Prophylactic antibiotics in the insertion of Tenckhoff catheters.

We assessed the efficacy of preoperative antibiotic prophylaxis in a prospective trial for patients undergoing insertion of Tenckhoff catheters for continuous ambulatory peritoneal dialysis (CAPD). The prophylactic regimen was a single dose of cefazolin (500 mg) and gentamicin (80 mg) given intravenously half an hour before surgery. There was no significant difference in the number of exit site infections (8 in the antibiotic group vs. 8 in the controls) and the number of episodes of peritonitis (5 in the antibiotic group vs. 2 in the controls). Our study showed that prophylactic preoperative antibiotics did not reduce the number of exit site infections and peritonitis after the insertion of Tenckhoff catheters.     

Successful treatment of Pseudomonas peritonitis during continuous ambulatory peritoneal dialysis

Successful eradication of Pseudomonas peritonitis is described in 12 (57%) of 21 cases from a large continuous ambulatory peritoneal dialysis (CAPD) program at a tertiary care center. In successful cases, cure was achieved within 17 days using therapy which included aminoglycoside started routinely at the onset of symptoms and an antipseudomonal penicillin or cephalosporin derivative added as soon as pseudomonas infection was identified on culture. Of the 9 treatment failures which required catheter removal, 2 had failure of peritoneal drainage, 4 had infection with multiple and/or drug-resistant Pseudomonas strains, and 3 had persistent catheter tunnel infection which resulted in recurrent Pseudomonas peritonitis. Factors such as diabetes mellitus and pediatric age group did not prevent successful medical therapy. Predisposing factors favoring development of Pseudomonas peritonitis included technical failures and in a few cases recent antibiotic therapy. We conclude that Pseudomonas peritonitis complicating CAPD can be successfully cured without catheter removal or discontinuation of CAPD in many cases, particularly when complicating factors are not present.     

A five-year study of the microbiologic results of exit site infections and peritonitis in continuous ambulatory peritoneal dialysis

We studied the culture results from 321 continuous ambulatory peritoneal dialysis (CAPD) related infections (exit site, tunnel infections, and peritonitis) in 137 patients over a 5-year period to determine the contribution of exit site and tunnel infections to peritonitis and catheter loss. Seventeen percent of peritonitis episodes were associated temporally and by microbiologic results with exit site or tunnel infections. Twenty-one percent of exit site and tunnel infections and 20% of peritonitis episodes resulted in catheter loss. Peritonitis due to Staphylococcus aureus was more likely to be associated with an exit site or tunnel infection and was more likely to result in loss of the catheter than peritonitis due to Staphylococcus epidermidis. Peritonitis and exit site infections due to Pseudomonas sp also frequently resulted in catheter removal. We found that exit site infections cause significant morbidity in CAPD patients. Further studies in this area are needed.     

The clinical course of peritoneal dialysis-related peritonitis caused by Corynebacterium species.

BACKGROUND: Corynebacterium species are part of the normal skin flora. The incidence of nosocomial infections caused by Corynebacterium species have increased substantially over the past two decades. However, the clinical course of Corynebacterium peritonitis complicating peritoneal dialysis remains unclear. METHOD: We reviewed all the Corynebacterium peritonitis in our dialysis unit from 1995 to 2002. During this period, there were 1485 episodes of peritonitis recorded; 27 (1.8%) of which were caused by Corynebacterium species. RESULTS: The underlying renal diagnosis and prevalence of comorbid conditions of the 27 patients were similar to our whole dialysis population. The bacteria isolated were resistant to penicillin in 8 cases (29.6%). Three cases (11.1%) had concomitant exit-site infection. The overall primary response rate was 74.1%; the complete cure rate was 37.0%. Episodes that received vancomycin as initial antibiotic had a marginally higher primary response rate (9 in 10 vs 11 in 17 episodes, P = 0.2) and complete cure rates (7 in 10 vs 3 in 17 episodes, P = 0.12) than the episodes that received cephalosporins, although neither of the differences was statistically significant. Thirteen cases (48.1%) had recurrent peritonitis after antibiotic therapy, 8 of which had the recurrent episode at least 30 days after stopping antibiotics (median 54 days, range 43-60 days). Eight recurrent cases (61.5%) were successfully cured by another 3 week course of intra-peritoneal vancomycin. CONCLUSIONS: Recurrent Corynebacterium peritonitis is common after a 2 week course of antibiotics. Recurrent Corynebacterium peritonitis may be delayed up to 2 months after the antibiotic is stopped. Recurrent peritonitis can usually be cured with a 3 week course of intra-peritoneal vancomycin, which is probably the preferred antibiotic regimen for Corynebacterium peritonitis.     

Surgical management of peritoneal dialysis catheters in children: five-year experience with 1,800 patient-month follow-up

Currently at our institution more than 90% of the children with end-stage renal disease are managed with continuous ambulatory peritoneal dialysis (CAPD) in preference to hemodialysis until a successful transplant is accomplished. Recent refinements in CAPD catheters and dialysis techniques have greatly added to the many medical, psychological, and economic advantages of CAPD compared with chronic hemodialysis. Ninety-three patients less than 21 years of age underwent insertion of 167 peritoneal dialysis (PD) catheters over a 5-year period. A variety of PD catheters were used, including 121 (73%) double-cuff Tenckhoff catheters, 22 (13%) single-cuff, and 24 (14%) column disc catheters (Lifecaths, Physio-Control Corp, Redmond, WA). There were three (3%) noncatheter-related mortalities and minimal significant morbidity during the 1,819 patient-months of catheter use. Exit site infections (61%) and peritonitis (59%) were frequent but minor complications, occasionally requiring catheter replacement. Other noninfectious complications included abdominal hernias (42%), dialysis leaks (14%), distal cuff extrusion (11%), catheter obstruction (7%), and hydrothorax (2%). Forty-five of the 60 hernias (75%) were surgically repaired in patients while receiving CAPD. Persistent or recurrent peritonitis was common with Pseudomonas, Serratia, and fungal infections and often resulted in catheter removal and loss of the peritoneal dialysis membrane. Catheter survival for the double-cuff Tenckhoff was significantly better (P .005) than the single-cuff or Lifecath. Based on this experience we have found that using specific operative techniques for CAPD catheter placement and early surgical management for severe peritonitis reduces the incidence of complications and modality failure.     

Enterobacteriaceae peritonitis complicating peritoneal dialysis: a review of 210 consecutive cases

Enterobacteriaceae peritonitis is a serious complication in peritoneal dialysis (PD), but the clinical course of PD-related Enterobacteriaceae peritonitis remains unclear. We reviewed all Enterobacteriaceae peritonitis in our dialysis unit from 1995 to 2004. During this period, there were 1748 episodes of peritonitis recorded; 210 episodes (12.0%) in 123 patients were caused by Enterobacteriaceae. The most common species was Escherichia coli, accounting for 111 episodes. The primary response rate was 84.8% and complete cure rate was 58.1%. The presence of exit site infection was associated with a lower complete cure rate (43.2 versus 61.3%, P = 0.034). A total of 82 episodes (39.0%) did not respond to single antibiotic treatment despite sensitivity in vitro, and a second antibiotic was added. Patients treated with two antibiotics had a marginally lower risk of relapse and recurrence than those with one antibiotic (21.4 versus 36.1%, P = 0.051). The episodes that had recent antibiotic therapy had a marginally lower complete cure rate (49.3 versus 62.8%, P = 0.06). There was a gradual increase in the prevalence of resistance to several commonly used antibiotics over the years. Recent antibiotic therapy was associated with resistance to cefotaxime, ceftazidime, cefoperazone/sulbactam, and piperacillin/tazobactam. We conclude that Enterobacteriaceae peritonitis is a serious complication of PD. Recent antibiotic therapy is the major risk factor of antibiotic resistance. Exit site infection, and probably recent antibiotic therapy, is associated with poor therapeutic response. Contrary to the current recommendation, treatment with two antibiotics may reduce the risk of relapse and recurrence.     

Treatment of fungal peritonitis complicating continuous ambulatory peritoneal dialysis with oral fluconazole: a series of 21 patients

Twenty-one episodes of fungal peritonitis occurred over 35 monthsamong 290 patients on CAPD, accounting for 6.3% of all peritonitisepisodes. Patients with more frequent bacterial peritonitiswere at higher risk of developing fungal peritonitis, and 28.6%of cases followed antimicrobial therapy. Candida species accountedfor 85.7% of cases. Oral fiuconazole was used as initial therapyin all patients, which was followed by catheter removal if peritonitisfailed to improve. The cure rate with fluconazole therapy alonewithout catheter removal was 9.5%. Fluconazole plus catheterremoval, the latter necessitated in 85.7% of cases, resultedin a cure rate of 66.7%. The remaining 3 (14.3%) patients respondedto intravenous amphotericin given as salvage therapy. Disease-relatedmortality was 14.3%. Reinsertion of dialysis catheter was attemptedin 15 patients and CAPD was successfully resumed in 13 (86.7%).We conclude that oral fluconazole can be safely used as initialtherapy in patients with fungal peritonitis complicating CAPD.Although catheter removal was necessary in the majority of patients,this sequential approach resulted in a relatively low prevalenceof peritoneal adhesions and subsequent CAPD failure.     

Peritoneal dialysis access: prospective randomized comparison of single-cuff and double-cuff straight Tenckhoff catheters

Background: A prerequisite to the technical success of chronic peritoneal dialysis is a functioning peritoneal catheter. The option of using Tenckhoff catheters with single or double Dacron cuffs has been available for almost 3 decades, but still there is no consensus as to which is the preferable type. Methods: Sixty consecutive patients requiring a catheter for CAPD were randomized to receive either a straight deep single-cuff Tenckhoff catheter or a double-cuff Tenckhoff catheter. The catheters were surgically inserted. Results: There were no early failures. Two subcutaneous cuff extrusions were treated with shaving of the cuff. In the long term, eight patients in both groups required transfer to haemodialysis (5 and 3 prolonged peritonitis, 1 and 0 exit-site infection, 2 and 5 unable to cope or inadequacy of dialysis). There was no significant difference in the probability of developing first episode or peritonitis or exit site infection between the groups. Overall probability of catheter survival was 95.5 and 96.7% at 1 year, 82.7 and 79.9% at 2 in the two groups respectively. Conclusions: There was no significant difference between catheters with single or doble cuffs with respect to catheter survival, episodes of peritonitis and exit-site infections.     

Fungal peritonitis during continuous ambulatory peritoneal dialysis: a report of 17 cases

Seventeen cases of fungal peritonitis and one case of Nocardia asteroides peritonitis were observed in 141 patients during the first 5 years of our continuous ambulatory peritoneal dialysis program (CAPD). Fungal peritonitis accounted for 7% of the episodes of peritonitis observed in this interval. There were eight deaths associated with fungal peritonitis. In only three instances could factors predisposing to fungal peritonitis be identified. We were unable to predict who would develop fungal peritonitis by analysis of nutritional, demographic, or technical factors associated with the dialysis procedure. The diagnosis of fungal peritonitis was easily established using routine blood agar culture techniques. Successful management of these patients included prompt removal of the Tenckhoff catheter and intravenous (IV) administration of amphotericin.     

Brucella peritonitis in a patient on continuous ambulatory peritoneal dialysis with acute brucellosis

Peritonitis is an uncommon complication of brucellosis. Brucella peritonitis in chronic ambulatory peritoneal dialysis (CAPD) patients has not been reported before. A male patient is presented with peritonitis caused by Brucella melitensis who was on CAPD. The source of infection was thought to be unpasteurized, unsalted cheese eaten a month before the onset of symptoms. At the beginning, antibiotic therapy with doxycyline and rifampicin led to a rapid clinical improvement, with disappearance of the organism in the peritoneal fluid. However, peritonitis relapsed after discontinuation of antimicrobial therapy. Successful management required a combination of medical therapy and removal of the Tenckhoff catheter.     

Persistence of Candida despite seemingly adequate systemic and intraperitoneal amphotericin B treatment in a patient on CAPD

A case of Candida peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD) is presented. Despite 2 weeks of intravenous and 4 weeks of intraperitoneal amphotericin B, good clinical response, and repeatedly negative fungal cultures from the peritoneal dialysate, her Tenckhoff catheter upon removal grew the same Candida species. This case emphasizes the point that Candida may persist on the catheter despite seemingly adequate antifungal treatment and good clinical and microbiologic response.     

Peritonitis secondary to dialysis tubing contamination among patients undergoing continuous ambulatory peritoneal dialysis

Patients were asked to report all dialysis system contaminations occurring from December 1985 through May 1988 to the home training facility. There were 74 instances of peritoneal dialysis system contamination, 20 of which resulted in peritonitis. Prophylactic antibiotics were used in 48 of 54 episodes not resulting in peritonitis. Three cultures yielded gram-positive organisms without clinical peritonitis becoming evident. Fourteen of the 20 episodes of peritonitis had received antibiotics prophylactically. System contaminations were classified into tears or holes of the catheter at the adapter on the Tenckhoff catheter or at the tubing connection to the dialysate bag and breaks of the connecting devices from either dialysis catheter to dialysis tubing or dialysis tubing to dialysate bag. System contaminations accounted for 20 of the 333 episodes of peritonitis that occurred during this time. Identifying system contamination is useful because prophylactic antibiotic therapy may prevent peritonitis.     

The use of intracatheter instillation of streptokinase in the treatment of recurrent bacterial peritonitis in continuous ambulatory peritoneal dialysis

Recurrent bacterial peritonitis resistant to therapy with antibiotics is seen in a small percentage of patients maintained on continuous ambulatory peritoneal dialysis. In these patients, removal of the Tenckhoff catheter is necessary to achieve a cure. Sequestration of bacteria within fibrin clots located on the catheter has been postulated to contribute to this resistance to standard therapy. We, therefore, examined the efficacy of intraperitoneal streptokinase in combination with antibiotic therapy in the treatment of two patients with recurrent bacterial peritonitis. After addition of streptokinase to the therapeutic regimen, no further episodes of peritonitis were observed after 6 to 8 weeks follow-up. These data suggest that intraperitoneal streptokinase may be useful as adjunctive therapy in the treatment of recurrent bacterial peritonitis.     

Predictors of the outcome following peritoneal dialysis-related bacterial-complicating peritonitis

Objective To investigate the risk factors predicting the outcome of peritoneal dialysis (PD)-related bacterial-complicating peritonitis. Methods In this retrospective study, all the episodes of PD-related bacterial peritonitis presenting during Jan 2009 to Dec 2013 in our center were reviewed. Clinical and laboratory parameters at the onset of peritonitis, including patient demographic information, age, gender, duration of PD, residual renal function, local and systemic inflammation state, daily exchange number, peritoneal glucose exposure and so on, were recorded. Patients episodes were divided into three groups according to the outcome: complete cure (complete resolution of peritonitis without relapse or recurrence or repeat), peritonitis-related catheter removal/death group, and relapse (relapse or recurrence or repeat) group. Results 187 CAPD patients with 27.15(11.15, 53.13) PD duration were enrolled in the study. Total of 347 episodes of bacterial peritonitis in these patients were analyzed, with 130 episodes of gram-positive bacterial infection, 71 episodes of gram-negative bacterial infection, 15 episodes of polymicrobial and 131 episodes of cultured negative. Compared to the complete cure group and the relapse group, gram negative bacterial infection was more prevalent in the peritonitis-related catheter removal/death group. Furthermore, patients in the peritonitis-related catheter removal/death group showed longer PD age (P﹤0.01) and higher serum hs-CRP (P﹤0.01). Compared to the complete cure group, the serum albumin concentration was lower in the peritonitis-related catheter removal/death group (P﹤0.01). Kt/V was significantly lower in the relapse group than that in the complete cure group (P﹤0.05). Logistic analysis indicated age, non gram positive bacterial infection and increased hs-CRP were independent predictors for peritonitis-related catheter removal or death. Conclusions Age, non gram positive bacterial infection and hs-CRP are risk factors predicting peritonitis-related catheter removal or death in CAPD patients.     

Clinical outcomes of systemic lupus erythematosus patients undergoing continuous ambulatory peritoneal dialysis.

OBJECTIVES: The purpose of this study was to evaluate the outcome of systemic lupus erythematosus (SLE) patients on continuous ambulatory peritoneal dialysis (CAPD). METHODS: Eighteen SLE patients who had been undergoing CAPD for at least 3 months in our unit were compared with 36 other age- and gender-matched non-diabetic CAPD patients with an underlying primary chronic glomerulonephritis (CGn). The clinical outcome, infective complications, lupus activities, biochemical parameters, haemoglobin level and the use of erythropoietin were reviewed. RESULTS: The duration of dialysis of the two studied groups was not different, with a mean of 35.4 months for the SLE group and 36.7 months for the CGn group. Before dialysis, SLE patients had a significantly lower albumin level (30.4+/-6.6 vs 35.4+/-5.59 g/dl, P<0.01), while the mean haemoglobin levels of the two groups were similar (8.5+/-1.8 g/dl for SLE vs 9.0+/-1.9 g/dl for the control group). However, the weekly dose of erythropoietin (EPO) used was significantly higher in the SLE group (6000 vs 3818 U/week, P<0.01) to maintain a similar haemoglobin level during dialysis. Regarding the infective complications, the SLE group had a higher peritonitis rate (5.7 episodes/100 patient-months vs 2.4 episodes/100 patient-months, P<0.05), and an increase in the non catheter related infection rate (6.67 episodes/100 patient-months vs 1.1 episodes/100 patient-months, P<0.001). However, no significant difference could be demonstrated in the Tenckhoff catheter exit site infection rate (2 episodes/100 vs 1.7 episode/100 patient-months). The number of patients who received a kidney transplant or required a change of mode to haemodialysis was similar among the two groups. Seven patients died during the follow-up period, and the overall mortality rate was much higher in the SLE group than in the control group (0.83/100 vs 0.15/100 patient-months, P<0.05). CONCLUSIONS: SLE patients on CAPD have a significantly lower pre-dialysis serum albumin level and use a higher dose of Epo to achieve a comparable haemoglobin level than other non-diabetic CGn CAPD patients. They also have a poorer prognosis in terms of infective complications and mortality rate.     

Vancomycin and tobramycin in the treatment of CAPD peritonitis

Seventy-five episodes of continuous ambulatory peritoneal dialysis (CAPD) peritonitis were studied during a 1 year period at the Queen Elizabeth Hospital, Birmingham. When two simple culture methods were used in parallel, the causative organisms were identified in 97% of cases. Nearly two thirds of episodes of peritonitis were caused by coagulase-negative staphylococci (C-NS), many of which were multiply antibiotic-resistant. On the basis of detailed antibiotic sensitivities, intraperitoneal vancomycin and tobramycin were chosen for the initial treatment of CAPD peritonitis. With this regime, a cure was achieved in 32 of 38 episodes, compared with 15 of 27 episodes when cefuroxime was used. All but 1 of 24 episodes caused by C-NS were cured by vancomycin.     

双涤纶套鹅颈管与Tenckhoff管在腹膜透析患者中的疗效比较

目的 比较双涤纶套鹅颈管与Tenckhoff管在持续性非卧床腹膜透析（CAPD）患者中的临床疗效。 方法 前瞻性入选首次植管并接受CAPD治疗的终末期肾脏病（ESRD）患者110例，随机分为鹅颈管组（A组）和Tenckhoff管组（B组），各55例。腹透管末端均为直型，以常规手术法植入，随访1年。记录并发症、生存时间、退出透析或死亡等结局。采用Kaplan-Meier法、Log-Rank检验进行生存分析。 结果 随访结束时，110例CAPD患者中17例死亡，3例转为肾移植，8例转为血液透析治疗，3例转至其他医院，79例（71.8％）继续在我院腹透治疗。两组患者共发生腹膜炎26例（35例次），总腹膜炎发生率为0.32次/病人年，A组为0.35次/病人年和B组为0.29次/病人年（P > 0.05）。植管距离首次腹膜炎时间分别为A组（30±29）周和B组（29±24）周（P > 0.05）。12个月时两组发生腹膜炎的风险同为26.97％。两组共发生隧道感染2次，出口感染9次，隧道及出口感染的发生率为0.1次/病人年。与A组比较，B组隧道感染（0.036次/病人年比0）和出口感染（0.11次/病人年比0.06次/病人年）发生率较高，但差异无统计学意义（P > 0.05）。两组间导管机械并发症（导管移位、大网膜包裹、腹透液渗漏、外涤纶套滑出）、腹股沟疝及腹痛的发生率差异均无统计学意义（P > 0.05）。两组各有4例拔管，12个月技术生存率两组同为92.73％。两组共17例死亡（15.45％），其中A组死亡7例，B组死亡10例（P > 0.05），死亡原因主要为心脑血管并发症（47.1％）和感染（23.5％）。患者12个月生存率A组为86.34％，B组为80.68％（P > 0.05）。 结论 鹅颈管与Tenckhoff管应用于CAPD患者，在感染并发症与机械并发症的发生率、12个月技术生存率及患者生存率等方面的差异均无统计学意义，两种腹透管的疗效相近。     

Algal peritonitis complicating continuous ambulatory peritoneal dialysis

A 41-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) presented with algal peritonitis. Prototheca wickerhamii was isolated from multiple dialysate effluent cultures. Despite treatment with amphotericin B, catheter removal was required. An attempt to reinsert a Tenckhoff catheter 3 months later was unsuccessful because of dense intraperitoneal adhesions. Prototheca sp are a rare cause of human disease, this being the first reported case of algal peritonitis complicating CAPD.     

Peritoneal dialysis-associated peritonitis in Scotland (1999-2002).

BACKGROUND: Peritonitis is a major complication of peritoneal dialysis (PD). We have performed a national study of all patients on PD in Scotland over a 3.5 year period examining the causes of technique failure, rates of peritonitis, causative organisms, clinical outcomes and differences between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). METHODS: All 10 adult renal units in Scotland participated in the study and the data include all 1205 patients who were on PD in Scotland from January 1999 to June 2002. The data were collected prospectively by the PD nurses and reported to the Scottish Renal Registry every 6 months. RESULTS: Refractory or recurrent peritonitis was the cause of technique failure in 167 patients (42.6% of all cases of technique failure). There were 928 cases of peritonitis in 1487 patient-years, which equates to an overall peritonitis rate of one episode every 19.2 months. The peritonitis rates for APD and CAPD were similar at one episode every 20.3 months and one episode every 18.6 months, respectively. These results include 88 cases of peritonitis due to relapse or re-infection. There was a statistically significant difference (P = 0.012) in peritonitis rates between units using nasal mupiricin (one episode every 21.9 months) and those that did not (one episode every 18.3 months). Coagulase-negative Staphylococcus was the most common cause of peritonitis (29%), although this rate is lower than in historic studies. The overall initial cure rate was 75%. The initial cure rate for APD was 77.2% and for CAPD was 73.7%. No causative organism was isolated in 17% of cases. CONCLUSION: PD-associated peritonitis is the leading cause of technique failure in Scotland. We validate previous studies showing a decrease in the proportion of peritonitis episodes that are caused by coagulase-negative staphylococci. APD peritonitis rates are not significantly better than CAPD peritonitis rates in Scotland, and the initial cure rates for APD and CAPD are similar.     

Feasibility of resuming peritoneal dialysis after severe peritonitis and Tenckhoff catheter removal

Published guidelines suggest that after an episode of severe peritonitis that requires Tenckhoff catheter removal, peritoneal dialysis can be resumed after a minimum of 3 wk. However, the feasibility of resuming peritoneal dialysis after Tenckhoff catheter removal remains unknown. One hundred patients were identified with peritonitis that did not respond to standard antibiotic therapy in a specific center. Their clinical course was reviewed; in all of them, Tenckhoff catheters were removed and reinsertion was attempted at least 4 wk later. In 51 patients, the Tenckhoff catheter was successfully reinserted and peritoneal dialysis was resumed (success group). In the other 49 patients, reinsertion failed and the patient was put on long-term hemodialysis (fail group). The patients were followed for 18.5 +/- 16.8 mo. The overall technique survival was 30.8% at 24 mo. In the success group, 11 patients were changed to long-term hemodialysis within 8 mo after their return to continuous ambulatory peritoneal dialysis. In the fail group, 18 of the 20 deaths occurred within 12 mo after conversion to long-term hemodialysis. After resuming peritoneal dialysis, there was a significant decline in net ultrafiltration volume (0.38 +/- 0.16 to 0.21 +/- 0.19 L; P = 0.03) and a trend of rise in dialysate-to-plasma ratios of creatinine at 4 h (0.664 +/- 0.095 to 0.725 +/- 0.095; P = 0.15). Forty-five patients (88.2%) required additional dialysis exchanges or hypertonic dialysate to compensate for the loss of solute clearance or ultrafiltration, although there was no significant change in dialysis adequacy or nutritional status. It was concluded that after an episode of severe peritonitis that required Tenckhoff catheter removal, only a small group of patients could return to peritoneal dialysis. An early assessment of peritoneal function after Tenckhoff catheter reinsertion may be valuable.