Early-onset peritonitis and outcomes in peritoneal dialysis: mortality and technique failure in a retrospective Peruvian cohort

Joseph V. Pezo-Medina, Servicio de Nefrología, Departamento de Medicina Interna, Hospital II-2 Tarapoto, Perú; Facultad de Medicina, Universidad Nacional de San Martín, Perú
Isabel Saravia, Departamento Médico, Vantive, Bogotá D.C., Colombia
Linda M. Ibatá-Bernal, Departamento de epidemiología, EpiThink Health Consulting, Bogotá D.C., Colombia

Background: Peritoneal dialysis (PD) sustainability is threatened by peritonitis. The timing of the first episode may carry prognostic value in Latin American programs. Objective: To assess whether early-onset peritonitis is associated with higher all-cause mortality compared with no peritonitis or late-onset peritonitis; to describe incidence and microbiology; to estimate technique failure using competing risks; and to explore diabetes effect modification. Methods: A retrospective cohort was conducted at a public hospital in Peru (2020–2024) including incident adult PD patients with at least one follow-up visit. The exposure was the first peritonitis timing. Outcomes were all-cause mortality, technique failure, modeling death as a competing event. Peritonitis incidence and microbiology were estimated. Adjusted multivariable Cox models, Fine–Gray subdistribution hazards for technique failure and incidence rates via Poisson with 95% CIs were utilized. Sensitivity analyses (60/120-day cutoffs; culture-confirmed episodes) were performed. Results: 123 participants were included (59% female; mean age 52.8 years). Exposure groups: none 77 (63%), early 10 (8%), late 36 (29%). There were 39 deaths (25.0 per 100 person-years). We recorded 68 peritonitis episodes in 46 patients; incidence rates were 186.9 (early) and 69.4 (late) per 100 person-years. Adjusted Cox: HR 2.29 (early vs none) and 0.97 (late vs none). Fine–Gray: adjusted SHR 1.50 (early) and 1.30 (late). Sensitivity analyses strengthened the early-onset association when restricting to culture-confirmed events. Conclusions: Early-onset peritonitis marks a high-risk window in PD. Programmatic strategies—reinforced training, rapid evaluation pathways, and telemonitoring—may reduce early events.

Keywords: Peritonitis. Peritoneal dialysis. Mortality. Competing risks. Telemedicine. Incidence. Latin America.