Clinical outcomes in peritoneal dialysis with refractory peritonitis: significance of the day 5 cell count.

Peritoneal dialysis-associated peritonitis is a common and severe complication of peritoneal dialysis, associated with high morbidity and mortality. However, there's a lack of research on refractory peritonitis, which is difficult to manage and has a poor prognosis. Our study aimed to investigate factors affecting clinical outcomes in peritoneal dialysis patients with refractory peritonitis over a 12-year period at a medical faculty hospital in Turkey. We conducted a retrospective study at a single center from January 2009 to December 2020, involving 135 patients with 236 episodes of refractory peritonitis. The average age of the patient cohort was 53.0 ± 15.9 years, and 72 (53.4%) of the patients were male. The leading identified causes of end-stage kidney disease were glomerulonephritis, hypertensive glomerulosclerosis, and diabetic nephropathy. Data on microbiological etiology, dialysate white blood cell counts, and patient demographics were analyzed to identify catheter removal risk factors. Statistical significance was set at p ≤ 0.05. Comparative analysis between patients with and without catheter loss revealed no significant differences in gender, age, presence of diabetes, prior hemodialysis, or duration of peritoneal dialysis. However, multivariate logistic regression analysis showed that a dialysate white blood cell count exceeding 1000/mm3 on day 5 and hospitalization had a positive association with catheter loss, while the presence of gram-positive bacterial growth had an inverse correlation. Our study shows that fifth-day dialysate white blood cell count predicts refractory peritonitis outcomes. Future research should focus on developing tools to manage catheter removal proactively and enhance patient prognosis.

Berke I ，Barutcu Atas D ，Tugcu M ，Arikan H ，Velioglu A ，Asicioglu E ... -  《-》

A predictive model of treatment effectiveness of refractory peritoneal dialysis-related peritonitis in patients with peritoneal dialysis: a single-center observational study in South China.

To prevent loss of peritoneal function caused by persistent abdominal inflammation, the guidelines recommend early extubation in patients with refractory peritoneal dialysis (PD)-associated peritonitis (rPDAP). In attempt to pinpoint high-risk patient cohorts that did not respond to treatment for refractory peritonitis, we created a model to predict the effectiveness of peritonitis treatment. This observational cohort study included PD patients from 1 January 2011 to 31 December 2020. Multivariate logistic regression analysis was used to explore the factors affecting the occurrence and prognosis of rPDAP, and to construct a predictive model for the success of rPDAP treatment. Receiver operator characteristic curve, calibration and decision curve were drawn to evaluate the predictive performance of the model. A total of 1397 cases of PDAP occurred in our center during the study period, of which 558 cases were diagnosed as rPDAP. The incidence of refractory peritonitis was 0.047 cases/patient-year. In the study, 440 cases with rPDAP were included. Among them, 304 cases (69.1%) had been successfully cured, while 136 cases (30.9%) were treatment failure, of which 19 cases (13.9%) died, 85 cases (62.5%) transferred to hemodialysis and 32 cases (23.5%) were relapse/recurrent peritonitis. Dialysate culture results showed 132 (30.0%) cases were infected with Gram-positive bacteria and 161 (36.6%) Gram-negative bacteria. Multivariate logistic regression analysis showed that episodes of peritonitis previously ≤3 times were correlated with the better prognosis of rPDAP, but white blood cell (WBC) counts in peritoneal dialysate on the third day of peritonitis or WBC counts on the fifth day ≥300 × 106/L, the pathogenic microorganism with Gram-negative bacteria, as well as longer duration of PD were associated with poor outcomes. The C-statistical value of the training data set was 0.870 (95% confidence interval 0.821-0.918). The calibration curve and clinical decision-making curve also proved that this nomogram could accurately predict the success of treatment in patients with refractory peritonitis. The nomogram model created through internal verification indicated a strong clinical application value and a high prognostic prediction accuracy for rPDAP.

Dong X ，Yi C ，Ye H ，Guo J ，Liu R ，Guo Q ，Huang F ，Yang X ... -  《-》

Peritoneal dialysis peritonitis due to Neisseria: clinicopathological features of 10 patients with a review of the literature.

Sun Y ，Chen X ，Ni J ，Yu J ... -  《-》

Prevalence, microbiology, and outcome of peritonitis in peritoneal dialysis patients in vietnam: a multicenter study.

Chronic kidney disease (CKD) is a substantial contributor to global mortality, requiring interventions like kidney transplantation and dialysis. Peritoneal dialysis (PD) has emerged as an effective dialytic modality despite the susceptibility to peritonitis. The study aimed to determine the prevalence of peritonitis among PD patients, elucidating pivotal factors affecting its occurrence, causative bacterial agents, and treatment outcomes (mortality rates, removal of the Tenckhoff catheter, and switch to hemodialysis). A retrospective cohort study was conducted, which included patients who underwent PD between January 2019 and December 2021 at nine dialysis centers in Vietnam. The prevalence rate of peritonitis was estimated as the quotient of total peritonitis episodes and cumulative patient-years. The association of peritonitis with factors such as age, care (self-care or helper-assisted PD), comorbidities, education level was analyzed using regression analysis. Peritonitis outcomes including mortality rate, Tenckhoff catheter removal, and transitions to hemodialysis were evaluated. PD-related infections were assessed. Additionally, the causative bacterial agents and the negative culture rate were determined. A total of 691 PD patients from nine centers from the south of Vietnam were recruited for the study. Peritonitis was reported in 32.42% of the patients during the study period of 2019-2021. An increase in the number of patients reporting peritonitis was observed over the years. A significant association (p = 0.01) between peritonitis rate and level of literacy was found. The mortality rate among patients who underwent PD was 2.68%. About 16.18% of patients with peritonitis had to have the Tenckhoff catheter removed and needed to be switched to hemodialysis. Around 46.98% of the peritonitis cases were culture-positive. The prevalence of peritonitis among PD patients in Vietnam increased from 2019 to 2021. Lower literacy positively correlated with peritonitis, regardless of the type of PD. The high prevalence of culture-negative peritonitis cases indicated gaps in diagnostic procedures or the presence of unusual pathogens. These outcomes highlight the need for improved education, diagnostic practices, and interventions to reduce peritonitis risks and enhance patient care in PD programs in Vietnam.

Bach N ，Chi TTK ，Trung LC ，Ngoc NHB ，Hoa TPT ，Huynh TNP ，Khai TH ，Dao DA ，Tuoc PX ，Dung VQ ... -  《-》

[Bacterial biofilm formation of peritoneal dialysis catheter in patients with peritonitis-associated catheter removal].

Liu A ，Zhao H ，Wu B ，Zheng S ，Zuo L ，Wang M ... -  《-》