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Peritonitis remains a serious complication of peritoneal dialysis and can lead to death of the patient. Most peritonitis is due to either contamination with the peritoneal dialysis exchange or exit site infection and can be prevented by protocols for appropriate training and exit site care. The micro-organism infecting the peritoneum is an important clue to the etiology: coagulase-negative Staphylococcus is generally due to touch contamination while Pseudomonas aeruginosa and Staphylococcus aureus are most often due to catheter infections. The etiology of other Gram-negative peritonitis is uncertain but appears to relate to bowel problems especially constipation, hypokalemia, perhaps leading to dysmotility, as well as touch contamination at the time of the exchange. The approach to treating peritonitis is always to rapidly resolve the infection, even if this entails removing the peritoneal catheter. Refractory peritonitis is generally defined as peritonitis treated with an appropriate antibiotic for fi ve days without evidence of resolution. The antibiotic to treat peritonitis should be chosen based on the past history of the organisms and sensitivities of the program, should cover Gram-negative and Gram-positive organisms, and tailored once the cause is identified. Relapsing peritonitis requires catheter exchange. Each program should have continuous quality improvement that tracks each episode, performing root cause analysis, examining organisms, rates of organisms, and outcome. In this way, each program can develop initiatives to lower peritonitis rates. Such protocols might include the use of routine exit site antibiotic cream as part of daily care, re-training of patients, prevention of constipation, and removal of infected catheters. With an aggressive approach peritonitis rates can be lowered to very low rates.

Patients on peritoneal dialysis (PD) have a high risk of dying from cardiovascular disease (CVD), including myocardial infarction, arrhythmias, valvular disease, and sudden death. The risk of dying on PD, in contrast to HD, is rather low initially but steadily increases over time. Risk factors for CVD on PD need to be closely examined and research on possible interventions designed. PD patients typically gain weight, often to excess. They develop hyperlipidemia, particularly low-density lipoprotein and triglyceride levels, in part from the glucose load. PD patients are often hypertensive and sometimes volume overloaded. These are all traditional risk factors for CVD. However, in addition, there are some poorly examined risk factors for PD patients, including hypokalemia, shown to be associated with an increased risk of both peritonitis and death. PD patients may be inflamed related to non-physiologic PD fluid and peritonitis. PD patients over time often become profoundly 25(OH) vitamin D deficient, due to dietary constraints, lack of sun exposure and effluent losses. Such insufficiency of 25(OH)vitamin D deficiency seems to be a risk factor for CVD. Many of the above-described risk factors are either treatable or preventable. Very few randomized trials targeting treatment of cardiovascular risk factors have been done in PD patients. Whether a multiple pronged approach to CVD risk in PD patients would lower the later mortality remains to be tested.

Peritonitis remains a serious problem in peritoneal dialysis patients accounting for technique failure and contributing to mortality. Many peritonitis episodes are due to contamination at the time o