MO680: Association of Systemic Inflammation with Changing Peritoneal Membrane Characteristics

Abstract

Abstract BACKGROUND AND AIMS Increasing transport status with ultrafiltration (UF) and solute-removal inadequacy is among the most challenging issues in peritoneal dialysis (PD) continuity. Decreased transport status is less frequent but also results in solute clearance. Although the current incidence of peritonitis has reduced considerably, defined membrane disruptions are still frequently observed. Our study examines the relationship between different types of membrane disruptions and the course of systemic inflammation in incident PD patients. METHOD This is a retrospective, single-site, cohort study of incident adult PD patients (n = 202) sampled between January 2000 and January 2020. An increase or decrease in transport status is defined as two or more categories of a rise or decline in peritoneal equilibration test (PET) from their baseline during follow-up. The 4-h dialysate/plasma creatinine ratio was used to classify PET categories. C-reactive protein (CRP) values were obtained from the annual tests in the routine controls of the patients. RESULTS Baseline demographics, diabetes frequency, residual renal function, baseline laboratory, frequency of renin–angiotensin–aldosterone system blockers, high glucose–containing dialysate and icodextrin use were similar among the groups. Total episodes of peritonitis and peritonitis rates within the first 5 years of follow-up was higher in patients with stable transport status with a median rate of 0 (min:0 to max:5) than patients with increased transport status [median rate of 0 (min:0 to max:3)] and decreased transport status [median rate of 0 (min:0 to max:1)] (P = 0.009). The main time-dependent effect of CRP was statistically significant [Wilks’ λ = 0.76, F (5, 127) = 7.75, P < 0.001]. The joint effect of the mean CRP value depending on time and group was also significant [Wilks’ λ = 0.91, F (10, 254) = 1.10, P = 0.36]. The effect of CRP and time was significantly different between the groups [F (2, 131) = 3.49, P = 0.03; partial η2 = 0.05]. While there was a significant difference between stable and increased transporters in the post-hoc analysis, no similar significance was found between stable and decreased transporters (P = 0.03 and P = 0.99, respectively). CONCLUSION Our study shows that the peritoneal membrane kinetics may change into different characteristics in many patients over time, despite the very low frequency of peritonitis episodes and similar baseline characteristics, and may be significantly affected by systemic inflammation. Systemic inflammation, in particular, appears to be related to increased transport status, which is most often responsible for the deterioration of UF and solute clearance over time.