Home›Nephrology› Global PD peritonitis incidence 0.31 episodes per patient-year, with wide regional variation
Global PD peritonitis incidence 0.31 episodes per patient-year, with wide regional variationGlobal data reveals varying rates of infection in peritoneal dialysis
Medical sciences (Basel, Switzerland)Published September 25, 2026Study authors: Nochaiwong Surapon, Ruengorn Chidchanok, Noppakun Kajohnsak, Koyratkoson Kiatkriangkrai, Chuamanocha…PubMed ↗DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
AI-generated summary of the cited source, checked by automated accuracy review.
How we work
Share
Key Takeaway
Interpret PD peritonitis rates against regional benchmarks; heterogeneity limits pooled estimates.
This meta-analysis synthesized data from 153 unique study populations, covering 132,000 patients across 37 countries, to estimate the incidence of peritoneal dialysis (PD)-associated peritonitis. The primary outcome was episodes per patient-year. The analysis captured 88,769 episodes over 264,296.30 patient-years.
The pooled global incidence rate was 0.31 episodes per patient-year (95% CI 0.28-0.34). Regional rates varied widely: Africa 0.99 (95% CI 0.68-1.45), South-East Asia 0.41 (95% CI 0.35-0.48), Eastern Mediterranean 0.39 (95% CI 0.31-0.49), Americas 0.38 (95% CI 0.31-0.45), Europe 0.37 (95% CI 0.30-0.46), and Western Pacific 0.21 (95% CI 0.19-0.24).
By causative microorganism, incidence was 0.127 for Gram-positive bacteria (95% CI 0.113-0.142), 0.073 for culture-negative episodes (95% CI 0.065-0.083), 0.065 for Gram-negative bacteria (95% CI 0.058-0.073), 0.017 for polymicrobial (95% CI 0.014-0.021), 0.009 for fungus (95% CI 0.008-0.011), and 0.004 for Mycobacterium (95% CI 0.003-0.006).
The authors report substantial heterogeneity across included studies. Safety outcomes, adverse events, and follow-up duration were not reported. Funding and conflicts of interest were not reported. The authors note high incidence rates in specific countries (South Africa, Portugal, Sri Lanka) and low rates in others (South Korea, mainland China, Japan).
The findings highlight variation in peritonitis incidence across regions and countries, suggesting a need for standardized and harmonized PD practice settings. Because of the substantial heterogeneity, these pooled estimates should be interpreted as broad benchmarks rather than precise targets for individual centers.
How this fits prior evidence
Prior coverage in this publication reported that exit-site infection significantly increases the risk of peritoneal dialysis-associated peritonitis. This meta-analysis does not address risk factors such as exit-site infection; instead, it quantifies the baseline incidence of PD-associated peritonitis globally and by region. Together, the findings are complementary: the earlier work identifies a modifiable risk factor, while this analysis provides pooled incidence benchmarks (0.31 episodes per patient-year globally) against which centers can compare their own rates. The substantial heterogeneity noted here also underscores that incidence varies widely by region, which may influence how risk-factor findings are applied locally.
Living with peritoneal dialysis involves a constant focus on safety, especially regarding peritonitis. This is a serious infection of the abdominal lining that can occur during the dialysis process. Because every patient's experience is different, researchers looked at a massive global dataset to see how often these infections occur across different regions.
By looking at 132,000 patients across 37 countries, the study found a global average of 0.31 episodes of peritonitis per patient-year. However, the numbers change significantly based on location. For example, the rate in Africa was much higher at 0.99, while the Western Pacific region saw a lower rate of 0.21. These differences suggest that local practices and environments play a major role in patient safety.
While the data is vast, the researchers noted significant differences in how various studies were conducted. These variations make it hard to pinpoint one single cause for the differing rates. The findings highlight the need for more consistent, standardized care practices across the globe to help keep patients safe regardless of where they live.
What this means for you:
Peritonitis rates vary greatly by region, highlighting the need for standardized care for peritoneal dialysis patients.
Common questions
How common is peritonitis in peritoneal dialysis?
The global average for peritonitis is 0.31 episodes per patient-year. This means that while infections occur, the frequency can vary significantly depending on the specific region and local healthcare environment where the patient receives their treatment.
Do infection rates vary by geographic location?
Yes, the data shows significant differences. For example, the rate in Africa was 0.99 episodes per patient-year, while the Western Pacific region reported a lower rate of 0.21. Other regions like Europe and the Eastern Mediterranean reported rates of 0.37 and 0.39, respectively.
What types of germs cause these infections?
The study identified several types of germs. Gram-positive bacteria had an incidence of 0.127, while Gram-negative bacteria were at 0.065. Other types included culture-negative (0.073), polymicrobial (0.017), fungus (0.009), and Mycobacterium (0.004).
: Since peritoneal dialysis (PD) has been used in nephrology practice for several decades, contemporary evidence on global, regional, and country incidence rates of PD-associated peritonitis has not been comprehensively synthesized. We performed a systematic review and meta-analysis to estimate the incidence rates of PD-associated peritonitis worldwide in contemporary PD practice. : We systematically searched 6 electronic databases to identify all relevant English-language articles that reported rates of PD-associated peritonitis according to International Society for Peritoneal Dialysis (ISPD) criteria, regardless of age, sex, or PD modality, from 2011 to 2026. We used a random-effects meta-analysis to estimate the pooled incidence rate (episodes per patient-year), with corresponding 95% confidence intervals. We reported summary incidence rates of PD-associated peritonitis for the global estimation (overall rate), World Health Organization (WHO) region, and each country. We also estimated meta-syntheses by causative microorganism of PD-associated peritonitis. : We identified 12,364 records, of which 153 unique study populations of PD patients fulfilled the study selection criteria. These included over 132,000 PD patients from 37 countries worldwide. Despite substantial heterogeneity, the global incidence rate estimate of PD-associated peritonitis was 0.31 (0.28-0.34) episodes per patient-year (total peritonitis episodes, 88,769; total patient-years at risk, 264,296.30). According to WHO region ( for difference between regions <0.001), the regional incidence rates of PD-associated peritonitis were 0.99 (0.68-1.45) for the African Region; 0.38 (0.31-0.45) for the Region of the Americas; 0.41 (0.35-0.48) for the South-East Asia Region; 0.37 (0.30-0.46) for the European Region; 0.39 (0.31-0.49) for the Eastern Mediterranean Region; and 0.21 (0.19-0.24) for the Western Pacific Region. Across 37 different countries, the top three highest incidence rates of PD-associated peritonitis were observed in South Africa, followed by Portugal and Sri Lanka. Meanwhile, the top three lowest incidence rates of PD-associated peritonitis were observed in South Korea, followed by mainland China and Japan. According to the ISPD benchmark, 10 of the 37 included countries had an overall PD-associated peritonitis rate > 0.40 episodes per patient-year. Regarding the causative microorganisms of PD-associated peritonitis, Gram-positive bacteria had the highest pooled incidence rate of PD-associated peritonitis (0.127 [0.113-0.142]), followed by culture-negative (0.073 [0.065-0.083]), Gram-negative bacteria (0.065 [0.058-0.073]), polymicrobial (0.017 [0.014-0.021]), fungus (0.009 [0.008-0.011]), and Mycobacterium (0.004 [0.003-0.006]). : These global estimates of PD-associated peritonitis incidence rates demonstrated variation across regions and countries. Given differences in healthcare systems across countries, sharing innovations and knowledge for continuous quality improvement and standardizing and harmonizing PD practice settings are warranted to improve quality indicators and patient well-being and reduce inequalities in PD management worldwide.
