Urokinase in the Management of Relapsing Peritoneal Dialysis-Related Peritonitis

Background: Peritonitis remains the commonest cause of morbidity in patients undergoing peritoneal dialysis. Relapse may be related to catheter colonisation with bacterial biofilm, and requires PD catheter exchange or removal. We changed our treatment protocols for relapsing peritonitis to include IP Urokinase in February 2014 and report a non-randomised single centre retrospective before and after study of clinical outcomes.

Methods and findings: We compared outcomes of 12 patients with relapse of peritonitis treated with Urokinase and antibiotics with 14 historical controls who received standard antibiotic treatment prior to the policy change. All patients with relapsing peritonitis between 1st January 2011 and 31st December 2015 were included.

Results: We identified 28 patients with relapsing peritonitis. Two patients died from causes unrelated to infection. 12 patients were treated with Urokinase and antibiotics and 14 received antibiotics alone (control group). Demographics were similar between the Urokinase and control group. 6/14 in the control group and 11/12 in the Urokinase group achieved complete cure (p=0.03). Refractory peritonitis occurred in 4/14 controls and 1/12 Urokinase group. 4/14 control patients relapsed.

Conclusions: The gold standard treatment for relapsing peritonitis is currently catheter exchange. This however is invasive and resource-intensive. This small study demonstrates significant improvement in outcomes of relapsing peritonitis by adding Urokinase lock to standard antibiotic therapy when compared to historical controls, without the need for catheter exchange.

Author(s): Sajeda Youssouf, Lilian Ekeh and Stanley L Fan

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