Design: Systematic review and random-effects meta-analysis
Population: 153 cohorts, over 132,000 PD patients in 37 countries
Primary outcome: PD-associated peritonitis incidence (episodes per patient-year)
Effect: Global 0.31 (95% CI 0.28–0.34); South-East Asia 0.41 (0.35–0.48)

This systematic review pooled 153 study populations with over 132,000 peritoneal dialysis patients in 37 countries, using ISPD definitions, from 2011 to 2026.

The global peritonitis rate was 0.31 episodes per patient-year (95% CI 0.28–0.34), with substantial heterogeneity. Rates differed by WHO region: 0.21 in the Western Pacific, about 0.37–0.39 in Europe, the Americas and the Eastern Mediterranean, 0.41 in South-East Asia and 0.99 in Africa. Ten of 37 countries exceeded the ISPD benchmark of 0.40. Gram-positive organisms caused the most episodes (0.127 per patient-year), followed by culture-negative (0.073) and Gram-negative (0.065) peritonitis; fungal and mycobacterial peritonitis were rarer.

The South-East Asia estimate is the relevant comparator for Indian programmes, and it sits just above the benchmark. The high culture-negative rate points at a fixable laboratory problem. The best-performing countries in the region show that far lower rates are achievable.

Track your unit's peritonitis rate in episodes per patient-year and compare it with the ISPD target of no more than 0.40.
Retrain patients in exchange technique after any peritonitis episode and periodically thereafter.
Reduce culture-negative peritonitis: inoculate effluent into blood culture bottles and process promptly.
Cover Gram-positive and Gram-negative organisms empirically, guided by local sensitivity data.
Consider mycobacterial and fungal causes in culture-negative or non-resolving peritonitis, especially in India.

Why it matters

It gives Indian and regional PD programmes a contemporary benchmark to measure themselves against.

The statistics, in plain English

An incidence of 0.31 episodes per patient-year means roughly one episode every three years of PD per patient on average. Heterogeneity was substantial, so individual units vary a lot around these regional averages.