Tuberculous peritonitis in patients on peritoneal dialysis: a 35-year experience from a large medical center in Northern Taiwan

Figures & data

Figure 1. Mean PDE WBC count categorized according to PD catheter removal and mortality.

Table 1. Demographic and clinical features of PD patients with tuberculous peritonitis.

Patient number	Year of diagnosis	Gender	Age (years)	BMI (Kg/m2)	Cause of ESRD	PD vintage (days)	DM	Residual urine volume (ml)	PD modality	Fever	Cloudy effluent	Abdominal pain	Previous episodes of peritonitis	Extraperitoneal TB	Time from diagnosis to treatment initiation (days)
1	1998	Female	60.0	21.5	DM	217	Yes	300	CAPD	Yes	Yes	Yes	1	No	20
2	1999	Female	47.4	23.6	Unknown	1714	No	400	CAPD	Yes	Yes	Yes	0	No	17
3	2001	Male	19.0	23.2	Unknown	751	No	100	CAPD	Yes	Yes	Yes	1	No	13
4	2001	Female	57.5	20.3	DM	434	Yes	500	CAPD	Yes	Yes	Yes	0	No	8
5	2004	Male	44.0	22.5	CGN	912	No	700	CAPD	Yes	Yes	Yes	3	No	24
6	2004	Female	87.7	19.7	CGN	28	No	1000	CAPD	No	Yes	Yes	0	No	47
7	2004	Male	53.4	26.8	CGN	1930	No	0	CAPD	Yes	Yes	Yes	0	No	14
8	2005	Male	50.5	22.2	OU	66	No	800	CAPD	Yes	Yes	Yes	0	No	33
9	2007	Female	48.8	22.9	DM	249	Yes	700	CAPD	Yes	Yes	Yes	0	Yes (miliary)	1
10	2007	Female	63.4	18.1	CGN	2486	No	0	CAPD	Yes	Yes	Yes	4	No	25
11	2008	Female	49.6	20.8	DM	216	Yes	1900	CAPD	Yes	Yes	Yes	0	No	23
12	2011	Female	71.4	20.9	DM	463	Yes	600	CAPD	Yes	Yes	No	0	No	33
13	2012	Male	38.3	22.2	CGN	446	No	150	CAPD	Yes	Yes	Yes	0	Yes (lung)	5
14	2013	Male	82.2	25.1	DM	434	Yes	50	APD	Yes	Yes	Yes	0	No	9
15	2014	Female	32.3	17.8	CGN	1768	No	0	APD	Yes	No	Yes	0	No	14
16	2014	Male	71.7	25.4	CGN	1203	No	200	CAPD	Yes	Yes	No	2	No	36
17	2016	Female	76.9	25.1	DM	627	Yes	0	CAPD	Yes	No	No	0	No	18
18	2018	Male	62.4	18.2	CGN	3166	No	0	CAPD	Yes	No	Yes	1	No	19

BMI: Body mass index; ESRD: end stage renal disease; PD: peritoneal dialysis; TB: tuberculosis; DM: diabetes mellitus; CGN: chronic glomerulonephritis; OU: obstructive uropathy; CAPD: continuous ambulatory peritoneal dialysis; APD: automated peritoneal dialysis.

Table 2. Peritoneal dialysis effluent and blood laboratory parameters of PD patients with tuberculous peritonitis.

Patient number	Year of diagnosis	Peritoneal dialysis effluent							Blood
		WBC count (/μL)	Neutrophil (%)	Lymphocyte (%)	RBC count (/μL)	AFS smear	TB PCR	TB culture	WBC count (/µL)	Hemoglobin (g/dL)	Platelets count (1,000/μL)	CRP (mg/L)	BUN (mg/dL)	Creatinine (mg/dL)	Albumin (g/dL)
1	1998	235	81	19	16	Negative	x	Yes	9600	9.3	167	126.8	74	9.8	3.3
2	1999	190	85	15	12	Negative	x	Yes	8700	8.1	286	x	57	13.4	2.5
3	2001	80	45	10	30	Positive	x	Yes	6300	7.1	353	x	35	11.3	x
4	2001	246	80	20	30	Positive	x	Yes	9600	11.1	291	x	x	6.9	x
5	2004	27	44	53	3	Negative	x	Yes	16700	13	292	117.1	x	13.5	x
6	2004	93	99	1	2	Positive	x	Yes	12600	9.5	452	110.7	42	7.9	x
7	2004	97	95	5	4	Positive	Positive	Yes	14600	8.8	321	222.9	x	10.7	x
8	2005	320	42	58	10	Negative	x	Yes	6100	12.5	292	x	94	10.2	3.3
9	2007	370	78	14	95	Negative	x	Yes	7400	8.1	137	79.3	50	4.2	x
10	2007	262	84	16	17	Positive	x	Yes	8800	9.9	416	122.10	37	6.3	3.3
11	2008	128	86	14	0	Negative	Positive	Yes	12500	8.8	168	53.02	40	5.7	2.8
12	2011	75	89	11	5	Negative	x	Yes	7900	9.4	232	108.92	64.9	3.93	2.01
13	2012	281	99	1	8	Positive	Positive	Yes	9400	7.7	153	59.73	91.1	10.99	3.15
14	2013	590	88	11	25	Positive	Positive	Yes	10000	9.3	443	316.09	69.0	7.22	2.73
15	2014	31	39	61	2	Negative	Positive	Yes	6900	11.5	240	x	56.6	14.22	3.94
16	2014	24	82	18	0	Negative	x	Yes	5900	9	143	63.1	99.5	14.23	3.69
17	2016	50	74	26	0	Negative	x	Yes	12700	10.3	372	11	111.8	5.31	3.36
18	2018	10	30	28	12	Negative	x	Yes	4700	11.4	82	x	100.9	15.97	3.67

WBC: white blood cell; RBC: red blood cell; AFS: acid fast stain; TB: tuberculosis; PCR: polymerase chain reaction; CRP: C-reactive protein; BUN: blood urea nitrogen.

Table 3. Clinical outcomes of PD patients with tuberculous peritonitis.

Patient number	Year of diagnosis	PD catheter removed	Catheter removal day number post-peritonitis episode	Keep on PD	Transfer to HD	Death	Cause of death	Survival vintage (days)	Technique survival vintage (days)
1	1998	No	x	No	No	Yes	Sepsis	49	49
2	1999	Yes	92	No	Yes	No	x	x	98
3	2001	Yes	14	No	Yes	No	x	x	14
4	2001	No	x	No	No	Yes	Sepsis	305	305
5	2004	Yes	11	No	Yes	No	x	x	11
6	2004	No	x	No	No	Yes	Sepsis	55	55
7	2004	Yes	30	No	Yes	No	x	x	30
8	2005	Yes	8	No	Yes	No	x	x	8
9	2007	No	x	Yes	No	Yes	Sepsis	109	109
10	2007	Yes	23	No	Yes	No	x	x	23
11	2008	No	x	Yes	No	No	x	x	3997
12	2011	No	x	No	No	Yes	Sepsis	41	41
13	2012	Yes	4	No	Yes	No	x	x	4
14	2013	Yes	3	No	Yes	No	x	x	3
15	2014	Yes	17	No	Yes	No	x	x	17
16	2014	Yes	15	No	Yes	No	x	x	15
17	2016	No	x	No	No	Yes	Liver failure	87	87
18	2018	No	x	No	No	Yes	Sepsis	67	67

PD: peritoneal dialysis; HD: hemodialysis.

Table 4. Demographic features, clinical features, peritoneal dialysate effluent laboratory parameters, blood laboratory parameters, peritoneal membrane characteristics, and clinical outcomes of PD patients with TBP categorized according to 1-year mortality.

	Total (n = 18)	Survival (n = 11)	Death (n = 7)	p Value
Male	8 (44.4%)	7 (63.6%)	1 (14.3%)	0.040
Age (years)	56.5 ± 17.7	50.2 ± 17.8	66.4 ± 13.1	0.063
BMI (kg/m^2)	22.0 ± 2.6	22.5 ± 2.8	21.2 ± 2.2	0.277
Cause of ESRD				0.128
DM	7 (38.9%)	2 (18.2%)	5 (71.4%)
CGN	8 (44.4%)	6 (54.5%)	2 (28.6%)
OU	1 (5.6%)	1 (9.1%)	0 (0%)
Unknown	2 (11.1%)	2 (18.2%)	0 (0%)
PD vintage (days)	950.6 ± 904.7	1084.2 ± 795.0	740.6 ± 1087.1	0.239
DM	7 (38.9%)	2 (18.2%)	5 (71.4%)	0.024
Residual urine volume (ml)	411.1 ± 492.5	390.9 ± 573.9	442.9 ± 369.0	0.583
PD modality (APD)	2 (11.1%)	2 (18.2%)	0 (0%)	0.231
Fever	17 (94.4%)	11 (100%)	6 (85.7%)	0.197
Cloudy effluent	15 (83.3%)	10 (90.9%)	5 (71.4%)	0.280
Abdominal pain	15 (83.3%)	10 (90.9%)	5 (71.4%)	0.280
Previous episodes of peritonitis	0.7 ± 1.2	0.9 ± 1.4	0.3 ± 0.5	0.516
Extraperitoneal TB	2 (11.1%)	1 (9.1%)	1 (14.3%)	0.732
Time from diagnosis to treatment initiation (days)	19.9 ± 11.8	19.4 ± 9.7	20.9 ± 15.3	0.928
PDE WBC count (/μL)	172.7 ± 153.6	184.6 ± 171.5	154.1 ± 131.1	0.684
PDE Neutrophil (%)	73.3 ± 22.4	71.7 ± 23.7	75.9 ± 21.8	0.786
PDE Lymphocyte (%)	21.2 ± 18.2	23.8 ± 22.1	17.0 ± 9.3	0.856
PDE RBC count (/μL)	15.1 ± 22.3	10.1 ± 10.2	22.9 ± 33.4	0.525
AFS smear	7 (38.9%)	5 (45.5%)	2 (28.6%)	0.474
WBC count (/µL)	9466.7 ± 3250.5	9627.3 ± 3599.7	9214.3 ± 2866.7	0.892
Hemoglobin (g/dL)	9.7 ± 1.6	9.6 ± 1.9	9.9 ± 1.1	0.441
Platelets count (1000/µL)	268.9 ± 111.7	282.5 ± 100.7	247.6 ± 132.6	0.770
CRP (mg/L)	115.9 ± 82.0	136.3 ± 98.8	87.3 ± 46.0	0.570
BUN (mg/dL)	68.2 ± 25.8	64.4 ± 25.4	73.9 ± 27.7	0.346
Creatinine (mg/dL)	9.5 ± 3.8	10.7 ± 3.1	7.7 ± 4.2	0.077
Albumin (g/dL)	3.1 ± 0.5	3.2 ± 0.5	3.1 ± 0.7	0.864
PD catheter removed	10 (55.6%)	10 (90.9%)	0 (0%)	<0.001

BMI: Body mass index; ESRD: end stage renal disease; DM: diabetes mellitus; CGN: chronic glomerulonephritis; OU: obstructive uropathy; PD: peritoneal dialysis; APD: automated peritoneal dialysis. TB: tuberculosis; PDE: peritoneal dialysis effluent; WBC: white blood cell; RBC: red blood cell; AFS: acid fast stain; CRP: C-reactive protein; BUN: blood urea nitrogen.

^aData are presented as n (%) or mean ± SD.

Bold values denote statistical significance at the p < 0.05 level.

Table 5. Relative risk of mortality of PD patients with TBP in univariate and multivariate cox regression analysis.

	Univariate (enter method)			Multivariate (enter method)
	HR	95% CI	p Value	HR	95% CI	p Value
Male (%)	0.158	0.019–1.321	0.089	4.242	0.091–198.429	0.461
Age (years)	1.050	1.000–1.102	0.048	1.078	0.977–1.190	0.136
BMI (kg/m^2)	0.862	0.649–1.145	0.306
Cause of ESRD	0.461	0.216–1.084	0.053
PD vintage (days)	1.000	0.998–1.001	0.417
Diabetes mellitus (%)	5.174	0.997–15.721	0.050	1.661	0.071–38.850	0.752
Residual urine (ml)	1.000	0.999–1.002	0.821
PD modality (APD)	25.247	0.002–315979	0.502
Fever	0.125	0.011–1.382	0.090
Cloudy effluent	0.425	0.080–2.244	0.313
Abdominal pain	0.339	0.065–1.772	0.200
Previous episodes of peritonitis	0.641	0.241–1.703	0.372
Extraperitoneal TB	1.180	0.141–9.848	0.879
Time from diagnosis to treatment initiation (days)	1.022	0.956–1.093	0.523
PDE WBC (/μL)	0.999	0.993–1.004	0.606
PDE Neutrophil (%)	1.008	0.972–1.046	0.663
PDE Lymphocyte (%)	0.981	0.933–1.031	0.447
PDE RBC (/μL)	1.011	0.986–1.037	0.392
AFS smear	0.523	0.101–2.705	0.439
WBC count (/µL)	1.000	1.000–1.000	0.798
Hemoglobin (g/dL)	1.055	0.691–1.612	0.803
Platelets count (1000/µL)	0.998	0.990–1.005	0.502
CRP (mg/L)	0.994	0.980–1.008	0.421
BUN (mg/dL)	1.010	0.979–1.041	0.542
Creatinine (mg/dL)	0.822	0.644–1.049	0.116
Albumin (g/dL)	0.560	0.068–4.581	0.589
PD catheter removed	0.005	0.000–5.590	0.137	0.000	0.000–8.741	0.940

BMI: Body mass index; ESRD: end stage renal disease; PD: peritoneal dialysis; APD: automated peritoneal dialysis. TB: tuberculosis; PDE: peritoneal dialysis effluent; WBC: white blood cell; RBC: red blood cell; AFS: acid fast stain; CRP: C-reactive protein; BUN: blood urea nitrogen.

Bold values denote statistical significance at the p < 0.05 level.

Table 6. Summary of published studies reporting PD patients with tuberculous peritonitis.

Year Area	Study Type FU	Patient number	Age (Y)	Vin (M)	Male	DM	AP	Fever	Cloudy PDE	WBC (/μL )	Neu	Treatment initiation delay (day)	Treatment protocol	CR	Mor
1996 HKG [21]	Sin 6 Y	10 of 601 (1.7%)	45.3 (24 ∼ 61)	18.1 (2 ∼ 60)	4 (40%)	1 (10%)	10 (100%)	9 (90%)	7 (70%)	103 ∼ 1530	9 (90%)	77 (14 ∼ 168)	HRZ ± O 9 ∼ 12 M (mean 11 M)	2 (20%) ?	2 (20%)
2000 mixed [11]	Mul 23 Y	52	49.7 (13 ∼ 77)	15.1 (1 ∼ 60)	24 (46%)	?	46 (92%)	39 (78%)	45 (90%)	?	31 (76%)	47	2–4 agents most 6–12 M	27 (53%) ?	13 (25%)
2001 HKG [5]	Sin 6 Y	14 of 790 (1.8%)	58 (29 ∼ 78)	22 (1 ∼ 168)	18 of 38 (47%)	13 of 38 (34%)	14 (100%)	10 (71%)	14 (100%)	125 ∼ 5620	8 (57%)	30 (7 ∼ 57)	HRZO 12 ∼ 15 M	2 (14%) ?	5 (36%)
2004 TWN [6]	Sin 9 Y	5 of 102 (4.9%)	50	27.4	1 (20%)	?	5 (100%)	5 (100%)	?	330 ∼ 23040	3 (60%)	21	?	1 (20%) ?	2 (40%)
2009 mixed [12]	Mul 8 Y	98	51.2 (12 ∼ 76) (n = 74)	19 (2 ∼ 84)	39 of 74 (53%)	?	89%	81%	77%	?	65%	48	HRZ ± E or Q	25 of 51 (49%) ?	19 of 56 (34%)
2012 ARE [22]	Sin 12 Y	4 of 89 (4.5%)	52.75 (48 ∼ 57)	17.25 (9 ∼ 48)	3 (75%)	3 (75%)	0 (0%)	0 (0%)	4 (100%)	200 ∼ 350	4 (100%)	?	HRZ 9 M	4 (100%) ?	0 (0%)
2013 IND [4]	Sin 12 Y	11 of 414 (2.6%)	49 (34 ∼ 72)	36 (6 ∼ 108)	8 (73%)	3 (27%)	?	?	?	200 ∼ 6000	9 (82%)	15 (2 ∼ 28)	HRZO	8 (73%) ?	2 (18%)
2014 TWN [23]	Sin 25 Y	4 of 1737 (0.2%)	53.5 (44 ∼ 71)	13.8 (7 ∼ 24)	1 (25%)	3 (75%)	4 (100%)	2 (50%)	4 (100%)	128 ∼ 1290	4 (100%)	?	HRZ ± E at least 9 M	1 (25%) ?	1 (25%)
2016 ZAF [13]	Sin 6 Y	12 of 170 (7.1%)	35.4 (17 ∼ 51)	21.6 (3 ∼ 70)	6 (50%)	2 (17%)	12 (100%)	?	12 (100%)	0 ∼ 3168	9 (75%)	29 (3 ∼ 69)	?	11 (92%) 18.7	7 (58.3%)
2022 mixed [24]	Mul	216	48.9 (n = 163)	20.3 (n = 143)	51.9% (n = 162)	28.3% (n = 99)	81.8% (n = 137)	67.2% (n = 137)	38% (n = 137)	mean 1163.4 (n = 76)	68.4% (n = 85)	43 (n = 120)	H 99.1% R 100% Z 81.7% E 45.9% Q 30.6% (n = 109)	52.4% (n = 167) ?	35.4% (n = 206)
2022 TWN Cur	Sin 35 Y	18 of 2084 (0.9%)	56.5 (19 ∼ 88)	31.7 (1 ∼ 106)	8 (44.4%)	7 (38.9%)	15 (83.3%)	17 (94.4%)	15 (83.3%)	10 ∼ 590	13 (72.2%)	20 (1 ∼ 47)	HRZ ± E at least 9 M	10 (55.6%) 21.7	7 (39%)

FU: follow-up duration; Y: year; Vin: PD vintage; M: month; AP: abdominal pain; WBC: initial PDE WBC; Neu: neutrophil predominant; Mor: mortality: CR: catheter removal rate and day number after peritonitis; Tx: treatment; HKG: Hong Kong; Sin: single-center study; H: isoniazid; R: rifampicin; Z: pyrazinamide; O: ofloxacin; Mul: multicenter study; E: ethambutol; Q: quinolone; TWN: Taiwan; ARE: United Arab Emirates; IND: India; ZAF: South Africa; Cur: current study.

Lui SL, Choy LC, Chan BY, et al. Optimal treatment and long-term outcome of tuberculous peritonitis complicating continuous ambulatory peritoneal dialysis. Am J Kidney Dis. 1996;28(5):747–751.

 PubMed Web of Science ®Google Scholar

Talwani R, Horvath JA. Tuberculous peritonitis in patients undergoing continuous ambulatory peritoneal dialysis: case report and review. Clin Infect Dis. 2000;31(1):70–75.

 PubMed Web of Science ®Google Scholar

Lui SL, Tang S, Li FK, et al. Tuberculosis infection in chinese patients undergoing continuous ambulatory peritoneal dialysis. Am J Kidney Dis. 2001;38(5):1055–1060.

 PubMed Web of Science ®Google Scholar

Hung YM, Chan HH, Chung HM. Tuberculous peritonitis in different dialysis patients in Southern Taiwan. Am J Trop Med Hyg. 2004;70(5):532–535.

 PubMed Web of Science ®Google Scholar

Akpolat T. Tuberculous peritonitis. Perit Dial Int. 2009;29(Suppl 2):S166–S169.

 PubMedGoogle Scholar

Waness A, Al Shohaib S. Tuberculous peritonitis associated with peritoneal dialysis. Saudi J Kidney Dis Transpl. 2012;23(1):44–47.

 PubMedGoogle Scholar

Ram R, Swarnalatha G, Akpolat T, et al. Mycobacterium tuberculous peritonitis in CAPD patients: a report of 11 patients and review of literature. Int Urol Nephrol. 2013;45(4):1129–1135.

 PubMed Web of Science ®Google Scholar

Lin JH, Wang WJ, Yang HY, et al. Non-tuberculous and tuberculous mycobacterial peritonitis in peritoneal dialysis patients. Ren Fail. 2014;36(7):1158–1161.

 PubMed Web of Science ®Google Scholar

Tamayo-Isla RA, de la Cruz MC, Okpechi IG. Mycobacterial peritonitis in CAPD patients in Limpopo: a 6-Year cumulative report from a single center in South Africa. Perit Dial Int. 2016;36(2):218–222.

 PubMed Web of Science ®Google Scholar

Thomson BKA, Vaughan S, Momciu B. Mycobacterium tuberculosis peritonitis in peritoneal dialysis patients: a scoping review. Nephrology (Carlton). 2022;27(2):133–144.

 PubMed Web of Science ®Google Scholar