Peritoneal Dialysis-associated Peritonitis Research Articles

Red cell distribution width to albumin ratio predicts treatment failure in peritoneal dialysis-associated peritonitis.

This study aims to investigate the potential correlation between baseline red cell distribution width (RDW) to albumin ratio (RAR) levels and treatment failure in peritoneal dialysis-associated peritonitis (PDAP) patients. A retrospective single-center study was conducted on 286 PDAP patients. Logistic regression and generalized estimation equation (GEE) analyses were employed to assess the relationship between RAR and treatment failure. RAR emerged as a robust predictor of treatment failure in PDAP patients. Elevated RAR levels were associated with an increased risk of treatment failure, exhibiting a linear relationship. Even after adjusting for demographic and clinical variables, this association remained statistically significant. ROC analysis revealed that RAR outperformed RDW and albumin individually in predicting PDAP prognosis. This study highlights RAR as a superior prognostic marker for treatment failure in PDAP patients, offering new insights into risk assessment and management strategies for this challenging condition.

A population-based study on the incidence and aetiology of infectious complications in peritoneal dialysis in South Sweden

Background Peritonitis is a major cause of morbidity in peritoneal dialysis (PD) and an independent risk factor for elevated all-cause mortality. The aims of this study were to report the incidence, trend, aetiology, and antimicrobial susceptibility of PD-associated peritonitis and catheter-related infections in South Sweden between 2011–2020. Methods This population-based observational cohort study included all patients with PD between the years 2011–2020 in the county of Skåne. Data was accessed through the Swedish Renal Registry and the Department of Clinical Microbiology in Lund. Definitions issued by the International Society for Peritoneal Dialysis were implemented to assess PD-associated infections. Results Medical records of 675 paediatric and adult PD patients were eligible for inclusion. Of those, 208 (31%) were female and the median age was 67 years (range 0-91). The overall rate of PD-peritonitis was 0.38 episodes per year at risk. Out of 484 episodes of peritonitis, 61% (n = 295) were caused by Gram-positive bacteria. There were 289 occurrences of exit site infections, of which most (n = 152, 53%) were Gram-positive. Tunnel infections occurred in 16 episodes and were caused by S. aureus or P. aeruginosa. Among all isolates, 37 were of MRSE, four of ESBL-producing E. coli, and one of MRSA. Conclusion The crude rate of PD-peritonitis was stable during the study period. Gram-positive bacteria dominated the microbial aetiology, and antibiotic resistance was limited. It is important to monitor the aetiology, incidence, and resistance rates in PD-associated infections, to base empirical antibiotic regimens and facilitate prevention.

Calprotectin blockade inhibits long-term vascular pathology following peritoneal dialysis-associated bacterial infection.

Bacterial infections and the concurrent inflammation have been associated with increased long-term cardiovascular (CV) risk. In patients receiving peritoneal dialysis (PD), bacterial peritonitis is a common occurrence, and each episode further increases late CV mortality risk. However, the underlying mechanism(s) remains to be elucidated before safe and efficient anti-inflammatory interventions can be developed. Damage-Associated Molecular Patterns (DAMPs) have been shown to contribute to the acute inflammatory response to infections, but a potential role for DAMPs in mediating long-term vascular inflammation and CV risk following infection resolution in PD, has not been investigated. We found that bacterial peritonitis in mice that resolved within 24h led to CV disease-promoting systemic and vascular immune-mediated inflammatory responses that were maintained up to 28 days. These included higher blood proportions of inflammatory leukocytes displaying increased adhesion molecule expression, higher plasma cytokines levels, and increased aortic inflammatory and atherosclerosis-associated gene expression. These effects were also observed in infected nephropathic mice and amplified in mice routinely exposed to PD fluids. A peritonitis episode resulted in elevated plasma levels of the DAMP Calprotectin, both in PD patients and mice, here the increase was maintained up to 28 days. In vitro, the ability of culture supernatants from infected cells to promote key inflammatory and atherosclerosis-associated cellular responses, such as monocyte chemotaxis, and foam cell formation, was Calprotectin-dependent. In vivo, Calprotectin blockade robustly inhibited the short and long-term peripheral and vascular consequences of peritonitis, thereby demonstrating that targeting of the DAMP Calprotectin is a promising therapeutic strategy to reduce the long-lasting vascular inflammatory aftermath of an infection, notably PD-associated peritonitis, ultimately lowering CV risk.

Gastric Acid Suppression Therapy and Its Association with Peritoneal Dialysis-Associated Peritonitis in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).

Peritonitis is a major peritoneal dialysis (PD) related complication. We determined whether gastric acid suppression (GAS) (proton pump inhibitor (PPI) or histamine-2 receptor antagonists (H2RA)) use was associated with all-cause and organism-specific peritonitis in PD patients. In the Peritoneal Dialysis Outcomes and Practice Patterns Study (595 facilities, 8 countries, years 2014-2022), associations between GAS use and time to first episode of all-cause peritonitis were examined using Cox proportional hazards models. The primary exposure of interest was GAS, and secondarily PPI or H2RA use. Secondary outcomes were organism-specific peritonitis, peritonitis cure rates, and death. Among patients (n=23 797) at study baseline, 6020 (25.3%) used PPIs, and 1382 (5.8%) used H2RAs. Overall risks of GAS use and peritonitis risk [adjusted hazard ratio (AHR)=1.05 (95% CI 0.98-1.13)], and use of PPI [AHR 1.06 (95% CI 0.99-1.14)] or H2RA [AHR 1.02 (95% CI 0.88-1.18)] did not reach statistical significance. In organism-specific analyses, GAS users displayed higher peritonitis risks for gram-negative (AHR 1.29, 95% CI 1.05-1.57), gram-positive (AHR 1.15, 95% CI 1.01-1.31), culture-negative (AHR 1.20, 95% CI 1.01-1.42), enteric (AHR 1.23, 95% CI 1.03-1.48), and particularly Streptococcal (AHR 1.47, 95% CI 1.15-1.89) peritonitis episodes. GAS was also associated with higher overall mortality [AHR 1.13 (95% CI 1.05-1.22)]. The association between GAS use and peritonitis risk was weaker (HR 1.05 [0.98-1.13]) than for streptococcal (HR 1.57 [1.15-1.89]) and gram-negative (HR 1.29 [1.05-1.57]) peritonitis. A better understanding of mechanisms surrounding the differential effects of GAS subtype on peritonitis risks is needed. Clinicians should be cautious when prescribing GAS. The impact of GAS deprescribing on peritonitis risk requires further evaluation.

Comparison of clinical outcomes between culture-negative and positive peritonitis in patients undergoing maintenance peritoneal dialysis: a prospective cohort study

BackgroundCulture-negative peritonitis is a serious complication in patients undergoing maintenance peritoneal dialysis (PD) and occurs in up to 40% of all peritonitis episodes. Despite its high incidence, data regarding treatment response and prognosis remain poorly defined. This study compared the clinical outcomes of patients with culture-negative and positive peritonitis.MethodThis prospective cohort study was conducted between 2021 and 2022. Patients treated with maintenance PD who developed PD-associated peritonitis were included and received standard treatment. The primary endpoint was the primary response (resolution of peritonitis 10 days after the initiation of treatment).ResultsOf the 81 patients who developed PD-associated peritonitis during the study, 35 and 46 had culture-negative and culture-positive peritonitis, respectively. Overall, 52 (64.2%) patients achieved the primary response: 24 (68.6%) in the culture-negative group and 28 (60.9%) in the culture-positive group (p = 0.630). There were no significant differences between the two groups in the incidence of complete cure (complete resolution of peritonitis without the need for Tenckhoff catheter removal or salvage antibiotic therapy or peritonitis within 120 days after treatment) (culture-negative vs. culture-positive group, 57.1% vs. 45.7%), refractory peritonitis (28.6% vs. 41.3%), relapse peritonitis (8.6% vs. 2.2%), repeat peritonitis (11.4% vs. 10.9%), salvage antibiotics (40.0% vs. 50.0%), permanent hemodialysis transfer (11.4% vs. 10.9%), Tenckhoff catheter removal (25.7% vs. 41.3%), or mortality (2.9% vs. 2.2%) (all p > 0.05).ConclusionThis study offers valuable insights into the clinical outcomes of culture-negative peritonitis versus culture-positive peritonitis. However, caution must be exercised in interpreting these findings due to the limitations of the small sample size.Clinical trial registrationThe study was retrospectively registered in the Thai Clinical Trials Registry (TCTR20221130006).

Decreased Peripheral Blood Lymphocyte Count Predicts Poor Treatment Response in Peritoneal Dialysis-Associated Peritonitis.

Peripheral blood lymphocyte counts is a pivotal parameter in assessing the host's immune response during maladies and the equilibrium of the immune system which has been found to correlate with various diseases progression and prognosis. However, there was no study on patients with peritoneal dialysis-associated peritonitis (PDAP). We sought to investigate the prognostic value of baseline peripheral blood lymphocyte count in PDAP patients. This retrospective study analyzed data from 286 PDAP patients over nine years. Episodes were categorized according to the tertiles of peripheral blood lymphocyte counts (Very Low Lymphocyte Count (VLLC) Group, <0.72×106/L; Low Lymphocyte Count (LLC) Group, 0.72-1.11×106/L; Normal Lymphocyte Count (NLC) Group, ≥ 1.11×106/L). Demographic, laboratory, and infection-related variables were analyzed. Cox regression and generalized estimating equation (GEE) models were used to estimate the association between lymphocyte counts and PDAP treatment failure, which included PD catheter removal and death. After adjusting for other potential predictors, decreased lymphocyte counts exhibited an incremental relationship with the risk of treatment failure. The VLLC group indicated a 270% (95% CI, 1.168-6.247, P=0.020) and 273% (95% CI, 1.028-7.269, P=0.044) increased venture of treatment failure in Cox regression and GEE analyses, respectively, compared with the NLC group. As a continuous variable, the restricted cubic spline showed a linear negative correlation between lymphocyte counts and the treatment failure risk (P for overall = 0.026). The multivariate model C (combined lymphocyte count with baseline age, sex, dialysis age, Charlson Comorbidity index (CCI), etiology of kidney failure, hemoglobin, albumin, total bilirubin and infection type) showed an area under the curve of 0.824 (95% CI, 0.767-0.881, P=0.001) for the prediction of treatment failure. Lower lymphocyte counts are linked to increased PDAP treatment failure risk. This highlights lymphocyte count's potential as a prognostic indicator for PDAP.

Random Forest Can Accurately Predict the Technique Failure of Peritoneal Dialysis-Associated Peritonitis Patients

Random Forest Can Accurately Predict the Technique Failure of Peritoneal Dialysis-Associated Peritonitis Patients

Predictors of culture-negative peritoneal dialysis-associated peritonitis: a single center, retrospective study

BackgroundEmpirical antibiotic treatment against peritoneal dialysis (PD)-related peritonitis should be immediately initiated before PD effluent culture results are obtained. As culture results guide the choice of antibiotics, culture-negative peritonitis (CNP) is a serious issue. In addition, the identification of the causative organism often indicates a possible source of infection. This study aimed to clarify the predictors of CNP.MethodsThis single-center, retrospective study was conducted from November 2007–December 2018 in patients undergoing PD with peritonitis at our institution, where 204 peritonitis episodes (57 culture-negative, 147 culture-positive) were investigated based on demographics, and clinical parameters. CNP predictors were investigated using logistic regression.ResultsCNP rate was significantly higher in female and in patients with higher platelet counts, lower dialysate cell counts at peritonitis diagnosis, and higher serum β2-microglobulin levels. In multivariate logistic regression, female sex (odds ratio [OR] 2.69, 95% confidence interval [CI] 1.31–5.54), dialysate cell count at diagnosis (OR0.99, 95% CI 0.99–0.99), and serum β2-microglobulin level (OR 1.04, 95% CI 1.00–1.07) were significantly associated with CNP. The areas under the receiver operating characteristic curve for female patients, dialysate cell counts at diagnosis of peritonitis, serum β2-microglobulin level, and female patients + dialysate cell counts at diagnosis of peritonitis + serum β2-microglobulin level were 0.604, 0.694, 0.603, and 0.751, respectively.ConclusionsFemale sex, dialysate cell counts at peritonitis diagnosis, and serum β2-microglobulin levels may be predictors of CNP.

Association of Different Total Bilirubin Levels with Prognosis of Peritoneal Dialysis-Associated Peritonitis.

Background and Objectives: Peritoneal dialysis-associated peritonitis (PDAP) poses significant challenges in peritoneal dialysis (PD) patient management and outcomes. Total bilirubin has gained attention due to its antioxidant and immunomodulatory properties. However, its relationship with PDAP prognosis remains underexplored. Materials and Methods: We conducted a retrospective single-center study involving 243 PDAP patients stratified into tertile-based groups according to total bilirubin levels. The association between total bilirubin levels and treatment failure risk was investigated through statistical analyses and restricted cubic spline curve analysis. Results: Our analysis revealed a non-linear correlation between total bilirubin levels and PDAP treatment failure risk. At total bilirubin levels below 8.24 µmol/L, a protective effect was observed, while levels exceeding this threshold heightened the risk of treatment failure. Conclusions: This study unveils a dual role of total bilirubin in PDAP prognosis. Below a certain threshold, it confers protection, while higher levels exacerbate the risk of treatment failure. These findings emphasize the need for further investigation in larger, multicenter prospective studies to validate and elucidate the mechanisms behind bilirubin's impact on PDAP, potentially guiding the development of targeted therapeutic strategies.

First Case Report of Peritoneal Dialysis-associated Peritonitis Caused by Lysinibacillus Sphaericus.

We herein report a case of peritoneal dialysis-associated peritonitis caused by Lysinibacillus sphaericus in a 40s-year-old patient. Treatment was initiated with intermittent intraperitoneal cefazolin and ceftazidime. Later, both peritoneal dialysate and blood cultures detected L. sphaericus, so the antibiotic was changed to ampicillin (ABPC). The patient was treated with a combination of intraperitoneal intermittent and intravenous ABPC for 7 days, followed by 14 days of amoxicillin. The patient experienced no adverse events and no recurrence for 30 days. The patient had four dogs, and the infection was deemed likely to have been caused by environmental contamination and inadequate catheter replacement.

Peritoneal dialysis-associated peritonitis from pauci-septated mold: Life-threatening but curable

Two cases of PD-associated peritonitis due to Cunninghamella (C. bertholletiae and C. guizhouensis) were reported here with favorable outcomes, albeit presenting with septicemia. Both patients presented with classic features of bacterial peritonitis, cloudy effluent with a neutrophil predominance, followed by fever and septicemia/septic shock. The pathogen species were confirmed and verified by molecular phylogeny using universal and specific fungal primers. All isolations were susceptible/intermediately susceptible to amphotericin B but resistant to other antifungal agents, including triazoles, caspofungin, and terbinafine. Both cases were successfully treated with timely PD catheter removal and antifungal medications for 2–4 weeks.

Association between dialysis effluent leukocyte count after initial antibiotic treatment and outcomes of patients with peritoneal dialysis-associated peritonitis: a retrospective study

Background Among patients with peritoneal dialysis-associated peritonitis (PDAP), It has been regarded as an indicator of deterioration of clinical condition that peritoneal dialysis effluent leukocyte count (PDELC) cannot be restored to normal after initial antibiotic therapy. However, the precise relationship between PDELC on day 5 and the clinical outcomes of PDAP episodes remains uncertain. Aims To explore the association between PDELC on day 5 and clinical outcomes of PDAP episodes. Methods This retrospective study was based on the medical chart database of the Affiliated Hospital of Guangdong Medical University. Multivariable regressions were used to evaluate the association between PDELC on day 5 and 60-day mortality, half-year mortality, treatment failure, and the length of stay in hospital with adjustment for confounding factors. Results A total of 549 PDAP episodes in 309 patients were enrolled. The total 60-day mortality, half-year mortality, and rate of treatment failure was 6.0%, 9.8%, and 14.2%, respectively. Compared with patients with normal PDELC, those with PDELC ≥2000 × 106/L on day 5 had significantly higher 60-day mortality (31.1% vs 2.7%), half-year mortality (35.6% vs 5.6%), and treatment failure (46.7% vs 5.7%). In multivariate adjusted regression, the ORs (95%CI) were 6.99 (2.33, 20.92; p = 0.001), 4.97(1.93, 12.77; p = 0.001), and 5.77 (2.07, 16.11; p = 0.001), respectively. Patients with PDELC were 100–2000 × 106/L on day 5 had a higher rate of treatment failure than those with normal PDELC (26.9% vs 5.7%) (OR = 3.03, 95%CI 1.42, 6.46; p = 0.004). After sensitivity analysis, the results remained robust. Conclusions Among patients with PDAP, increased PDELC on day 5 was associated with a greater risk of 60-day mortality, half-year mortality, and treatment failure.

Construction and validation of a predictive model for the risk of peritoneal dialysis-associated peritonitis after peritoneal dialysis catheterization.

To construct and validate a risk prediction model for the development of peritoneal dialysis-associated peritonitis (PDAP) in patients undergoing peritoneal dialysis (PD). This retrospective analysis included patients undergoing PD at the Department of Nephrology, the First Affiliated Hospital of Anhui University of Chinese Medicine, between January 2016 and January 2021. Baseline data were collected. The primary study endpoint was PDAP occurrence. Patients were divided into a training cohort (n = 264) and a validation cohort (n = 112) for model building and validation. Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to optimize the screening variables. Predictive models were developed using multifactorial logistic regression analysis with column line plots. Receiver operating characteristic (ROC) curves, calibration curves, and Hosmer-Lemeshow goodness-of-fit tests were used to verify and evaluate the discrimination and calibration of the prediction models. Decision curve analysis (DCA) was used to assess the clinical validity of the prediction models. Five potential predictors of PDAP after PD catheterization were screened using LASSO regression analysis, including neutrophil-to-lymphocyte ratio (NLR), serum ALBumin (ALB), uric acid (UA), high sensitivity C-reactive protein (hsCRP), and diabetes mellitus (DM). Predictive models were developed by multi-factor logistic regression analysis and plotted in columns. The area under the ROC curve (AUC) values were 0.891 (95% confidence interval [CI]: 0.829-0.844) and 0.882 (95% CI: 0.722-0.957) for the training and validation cohorts, respectively. The Hosmer-Lemeshow test showed a good fit (p = 0.829 for the training cohort; p = 0.602 for the validation cohort). The DCA curves indicated that the threshold probabilities for the training and validation cohorts were 4-64% and 3-90%, respectively, predicting a good net gain for the clinical model. NLR, ALB, UA, hsCRP, and DM are independent predictors of PDAP after PD catheterization. The column line graph model constructed based on the abovementioned factors has good discriminatory and calibrating ability and helps to predict the risk of PDAP after PD catheterization.

Development of a clinical risk score system for peritoneal dialysis-associated peritonitis treatment failure

ObjectiveThis study aimed to construct a clinical risk score system for peritoneal dialysis-associated peritonitis (PDAP) treatment failure to provide a theoretical basis for clinical workers.MethodsA total of 161 PDAP individuals admitted to our hospital were included, among whom 70 cases were in the treatment-improved group and 87 cases were in the treatment failure group. We compared the general condition, clinical manifestations, and laboratory examination indicators of the two groups of individuals, used multivariate logistic regression analysis to identify the factors influencing PDAP treatment failure, and developed a clinical risk score system. The diagnostic performance of the risk score system was evaluated utilizing the receiver operating characteristic (ROC) curve.ResultsSignificant differences (P < 0.05) were observed between the two groups in terms of contamination, peritoneal fluid culture results, blood urea nitrogen (BUN) level, C-reactive protein (CRP) level, B-type natriuretic peptide (BNP) level, average residual urine (RU) volume, and urea clearance rate (UCR). Multivariate logistic regression analysis showed that BUN level, CRP level, BNP level, average RU volume, and UCR were independent risk factors affecting PDAP patient treatment outcomes (P < 0.05). The ROC curve analysis of the risk score system for predicting treatment failure in PDAP individuals showed an area under the curve of 0.895 [95% confidence interval (0.847–0.943)]. The optimal cut-off point was 2.5 points, with corresponding sensitivity and specificity of 88.5% and 74.3%, separately.ConclusionBUN level, CRP level, BNP level, average RU volume, and UCR are independent risk factors for PDAP treatment failure. The clinical risk score system based on these five independent risk factors can accurately predict the risk of treatment failure in PDAP individuals.

Development and validation of a nomogram for predicting gram-negative bacterial infections in patients with peritoneal dialysis-associated peritonitis

BackgroundThis study aimed to develop a nomogram for predicting gram-negative bacterial (GNB) infections in patients with peritoneal dialysis-associated peritonitis (PDAP) to identify patients at high risk for GNB infections. MethodsIn this investigation, hospitalization information was gathered retrospectively for patients with PDAP from January 2016 to December 2021. The concatenation of potential biomarkers obtained by univariate logistic regression, LASSO analysis, and RF algorithms into multivariate logistic regression was used to identify confounding factors related to GNB infections, which were then integrated into the nomogram. The concordance index (C-Index) was utilized to assess the precision of the model's predictions. The area under the curve (AUC) and decision curve analysis (DCA) was used to assess the predictive performance and clinical utility of the nomogram. ResultsThe final study population included 217 patients with PDAP, and 37 (17.1%) patients had gram-negative bacteria due to dialysate effluent culture. After multivariate logistic regression, age, procalcitonin, and hemoglobin were predictive factors of GNB infections. The C-index and bootstrap-corrected index of the nomogram for estimating GNB infections in patients were 0.821 and 0.814, respectively. The calibration plots showed good agreement between the predictions of the nomogram and the actual observation of GNB infections. The AUC of the receiver operating characteristic curve was 0.821, 95% CI: 0.747–0.896, which indicates that the model has good predictive accuracy. In addition, the DCA curve showed that the nomogram had a high clinical value in the range of 1%–94%, which further demonstrated that the nomogram could accurately predict GNB infection in patients with PDAP. ConclusionsWe have created a new nomogram for predicting GNB infections in patients with PDAP. The nomogram model may improve the identification of GNB infections in patients with PDAP and contribute to timely intervention to improve patient prognosis.

PERITONEAL DIALYSIS-ASSOCIATED PERITONITIS : A SYSTEMATIC REVIEW

Background: Peritoneal dialysis is infectious and non-infectious. Peritoneal dialysis causes catheter exit, tube tunnel, and peritonitis. Noninfectious consequences of peritoneal dialysis include catheter malfunction, external leakage, abdominal wall anomalies, scrotal edoema, pleural-peritoneal fistulas, failed ultrafiltration, and encapsulated sclerosis. PD complications include peritonitis. The International Society for Peritoneal Dialysis (ISPD) offers specific recommendations on PD-associated peritonitis prevention and treatment, however clinical practise differs greatly amongst dialysis units. Aim: This article examines the link between peritoneal dialysis and peritonitis and presents its findings. Methods: By evaluating the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 standards, this study demonstrated that it met all of the requirements. This enabled the researchers to ensure that the study was as up to date as feasible. Publications published between 2000 and 2023 were included in the search strategy, which included a variety of electronic reference databases (including Pubmed and SagePub). We did not consider review papers, duplicate publications, or half completed articles. Result: In the PubMed database, the results of our search brought up 133 articles, whereas the results of our search on SagePub brought up 69 articles. The results of the search conducted for the last year of 2000 yielded a total of 20 articles for PubMed and 8 articles for SagePub. In the end, we compiled a total of 21 papers, six of which came from PubMed and three of which came from SagePub. We included nine research that met the criteria. Conclusion: Gram-positive bacteria are the most common cause of Parkinson's disease-associated peritonitis. Despite the high frequency of PD-associated peritonitis, it has a high cure rate.

Additional antibiotic lock in peritoneal dialysis-associated refractory peritonitis: A case series study and literature survey.

Refractory peritonitis is one of the leading causes of catheter failure in peritoneal dialysis (PD) patients. However, there are no established curative therapies available, and only catheter removal should be performed. Here we present a case series study to illustrate the efficacy of antibiotic lock for PD-associated refractory peritonitis. Patients with refractory peritonitis treated with intraperitoneal antibiotics plus antibiotic lock from September 2020 to March 2022 were retrospectively analyzed. Medical cure was identified as a success of treatment. We identified 11 patients, of which 7 (63.64%) had a history of PD-associated peritonitis, with the episode of continuous ambulatory peritoneal dialysis (CAPD) ranging from 1 to 158 months at a median of 36 (9.5, 50.5) months. The dialysis effluent culture showed Gram-positive, Gram-negative bacteria, and was culture-negative in 5, 2, and 4 cases, respectively. The cure rates were 85.71% for culture-positive cases and 25% for culture-negative cases, and the total cure rate was 63.64%. No relevant adverse events occurred, including sepsis. Treatment with the additional antibiotic lock was successful in most cases, especially in those that were culture-positive. Additional antibiotic lock deserves great attention and further investigation in treating PD-associated refractory peritonitis.

Body surface area and treatment failure in peritoneal dialysis-associated peritonitis.

This study mainly discussed the relationship between body surface area (BSA) and treatment failure of peritoneal dialysis-associated peritonitis (PDAP). The exposures were BSA grouped by the tertiles of BSA levels. The association between BSA and the risk of treatment failure in PDAP, defined as the temporary or permanent switch to hemodialysis and kidney transplantation, was evaluated in Cox proportional hazards models. A total of 483 episodes in 285 patients were recorded in our center. As a three-level categorical variable, in reference to G3, the G1 of BSA displayed a 4.054-fold increased venture of treatment failure in a fully adjusted model. In sensitivity analysis, a lower value of BSA (G1) was identified as an independent risk factor for peritonitis episodes (odds ratio = 2.433, 95% confidence interval: 1.184-4.999, p = 0.015). A lower level of body surface area was remarkably associated with a higher incidence of treatment failure among peritoneal dialysis-associated peritonitis episodes.

#3658 PERITONEAL INFLAMMATION INDUCES SYSTEMIC ERYPTOSIS IN PERITONEAL DIALYSIS-ASSOCIATED PERITONITIS

Abstract Background and Aims Eryptosis is stress-induced RBC (Red Blood Cell) death mechanism. Our preliminary data show that there is a significative increased of eryptosis during peritoneal dialysis-associated peritonitis. Furthremore, there is an elevation of local and systemic inflammatory mediators. The aim of this study was to evaluate the relationship between systemic eryptosis levels in peritonitis and specific peritonitis biomarkers in peritonitis effluent (PDE), such as Peritoneal White Blood cell count (pWBC), peritoneal NGAL (pNGAL) and peritoneal cytokines levels. Method We enrolled 22 PD patients with peritonitis and 17 healthy subjects. PD-related peritonitis was defined according to the Guidelines of the International Society of Peritoneal Dialysis. At the time of diagnosis, blood samples were collected for eryptosis and peritoneal effluent were taken to evaluate pWBC, pNGAL and cytokines. All eryptotic measurements were made in freshly isolated RBCs. PS avidly binds AnnexinV, which is thus employed to identify eryptotic cells. Thus, PS exposure at RBC surface was estimated from FITC-AnnexinV binding using flow cytometric analyses. Results 13/22 patients were treated with continuous ambulatory PD (CAPD) and 9 with automated PD (APD). The median length of PD treatment was 28.1 months and the range was: minimum: 3 – maximum: 124.9 months. The percentage of AnnexinV-binding RBCs was significantly higher in PD patients with peritonitis than in CTR (PD patients with peritonitis: 7.7; IQR 4.3-14.2, versus CTR: 0.8; IQR 0.7-1.3; p&amp;lt;0.001) (Figure 1). WBC, NGAL and cytokines levels in PDE are reported in Table 2. We observed important correlation between eriptosis levels and peritoneal biomarkers (Figure 2). Conclusion In conclusion, we investigated a potential connection between systemic eryptosis and peritoneal biomarkers involved in peritonitis. The presented results revealed that upregulated inflammatory markers could be the cause of high levels of systemic eryptosis during PD-related peritonitis.

Severe infections in peritoneal dialysis and home hemodialysis patients: An inception cohort study.

Infections are the most common non-cardiovascular cause of death among dialysis patients. Earlier studies have shown similar or higher risk of infectious complications in peritoneal dialysis (PD) compared to hemodialysis (HD) patients, but comparisons to home HD patients have been rare. We investigated the risk of severe infections after start of continuous ambulatory PD (CAPD) and automated PD (APD) as compared to home HD. All adult patients (n = 536), who were on home dialysis at day 90 from starting kidney replacement therapy (KRT) between 2004 and 2017 in Helsinki healthcare district, were included. We defined severe infection as an infection with C-reactive protein of 100 mg/l or higher. Cumulative incidence of first severe infection was assessed considering death as a competing risk. Hazard ratios were estimated using Cox regression with propensity score adjustment. The risk of getting a severe infection during the first year of dialysis was 35% for CAPD, 25% for APD and 11% for home HD patients. During five years of follow-up, the hazard ratio of severe infection was 2.8 [95% CI 1.6-4.8] for CAPD and 2.2 [95% CI 1.4-3.5] for APD in comparison to home HD. Incidence rate of severe infections per 1000 patient-years was 537 for CAPD, 371 for APD, and 197 for home HD patients. When excluding peritonitis, the incidence rate was not higher among PD than home HD patients. CAPD and APD patients had higher risk of severe infections than home HD patients. This was explained by PD-associated peritonitis.