Mycobacterium tuberculosis peritonitis in peritoneal dialysis patients: A scoping review

Abstract

Background: The clinical syndrome of Mycobacterium tuberculosis (M. tuberculosis) peritoneal dialysis (PD) peritonitis is poorly understood. Whether local tuberculosis (TB) patterns modify the clinical syndrome, and what factors associate with poor outcomes is also unknown.Methods: A scoping review identified published cases of TB PD peritonitis. Cases from low-and high-TB burden areas were compared, and cases that did or did not suffer a poor clinical outcome were compared.Results: There were 216 cases identified. Demographics, presentation, diagnosis, treatment and outcomes were described. Significant delays in diagnosis were common (6.1 weeks) and were longer in patients from low-TB burden regions (7.3 vs. 3.7 weeks). In low-TB burden areas, slower diagnostic methods were more commonly used like PD fluid culture (64.3% vs. 32.7%), and treatment was less likely with quinolone antibiotics (6.9% vs. 34.1%). Higher national TB incidence and lower GDP per capita were found in cases that suffered PD catheter removal or death. Diagnostic delays were not longer in cases in which a patient suffered PD catheter removal or death. Cases that suffered death were older (51.9 vs. 45.1 years) and less likely female (37.8% vs. 55.7%). Removal of PD catheter was more common in cases in which a patient died (62.0% vs. 49.1%).

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

“…378 Measurement of adenosine deaminase in the peritoneal dialysate is a screening test but its specificity is not sufficiently high enough. Another reliable and more rapid adjunctive tool is PCR analysis to detect M. tuberculosis DNA, 377,379 although its sensitivity is insufficient to exclude tuberculosis.…”

“…PD catheter removal was not associated with an increased probability of survival. 377 Early diagnosis is essential in the management of tuberculous peritonitis complicating PD because treatment delay is the only significant factor predicting mortality.…”

Tuberculous peritonitis in patients on peritoneal dialysis: a 35-year experience from a large medical center in Northern Taiwan

“…In previous literature, the mortality of PD patients with TBP has been reported to range from 18 to 58% [ 4–6 , 11–13 , 21 , 23 , 24 ]. One study from the United Arab Emirates reported that all 4 patients with catheter removal survived infection for 3 years [ 22 ].…”

“…also reported that the risk of TB infection in CAPD was 11 times higher in females than in males [ 3 ]. However, a scoping review of MTB peritonitis in PD patients reported that in a cohort of patients with TB PD peritonitis, the 45 patients who died were less likely to be female (37.8%) [ 24 ]. The relationship between sex and mortality in PD patients with TBP is still inconclusive.…”

“…The more critical point was early diagnosis and appropriate therapy before the decision of catheter removal [ 4 ]. A scoping review of MTB peritonitis in PD patients also indicates that catheter removal is not associated with an increased probability of survival [ 24 ]. The 2022 ISPD peritonitis guidelines and most studies do not believe that catheter removal is mandatory [ 4 , 5 , 11–13 , 21 , 27 , 32 ].…”