Systematic Review on Treatment and Outcomes of Tuberculous Peritonitis in Patients on Peritoneal Dialysis

BackgroundPeritoneal dialysis (PD)-associated peritonitis due to tuberculosis is associated with poor outcomes and optimal treatment strategies for this condition remain unknown. Our study aimed to (1) systematically review the published literature on peritonitis caused by Mycobacterium tuberculosis (M. tuberculosis) in patients on PD and (2) review cases of peritonitis due to M. tuberculosis in PD patients reported in Australia and New Zealand to determine the epidemiology, management strategies and outcomes of this condition.MethodsA literature search of Medline, Scopus, Embase, ClinicalTrials.gov, Cochrane CENTRAL Register of Controlled Trials and Google Scholar for articles published from inception date to June 2022 was conducted. To be eligible, articles had to describe patient characteristics, initial antituberculosis therapy and treatment outcomes in all PD patients with peritonitis caused by M. tuberculosis. Data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry of PD patients who developed peritonitis due to M. tuberculosis between September 2001 and December 2020 were included and analysed.ResultsThe systematic literature review identified 70 case studies (151 patients) and 8 cohort studies (97 patients), whilst the ANZDATA Registry identified 17 cases of peritonitis due to M. tuberculosis. Overall, in patients diagnosed with peritonitis due to M. tuberculosis, the rates of PD catheter removal and permanent transfer to HD were numerically higher in the ANZDATA Registry cases (82%) than in the case studies (23%) and cohort studies (20%). Observed all-cause mortality rates were also higher as observed in the case studies (33%) and cohort studies (26%) than in the ANZDATA Registry cases (6%).ConclusionsTuberculous peritonitis is uncommon in patients on PD and is associated with poor outcomes. Prospective studies are warranted to study the effect on retaining PD catheters after M. tuberculosis infection on patient outcomes.