Peritoneal tuberculosis in patients receiving continuous ambulatory peritoneal dialysis

Background. Patients with chronic renal failure have an increased risk of t uberculosis (TB). This occurs with much higher frequency within the first 1 2 months of initialing dialysis and is usually extrapulmonary in nature. Pa tients most at risk are those from susceptible ethnic groups, especially th e Indian subcontinent. Peritoneal TB, otherwise relatively uncommon, has em erged as an important form of TB in patients undergoing continuous ambulato ry peritoneal dialysis (CAPD). Methods. All cases of peritoneal TB occurring at our institution in patient s undergoing CAPD over a 13 year period were identified and analysed. Results. Eight cases were identified, of which seven were non-Caucasian. Th ese patients' characteristics and outcomes are presented. All were undergoi ng CAPD and most developed TB within 12 months of initiating dialysis. All presented with fever, but symptoms and signs were indistinguishable from ba cterial peritonitis. Six were culture-positive, mainly from peritoneal dial ysis fluid, but only two cases proved smear-positive. All were treated with standard anti-tuberculous chemotherapy. Three went on to permanent haemodi alysis as a result of peritonitis and three have died, one of these as a re sult of TB. Conclusions. Peritoneal TB, whilst otherwise relatively uncommon, is an imp ortant manifestation of TB in CAPD patients and usually develops soon after commencing dialysis. The reasons for this are unknown and require further research.