Systematic Review on Treatment and Outcomes of Tuberculous Peritonitis in Patients on Peritoneal Dialysis

Chau Wei Ling; Kamal Sud; Ronald L Castelino; David W Johnson; Trevor H Y Tan; Vincent W Lee

doi:10.1016/j.ekir.2023.11.012

Systematic Review on Treatment and Outcomes of Tuberculous Peritonitis in Patients on Peritoneal Dialysis

Kidney Int Rep. 2023 Nov 19;9(2):277-286. doi: 10.1016/j.ekir.2023.11.012. eCollection 2024 Feb.

Authors

Chau Wei Ling¹, Kamal Sud^{2

3

4}, Ronald L Castelino^{1

5}, David W Johnson^{4

6

7

8}, Trevor H Y Tan⁹, Vincent W Lee^{10

11

12}

Affiliations

¹ Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia.
² Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Sydney, New South Wales, Australia.
³ Peritoneal Dialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, New South Wales, Australia.
⁴ Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry Peritoneal Dialysis Working Group, Adelaide, South Australia.
⁵ Department of Pharmacy, Blacktown Hospital, Blacktown, New South Wales, Australia.
⁶ Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.
⁷ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia.
⁸ Translational Research Institute, Brisbane, Australia.
⁹ National Centre for Infectious Diseases, Singapore.
¹⁰ Department of Renal Medicine, Westmead Hospital, New South Wales, Australia.
¹¹ Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Australia.
¹² Centre for Kidney Research, School of Public Health, The University of Sydney, New South Wales, Australia.

Abstract

Introduction: Peritoneal dialysis (PD)-associated peritonitis due to tuberculosis (TB) is associated with poor outcomes and optimal treatment strategies for this condition remain unknown. Our study aimed to: (i) systematically review the published literature on peritonitis caused by Mycobacterium tuberculosis in patients on PD and (ii) review cases of peritonitis due to M tuberculosis in patients on PD reported in Australia and New Zealand to determine the epidemiology, management strategies, and outcomes of this condition.

Methods: A literature search of Medline, Scopus, Embase, ClinicalTrials.gov, Cochrane CENTRAL Register of Controlled Trials and Google Scholar for articles published from inception date to June 2022 was conducted. To be eligible, articles had to describe patient characteristics, initial anti-TB therapy, and treatment outcomes in all patients on PD with peritonitis caused by M tuberculosis. Data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry of patients on PD who developed peritonitis due to M tuberculosis between September 2001 and December 2020 were included and analyzed.

Results: The systematic literature review identified 70 case studies (151 patients) and 8 cohort studies (97 patients), whereas the ANZDATA Registry identified 17 cases of peritonitis due to M tuberculosis. Overall, in patients diagnosed with peritonitis due to M tuberculosis, the rates of PD catheter removal and permanent transfer to hemodialysis (HD) were numerically higher in the ANZDATA Registry cases (82%) than in the case studies (23%) and cohort studies (20%). Observed all-cause mortality rates were also higher as observed in the case studies (33%) and cohort studies (26%) than in the ANZDATA Registry cases (6%).

Conclusion: Tuberculous peritonitis is uncommon in patients on PD and is associated with poor outcomes. Prospective studies are warranted to study the effect of retaining PD catheters after M tuberculosis infection on patient outcomes.

Keywords: Mycobacterium tuberculosis; antituberculosis regimen; outcomes; peritoneal dialysis; peritonitis; treatment.