Peritonitis In Peritoneal Dialysis Patients Research Articles

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

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.

#1513 Update on the peritonitis trend in central Spain

Abstract Background and Aims Peritonitis is one of the most common and severe complications associated with peritoneal dialysis (PD) traditionally cited as the primary cause of catheter loss and discontinuation of the dialysis technique. Nevertheless, the incidence and severity of peritonitis has been significantly reduced over time. Therefore, we aimed to update the current impact of peritonitis in PD patients. Method We performed an observational, multi-centre, prospective cohort including 3,037 patients who started PD between 2003-2020 followed for a median of 1.6 [0.8-2.9] years. Results We observed 2 941 episodes of peritonitis, with a peritonitis rate (PR) of 0.46 episodes per patient year and a mean of 2.6 years CI 95% [2.4-2.8] to first peritonitis episode. As expected, gram-positive organism was identified in the 69.3% of the cases, followed by gram-negative (19.6%) and sterile culture (15.6%). The usual course of the peritonitis is favourable, with complete recovery in the 76.4% of the cases, whereas just the 37.6% require admission during a median of 5 [3-9] days, with a peritonitis recurrence of 11.2%. A fatal peritonitis (resulted in PD cessation) was observed in 11.7% of the patients with an overall mortality of 0.7% (considering all the deaths within the 90 days after peritonitis). Factors associated with a 90-days mortality rate related to PD rate were age > 65 years (OR 2.99 [1.84-4.85]), Charlson index (OR 1.19 [1.07-1.33]), and the type of microorganism: fungus (OR 9.8 [4.16-23.43], multi-bacterial (OR 7.97 [0.91-69.88] and gram- negative OR (2.41 [1.45, 3.99]). Comparing patients who developed peritonitis (P) (N = 1230) vs patients who not developed peritonitis (NP) (N = 1807), P patients were older (P 59 ± 15.5 years vs NP 55 ± 15.5 years, p < 0.001) and associated higher comorbidity (such as Charlson index, cardiovascular and diabetes mellitus history) than NP patients. P patients more commonly had a prior history of renal replacement therapy (kidney transplant P 9.2% vs NP 6.9% and hemodialysis 18.8% vs 17.1%) compared with NP patients. PR has significantly decreased over three consecutive 5-year periods: from 0.51 [0.48-0.54] peritonitis cases per year during 2003-2008 to 0.45 [0.43-0.48] during 2009-2014 (p 0.03), and further dropping to 0.41 [0.38-0.44] for the period 2015-2020 (p < 0.001). Conclusion Over the past 17 years, the incidence and severity of peritonitis have significantly reduced, despite PD patients becoming older and associated high comorbidities.

#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.

Early diagnosis of tuberculous peritonitis in peritoneal dialysis patients using the T-SPOT test.

A 49-year-old man was admitted with peritonitis nine months after starting continuous ambulatory peritoneal dialysis (CAPD) for kidney failure. Ceftazidime and cefazolin were started. Peritoneal dialysate culture was negative for bacteria, but antibiotic treatment was continued because peritonitis improved. Twenty days later, the patient was discharged with no signs of peritonitis. However, 40-day culture of the original peritoneal dialysate detected Mycobacterium tuberculosis, and peritonitis recurred, leading to readmission. A T-SPOT test was performed and was positive in 4days. Anti-tuberculosis therapy was started, which cured the peritonitis. The T-SPOT test may enable early diagnosis of tuberculosis.

Rapid point-of-care test for diagnosis of peritonitis in peritoneal dialysis patients.

Periplex® is a rapid point-of-care test based on the detection of interleukin-6 (IL-6) or matrix metalloproteinase-8 (MMP-8) to diagnose peritonitis in peritoneal dialysis (PD) patients. This single-centre study was conducted in Singapore General Hospital from 2019 to 2022. The study recruited PD patients suspected of having peritonitis. Periplex was performed at the presentation and recovery of peritonitis. Primary outcomes were sensitivity and specificity of Periplex at presentation. The positive and negative predictive values of tests were also performed. A total of 120 patients were included in the study. The mean age was 60.9 ± 14.9 years, 53% were male, 79% were Chinese and 47.5% had diabetes mellitus. Periplex was positive in all patients with peritonitis (n = 114); sensitivity of 100%; 95% confidence interval (CI): 100-100%. Periplex was falsely positive in three patients with non-infective eosinophilic peritonitis, resulting in a low specificity of 50%; 95% CI: 41.1-59.0%. Periplex had a positive predictive value of 97.4% and a negative predictive value of 100%. During recovery from peritonitis, Periplex had high specificity (93.6%) and negative predictive value (98.7%) to indicate the resolution of infection. MMP-8 was more sensitive than IL-6 in detecting peritonitis. Periplex was positive in all patients with peritonitis regardless of the types of PD solutions used. Periplex had high sensitivity, and positive and negative predictive values in the diagnosis of peritonitis can be considered as a screening tool for peritonitis. Given its high specificity and negative predictive value, it may also be used to document the resolution of peritonitis.

Relationship between the level of uric acid and peritonitis in peritoneal dialysis patients; a retrospective cohort study

Introduction: Peritonitis is a cause of mortality among peritoneal dialysis (PD) patients. Some studies suggested that uric acid (UC) levels may be effective in inflammatory processes. Objectives: We have examined the relationship between serum UC and peritonitis in PD patients. Patients and Methods: A retrospective cohort study was conducted over six years. The statistical population was all PD patients who underwent PD for at least six months. The sample size included 151 patients based on serum UC levels (less than or equal to 6.5 mg/dL, more than 6.5 mg/dL) and was divided into two groups. Both groups were compared using inflammatory factors and peritonitis. Results: In total, around 100 patients (66.2%) had UC levels ≤6.5 mg/dL, and 51 patients (33.7%) had serum UC levels >6.5 mg/dL. Peritonitis was observed in 72 (47.6%) patients. The frequency of peritonitis in the patients with greater levels of serum UC (51%) was higher compared to the other group (46%), but this difference was not statistically significant (P=0.56). The average hemoglobin level was lower in higher serum UC levels group (P=0.002). The mean levels of serum albumin (P=0.002), phosphorus (P=0.004), and creatinine (P=0.02) were lower in the group with serum UC below 6.5 mg/dL group. Conclusion: There was no correlation discovered between peritonitis and serum UC levels. However, it seems that serum UC can serve as a marker among PD patients to predict the occurrence of anemia and malnutrition.

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.

#4673 POLY(I:C) INDUCES MORPHOLOGICAL CHANGES AND TYPE I INTERFERON-MEDIATED INFLAMMATORY RESPONSE IN MESOTHELIAL CELLS FROM PERITONEUM

Abstract Background and Aims Peritonitis is a major cause of morbidity and discontinuation of the therapy in peritoneal dialysis (PD) patients. Most of peritonitis episodes during PD may be imputed to bacterial infection, although in about 20% of the cases a viral origin may be hypothesized. Toll-like receptors (TLRs) play a critical role in innate immune responses by specifically recognizing molecular patterns from different microorganisms, including bacteria, fungi, and viruses. Polyinosinic:polycytidylic acid (Poly(I:C)) is a synthetic analogue of double-stranded RNA (dsRNA) that mimics the anti-viral immune response by activating TLR3. Upon activation, TLR3 signaling pathway leads to the induction of NF-ΚB pathway and the interferon response (IRF3 activation). The aim of this work is to study the ex vivo and in vivo effect of Poly(I:C) treatment in primary human mesothelial cells (MCs) and mice peritoneum. Methods MCs were collected from effluent fluids of 8 clinically stable PD patients and amplified for ex vivo experiments. MCs were treated with Poly(I:C) (2 ng/μl) or TGFβ1 (2 ng/ml). After 48 hours of stimulation, samples were collected for RNA subsequent analysis. Poly(I:C) was intraperitoneally delivered to mice daily for 10 days, using two different doses: 30 mg/kg (n = 6) and 90 mg/kg (n = 4) of weight. Non-treated mice were used as control (n = 6). Mice were euthanized and peritoneal tissue was collected for the subsequent RNA, protein, and histological experiments. Gene expression analyses of TLRs, interferon-stimulated genes (ISGs), and other inflammatory markers were performed by qPCR. Protein analysis from cell lysates was performed by western blot and cytokine and chemokine levels from cell supernatants were detected by ELISA assay. Results MCs from PD patients expressed a specific subset of TLRs, which were modulated by stimulation with Poly(I:C), being TLR3 the most induced receptor. Additionally, Poly(I:C) induced a bona fide mesothelial to mesenchymal transition (MMT), characterized by the acquisition of a spindle-like morphology, increased expression of mesenchymal markers such as SNAIL, TGFB1, FN1, MMP9, and MMP14, and decreased expression of the epithelial markers ECAD and CALB2. Moreover, Poly(I:C) increased mRNA and protein levels of several cytokines and chemokines, such as TNFα, IL-6, IL-1β, IFNβ, CXCL8, and CXCL9; and ISGs, including CXCL10, MX1, IFIT1, and IFITM1. In vivo, Poly(I:C) administration in mice induced peritoneal inflammation, characterized by increased gene expression of proinflammatory response-related factors, including Ccl5, Arg1, and the ISGs Cxcl10 and Ifit1, in a dose-dependent manner. Conclusion Treatment with Poly(I:C) is sufficient to induce a profibrotic/proinflammatory response in MCs in ex vivo and in vivo settings. These discoveries highlight the role of viral infections in peritoneum damage and may provide insight for further studies aimed at specifically counteracting the effect of viral infections in peritonitis in PD patients.

Effect of different dialysis duration on the prognosis of peritoneal dialysis-associated peritonitis: a single-center, retrospective study

Background Peritoneal dialysis (PD)-associated peritonitis is a serious complication observed in peritoneal dialysis patients. Herein, we investigated the clinical characteristics and treatment outcomes of PD peritonitis in patients with different PD durations. Methods All peritonitis episodes from January 2007 to December 2020 at Peking University People’s hospital PD center were retrospectively analyzed and divided into the long-dialysis duration (≥60 months, LDD) and short-dialysis duration (<60 months, SDD) groups. Clinical characteristics and outcomes were compared between these groups. The risk factors for treatment failure were analyzed using a logistic regression model. Results During 14 years, 156 patients had 267 peritonitis episodes. There were 83 (31.1%) peritonitis episodes in the LDD group and 184 (68.9%) in the SDD group. No statistical difference was noted in peritonitis causes and the composition of causative pathogens between the two groups. The hospitalization, treatment failure, and transfer-to-hemodialysis rates, and peritonitis-related mortality were significantly higher in the LDD group than in the SDD group (all p < .05). Logistic regression analysis revealed that PD duration was an independent risk factor for PD-associated hospitalization, treatment failure and peritonitis-related death (p < .05). The receiver operating characteristic curve analysis results showed that when the cutoff value of PD duration was 5.5 years, the sensitivity of predicting PD peritonitis treatment failure was 51.1%, specificity was 78.8%, and the area under the curve was 0.679 (95% confidence interval: 0.594–0.765, p < .001). Conclusions PD duration is an independent risk factor for poor prognosis in PD peritonitis. Careful and active attention should be paid to the prevention of peritonitis in PD patients with long PD duration.

Effect of national holidays on health outcomes of patients receiving peritoneal dialysis in a single center over a ten-year period

Background National holidays are associated with high mortality in some diseases, but little is known about patients undergoing peritoneal dialysis (PD). The research aimed to investigate the impact of national holidays on the health outcomes of PD patients. Methods Over ten years, all episodes of unplanned hospitalization, death, and peritonitis in PD patients were collected in our center. Seven national holidays in China were chosen, and non-holiday days were selected as the control period. The effect of national holidays was observed by comparing the hospitalization, death, and peritonitis rates between holiday and non-holiday groups. Results There were 297 events in all holiday periods and 1247 in non-holiday periods. There is no significant difference in hospitalization rate between holiday and non-holiday groups (32.4% ± 6.4% vs. 29.2% ± 3.4%, p = 0.175). So is the death rate [6.3% (4.8–12.3%) vs.5.0% (4.2–8.9%), p = 0.324] and peritonitis rate [0.19 (0.13–0.53) vs. 0.22 (0.18–0.27), p = 0.445] between the two groups. Significant differences were observed in the distribution of peritonitis causes between the two groups (p = 0.017). The rate of secondary to other infections in the holiday group was significantly higher than in the non-holiday group (25.0 vs. 10.3%, p = 0.015). Conclusion Our study suggested no national holiday effect on health outcomes of PD patients based on ten-year data in our center.

Effect of different nursing interventions on the incidence of peritonitis in peritoneal dialysis patients at home: a network meta-analysis

Effect of different nursing interventions on the incidence of peritonitis in peritoneal dialysis patients at home: a network meta-analysis

Platelet-to-lymphocyte ratio and the first occurrence of peritonitis in peritoneal dialysis patients

BackgroundPlatelet-to-lymphocyte ratio (PLR) has been used as a potential biomarker of inflammation-related diseases, but its role in the peritoneal dialysis-related peritonitis (PDRP) is still uncertain. This study was aimed to investigate the association between PLR and the new-onset PDRP in peritoneal dialysis (PD) patients.MethodsIn this multicenter retrospective study, 1378 PD Chinese PD patients were recruited from four centers, who were divided into the high PLR group (HPG) and the low PLR group (LPG) according to the cutoff value of PLR. The correlation between PLR and the new-onset PDRP was assessed using the Cox regression model analysis.ResultsDuring follow-up, 121 new-onset PDRP events were recorded. Kaplan–Meier survival curve showed a higher risk of new-onset PDRP in the HPG (log-rank test, P < 0.001). After adjusting for confounding factors, the Cox regression model showed the risk of new-onset PDRP was higher in the HPG than that in the LPG (HR 1.689, 95%CI 1.096–2.602, P = 0.017). Competitive risk model analysis showed that significant differences still existed between the two PLR groups in the presence of other competitive events (P < 0.001).ConclusionPLR is independently associated with the new-onset PDRP in PD patients.

The impact of Propolis on catheter exit site infection and peritonitis in peritoneal Dialysis patients: a clinical trial

BackgroundPeritonitis is one of the major complications of peritoneal dialysis. The most common cause of peritonitis is infection at the catheter exit site. This study aimed to determine the effect of propolis on the incidence of catheter exit site infection and peritonitis in peritoneal dialysis patients.MethodThis study was a double-blind clinical trial (2019–2020) with peritoneal dialysis patients. Ninety peritoneal dialysis patients were allocated to three groups (placebo, control, intervention) using block randomization method. Catheter exit site was washed with 0.9% normal saline and dressing was done every other day after the morning peritoneal dialysis exchange by use of normal saline in placebo, mupirocin in control, and propolis in intervention group, for 6 months.Discussion10% of the patients in the placebo and 6.7% in the control group developed catheter Exit Site Infection, but none patient in the intervention group developed this infection (P = 0.469). Whereas 6.7% in both the placebo and control groups developed peritonitis, but none patient in the intervention group contracted peritonitis (P = 0.997). No significant differences in the incidence of catheter exit site infection and peritonitis among the three groups were observed. Considering that mupirocin is of chemical origin and may lead to drug resistance whereas propolis is of plant origin and does not produce drug resistance, the use of propolis is recommended.Trial registrationIranian Registry of Clinical Trials [IRCT20110427006318N10] (17/01/2019).

Neisseria elongata -mediated peritonitis in an end-stage renal disease patient on automated peritoneal dialysis, A case report and literature review

Peritoneal dialysis (PD) can result in peritonitis, which frequently causes severe and near-fatal clinical implications if left untreated. Usually, Gram-positive bacteria are the most common organisms involved. Uncommonly recognized as the cause of peritonitis in PD patients, Neisseria Elongata is a gram-negative nasal and oropharyngeal normal flora organism. We report a rare case of a 29-year-old man who had received automated peritoneal dialysis for six years and had Neisseria Elongata peritonitis. Several case Reports of niseria-related peritonitis may point to the potential pathogenicity of such organisms and suggest that many cases of culture-negative peritonitis may have been misdiagnosed. Poor nutrition and chronic kidney disease have been suggested as potential risk factors for Neisseria elongata peritonitis [8], both of which are present in our patient. With appropriate antibiotic use, most of the cases respond well to empirical treatment. Although rare, Neisseria Elongata can lead to Peritoneal Dialysis catheter Peritonitis that, in some cases, require changing to hemodialysis.

Comparison of risk of peritoneal dialysis-associated peritonitis between roxadustat and recombinant human erythropoietin in peritoneal dialysis patients: a retrospective comparative cohort study

Roxadustat and recombinant human erythropoietin (rhuEPO) have been approved for the treatment of renal anemia in patients undergoing dialysis. The comparison of risk of peritoneal dialysis (PD)-associated peritonitis between roxadustat and rhuEPO in PD patients remains uncertain. We aimed to compare the risk of PD-associated peritonitis between roxadustat and rhuEPO and examine possible modifiers for the comparison in PD patients. A total of 437 PD patients with renal anemia (defined as hemoglobin ≤10.0 g/dL) from 4 centers were selected. Participants were scheduled for follow-up every 1-3 months at each center. We compared differences in baseline characteristics by medication group and 1:1 matching group based on propensity scores. PD-associated peritonitis was defined according to the International Society for Peritoneal Dialysis guidelines. Univariable and multivariable Cox proportional hazard analyses were performed to compare the risk of PD-associated peritonitis between roxadustat and rhuEPO in PD patients. Propensity score matching method was used to examine the robustness of results. A total of 437 participants, including 291 in roxadustat group and 146 in rhuEPO group, were included in the current study, respectively. During a median follow-up of 13.0 (25th-75th, 10.0-15.0) months, PD-associated peritonitis occurred in 68 patients, including 26 of 291 (0.10 episodes per patient-year) patients in the roxadustat group and 42 of 146 (0.27 episodes per patient-year) patients in the rhuEPO group. Overall, compared to patients in the rhuEPO group, the roxadustat group (hazard ratio, 0.345; 95% confidence interval: 0.202-0.589) was associated with a lower risk of PD-associated peritonitis with adjustment of use of roxadustat medication, age, sex, hypertension status, diabetes status, dialysis vintage, serum potassium, hemoglobin, and albumin. Furthermore, the results were consistent with the propensity score analysis. None of the variables, including age, sex, body mass index, PD vintage, presence of residual renal function, hemoglobin, albumin, serum potassium, and C-reactive protein levels, significantly modified the associations. Our study demonstrated that compared with rhuEPO, roxadustat may reduce the risk of PD-associated peritonitis in PD patients, highlighting the importance of roxadustat for the prevention of PD-associated peritonitis in PD patients.

Proton pump inhibitor usage associates with higher risk of first episodes of pneumonia and peritonitis in peritoneal dialysis patients

Background A large number of studies have shown that proton pump inhibitors (PPIs) are associated with infection events. Therefore, we retrospectively evaluated the association of PPI therapy with the occurrence of first pneumonia and peritoneal dialysis(PD)-related peritonitis events in the maintenance PD patients. Methods We collected PD patients in two large hospitals from January 1, 2012 to December 31, 2016, and divided them into the PPI group and the non-PPI group. Multivariate Cox proportional hazards models were applied to evaluate the cumulative incidence and hazard ratios (HRs). Inverse probability of treatment weight (IPTW) method was used to adjust for covariate imbalance between the two groups and further confirm our findings. Results Finally, 656 PD patients were included for data analysis, and the results showed that PPI usage was associated with an increased risk of pneumonia [HR 1.71; 95% CI 1.06-2.76; p = 0.027] and peritonitis [HR 1.73; 95% CI 1.24-2.40; p = 0.001]. IPTW-adjusted HRs for the association of PPIs with pneumonia and peritonitis were 1.58 (95% CI:1.18-2.12; p = 0.002) and 2.33 (95% CI:1.91-2.85; p < 0.001), respectively. Moreover, the competitive risk model proved that under the conditions of competition for other events(including transfer to hemodialysis therapy, kidney transplant, transfer from our research center, loss to follow-up, and death), the differences in endpoints events between the two groups were still statistically significant (p = 0.009, p < 0.001, respectively). Conclusions PPIs was associated with an increased risk of first pneumonia and PD-related peritonitis events in PD patients, which reminds clinicians to be cautious when prescribing acid-suppressing drugs for PD patients.

Is simply washing hands before dialysis procedures sufficient for reducing peritoneal dialysis peritonitis?-A single center study from 2015 to 2020 in Yiwu, China.

The study aimed to improve the qualified rate of hand hygiene and reduce the incidence of peritonitis in peritoneal dialysis (PD) patients. A hand hygiene questionnaire was distributed to patients during home visits and outpatient visits in 2015 and 2020. Hand-washing practices were evaluated by collecting cultures from the hands of patients after hand washing, evaluating their household environment, and recording the antimicrobial resistance of pathogenic bacteria. Compared to patients in 2015, patients in 2020 had fewer errors in hand washing (p < 0.05), but the rate of qualification after hand washing was lower (p < 0.01). Furthermore, patients who used hand disinfectants after washing had a higher qualified rate. Coagulase-negative staphylococcus (CNS) was the most common isolated bacteria. From 2015 to 2020, the annual incidence of CNS PD peritonitis did not decrease, while the proportion of methicillin-resistant CNS decreased. The use of hand disinfectants after standard hand washing may help reduce the incidence of peritonitis in PD patients.

Interactive effect of hypoparathyroidism and type 2 diabetes mellitus on peritoneal dialysis related peritonitis

Objective: To investigate the interactive effect of hypoparathyroidism (HPTH) and type 2 diabetes mellitus (T2DM) on peritonitis in patients on peritoneal dialysis (PD). Methods: In this retrospective cohort study, all PD patients who were firstly catheterized in the peritoneal dialysis center of Guizhou Provincial People's Hospital from January 1, 2012 to December 31, 2018 were included. The characteristics of demographics, baseline clinical and laboratory data were collected, and patients were followed up until December 31, 2020. Kaplan-Meier survival curve and Cox regression analysis were used to explore the associations between the interaction of HPTH+T2DM and peritonitis. Results: A total of 270 PD patients were enrolled in this study, aged (39.9±13.2) years, including 143 males and 24 T2DM patients. These serum levels of intact parathyroid hormone (iPTH) [M(Q1, Q3)] was 268.1 (121.7, 447.0)pg/ml. After a median follow-up of 29.5 (range from 4.0 to 75.0) months, peritonitis occurred in 69 (25.6%) PD patients for the first time. After controlling for confounding factors, the interaction analysis showed that the risk of peritonitis in T2DM patients with HPTH (n=12) was 3.48 times that of non-T2DM patients without HPTH (n=180) (HR=3.48, 95%CI: 1.04-3.87, P=0.034), which was also greater than the sum of the factors alone (HR=1.35, 95%CI: 0.78-2.31 and HR=0.82, 95%CI: 0.20-3.40). The synergy index between HPTH and T2DM was 1.95, the attributable proportion of interaction was 67.6%, and the relative excess risk of interaction was 2.35. The receiver operating characteristic (ROC) curve indicated that the area under the curve of combined diagnosis of HPTH and T2DM was 0.626 (95%CI: 0.550-0.703, P=0.039). Conclusion: The positive interaction between HPTH and T2DM is an independent risk factor for peritonitis in PD patients, both of which can significantly increase the risk of peritonitis.

Does Far-Infrared Therapy Improve Peritoneal Function and Reduce Recurrent Peritonitis in Peritoneal Dialysis Patients?

The use of peritoneal dialysis in end-stage renal disease is increasing in clinical practice. The main purpose of this study was to evaluate the effect of far-infrared radiation therapy on inflammation and the cellular immunity of patients undergoing peritoneal dialysis. We recruited 56 patients undergoing peritoneal dialysis, and we included 32 patients for the experimental group and 24 patients from the control group in the final analysis. The experimental evaluation in our study was as follows: (1) We used abdominal computed tomography to explore the changes in abdominal blood vessels. (2) We compared the effects of peritoneal dialysis using blood glucose, HbAlC, albumin, urea nitrogen, creatinine, white blood cells, hs-CRP; peritoneal Kt/V of peritoneal function, and eGFR. (3) We compared the cytokines’ concentrations in the two groups while controlling for the other cytokines. Results and Discussion: (1) There was no significant difference in the abdominal blood vessels of the experimental group relative to the control group according to abdominal CT over the 6 months. (2) Our study demonstrates statistically significant effects of FIR therapy on the following parameters: creatinine (p = 0.039 *) and hs-CRP (p < 0.001 **) levels decreased significantly, and eGFR (p = 0.043 *), glucose (p < 0.001 **), and albumin (p = 0.048 *) levels increased significantly. Our study found that in the experimental group, creatinine and hs-CRP levels decreased significantly due to FIR therapy for 6 months. However, our study also found that the glucose level was significantly different after FIR therapy for 6 months. Peritoneal dialysis combined with FIR can reduce the side effects of the glucose in the dialysis buffer, which interferes with peritoneal inflammation and peritoneal mesothelial cell fibrosis. (3) In addition, we also found that no statistically significant difference in any inflammatory cytokine after FIR therapy. IFN-γ (p = 0.124), IL-12p70 (p = 0.093), IL-18 (p = 0.213), and TNF-α (p = 0.254) did not exhibit significant improvements after peritoneal dialysis with FIR treatment over 6 months. Conclusions: We found that the effectiveness of peritoneal dialysis was improved significantly with FIR therapy, and significant improvements in the peritoneal permeability and inflammatory response were observed.

Phenotypic and Molecular Characterization of Nonfermenting Gram-Negative Bacilli Causing Peritonitis in Peritoneal Dialysis Patients.

(1) Background: Peritonitis due to nonfermenting Gram-negative bacilli (NF-GNB) is a dramatic complication of peritoneal dialysis (PD) with bad outcomes. Previous studies of PD-related peritonitis due to Pseudomonas species have shown a low-resolution rate, without a high resistance rate to antipseudomonal antibiotics. This suggests that bacterial virulence factors can act and influence peritonitis evolution. This study aimed to describe the microbiological characteristics of NF-GNB causing PD-related peritonitis and analyze their influence on the outcome. (2) Methods: We analyze the 48 isolates from NF-GNB peritonitis, which were stored in our culture collection regarding bacterial resistance, biofilm, and other virulence factors’ production, and clonal profile. Additionally, we collected data on treatment and outcomes from patients’ clinical registers. (3) Results: The etiologies were species of Pseudomonas (50%), Acinetobacter (36%), and other NF-GNB (14%). There was a high (75%) proportion of biofilm producer lineages. The in vitro susceptibility rate of Pseudomonas spp. to amikacin, ciprofloxacin, and ceftazidime was significantly greater than that of Acinetobacter spp. and other species; however, there was a similar low-resolution rate (<45%) among the episodes attributable to them. Pseudomonas species have a polyclonal profile, while we found a clone of five multiresistant Acinetobacter baumannii over an 8-year interval (2000–2008), which suggest an origin from the healthcare environment. (4) Conclusions: We are not able to identify any predictor of outcome, but it is possible that biofilm and others virulence factors can act in concert and contribute to the bad outcome.