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Peritonitis is an infection of the peritoneum, which can occur during peritoneal dialysis. Symptoms include abdominal pain, fever, and cloudy peritoneal fluid. Prompt treatment is crucial.

What is Peritonitis?

The peritoneum is a thin protective layer inside your belly that covers and supports your organs, like your stomach and intestines. It holds a small amount of fluid, and this layer can act as a natural filter. In peritoneal dialysis, waste products are filtered through the peritoneum and removed with a cleansing fluid called dialysate which is washed in and out of your abdominal cavity (belly) in cycles. Peritonitis is inflammation of the peritoneum.  

What causes peritonitis?

Peritonitis is usually due to a bacterial or fungal infection. The infection can happen from any infection in the belly, such as appendicitis or burst appendix. It can also happen from any injury or trauma to belly area, or as a complication of other medical problems.

Peritonitis can also affect people on peritoneal dialysis as it involves cycling fluids in and out of the peritoneum. Improved technology and self-care methods have lowered the risk of peritonitis for people on peritoneal dialysis, but the risk for infection remains. Therefore, if you are on peritoneal dialysis, it is important to practice good hygiene during your dialysis treatment and to be sure to take the right steps to help reduce the risk of infection. These include washing your hands before dialysis treatment, applying an antibiotic cream to the catheter exit site as often as prescribed, and other steps such as wearing a mask or gloves, as recommended by your healthcare team.

Is Peritonitis serious?

Peritonitis can be life-threatening and may cause serious complications, depending on the cause and severity. It can also lead to sepsis, a life-threatening condition caused by the body’s reaction to an infection so it is important not to delay treatment. Common symptoms of peritonitis can include:

• Pain in the abdomen (belly area)
• Tenderness with abdomen
• Bloating or outward expansion of the abdomen also known as distention
• Nausea and Vomiting
• Fever
• Cloudy peritoneal fluid during peritoneal dialysis treatment

Peritonitis can be quite serious, so if you have any of these symptoms, you should seek medical help right away.

How is Peritonitis diagnosed?

You will receive a physical exam for signs and symptoms. Your belly will be checked for tenderness or distention. Blood tests, X-rays, or computerized tomography (CT) scans might also be done. Small volume peritoneal fluid from dialysis will be removed for testing to confirm whether an infection is present.

How is Peritonitis treated?

Depending on the causative bacteria/fungi and severity of the infection, antibiotics can be given mixed in the peritoneal dialysis fluid. If severe infection or treatment-resistant then you may be admitted to the hospital for injecting intravenous antibiotics into your veins. If sepsis is a concern, you may also receive intravenous fluid drips and medications to help with fever and blood pressure. Symptoms of sepsis can include low blood pressure, fast heart rate, fever, or difficulty breathing, so other treatments might also be needed. Occasionally a different form of dialysis might be needed temporarily while the body heals from the infection.

In the case of a problem in the belly such as a ruptured appendix, emergency surgery can also be considered. An operation may also be needed to remove damaged parts of the peritoneum.

If peritonitis continues or keeps returning despite treatment, then peritoneal dialysis might need to be stopped to switch to a different form of dialysis in the long-term.

Written February 2025
Reviewed by Dr Oshini Shivakumar ‘Specialist Renal Registrar’
Next review February 2028

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The National Kidney Federation cannot accept responsibility for the information provided. The above is for guidance only. Patients are advised to seek further information from their doctor.