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Life sciences · Journal article
Multidisciplinary Health Research · September 30, 2026
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Introduction: Peritoneal dialysis-associated peritonitis is a significant infectious complication in patients with advanced chronic kidney disease and may lead to peritoneal dialysis technique failure. Timely identification of refractory forms is essential to reduce complications and establish a safe renal replacement therapy strategy. Case description: This article describes the case of a 65-year-old man with stage 5 chronic kidney disease receiving peritoneal dialysis, with a history of type 2 diabetes mellitus and systemic arterial hypertension, who was admitted with abdominal pain, progressive dyspnea, volume overload, and bilateral pleural effusion predominantly affecting the right side. Peritoneal effluent analysis revealed 3, 700 cells/mm³, with 75% polymorphonuclear leukocytes, consistent with peritoneal dialysis-associated peritonitis. Interventions: Empirical intraperitoneal antimicrobial therapy was initiated in accordance with international recommendations and subsequently adjusted based on microbiological findings. Results: Escherichia coli, susceptible to amikacin and carbapenems, was isolated; Pseudomonas aeruginosa was also identified during the clinical course. Although the patient initially showed clinical improvement and a reduction in peritoneal cell count, he subsequently developed recurrent inflammation, neutrophilia, and findings suggestive of fungal colonization, consistent with refractory polymicrobial peritonitis. Recurrence, persistent inflammatory response, and involvement of multiple microorganisms were associated with peritoneal dialysis technique failure. Conclusion: Microbiological surveillance, targeted antimicrobial therapy, and early recognition of refractory disease supported Tenckhoff catheter removal and transition to hemodialysis as measures aimed at ensuring patient safety.