#1832 Unraveling enteric peritonitis risk factors: the role of nutrition

Abstract

Abstract Background and Aims Malnutrition estimated to have a prevalence of 30-50% among peritoneal dialysis (PD) patients. It independently correlates with increased patient morbidity and a lower technique survival, and it is exacerbated by protein loss through peritoneal fluid. Enteric-origin peritonitis in PD patients represents a severe complication also linked to elevated morbidity, hospitalizations, and inferior technique survival. However, the association between both is not well established. This study aims to analyze malnutrition-related as well as general risk factors and their association with peritonitis type (enteric/cutaneous). Method A longitudinal and retrospective observational analysis was conducted on PD patients with peritonitis at Hospital La Fe from 2012 to 2023. Demographic data (age, gender, obesity, diabetes, immunosuppression, polycystic kidney disease), analytical parameters (albumin, total proteins, potassium, phosphorus), number of exchanges, adequacy, surgical interventions, and/or catheter placement 6 months prior were analyzed for their association with peritonitis type (Cutaneous/Enteric/Mixed). Recurrences and peritonitis without microbial isolation were excluded. Results We collected data about 109 peritonitis cases; 59.6% cutaneous, 38.5% enteric, and 1.8% mixed, from 61 predominantly male patients (68.9%) with a mean age of 61.35 years. Common germs were S. epidermidis in cutaneous peritonitis and E. coli in enteric peritonitis. Obesity (27.9% of the sample), immunosuppression (16.4%), and hypoalbuminemia (56%) were statistically significantly associated with enteric peritonitis development (p 0.08, p 0.039, and p 0.036, respectively). No statistically significant differences were found for peritonitis type and gender, diabetes, residual renal function, hypokalemia, hypophosphatemia, and underdialysis. 85.3% of peritonitis cases involved manual exchanges, and 14.7% automated PD. While no statistically significant association was found between modality and peritonitis type, more manual exchanges correlated with increased peritonitis cases. Peritoneal catheter insertion and other surgical interventions in the previous 6 months were not significantly related to peritonitis type. Conclusion The presence of malnutrition-related factors such as hypoalbuminemia and obesity increases the risk of developing enteric peritonitis, likely linked to digestive bacterial translocation to peritoneal fluid facilitated by malnutrition. Ensuring preventive nutritional strategies is imperative for these patients.