Assessing and comparing peritonitis detection techniques on patients on peritoneal dialysis in a tertiary care setting of Lahore, Pakistan

Sheikh Muhammad Rizwan, Ahmad Azam Malik, Marwan A Bakarman, Nadeem Shafique Butt, Hina Nasreen Malik3 Muhammad Anees, S M Irfan

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Abstract

Peritonitis is considered as one of the foremost major complication of peritoneal dialysis (PD). Several studies have explored different techniques to rapidly diagnose peritonitis. Considering limited literature in this context from the region, this study was designed to determine the frequency of peritonitis and to assess and compare the detection role of different techniques in the diagnosis of bacterial peritonitis during first 48 hours in patients undergoing acute peritoneal dialysis in Lahore, Pakistan. It was a cross-sectional study conducted in Nephrology Department, Sheikh Zayed Hospital, Lahore over a period of six months. Sample of 400 patients was taken. Initial evaluation and biochemical profile was done before starting PD, All episodes of positive culture, presence of clinical peritonitis and urine dipstick (leucocyte esterase reagent) were detected and compared with culture using ROC curve and McNemar test at 24 hours and 48 hours. The pre dialysis biochemical profile of majority of the patients was mostly found deranged. Study found 156 out of 194 cultures positive where clinically peritonitis was not present. In comparison of sensitivity, specificity, ROC curve and McNemar test at 24 hours and 48 hours, urine dipstick was found to be relatively better option. Determination of culture may be reserved for confirmation of clinically suspected peritonitis but study findings suggests that urine dipstick being relatively more cost effective and convenient to practice may be used as an alternative or complementary option depending upon the available resources to help in the diagnosis of peritonitis.

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