Evaluation of the epidemiologic triad in the incidence of peritonitis among pediatric patients with chronic kidney disease undergoing peritoneal dialysis: a single-center study in Indonesia

INTRODUCTION: Peritonitis is the most common and serious complication of Continuous Ambulatory Peritoneal Dialysis (CAPD) in children. Understanding the interaction of host, agent, and environmental factors-based on the epidemiologic triad-may help reduce its incidence in pediatric populations, especially in resource-limited settings. This study aimed to evaluate host and environmental factors associated with peritonitis among pediatric CAPD patients while descriptively characterizing the causative microorganisms involved. METHODS: This retrospective study included 35 pediatric patients receiving CAPD from 2019 to 2024. Clinical, socioeconomic, nutritional, and environmental data were collected. Peritonitis diagnosis followed ISPD criteria. Peritonitis incidence and peritonitis-free survival were analyzed using Kaplan-Meier curves and bivariate statistical tests. RESULTS: Eleven patients (31.4%) developed peritonitis, with an overall rate of 4.5 episodes per 100 person-months. Low dietary diversity, well water consumption, and low paternal education or labor/driver occupations were associated with higher peritonitis occurence (p < 0.05). Kaplan-Meier analysis showed that low dietary diversity significantly reduced peritonitis-free survival (p = 0.021). Trends were observed for water source and occupation. CONCLUSION: Peritonitis in pediatric CAPD patients results from a multifactorial interplay of nutritional, environmental, and socioeconomic factors. Addressing these determinants through dietary support, hygiene education, and socioeconomic assistance may help reduce peritonitis risk and support better outcomes.