitis. We observed no significant difference in PET results. Clearly, more micro-organisms are present in the peritoneal fluid in patients with a positive culture than in those with a negative culture, meaning that they have severe peritonitis, which responds poorly to treatment. Beyond a consideration of possibly inappropriate culturing techniques, the variations in effluent culture results might reflect geographic or ethnic differences. Positive culture results and a high PLC should be considered risk factors for catheter loss and mortality in PD. Moreover, culture results might show geographic and ethnic differences. In peritonitis follow-up, CRP may be a better marker than erythrocyte sedimentation rate is.