Peritoneal Dialysis-associated Peritonitis Research Articles

#766 A prognostic model (BLEND35) with internal validation for treatment failure in patients with peritoneal dialysis-associated peritonitis

Abstract Background and Aims Globally, peritoneal dialysis (PD)-associated peritonitis (PDAP) is a common and severe complication in PD. Early identification of high risk PDAP helps to prevent adverse outcomes. Currently, there is no recognized predictive tool for treatment failure of PDAP. Therefore, this study aimed to develop and validate a prediction model for treatment failure in patients with PDAP. Method We retrospectively collected 313 PDAP episodes occurred between January 2007 and August 2023, from real-world clinical practice in a tertiary center in Beijing, North China. The candidate predictors including patient characteristics, latest laboratory tests before PDAP, laboratory tests at PDAP onset and the causative organisms in peritoneal effluent. The prognostic model was developed from a multivariable logistic regression model with predictors selected using the stepwise backward regression. The C-statistic and the calibration curve plot were used to assess the discrimination and calibration of the prediction model. A bootstrap with 100 resampling was also performed as internal validation to further determine the robustness of the model. Results Among 313 PDAP episodes, 63 was reported treatment failure. The final model included 7 variables and was termed BLEND35 (sex, PD duration, platelet-to-lymphocyte ratio before PDAP, Gram-negative peritonitis, blood white cell counts at PDAP onset, dialysate white blood cell counts on day 3 and day 5). The C-statistic of the model was 0.936 (95% CI 0.897–0.974), revealing great discrimination. Calibration plot indicated that the model-predicted probabilities correlated well with the actual observed frequencies (Hosmer-Lemeshow test, P = 0.1223; Brier score = 0.064). Decision-curve analysis also revealed a positive net benefit. Conclusion The BLEND35 model will help to identify those with most high risk of treatment failure of PDAP and contribute to personalize and precise treatment. However, external validation is required before future application.

#1060 Prevalence and adverse outcomes of hypokalemia and the role of potassium supplementation in patients receiving peritoneal dialysis

Abstract Background and Aims Hypokalemia is common and potentially life-threatening in patients undergoing peritoneal dialysis (PD). The reported prevalence of hypokalemia in PD patients varies significantly across studies, with ongoing debate about its association to adverse outcomes and the effects of potassium supplementation. Method We searched MEDLINE, Embase, Web of Science and references from eligible studies from database inception through September 2023 without language restriction for randomized controlled trials (RCTs), cohort studies, case-control studies, and cross-sectional studies on the prevalence and adverse outcomes (all-cause mortality, cardiovascular mortality, infection-related mortality, and PD-associated peritonitis) of hypokalemia or the role of potassium supplementation in patients receiving PD. Random effects meta-analysis is conducted to pool Hazard ratio (HR) and 95% confidence interval (CI) for the outcomes of interest. The certainty of findings was rated according to GRADE criteria. Results Out of 3 298 reports identified, 23 studies involving 59 433 participants met inclusion criteria. The prevalence of hypokalemia across all definitions was 37.9% (95% CI: 27.2-52.7%), 19.0% (95% CI: 13.0-27.6%) (Fig. 1), and 4.4% (95% CI: 1.9-10.2%) for patients with potassium level below 4.0, 3.5 and 3.0 mmol/L. Hypokalemia was associated with increased risk of all-cause mortality (HR: 1.49; 95% CI: 1.18-1.89) (Fig. 2), cardiovascular mortality (HR: 1.50; 95% CI: 1.19-1.88), and PD-associated peritonitis (HR: 1.53; 95% CI: 1.23-1.88). These associations were consistent, but evidence was predominantly of low to very low certainty. Results for subgroup and sensitivity analyses were consistent with the primary finding. Only two studies examined the impact of correcting hypokalemia with potassium supplementation in PD patients, and the results are inconclusive. Conclusion Hypokalemia is common and portends poorer survival and higher risk of peritonitis among PD patients. Further research into the optimal prevention and treatment strategies for hypokalemia is warranted to improve outcomes.

#1262 Risk factors of peritoneal dialysis associated peritonitis caused by gram-negative bacteria: a single-center retrospective study over 16 years

Abstract Background and Aims To analyse the clinical characteristics, pathogen distribution, and treatment outcomes of peritoneal dialysis associated peritonitis (PDAP) caused by gram-negative bacteria, and explore the risk factors for the occurrence and treatment failure of gram-negative bacterial peritonitis. Method We performed a single-center retrospective study included 544 PD patients who underwent regular follow-up between January 1, 2007, and December 31, 2022. After excluding culture-negative peritonitis, fungal peritonitis, and tuberculous peritonitis, based on the pathogens, all episodes were divided into the gram-negative peritonitis group (GNP) and the non-gram-negative peritonitis group (non-GNP). Demographic characteristics, laboratory examinations, pathogenic bacteria, and treatment outcomes were collected and compared between the two groups of peritonitis. Results Over the course of 16 years, 297 episodes of peritonitis occurred in 179 patients. Although the overall incidence of peritonitis is showing a year-on-year downward trend, the incidence of GNP has not changed significantly. However, the percentage of GNP cases among all peritonitis cases is on the rise. After excluding episodes of culture-negative peritonitis, fungal peritonitis, and tuberculous peritonitis, a total of 226 cases of peritonitis were included in the study. Among them, females accounted for 50.0%, with an average age of 63.04 ± 11.58 years and a median PD duration of 42 (21, 73) months. Escherichia coli was the main pathogen responsible for gram-negative bacterial peritonitis in our center (37/80, 46.3%), followed by Klebsiella pneumoniae (9/80, 11.3%). The GNP group had significantly higher white blood cell counts in peritoneal effluent on day 0, day 3, and day 5 after peritonitis onset compared to the non-GNP group (p < 0.001 for all). In terms of treatment outcomes, the GNP group had significantly higher rates of developing refractory peritonitis, treatment failure, and peritonitis-associated death compared to the non-GNP group (p < 0.001 for all). Multivariate logistic regression analysis revealed that enteric infection was an independent risk factor for GNP occurrence (OR = 6.315, 95% CI 3.364-11.854, p < 0.001). White blood cell counts on day 3 of peritoneal effluent (OR = 2.666, 95% CI 1.099-6.469, p = 0.030) and post-PDAP blood white blood cell counts (OR = 1.389, 95% CI 1.060-1.820, p = 0.017) were independent risk factors for treatment failure in GNP. Conclusion Over the past 16 years, the incidence rate of GNP in our center has shown no significant decrease, and the proportion of GNP cases has been increasing year by year. Escherichia coli is the main pathogen responsible for GNP in our center. GNP cases are more difficult to treat and have a poorer prognosis compared to non-GNP cases. Therefore, it is important to strengthen preventive measures for peritoneal dialysis patients, reduce the risk of enteric infection, and actively treat patients who have already developed gram-negative bacterial peritonitis to avoid adverse outcomes.

#784 Peritoneal dialysis-related infections by Kocuria kristinae: cases from a Mexican hospital

Abstract Background and Aims Kocuria species, gram-positive actinobacteria, are typically found in the environment, on human skin and as oral flora. These microorganisms are considered saprophytes and non-pathogenic. They rarely cause infections. Patients generally have some compromise due to underlying conditions, including solid tumors, hematologic malignancies, or metabolic disorders. There are few cases in the literature of peritoneal dialysis-associated peritonitis due to these germs. Reports of exit site infections or tunnel infections are even rarer or doesn't exist. Method Retrospective description of 4 cases of exit site and/or tunnel infections due to Kocuria kristinae over a 3-year period in a single center. Results Four cases of exit site infection were evaluated, with an average age of 63.2 ± 8.8 years. Half of the patients were diabetic. No patient had a history of peritoneal dialysis-related infection. The dialysis modality for all patients was CAPD (Continuous Ambulatory Peritoneal Dialysis). All patients presented symptoms of exit site infection, such as erythema and purulent discharge, but none of them had peritonitis. Three cases were treated with quinolones, and one received linezolid. One case received two antibiotic treatment regimens without an adequate response, and tunnel infection developed, required the removal of the dialysis catheter and a change in modality to HD (hemodialysis). Conclusion Exit site infections due to Kocuria are extremely rare. Despite the absence of specific management guidelines, the response to treatment is usually adequate. Due to the theoretical ability to produce biofilm, Kocuria infections should be considered a potential risk for recurrence and refractory disease. To our knowledge, there are no reports of exit site infections due to Kocuria.

#897 Peritoneal inflammation in PD-related peritonitis induces systemic eryptosis: in vitro and in vivo assessments

Abstract Background and Aims Erythrocytes (RBCs) have a highly specialized and organized membrane structure and undergo programmed cell death, known as eryptosis ( = stress-induced RBC death mechanism). Triggers of eryptosis include oxidative stress, inflammation and several uremic toxins. Our preliminary data show a significant increase of eryptosis during peritoneal dialysis (PD) -associated peritonitis in PD patients. The aims of this study were: assessment of incrementation of eryptosis in PD patients with peritonitis, evaluation of the relationship between systemic eryptosis in peritonitis and specific peritonitis biomarkers in PD effluent (PDE), and confirmation of the induction of eryptosis by peritonitis in a vitro setting. Method We enrolled 34 PD patients in stable condition (without systemic inflammation nor PD-related peritonitis in the last 3 months), 31 PD patients with acute peritonitis, and 17 healthy subjects (CTR). For PD stable patients, blood samples for eryptosis evaluation were drawn during the regular outpatient. For PD patients with peritonitis, blood samples and PDE samples were collected at the time of peritonitis diagnosis. PDE samples were used for peritoneal White Blood Cell count (pWBC), peritoneal Neutrophil Gelatinase-associated Lipocalin (pNGAL) and peritoneal cytokines levels (IL-1β and IL-6) measurements. For in vitro study, healthy RBCs were exposed to plasma of 31 PD patients with peritonitis and plasma of CTR group for 2, 4 and 24 hours. Morphological markers of eryptosis (cell membrane scrambling, cell shrinkage) and eryptosis percentage (based on PS exposure at RBC surface and AnnexinV-binding) were evaluated by flow cytometric analyses in vivo and in vitro. Results Totally, 65 chronic PD patients were included in this study. 57% of patients were treated with continuous ambulatory PD (CAPD) and 43% with automated PD (APD). The median PD vintage was 38 months (IQR 3.6–124.9 months). Table 1 reports clinical data for our PD population (Table 1). The percentage of AnnexinV-binding RBCs was significantly higher in PD patients than in CTR (2.7%; IQR 1.6–3.9 vs CTR: 0.8; IQR 0.7–1.3 P < .05). Eryptosis levels did not differ significantly between PD pts with and without diabetes, with and without hypertension, with and without cardiovascular disease. Eryptosis showed no significant differences between patients treated by CAPD/APD, and with Kt/Vurea values ≤ 1.7 and > 1.7. Generally, RBCs of all 65 PD patients were dramatically deranged in their morphology. In particular, RBCs from PD patients with peritonitis were characterized by dramatically deranged morphology and increased median cell volume in comparison with PD stable patients (P < .001). The percentages of AnnexinV-binding RBCs were significantly increased in the PD-associated peritonitis group (9.6%; IQR 4.2–16.7 versus 2.7%; IQR 1.6–3.9) (P<.0001) (Fig. 1). The percentage of AnnexinV-binding RBCs was significantly higher in PD patients with peritonitis than in healthy CTR (P < .001). We confirmed these in vivo data by in vitro results: healthy RBCs incubated with plasma from PD patients with peritonitis demonstrated a significant increase of eryptosis compared to healthy RBCs exposed to plasma from control group at all times (Fig. 2). Furthermore, significant positive strong correlations were observed between eryptosis level and all analysed peritoneal biomarkers of peritonitis (Spearman's rho pWBC = 0.77, P<.001, Spearman's rho pNGAL = 0.64, P = .001, Spearman's rho IL-6 = 0.61, P = .003 and Spearman's rho IL-1β = 0.64, P = .001,) (Fig. 3). Conclusion We investigated a potential connection between systemic eryptosis and peritoneal biomarkers of peritonitis. In particular, we theorized that the eryptosis enhancement is directly connected with peritonitis, and, based on the results, we hypothesized that the peritoneal membrane injury could be related to eryptosis. Upregulation of inflammatory markers could explain the increased rate of systemic eryptosis during PD-related peritonitis. In particular, we corroborated this point with our observations about in vitro induction of eryptosis by plasma from PD patients on the first day of peritonitis.

Higher N-terminal pro-brain natriuretic peptide level at onset of peritoneal dialysis-related peritonitis is a risk factor for technique failure.

Recent studies have suggested that the N-terminal fragment of B-type natriuretic peptide (NT-proBNP) level serve as a significant risk factor for mortality in patients with end-stage renal disease. However, the relationship between NT-proBNP levels and technique failure in peritoneal dialysis-associated peritonitis (PDAP) remains unclear. This study investigated the relationship between NT-proBNP levels at the onset of PDAP and the risk of technique failure in patients with PDAP. A retrospective analysis was conducted on patients with PDAP from December 1, 2009, to December 31, 2021, at our peritoneal dialysis center. We recorded all demographic and baseline clinical data at the time of admission for each PDAP episode. Logistic and Cox regression analyses were performed to assess the association between NT-proBNP levels and technique failure. Of 485 PDAP episodes included in this study, 130 episodes of technique failure were observed. Multivariate logistic analysis revealed that hospital stay, Na and NT-proBNP levels, and peritoneal dialysate white blood cell counts on days 3 and 5 were independently associated with technique failure. The receiver operating characteristic curve demonstrated that the NT-proBNP level was a better indicator than the other four variables in indicating technique failure. In the multivariate Cox regression analysis, after adjusting for confounding factors, higher NT-proBNP levels (HR of 3.020, 95% CI 1.771, 5.150, P < 0.001) were associated with PDAP technique failure. This retrospective study identified the serum NT-proBNP level at the onset of PDAP as an independent risk factor for technique failure in these patients.

Clinical characteristics and antibiotic treatment of peritoneal dialysis-associated peritonitis caused by Pseudomonas species: a review of 15 years' experience from southern China.

Although the incidence of peritoneal dialysis-associated peritonitis caused by Pseudomonas is very low, it seriously affects the technique survival of peritoneal dialysis patients. However, there are few studies and reports on Pseudomonas peritonitis in the Chinese mainland area. Therefore, the purpose of this study is to describe the clinical characteristics, the regimens of antibiotic, drug resistance, and outcome of peritoneal dialysis patients in southern China in the past 15 years and summarize the clinical experience in the treatment of Pseudomonas peritonitis.

Optimizing home visits through machine learning for preventing peritoneal dialysis-associated peritonitis: a proof of concept study and results from PDOPPS.

Optimizing home visits through machine learning for preventing peritoneal dialysis-associated peritonitis: a proof of concept study and results from PDOPPS.

Pharmacokinetics of intravenous piperacillin/tazobactam among patients with peritoneal dialysis-associated peritonitis.

Currently, pharmacokinetic information on intravenous (IV) piperacillin/tazobactam in patients with peritoneal dialysis-associated peritonitis (PD peritonitis) is limited. This study employed a prospective single-dose pharmacokinetic design to assess the pharmacokinetics of IV piperacillin/tazobactam in these patients. Four patients with PD peritonitis who received an IV loading dose of 4000 mg/500 mg piperacillin/tazobactam were enrolled in this study. The concentrations of piperacillin and tazobactam in plasma, peritoneal dialysis fluid (PDF) and urine were determined by high-performance liquid chromatography. Non-compartmental methods were used for pharmacokinetic analysis. During a 6-h dwell time for chronic ambulatory peritoneal dialysis (CAPD), 9.23 ± 4.01% of the piperacillin was recovered in the PDF. This result is greater than that observed in patients without peritonitis in prior research. Piperacillin's PD clearance (CLPD), steady-state volume of distribution (Vss) and terminal half-life (t 1/2) were 5.79 ± 2.55 mL/min, 24.35 ± 11.26 L and 5.74 ± 1.53 h, respectively. These values are also higher than those of patients without peritonitis in a prior study. Eight hours following the loading dosage, the plasma and PDF piperacillin concentrations of all patients (98.25 ± 26.03 and 52.70 ± 22.99 mg/L, respectively) surpassed the Pseudomonas aeruginosa and Enterobacterales Clinical and Laboratory Standards Institute susceptible breakpoints. In summary, the CLPD, Vss and t 1/2 for piperacillin were found to be greater in patients with PD peritonitis than in CAPD patients without peritonitis when compared with the results of a previous study. The IV loading dose of 4000 mg/500 mg piperacillin/tazobactam is sufficient to treat peritonitis caused by susceptible P. aeruginosa and Enterobacterales. The multiple-dose pharmacokinetics of IV piperacillin and tazobactam in this specific patient group should be further investigated.

Application of metagenomic next-generation sequencing technology in the etiological diagnosis of peritoneal dialysis-associated peritonitis.

Pathogens detected by metagenomic next-generation sequencing (mNGS) and the laboratory blood culture flask method were compared to understand the advantages and clinical significance of mNGS assays in the etiological diagnosis of peritoneal dialysis-associated peritonitis (PDAP). The study involved a total of 37 patients from the hospital's peritoneal dialysis centre, six of whom were patients with non-peritoneal dialysis-associated peritonitis. Peritoneal dialysis samples were collected from the 37 patients, who were divided into two groups. One group's samples were cultured using conventional blood culture flasks, and the other samples underwent pathogen testing using mNGS. The results showed that the positive rate of mNGS was 96.77%, while that of the blood culture flask method was 70.97% (p < 0.05). A total of 29 pathogens were detected by mNGS, namely 24 bacteria, one fungus, and four viruses. A total of 10 pathogens were detected using the bacterial blood culture method, namely nine bacteria and one fungus. The final judgment of the PDAP's causative pathogenic microorganism was made by combining the clinical condition, response to therapy, and the whole-genome sequencing findings. For mNGS, the sensitivity was 96.77%, the specificity was 83.33%, the positive predictive value was 96.77%, and the negative predictive value was 83.33%. For the blood culture flask method, the sensitivity was 70.97%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 0%. In conclusion, mNGS had a shorter detection time for diagnosing peritoneal dialysis-related peritonitis pathogens, with a higher positive rate than traditional bacterial cultures, providing significant advantages in diagnosing rare pathogens.

Pet-Related Pasteurella Multocida-Induced Peritonitis in Peritoneal Dialysis: A Case Report

Pasteurella multocida is a small, Gram-negative cocco-bacillus usually found in the oral cavities of most healthy cats and dogs as part of their natural oral flora. This zoonotic pathogen can cause a variety of infections in humans. The number of reported cases of peritoneal dialysis-associated peritonitis caused by P. multocida has been limited worldwide. We report here the case of a 38-year-old woman on continuous peritoneal dialysis (PD) that presented to the emergency department with abdominal pain and vomiting lasting for two days. A sample of peritoneal dialysis fluid was explored in the microbiology laboratory where grown microorganisms was identified by the VITEK2 system as P. canis with 90% accuracy. Then whole genome sequencing concluded that the species is rather P. multocida and that the strain was sensitive to all antibiotics tested and harbored various virulence genes. Patient was treated by intraperitoneal antibiotic course with cefotaxime for 3 weeks.

Pathogenic spectrum and risk factors of peritoneal dialysis-associated peritonitis: a single-center retrospective study

The present study aimed to explore the pathogenic spectrum and risk factors of peritoneal dialysis-associated peritonitis (Peritoneal dialysis associated peritonitis, PDAP) in Yongzhou, Hunan, China. The clinical and epidemiological data on regular peritoneal dialysis (Peritoneal dialysis, PD) between January 2016 and December 2020 in Yongzhou were collected for retrospective analysis. The related factors of peritonitis were evaluated by single-factor analysis, while risk factors of refractory PDAP were evaluated by multivariate logistic regression analysis.172/331 172 (51.9%) patients developed peritonitis. The risk factors of PDAP in PD patients included high C-reactive protein (C-reactive protein, CRP), low albumin(Albumin, ALB), low hemoglobin (Hemoglobin, Hb), low educational level (junior high school or lower), preference of spicy food, irregular diet, low annual household income, unfavorable fluid exchange conditions, unstable employment (including working as a farmer), and unfavorable humidity conditions (P < 0.05). 63/172 (36.6%) PDAP patients were intractable cases with a pathogenic bacteria positive rate of 74.60% in the peritoneal dialysate cultures, and 109/172 patients were non-intractable cases with a pathogenic bacteria positive rate of 53.21%. Gram-positive bacteria (G+) were detected in most of the dialysate cultures, with Staphylococcus epidermidis (S. epidermidis) as the most common type, while Escherichia coli (E. coli) was the most common Gram-negative bacteria (G-). Gram-positive bacteria were sensitive to vancomycin and linezolid, while G- bacteria were sensitive to imipenem and amikacin. Lifestyle, educational level, and environmental factors are the major contributors to PDAP in PD patients. Fungal and multi-bacterial infections are the major causes of death; PD is stopped for such patients.

Brucellosis-induced peritonitis and abdominal aortitis in a non-endemic area patient on peritoneal dialysis: a case report and literature review

BackgroundBrucella infection is uncommon among peritoneal dialysis (PD) patients in non-endemic areas, and the occurrence of both peritonitis and abdominal aortitis is rare.Case presentationIn December 2023, a 63-year-old male patient undergoing PD was admitted to Shaoxing Second Hospital due to fever, abdominal pain, and cloudy dialysate. Upon physical examination, diffuse mild abdominal pain and tenderness were observed. Subsequent investigation into the patient's medical history revealed consumption of freshly slaughtered lamb from local farmers 3 days prior to the onset of symptoms. Various diagnostic tests, including routine blood tests, procalcitonin levels, and PD fluid analysis, indicated the presence of infection. Abdominal computed tomography (CT) imaging revealed localized lumen widening of the abdominal aorta with surrounding exudative changes. On the sixth day in the hospital, blood and PD fluid cultures confirmed Brucella melitensis infection. The patient was diagnosed with brucella-associated peritonitis and aortitis. Treatment was adjusted to include rifampin and doxycycline for 6 weeks, and the decision was made to keep the PD catheter. Remarkably, the patient exhibited resolution of peritonitis and abdominal aortitis within the initial week of the adjusted treatment. Currently, the patient continues to receive ongoing clinical monitoring.ConclusionBrucella is rare but can cause PD-associated peritonitis and arteritis. Prompt diagnosis and treatment can lead to a good outcome in PD patients. Dual therapy is effective, but the need for catheter removal is unclear. Consider international guidelines and patient factors when deciding on catheter removal.

WCN24-643 PERITONITIS RATE AND PROGNOSIS OF PERITONEAL DIALYSIS ASSOCIATED PERITONITIS IN A THIRD LEVEL HOSPITAL IN MEXICO CITY

WCN24-643 PERITONITIS RATE AND PROGNOSIS OF PERITONEAL DIALYSIS ASSOCIATED PERITONITIS IN A THIRD LEVEL HOSPITAL IN MEXICO CITY

Research Progress of Chinese Medicine Compound Intervention in Peritoneal Dialysis-associated Peritonitis

Research Progress of Chinese Medicine Compound Intervention in Peritoneal Dialysis-associated Peritonitis

Unusual and complicated peritonitis: Your questions answered.

Effective treatment of infections is a growing challenge owing to antimicrobial resistance. Peritoneal dialysis (PD) patients experience more frequent hospitalisations than the general population and have greater exposure to antibiotics, making them particularly vulnerable to this threat. Over the last decade, we have noted a surge in cases of complicated peritoneal dialysis-associated peritonitis (PD peritonitis) caused by antimicrobial-resistant organisms, including extended-spectrum beta-lactamase (ESBL), AmpC beta-lactamase-producing Enterobacterales, Pseudomonas aeruginosa and fungi. Practitioners must be alert to these organisms, seek early recognition of these resistance patterns and make timely adjustments in order to avoid delay in treatment that may increase risk of PD catheter removal and technique failure. We present a case of successful treatment of ESBL peritonitis, highlight its challenges, while providing guidance on management of other unusual and complicated PD peritonitis.

Frequency and prognosis of peritoneal dialysis-associated peritonitis in children.

Peritonitis is the leading cause of peritoneal dialysis (PD) discontinuation. However, few data concern risk factors of peritonitis development and catheter removal caused by treatment failure in pediatric patients. This single-center, retrospective study analyzed data from pediatric patients who underwent chronic PD between March 2002 and June 2022. The incidence rates of peritonitis by the person-year method were calculated, and they were stratified by patient age groups. Risk factors for peritonitis development and catheter removal were also analyzed by multivariate analysis using logistic regression model. Ninety patients were enrolled, and 62 peritonitis episodes were observed in 41 (46%) patients. The incidence rate of peritonitis was 0.21 episodes per patient-year, which was the highest in children aged under 2years old (0.26 episodes per patient-year). Moreover, 44 (71%) cases were successfully cured by antibiotics alone, although 17 (27%) cases required catheter removal, and 4 (6%) cases transitioned to chronic hemodialysis because of peritoneal dysfunction. One patient died. The risk factor for peritonitis development and catheter removal caused by treatment failure was PD insertion at under 2years old (odds ratio = 2.5; P = 0.04) and Pseudomonas aeruginosa (odds ratio = 11.0; P = 0.04) in the multivariate analysis. P. aeruginosa was also a risk factor for difficulty in re-initiating PD (P = 0.004). The incidence rate of peritonitis was the highest in children under 2years old. P. aeruginosa peritonitis is a risk factor for catheter removal and peritoneal dysfunction.

The association between new inflammation markers and frequent peritoneal dialysis-associated peritonitis

ObjectiveTo validate an association between new inflammation and frequent peritoneal dialysis-associated peritonitis (PDAP).Materials and methodsIn China, retrospective clinical data were collected on 208 patients who received continuous ambulatory peritoneal dialysis (CAPD) between 2010 and 2021. The patients were divided into two groups: non-frequent PDAP (the interval between two peritonitis episodes of more than one year) and frequent PDAP (the interval between two peritonitis episodes of less than one year). Patients with their first episode of peritonitis had their age, gender, history of hypertension, diabetic disease, underlying renal disease, bacterial infection, and laboratory data collected. The outcomes of bacterial dispersion, systemic immune-inflammation index (SII), high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP), and risk variables associated with frequent PDAP were analyzed.ResultsThere are differences between the two groups in dialysis time (p = 0.006), hypertensive nephropathy (p = 0.038), staphylococcus (p = 0.035), white blood cells (p = 0.001), neutrophil (p < 0.01), lymphocyte (p < 0.01), platelet(p = 0.01), SII(p < 0.01), CRP/HDL-C (p = 0.002), CRP (p < 0.001), serum creatinine (p = 0.007), blood urea nitrogen (p = 0.05), serum magnesium (0.03), serum potassium (p = 0.007), and dialysate polymorphonuclear cells (p = 0.004). Multifactorial logistic regression analysis found that SII (p < 0.001), CRP/HDL-C (p = 0.041), and Diabetes mellitus (p = 0.027) were independent risk factors for frequent PDAP. The ROC curve analysis revealed that combining SII with CRP/HDL-C resulted in the largest AUC area (AUC = 0.814).ConclusionsOur findings offer clinical proof of the combination of SII and CRP/HDL-C in patients with frequent PDAP.

Peritoneal Dialysis-associated Peritonitis Complicated with Intestinal Obstruction

Peritoneal Dialysis-associated Peritonitis Complicated with Intestinal Obstruction

Evolution of Peritoneal Dialysis-Associated Peritonitis: Pathogen, Antibiotic Resistance, and the Impact of Lymphocyte Count on Treatment Outcomes.

Antibiotic administration leads to alterations in pathogenic organisms and antibiotic resistance, posing a significant risk to peritoneal dialysis patients' health. This study aimed to investigate changes in the cause-specific peritonitis, pathogen profiles, antibiotic resistance, and the prognostic factors among patients with peritoneal dialysis-associated peritonitis (PDAP) at our center. We included 463 PDAP patients who attended Peking University Shenzhen Hospital between 2002 and 2023. We analyzed the effects of empirical treatment regimens with cefazolin and ceftazidime or gentamicin. From 2002 to 2023, we observed that gram-positive staphylococci emerged as the primary causative agents, while the proportion of gram-negative bacillary, enteric peritonitis, and catheter-associated peritonitis decreased significantly. However, the overall cure rate for PDAP and gram-negative bacillary peritonitis declined significantly from 2014 to 2023. Notably, we observed no increase in antibiotic resistance associated with antibiotic drugs use. In addition, reduced lymphocyte counts due to the prevalence of 2019 coronavirus disease (COVID-19) emerged as an independent risk factor for treatment failure in cases of gram-negative bacillary peritonitis. We did not observe elevated antibiotic resistance in our center when employing empirical dosing strategies involving cefazolin, ceftazidime, or gentamicin. Additionally, we found that a decrease in lymphocyte count due to the COVID-19 epidemic was a significant risk factor for treatment failure in cases of gram-negative bacillary peritonitis at our center. This study provides a foundation for developing clinical treatment strategies for PDAP.