A close look at peritonitis in Saudi Arabia

Identifying high rates of peritonitis in children undergoing dialysis at a Saudi hospital will stimulate a strategy for improvement

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A study of Saudi children receiving peritoneal dialysis to treat kidney disease reveals a worryingly high rate of peritonitis – an infection in the lining of the abdominal cavity. 

Peritonitis is a key factor leading to treatment failure for peritoneal dialysis and poor outcomes for patients, including other diseases and death

Peritoneal dialysis uses a tube inserted through the wall of the peritoneum to flush out the toxins that accumulate in a patient’s abdomen when their kidneys are failing. It is often used as an alternative to hemodialysis, which directly extracts and cleanses the blood, as it can bring better outcomes for patients in many circumstances. 

“Peritonitis is a frequent complication among children, [but its incidence] has not been widely reported in Saudi Arabia,” say the KAIMRC-based authors of the research report. To fill this gap, they turned to the medical records of children at King Abdullah Specialist Children’s Hospital-Riyadh (KASCH-R), in Saudi Arabia.

The researchers looked at the medical history of 27 children who received peritoneal dialysis between September 2007 and December 2017. They identified 86 diagnoses of peritonitis, with around two-thirds of the children experiencing at least two episodes of the condition. 

This rate of peritonitis is high when compared with data from other countries and above the acceptable levels set out in the recommendations of the International Society for Peritoneal Dialysis. This KAIMRC study supports similar, albeit limited, findings from some previous studies of Saudi patients.

The key challenge for the researchers was to try to identify the reasons for the higher rates of peritonitis in the Saudi hospital, and to come up with interventions to tackle the problem. 

“We tested the hypothesis that certain demographic and clinical factors may be associated with the high frequency of peritonitis,” the authors report.

They managed to determine several variables that could increase the likelihood of developing peritonitis, such as being female and older. Coming from a low socioeconomic background, and being shorter and lighter than average could also increase the probability. 

The team also found that having the kidney condition called congenital nephrosis, some specific biochemical indicators of disease, and having undergone long-term treatment with antibiotics were also risk factors that increased the odds of children developing peritonitis.

Armed with these insights, the research team now plan to develop “an optimal peritonitis prevention strategy or best-practice guideline” in order to try to reduce and prevent peritonitis occurrence at their centre. Their strategy could also be applied more widely throughout Saudi Arabia and elsewhere.

References

  1. Al Mokali, K., Al Sannaa, Z., Al Mutairi, F., Ahmed, A. E.  Factors influencing occurrence of peritonitis in Saudi children on peritoneal dialysis. BMC Pediatrics 20:42 (2020) | article

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