Consensus Guidelines for the Treatment of Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis

Although the diagnostic criteria for peritonitishave not been validated in clinical studies, they rep-resent an international consensus among adult andpediatric nephrologists (4–11). Abdominal pain andfever are generally features that are too nonspecificin children to predict peritonitis in the absence of anelevated dialysate leukocyte count. If the effluent iscloudy, the initial sample is optimal for evaluation,irrespective of the length of the exchange dwell time.In equivocal cases, or in patients on cycler dialysiswith short exchange dwell times and with systemicor abdominal symptoms, and in whom the effluentappears to be clear, a second exchange is performedwith a dwell time of at least 1 hour and the appear-ance of the effluent is re-evaluated. It is noteworthythat 6% of adults with culture-positive peritonitispresent with clear fluid and abdominal pain (10).(Only two thirds of these patients subsequently de-velop cloudy effluent.) Dialysate culture results aretypically not available before 24 hours and, albeit con-firming the diagnosis in retrospect, are not helpfulin initial clinical decision making. A negative cul-ture does not exclude bacterial peritonitis. In up to20% of pediatric peritonitis episodes, culture resultsare negative (4,11–14).Eosinophilic peritonitis (diagnosed when eosi-nophils represent more than 10% of the total di-alysate polymorphonuclear leukocyte count) iscommonly associated with the development ofcloudy effluent in an asymptomatic patient new todialysis. It is likely secondary to a local allergicreaction to components of the dialysis fluid or sub-stances released from the dialysis equipment. It istypically self-limited (4,10).