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 p redisposing factor for CAPD peritonitis, as well as the outcome of suc h episodes, remains uncertain. Methods. The incidence, spectrum of inf ectious 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. Immunosuppres sed patients were younger (mean 44 vs 57 years, P<0.001) and had an in creased incidence of previous transplantation, glomerulonephritis, sys temic lupus erythematosus, and vasculitis. Immunosuppressed patients h ad more episodes of peritonitis (69/39 patients vs 99/147, P<0.001), r equired more frequent hospital admission (25/39 vs 33/146, P<0.001), h ad more days off CAPD (331 vs 242, P<0.001), and required more laparot omies to remove infected CAPD catheters (11/39 vs 14/146, P<0.01). Imm unosuppression was associated with increased infection due to S. aureu s and fungi, which may have contributed towards increased morbidity in this group. Current immunosuppression or a recent history of immunosu ppression appeared to be equally potent risk factors for infection. Th ere was a trend for the incidence of infection to parallel the aggress iveness of immunosuppression. Conclusions. Immunosuppression is an imp ortant 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.