OPTIMAL TREATMENT AND LONG-TERM OUTCOME OF TUBERCULOUS PERITONITIS COMPLICATING CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

A retrospective study of the treatment and short- and long-term outcom es of tuberculous peritonitis (TBP) complicating continuous ambulatory peritoneal dialysis (CAPD) among our dialysis patients over a 6-year period was performed. Ten cases of TBP complicating CAPD were identifi ed among 601 dialysis patients between January 1988 and December 1994. There were four male and six female patients. The most common clinica l features were abdominal pain, fever, and cloudy peritoneal fluid (PD F). Two patients had concurrent bacterial peritonitis. Extraperitoneal tuberculosis was not observed. The majority of the patients showed ne utrophil predominance in the PDF, Only one patient had a positive acid -fast bacilli smear of the PDF. The acid-fast bacilli culture of the P DF was positive in all patients. The patients were treated with isonia zid, rifampicin, and pyrazinamide for 9 to 12 months (mean, 11 months) . Continuous ambulatory peritoneal dialysis was continued in all patie nts. Two patients died, one from multiorgan failure at 2 months and th e other from sudden cardiac death at 9 months. Two patients were conve rted to hemodialysis at 3 months. Six patients continued to receive CA PD after completion of the antituberculous treatment. Four of these si x patients were stilt alive 5 years after the TBP, Three patients were still undergoing CAPD with satisfactory ultrafiltration and solute cl earance. None of the patients developed relapse of TBP, We concluded t hat (1) TBP is a rare but important complication of CAPD, (2) removal of the Tenckhoff catheter is not mandatory in the management of TBP co mplicating CAPD, and (3) long-term continuation of CAPD is possible af ter TBP. (C) 1996 by the National Kidney Foundation, Inc.