The influence of seasonal factors on the incidence of peritonitis in continuous ambulatory peritoneal dialysis in the temperate zone.

Many factors contribute to the development of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. The role of climate in CAPD peritonitis has received relatively little attention. We retrospectively analyzed the incidence of CAPD peritonitis according to temperature and relative humidity. Data from 80 patients were examined. The monthly mean temperature and relative humidity during study period varied between -3.4 degrees C and 25.4 degrees C and between 61% and 81%, respectively. In 1123 patient-months, 53 cases of peritonitis occurred. The occurrence of peritonitis paralleled temperature and relative humidity, being the highest (0.180 episodes/patient-month) in July (mean temperature, 24.6 degrees C; relative humidity, 81%) and lowest (0.013 episodes/patient-month) in November (mean temperature, 6.6 degrees C; relative humidity, 66%). Significant correlations were seen between the monthly frequency of CAPD peritonitis and temperature (r = 0.53, p < 0.05) and relative humidity (r = 0.59, p < 0.05). The incidence was higher in the warm season (months with a mean temperature > or = 15 degrees C, that is, May-September) than in the cold season (months with a mean temperature < 15 degrees C, that is, October-April), at 0.074 episodes/patient-month versus 0.024 episodes/patient-month, p < 0.05. We also found a tendency for gram-negative peritonitis to occur uniformly throughout the year, but for gram-positive peritonitis to increase during hot and humid months, especially the rainy month of July. Gram-positive organisms caused 50% of peritonitis from March to August, but just 17.7% from September to February. Gram-negative organisms caused 7.3% and 29.4% of peritonitis during the same periods (p < 0.05). The results indicate a clear seasonal change in the rate of CAPD peritonitis and in the causative micro-organisms. The observation that CAPD peritonitis increases in the season of high temperature and high humidity suggests the influence of climate on CAPD peritonitis in the temperate zone.