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Objective: To construct and apply a risk screening and intervention system for malnutrition in peritoneal dialysis patients based on the Omaha System., Materials and Methods: A total of 75 peritoneal dialysis patients were randomly divided into control (38 cases) and intervention group (37 cases). The control group received routine operation training and health education, and the intervention group implemented a nutritional management plan based on the Omaha System. The modified quantitative subjective comprehensive nutritional scale (MQSGA) score, kidney disease dietary compliance attitude (RAAQ) and behavior (RABQ) score, body mass index (BMI), serum albumin (ALB), prealbumin (PA), and hemoglobin (Hb) were observed., Results: Before intervention, there was no significant difference in these indicators between the two groups (p > 0.05). After 6 months, the MQSGA score in the intervention group was significantly lower than that in the control group (p < 0.05). RAAQ score and RABQ score in the intervention group were higher than those in the control group and (p < 0.05), and the nutritional indicators in the intervention group, such as BMI, ALB, PA, and Hb, were higher than those in the control group (p < 0.05)., Conclusion: A nutritional management plan based on the Omaha System can help improve the nutrition condition of peritoneal dialysis patients, and improve the dietary compliance of chronic kidney disease patients.

Peritoneal dialysis (PD) patients who undergo gastroendoscopy and colonoscopy are at increased risk of peritoneal dialysis-associated peritonitis (PD peritonitis) following the procedure (defined as occurring within 7 days of intervention). As per current International Society for PD (ISPD) guidelines, antibiotic prophylaxis is currently recommended pre-colonoscopy in PD patients given the risk of post-colonoscopy PD peritonitis. The risk of PD peritonitis in patients undergoing capsule endoscopy (CE) is unknown. This binational data-linkage study between the Australia and New Zealand Dialysis and Transplant Registry and all hospital admission data sets in Australia and New Zealand evaluated all patients with PD who underwent CE between 2006 and 2015. The objective of the study was to assess the risk of PD peritonitis in patients undergoing CE. Descriptive statistics were used to describe patient characteristics and clinical outcomes. Overall, 23 patients with PD underwent CE. Twelve patients underwent CE alone (i.e. no other concomitant procedures) and none of these patients experienced an episode of PD peritonitis. The remaining 11 patients underwent CE and other invasive endoscopic/abdominal surgical procedures, of whom 2 suffered PD peritonitis. CE is likely a relatively safe procedure in PD patients. PD patients undergoing CE may not require prior antibiotic prophylaxis. Given their relative safety, CE may be an appealing diagnostic tool in a select group of PD patients for the investigation of gastrointestinal disease., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DWJ is a current recipient of an Australian National Health and Medical Research Council Leadership Investigator Grant. DWJ has received consultancy fees, research grants, speaker’s honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care, consultancy fees from Astra Zeneca, Bayer and AWAK, speaker’s honoraria from ONO and BI & Lilly, and travel sponsorships from Ono and Amgen. CMH has received funding from Janssen and GlaxoSmithKline to her institution for trial steering committee roles and research grant support to her institution from Shire, Baxter, Fresenius and Otsuka and travel sponsorship from Otsuka.

Background: 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., Methods: 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., Results: 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., Conclusions: 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., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: HH has received consultancy fees, speaker’s honoraria and travel sponsorships from Baxter Healthcare and consultancy fees and travel sponsorships from AWAK Technologies, speaker’s honoraria from Fresenius Medical Care, grants from Johnson & Johnson Company, grants from SingHealth NIG, outside the submitted work, and MWYF has received grants from National Medical Research Council for the study; consultancy fees and speaker’s honoraria and travel sponsorships from Baxter Healthcare, consultancy fees and travel sponsorships from AWAK Technologies. DWJ has received consultancy fees, research grants, speaker’s honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care, consultancy fees from Astra Zeneca and AWAK, speaker’s honoraria and travel sponsorships from ONO and travel sponsorships from Amgen. The other authors have nothing to disclose.

Peritoneal dialysis (PD)-related infection rates have improved, but serious complications such as liver abscesses remain an issue, posing unique management challenges including safety of continuing PD versus early PD catheter removal. Current literature describing this is unfortunately limited. This study aims to describe the characteristics, management and outcomes of liver abscesses in PD patients from a retrospective review of prevalent PD patients on follow-up at Tan Tock Seng Hospital between 1st January 2016 and 30th June 2021. A total of 11/383 PD patients (2.9%) were treated for liver abscesses. Most were diabetic ( n =10, 90.9%), with a median PD vintage of 541 days (interquartile range: 310-931 days). Fever ( n = 7, 63.6%), bacteraemia ( n = 7, 63.6%) and concomitant PD peritonitis ( n = 7, 63.6%) were the most common presenting symptoms. Majority of patients underwent radiological aspiration of abscess in addition to antibiotics ( n = 7, 63.6%). PD catheter was removed in eight patients (72.7%), with the most common indications being empirical removal due to intra-abdominal abscess ( n = 5, 62.5%) followed by septic shock ( n = 2, 25%) and refractory PD peritonitis ( n = 1, 12.5%). Only three patients (37.5%) remained on PD, as they did not develop PD peritonitis during their course of treatment. The overall mortality remains high with three patients (27.3%) passing away within 6 months of presentation. Liver abscesses in PD patients is associated with poor technique and overall survival. Absence of PD peritonitis appears to be a good prognostic factor, but larger studies are required to guide the optimal management of liver abscesses in PD patients., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Catheter-related tunnel infection may lead to peritonitis and discontinuation of performing high-quality peritoneal dialysis (PD). Tunnel infection is commonly caused by Staphylococcus aureus . Gas-forming bacterial infection is rare in patients with PD and even exceedingly rare when such a infection spreads along the PD catheter tract. The first case of emphysematous PD catheter infection is presented here., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors have read and understood Peritoneal Dialysis International’s policy on disclosing conflicts of interest and declare the following interests: JP has received speaking honoraria from Astra Zeneca, Baxter Healthcare, DaVita Healthcare Partners, Fresenius Medical Care, Dialysis Clinics Incorporated, Satellite Healthcare, and has served as a consultant for Baxter Healthcare, DaVita Healthcare Partners, Fresenius Medical Care, and LiberDi. TK has received consultancy fees from VISTERRA, ELEDON, Otsuka OLE and Otsuka VI-SIONARY as country investigators and current recipient of the National Research Council of Thailand and received speaking honoraria from Astra Zeneca and Baxter Healthcare. All other authors declare that they have none. Data related to the manuscript can be accessed and requested on personnel contact.

Background: Training caregivers performing PD is an important measure to prevent peritonitis. A low literacy rate hinders training in low-resource settings. We designed a structured training initiative (STI) and objective structured assessment (OSA) using visual and kinesthetic resources with minimal use of written resources. We studied the impact of STIs on caregivers' knowledge and practical skills and the rate of peritonitis., Methods: This prospective study conducted initial STI (iSTI) for caregivers of children initiating PD and retraining STI (rSTI) for those already on PD. OSA was administered after completion of training, and those scoring < 95% were retrained. Re-assessment was done at 3, 6, and 12 months, and those who scored < 95% underwent re-training. The rate of PD peritonitis and the time to first peritonitis were compared between the STI group and the cohort on PD in our center who received standard training before STI (controls)., Results: Caregivers of 40 children were included. The median duration of iSTI and rSTI was 19.5 (18, 20) and 9 (9, 9.5) hrs, and the OSA scores were 97% (97%, 98%) and 96% (96%, 98%), respectively. Only 5% required retraining. There was a significant reduction in the rate of PD peritonitis (0.29 vs. 0.69 episodes/patient-year; p < 0.001) and longer time to peritonitis (189 vs. 69 days; p < 0.001) in the STI group when compared to the controls (n = 32)., Conclusions: STI was effective in training caregivers for peritoneal dialysis. There was a reduction in the rate of peritonitis and a longer time to first peritonitis in the STI cohort., (© 2024. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)

Background: The risk of peritonitis has limited wider adoption of peritoneal dialysis (PD) in the United States. We developed a prototype bedside dialysate turbidity monitoring system, aiming to improve diagnostic accuracy relative to conventional approaches which depend on visual inspection and reporting of insensitive and non-specific symptoms., Methods: The prototype system was tested in a single-centre, proof-of-principle clinical study in patients receiving intermittent PD. We obtained multiple effluent dialysate samples from each consenting participant. We compared turbidity measurements with diagnostic criteria endorsed by the International Society of Peritoneal Dialysis (ISPD)., Results: Overall, we analysed 983 specimens from 65 patients, including 105 samples from patients with peritonitis and 878 samples from patients without peritonitis. An operating point derived from a previous in vitro study yielded an unadjusted sensitivity and specificity of 95.2% and 91.5%, respectively. The majority of samples that did not meet ISPD diagnostic criteria were either cases detected before criteria were met or were related to active peritonitis treatment and resolution., Conclusion: This proof-of-principle study demonstrates the feasibility and diagnostic accuracy of a prototype dialysate turbidity monitoring system for peritonitis surveillance., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: BB, GW and GMC are advisors to CloudCath, and receive compensation for their effort. GG, MI and LA received grants from CloudCath to conduct the study. EY, AEB, BF and DW are employees of CloudCath.

Background: Intraperitoneal (IP) aminoglycosides (AGs) continue to be the cornerstone of empiric management of peritonitis. AG dosing during automated peritoneal dialysis (APD), however, has not been well studied in patients with peritonitis. We sought to identify differences in AG exposure in the peritoneum and plasma for two different dosing regimens with little supporting evidence in patients on APD with peritonitis., Methods: A retrospective design that utilised the peritoneal and plasma concentration-time data from a prior study of 18 continuous ambulatory peritoneal dialysis (CAPD) patients with peritonitis to generate an in silico peritoneal and plasma PK model. This model was then used to compare via simulation using Phoenix© WinNonlin Software with IP AG dosing for a loading-dose regimen (1.5 mg/kg first dose) versus a fixed-dose regimen (0.6 mg/kg/d) in patients on APD with peritonitis., Results: Outcome measures were (1) percentage of time where peritoneal peak concentrations/minimal inhibitory concentration (MIC) ratio >10, (2) AUC/MIC > 74 and (3) plasma Cmin concentrations. Both regimens resulted in > 90% optimal peak/MIC ratio and AUC/MIC ratios on days 1 and 5 of the dose protocol. The loading-dose regimen resulted in IP exposures that were 2.5 times greater in the peritoneal compartment on day 1. By day 5, both protocols resulted in similar accumulation of AG plasma Cmin concentrations of 2.5-3.4 mg/L versus 2.4-3.3 mg/L, respectively, for the loading-dose regimen versus fixed-dose regimen., Conclusions: The current international guidelines for the treatment of peritoneal dialysis-associated peritonitis can continue to recommend the fixed-dose regimen for those on APD with the addition of plasma Cmin monitoring after 3 days to assess for drug accumulation., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Cat ownership is common in peritoneal dialysis (PD) patients, even with recent guidelines recommending avoiding domestic animals during PD exchanges to limit the risk of peritonitis due to pet contamination. We analysed the outcomes of patients who experienced cat-related peritonitis compared with those who experienced peritonitis due to other causes., Methods: This retrospective study based on the Registre de Dialyse Peritoneale de Langue Française data analysed the outcomes of 52 patients experiencing cat-related peritonitis from the beginning of the database (1986) until 21 June 2022 compared with those of 208 matched patients experiencing peritonitis due to other causes. A Cox regression model examined the association between cat-related peritonitis and the composite end point of death in PD or transfer to haemodialysis (HD), death in PD and transfer to HD., Results: Among patients with an episode of cat-related peritonitis, 11 (21.1%) died, 19 (36.5%) were transferred to HD and 11 (21.1%) were transplanted. In the group with other causes of peritonitis, these numbers were 67 (32%), 81 (39%) and 26 (12.5%), respectively. In multivariate survival analysis, age (hazard ratio (HR): 1.39; 95% confidence interval (CI): 1.13-1.70) and use of assisted PD (HR: 4.07; 95% CI: 2.11-7.86) were associated with the risk of death. Having experienced cat-related peritonitis was not significantly associated with any of the three outcomes (death, transfer to HD or PD cessation)., Conclusions: Patients on PD should be aware that cats may cause a peritoneal infection, which results in similar consequences to those of other causes of peritonitis. However, pets at home should not be considered a contraindication to PD., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Acute kidney injury (AKI) occurs frequently in the neurocritical intensive care unit and is associated with greater morbidity and mortality. AKI and its treatment, including acute kidney replacement therapy, can expose patients to a secondary greater brain injury. This study aimed to explore the role of peritoneal dialysis (PD) in neurocritical AKI patients in relation to metabolic and fluid control, complications related to PD and outcome., Methods: Neurocritical AKI patients were treated by PD (prescribed Kt/V = 0.40/session) using a flexible catheter and a cycler and lactate as a buffer., Results: A total of 58 patients were included. The mean age was 61.8 ± 13.2 years, 65.5% were in the intensive care unit, 68.5% needed intravenous inotropic agents, 72.4% were on mechanical ventilation, APACHE II was 16 ± 6.67 and the main neurological diagnoses were stroke (25.9%) and intracerebral haemorrhage (31%). Ischaemic acute tubular necrosis (iATN) was the most common cause of AKI (51.7%), followed by nephrotoxic ATN AKI (25.8%). The main dialysis indications were uraemia and hypervolemia. Blood urea and creatinine levels stabilised after four sessions at around 48 ± 11 mg/dL and 2.9 ± 0.4 mg/dL, respectively. Negative fluid balance and ultrafiltration increased progressively and stabilised around 2.1 ± 0.4 L /day. Weekly delivered Kt/V was 2.6 ± 0.31. The median number of high-volume PD sessions was 6 (4-10). Peritonitis and mechanical complications were not frequent (8.6% and 10.3%, respectively). Mortality rate was 58.6%. Logistic regression identified as factors associated with death in neurocritical AKI patients: age (odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.09-2.16, p = 0.001), nephrotoxic AKI (OR = 0.78, 95% CI = 0.69- 0.95, p = 0.03), mechanical ventilation (OR = 1.54, 95% CI = 1.17-2.46, p = 0.01), intracerebral haemorrhage as main neurological diagnoses (OR = 1.15, 95% CI = 1.09-2.11, p = 0.03) and negative fluid balance after two PD sessions (OR = 0.94, 95% CI = 0.74-0.97, p = 0.009)., Conclusion: Our study suggests that careful prescription may contribute to providing adequate treatment for most neurocritical AKI patients without contraindications for PD use, allowing adequate metabolic and fluid control, with no increase in the number of infectious, mechanical and metabolic complications. Mechanical ventilation, positive fluid balance and intracerebral haemorrhage were factors associated with mortality, while patients with nephrotoxic AKI had lower odds of mortality compared to those with septic and ischaemic AKI. Further studies are needed to investigate better the role of PD in neurocritical patients with AKI., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: The authors report no conflicts of interest. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article. The authors alone are responsible for the content and writing of this article. The lead authors (DP and ALB) confirm that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned (and, if relevant, registered) have been explained.

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., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JMB is speaker and consultant at Baxter Healthcare and DaVita Healthcare Partners. This paper only addresses PD peritonitis management in adults; the approach in children may differ.

BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of peritoneal dialysis (PD). It is characterized by a fibrous membrane partially or totally encasing the small bowel and is a rare cause of small bowel obstruction (SBO). Here we present a case of a young woman with a history of PD presenting with SBO due to EPS. CASE REPORT A 37-year-old woman with end-stage renal disease secondary to uncontrolled hypertension previously on PD presented to the emergency department for evaluation of 1 week of intractable nausea and vomiting associated with diffuse abdominal pain. Computed tomography of the abdomen showed findings consistent with a fibrous membrane encapsulating the small bowel and a small bowel follow-through revealed an SBO. She was diagnosed with secondary stage 3 EPS due to PD. She was started on prednisone and tamoxifen with quick resolution of her symptoms. Unfortunately, due to numerous recurrent SBOs, she is now being evaluated for surgical treatment options. CONCLUSIONS This report has presented a case of EPS, a rare complication of PD, which requires early diagnosis and management to prevent potentially fatal consequences. Management should focus on treating the underlying condition, optimizing nutrition, and using corticosteroids or tamoxifen (alone or in combination) depending on disease state and contraindications, with the aim of reducing recurrent SBOs. Failure of conservative management may require surgical evaluation.

Background: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare disease seen in the general population and has been reported as showing an increased incidence in the peritoneal dialysis (PD) population, as documented in case reports., Methods: We conducted a case-control study using data from the Taichung Veterans General Hospital electric medical record database from the years 2010 to 2023. We defined cases as CIDP with End-stage kidney disease (ESKD) and controls as without CIDP. A logistic regression analysis was used to investigate the association between CIDP and dialysis modality, age, gender, dialysis duration, plasma potassium > 5.5 mEq/L and < 2.5 mEq/L, and intact parathyroid hormone (i-PTH) > 613 pg/mL., Results: Our findings suggest that PD may be a risk factor in the ESKD population (Odds ratio: 5.125, C.I.: 1.078 ~ 24.372, p = 0.040) according to logistic regression analysis. Dialysis duration, gender, diabetes mellitus, HbA1c > 7%, hypokalemia, hyperkalemia, and hyperparathyroidism did not show an association with CIDP., Conclusion: There seems to be an association between PD and CIDP in this case-control study. Possible mechanisms may involve systemic inflammation induced by peritoneal dialysate exchange or the content of the dialysate. Further studies are still needed., (© 2024. The Author(s).)

Peritoneal fibrosis has been linked to hypoxia-inducible factor 1-alpha (HIF-1α) as well as O-linked-N-acetylglucosaminylation (O-GlcNAcylation) in peritoneal dialysis (PD). Genistein, recognized for its HIF-1α inhibitory and antifibrotic effects, presents a potential intervention against peritoneal mesothelial-mesenchymal transition (MMT) as well as fibrosis in PD. This study employed human peritoneal mesothelial cells (HPMCs) together with adenine-induced chronic kidney disease (CKD) rats undergoing peritoneal dialysis to explore Genistein's role in high glucose-induced peritoneal MMT and fibrosis. Our findings reveal that Genistein exerts anti-MMT and anti-fibrotic effects by inhibiting HIF-1α in HPMCs under high glucose conditions. Genistein inhibited O-GlcNAcylation status of HIF-1α through the mTOR/O-GlcNAc transferase (OGT) pathway, promoting its ubiquitination as well as the subsequent proteasomal degradation. In adenine-induced CKD rats undergoing peritoneal dialysis, Genistein suppressed the mTOR/OGT expression and reduced the abundance of O-GlcNAcylation along with HIF-1α in the peritoneum. Additionally, Genistein protected against increased peritoneal thickness, fibrosis, and angiogenesis, while improving peritoneal function. Based on our results, it could be inferred that Genistein might inhibit the abundance of HIF-1α via the mTOR/OGT pathway, thereby ameliorating MMT as well as fibrosis in PD., (© 2024. The Author(s).)

Listeria monocytogenes is a ubiquitous bacterium and opportunistic pathogen for immunocompromised patients. Peritoneal dialysis-related L. monocytogenes peritonitis is a rare clinical presentation, with a total of 23 cases reported to date and an overall mortality rate of 17.3%. The current report describes a case of peritoneal dialysis-related L. monocytogenes peritonitis in a woman in her 60s on long-term immunosuppressive therapies for a prior renal transplant. We treated this patient successfully with intraperitoneal ampicillin (125 mg/L in dialysate), in addition to intravenous ampicillin (1 g every 12 hours) for 10 days and subsequent oral amoxicillin 500 mg every 12 hours to complete a total 21-day course of therapy. This treatment regimen was informed by a literature review of pre-existing case studies, which demonstrated considerable variability in recommended antimicrobial dosing and frequency. A summary of this literature review is included in the current case report., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Data in terms of how active vitamin D supplementation affects muscle mass and function in end-stage renal disease (ESRD) patients has led to inconclusive results. The main goal of this research was to examine the association of active vitamin D supplementation and risk of the deterioration of muscle mass and function among ESRD patients on peritoneal dialysis (PD). Eligible ESRD patients on PD were prospectively included, and followed up at 3-month intervals in the tertiary care center. Based on the medications during the 12-month follow-up period, the patients were divided into two groups (vitamin D users and non-users). The deterioration of muscle mass and function was identified utilizing the criteria set by the Asian Working Group on Sarcopenia in 2019 (AWGS 2019). Primary outcome was defined as the deterioration of muscle mass and function at the end of the 12-month follow-up. The absolute diffecence and 95% confidence interval (CI) of the incidence of deterioration between vitamin D users and non-users was estimated. The association of vitamin D supplementation with risk of the deterioration of muscle mass and function during the 12-month follow-up period, was examined by employing multivariate logistic regression models. A total of 229 incident PD patients (6 of whom were lost in follow-up) were included. During the entire study period, 54.7% (122/223) of the remaining patients were considered users of oral active vitamin D. The incidence of deterioration in muscle mass and function was 30.5% (68/223) throughout the entire follow-up. In this regard, the rate was 23.0% (28/122) that received oral active vitamin D, while it was 39.6% (40/101) in the group that did not receive it, with an absolute diffecence of -16.6% (95% CI - 4.5, - 28.7) and an estimated relative risk (RR) of 0.784 (95% CI 0.651-0.943). After adjustment for potential confounding factors in logistic regression model, vitamin D users group was still associated with decreased risk of the deterioration of muscle mass and function (OR 0.330, 95% CI 0.159-0.683, P = 0.003). In secondary analysis, the relationship between oral active vitamin D and the deterioration of muscle mass and function remained consistent (≤ 0.25 µg per day vs. non-users; OR 0.300, 95% CI 0.131-0.688, P = 0.004); however, no significant relationship was identified in patients receiving a mean daily dose of > 0.25 µg compared with non-users (OR 0.389, 95% CI 0.146-1.034, P = 0.058). These results indicate that active vitamin D supplementation was significantly associated with a decreased risk of the deterioration of muscle mass and function in incident PD patients with ESRD. However, the amount and type of vitamin D used and the duration of the intervention warrant further randomized controlled trials to confirm the possibility that such medication improves sarcopenia in ESRD patients., (© 2024. The Author(s).)

Early peritoneal dialysis (PD)-related infection is a severe complication. This study investigated the relationship between patient-doctor contact (PDC) duration and early PD-related infection. In the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) Korea, incident dialysis patients receiving PD were divided into two groups based on PDC duration (< 15 min versus ≥ 15 min), which was defined as the duration a nephrologist typically spends with a patient receiving PD during each visit according to the facility practice pattern. Early risks of PD-related infections, such as peritonitis and catheter-related infection (onset within 3 and 12 months of PD), were compared to the PDC duration using Cox regression. The study included 276 patients (184 [66.7%] in the shorter PDC group [< 15 min] and 92 [33.3%] in the longer PDC group [≥ 15 min]). The average age did not differ between the groups. The incidences of 3- and 12-month PD-related infections were significantly lower in the longer PDC group than in the shorter PDC group (3 months: 1.1% versus 9.8%, P = 0.007; 12 months: 9.8% versus 23.4%, P = 0.007). Longer PDC was independently associated with a lower risk of PD-related infections at 3 and 12 months (3 months: adjusted hazard ratio [aHR], 0.11; 95% confidence interval [CI], 0.02-0.85, P = 0.034; 12 months: aHR, 0.43; 95% CI 0.19-0.99, P = 0.048). Overall, a longer PDC duration was associated with a significantly lower risk of early PD-related infection., (© 2024. The Author(s).)

Objective: The aim of this study is to determine whether there is a relationship between peritoneal membrane permeability and dyspepsia in peritoneal dialysis patients., Patients and Methods: This study included 95 peritoneal dialysis patients aged 18 and older. The presence of dyspepsia in patients was recorded according to the 2016 ROME-IV Functional Dyspepsia Diagnostic Criteria. Subsequently, the Glasgow Dyspepsia Severity Score questionnaire was administered to assess the severity of dyspepsia. Endoscopy was performed for those who agreed to exclude organic pathology, or the results of endoscopy conducted within the last 2 years were recorded. Furthermore, stool samples were examined for H. pylori to exclude organic causes of dyspepsia. PET (peritoneal equilibration test) and Kt/V values of patients were calculated using the "PD Adequest" computer software. PET values were categorized as low and low-normal for low permeability and high and high-normal for high permeability., Results: Dyspepsia was detected in 51.6% of all peritoneal dialysis patients. H. pylori was found positive in 11.6% of all patients and 12.2% of those with dyspeptic symptoms. There was no significant difference in the rate of H. pylori occurrence between low and high permeability groups. The Glasgow Dyspepsia Severity Score did not differ significantly between H. pylori-positive and -negative patients. Dyspepsia was more frequent and severe in the low permeability group. Dyspepsia in the low permeability group was mostly considered as functional dyspepsia due to the predominance of normal endoscopic findings., Conclusion: Dyspepsia is a common health problem in approximately half of peritoneal dialysis patients. Dyspepsia observed in those with low peritoneal membrane permeability is generally of functional origin. Furthermore, the frequency and severity of dyspepsia are higher in individuals with low permeability. When planning peritoneal dialysis for these patients, the current status should be taken into consideration, and patients should be informed about necessary precautions and recommendations., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Aim: Peritonitis is the most common complication of peritoneal dialysis (PD). This study aimed to investigate changes in the incidence, risk factors, microbiology, and clinical outcomes of PD-associated peritonitis in the past decades., Methods: This was a retrospective study that included children who initiated chronic PD at our institution between 2000 and 2017. The patients were divided into two groups according to the year of initiation: those who initiated PD between 2000 and 2008 and those who initiated PD between 2009 and 2017. The incidence and characteristics of peritonitis were compared between the groups., Results: A total of 184 patients with a median age of 10.2 years were included in this study. Of the patients, 92 experienced 210 episodes of peritonitis. The incidence rate of peritonitis decreased from 0.35 to 0.21 episodes/patient year during the study period (P = 0.001). During the 2000-2008 period, the 2-year peritonitis-free survival rate was significantly lower for patients under 2 years of age than for the other age groups (P = 0.004), whereas this was not observed during the 2009-2017 period. The multivariable Cox proportional hazard model showed that the <2 years age group had a significantly higher risk of developing peritonitis in the 2000-2008 period. However, this was not evident in the 2009-2017 period., Conclusions: The incidence of PD-associated peritonitis decreased, particularly in children under 2 years of age. Thus, younger age may not be a risk factor for PD-associated peritonitis., (© 2024 The Author(s). Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Aim: This research aimed to explore the serum levels of solute carrier family 7 member 11 (SLC7A11) in patients with maintenance peritoneal dialysis (MPD) and its correlation with vascular calcification (VC) and clinical results., Methods: This present prospective observational cohort study enrolled 189 patients with MPD who were undergoing regular peritoneal dialysis for over 3 months in our hospital from February 2020 to July 2022. The abdominal aortic calcification score was used to assess the VC condition of MPD patients. The serum SLC7A11, interleukin (IL)-6, IL-1β and C-reactive protein levels were measured by enzyme-linked immunosorbent assay (ELISA). Demographic and clinical statistics were collected. All patients were followed up for 1 year and the overall survival time (OS) of all patients were recorded. All data used SPSS 18.0 for statistical analyses., Results: Patients with moderate/severe calcification in MPD had a longer duration of dialysis, higher serum levels of phosphate (P) and calcium (Ca) and lower serum levels of SLC7A11. Spearman's analysis revealed a negative correlation between serum SLC7A11 levels and the levels of P, Ca and IL-1β. Additionally, we observed an association between serum SLC7A11 levels and clinical prognosis as well as the extent of VC in MPD patients. Multivariate logistic regression analysis indicated that dialysis duration, SLC7A11, and P were risk factors for VC in MPD patients., Conclusion: The serum SLC7A11 levels decreased remarkably in MPD patients with moderate/severe calcification. This study may provide new targets and comprehensive approach to cardiovascular protection in patients with chronic kidney disease., (© 2024 Asian Pacific Society of Nephrology.)

Introduction: Different initial manifestations of peritoneal dialysis-associated peritonitis (PDAP) may depend on the type of pathogenic organism. We investigated the association between the clinical characteristics of PDAP and susceptibility to vancomycin and investigated the possibility of using vancomycin monotherapy alone as an initial treatment regimen for some PDAP patients to avoid unnecessary antibiotic exposure and secondary infection., Methods: Patients with culture-positive PDAP were retrospectively analyzed and divided into two groups: peritonitis with only cloudy effluent (PDAP-cloudy) or with cloudy effluent, abdominal pain and/or fever (PDAP-multi). The bacterial culture of PD effluent and antibiotic sensitivity test results were compared between groups. Logistic regression was used to investigate factors predicting susceptibility to vancomycin., Results: Of 162 episodes of peritonitis which had a positive bacterial culture of PD fluid, 30 peritonitis were in the PDAP-cloudy group, and 132 peritonitis were in the PDAP-multi group. Thirty (100%) peritonitis in the PDAP-cloudy group had gram-positive bacterial infections, which was significantly greater than that in the PDAP-multi group (51.5%) (P < 0.001). Twenty-nine (96.7%) peritonitis in the PDAP-cloudy group were susceptible to vancomycin, compared to 67 (50.8%) in the PDAP-multi group (P < 0.001). The specificity of PDAP-cloudy for vancomycin-sensitive peritonitis was 98.48%. Only one patient (3.3%) in the PDAP-cloudy group experienced vancomycin-resistant peritonitis caused by Enterococcus gallinarum, which could neither be covered by vancomycin nor by the initial antibiotic regimen recommended by the current ISPD guidelines. The presence of only cloudy effluent was an independent predictor of susceptibility to vancomycin according to multivariate analysis (OR = 27.678, 95% CI 3.191-240.103, p = 0.003), in addition to PD effluent WBC counts (OR = 0.988, 95% CI 0.980-0.996, p = 0.004), diabetes mellitus (OR = 3.646, 95% CI 1.580-8.416, p = 0.002), first episode peritonitis (OR = 0.447, 95% CI 0.207-0.962, p = 0.039) and residual renal creatinine clearance (OR = 0.956, 95% CI 0.918-0.995, p = 0.027). Addition of these characteristics increased the AUC to 0.813 (95% CI 0.0.749-0.878, P < 0.001). The specificity of presenting with only cloudy effluent for vancomycin-sensitive peritonitis was 98.48%., Conclusions: Cloudy dialysate, as the only symptom at PDAP onset, was an independent predictor of vancomycin-sensitive PDAP, which is an important new insight that may guide the choice of initial antibiotic treatment., (© 2024. The Author(s).)

Background: Incremental peritoneal dialysis (IPD) refers to the use of less than standard full-dose peritoneal dialysis (SPD) in end-stage renal disease patients. While the use of IPD is being reported in the literature, its safety and efficacy vs. SPD is unclear. We hereby performed a systematic review of studies comparing mortality, peritonitis, technique survival, anuria-free survival and residual renal function (RRF) between IPD and SPD., Methods: All comparative studies published on PubMed, Embase, CENTRAL, Scopus, and Web of Science databases from inception to 5th September 2023 and reporting on given outcomes were eligible., Results: Ten studies were included. Definitions of IPD were heterogenous and hence mostly a qualitative synthesis was undertaken. Majority of studies found no difference in patient survival between IPD and SPD. Meta-analysis of crude mortality data also presented no significant difference. Peritonitis and technique survival were also not significantly different between IPD and SPD in the majority of studies. Data on RRF was conflicting. Some studies showed that IPD was associated with the preservation of RRF while others found no such difference., Conclusion: IPD may be a safe alternative to SPD in incident dialysis patients. There seems to be no difference in patient survival, peritonitis, and technique survival between the two modalities. However, the impact of IPD on RRF is still questionable. Evidence is heterogeneous and conflicting to derive firm conclusions., (© 2024. The Author(s).)

One of the most common causes of peritoneal dialysis withdrawal is ultrafiltration failure which is characterized by peritoneal membrane thickening and fibrosis. Although previous studies have demonstrated the inhibitory effect of p38 MAPK inhibitors on peritoneal fibrosis in mice, it was unclear which specific cells contribute to peritoneal fibrosis. To investigate the role of p38 MAPK in peritoneal fibrosis more precisely, we examined the expression of p38 MAPK in human peritoneum and generated systemic inducible p38 MAPK knockout mice and macrophage-specific p38 MAPK knockout mice. Furthermore, the response to lipopolysaccharide (LPS) was assessed in p38 MAPK-knocked down RAW 264.7 cells to further explore the role of p38 MAPK in macrophages. We found that phosphorylated p38 MAPK levels were increased in the thickened peritoneum of both human and mice. Both chlorhexidine gluconate (CG)-treated systemic inducible and macrophage-specific p38 MAPK knockout mice ameliorated peritoneal thickening, mRNA expression related to inflammation and fibrosis, and the number of αSMA- and MAC-2-positive cells in the peritoneum compared to CG control mice. Reduction of p38 MAPK in RAW 264.7 cells suppressed inflammatory mRNA expression induced by LPS. These findings suggest that p38 MAPK in macrophages plays a critical role in peritoneal inflammation and thickening., (© 2024. The Author(s).)

Background: Peritoneal dialysis (PD) is a home-based kidney replacement therapy (KRT) performed in people with kidney failure. PD can be performed by manual filling and draining of the abdominal cavity, i.e. continuous ambulatory PD (CAPD), or using a device connected to the PD catheter that is programmed to perform PD exchanges, i.e. automated PD (APD). APD is considered to have several advantages over CAPD, such as a lower incidence of peritonitis, fewer mechanical complications, and greater psychosocial acceptability. Acknowledging the increasing uptake of APD in incident and prevalent patients undergoing PD, it is important to re-evaluate the evidence on the comparative clinical and patient-reported outcomes of APD compared to CAPD. This is an update of a Cochrane review published in 2007., Objectives: To compare clinical and patient-reported outcomes of APD to CAPD in people with kidney failure., Search Methods: In this update, we searched the Cochrane Kidney and Transplant Register of Studies until 29 August 2024. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov., Selection Criteria: Randomised controlled trials (RCTs) comparing APD with CAPD in adults (≥ 18 years) with kidney failure., Data Collection and Analysis: Two authors independently screened the search results and extracted data. Data synthesis was performed using random-effects meta-analyses, expressing effect estimates as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data and mean differences (MD) with 95% CIs for continuous data. Certainty in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach., Main Results: Two RCTs (131 randomised people) comparing APD with CAPD were included in this update. One RCT had a follow-up of six months, and one RCT had a follow-up of 24 months. The risk of bias in the included studies was mostly low, except for the high risk of performance bias for subjective outcomes. The evidence is very uncertain about the effect of APD compared to CAPD on death, hospitalisations, PD-related peritonitis, change of dialysis modality, residual kidney function, health-related quality of life (HRQoL), overhydration, blood pressure, exit-site infections, tunnel infections, mechanical complications, PD catheter removal, or dialysis adequacy measures. These results were largely based on low to very low certainty evidence; hence, caution is warranted when drawing conclusions., Authors' Conclusions: Insufficient evidence exists to decide between APD and CAPD in kidney failure patients with regard to clinical and patient-reported outcomes. Therefore, current evidence is insufficient as a guide for clinical practice. Given that the sample sizes of existing studies are generally small with insufficient follow-up, there is a need for large-scale, multicentre studies. Future research should focus on possible differences between APD and CAPD in residual kidney function, euvolaemia, and patient-reported outcomes such as HRQoL, symptoms, patient satisfaction and life participation., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Tuberculosis (TB) is still a health problem in developing countries. Pulmonary involvement remains the most common clinical presentation. However, multiorgan involvement can be life-threatening. We present the case of a young woman on peritoneal dialysis who was admitted to hospitalisation for hypercalcaemia and low back pain. In his biochemical evaluation, suppressed intact parthyroid hormone (iPTH) and elevated 1,25-hydroxyvitamin D were detected. On a lumbar CT scan, a hypodense lesion in vertebral bodies compatible with Pott's disease was found. Positive cultures for Mycobacterium bovis were obtained in bronchoalveolar lavage and peritoneal fluid, for which specific treatment was initiated. Due to neurological deterioration, a CT scan was performed showing the presence of multiple tuberculomas. Retrospectively, the lack of an etiological diagnosis of chronic kidney disease, the initiation of dialysis 8 months before and the clear evidence of long-standing TB strongly suggest mycobacterium infection as the cause or trigger for the rapid decline in kidney function., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Peritoneal dialysis-associated peritonitis is a serious complication of peritoneal dialysis, and the prevention and treatment of this condition are important for improving the long-term survival and quality of life of patients. However, peritoneal dialysis-associated peritonitis due to Mycobacterium tuberculosis infection is relatively rare and not easily diagnosed. Here, we present a case of peritoneal dialysis-associated peritonitis caused by Mycobacterium tuberculosis identified by pathogenic microbial DNA high-throughput genetic sequencing. This case demonstrates that pathogenic microbial DNA high-throughput genetic sequencing could be used to improve the detection rate of pathogenic microorganisms in patients with complex conditions, thereby allowing for earlier initiation of treatment., (© 2024. The Author(s).)

Infection-related complications remain the most significant cause for morbidity and technique failure in infants, children and adolescents who receive maintenance peritoneal dialysis (PD). The 2024 update of the Clinical Practice Guideline for the Prevention and Management of Peritoneal Dialysis Associated Infection in Children builds upon previous such guidelines published in 2000 and 2012 and provides comprehensive treatment guidance as recommended by an international group of pediatric PD experts based upon a review of published literature and pediatric PD registry data. The workgroup prioritized updating key clinical issues contained in the 2012 guidelines, in addition to addressing additional questions developed using the PICO format. A variety of new guideline statements, highlighted by those pertaining to antibiotic therapy of peritonitis as a result of the evolution of antibiotic susceptibilities, antibiotic stewardship and clinical registry data, as well as new clinical benchmarks, are included. Recommendations for future research designed to fill important knowledge gaps are also provided., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Intraperitoneal pressure measurement offers therapeutic and prognostic benefits in predicting leak risks and gastrointestinal symptoms in Peritoneal Dialysis (PD) patients. This systematic review aims to evaluate the prognostic utility of intraperitoneal pressure measurements and different estimated intraperitoneal pressure equations in predicting the risk of non-infectious complications in PD patients., Methods: Databases including MEDLINE, EMBASE and Cochrane were searched up to July 2023. Randomised and non-randomised trials were included, focusing on End-Stage Kidney Disease (ESKD) patients undergoing PD. Primary outcomes were variables associated with intraperitoneal pressure, while secondary outcomes included PD-related non-infectious complications and gastrointestinal symptoms. Data synthesis combined meta-analysis with narrative synthesis. This review has been registered on PROSPERO (CRD42023475138)., Results: Out of 1828 identified studies, 12 were included for systematic review and 10 for meta-analysis. Body Mass Index (BMI) and Body Surface Area (BSA) showed a consistent positive correlation with intraperitoneal pressure (BMI: r = 0.49, 95% CI 0.35-0.61, I 2  = 67.39%, p = 0.003; BSA: r = 0.2, 95% CI 0.08-0.31, I 2  = 14.10%, p = 0.324). Conversely, the association between intraperitoneal pressure and age, intraperitoneal volume, and Charlson Comorbidity Index were less consistent. Subgroup analysis demonstrated an association between higher intraperitoneal pressure in patients with increased BMI and BSA. However, the relationship between intraperitoneal pressure and non-infectious mechanical complications remained inconclusive., Discussion: This review underscores a significant association between intraperitoneal pressure and anthropometric measures (BMI and BSA). The majority of the studies identified included a small sample and considerable bias. However, the association between intraperitoneal pressure and clinically relevant outcomes was not clear., Conclusions: While increasing body mass index and body surface areas are associated with increasing intraperitoneal pressure, the clinical relevance of measuring intraperitoneal pressure in an adult population remains unclear, particularly given the absence of an association with clinically relevant non-infectious outcomes., (© 2024. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Background: Hypokalemia has been associated with an increased risk of peritoneal dialysis (PD)-associated peritonitis. However, hypokalemia is commonly associated with malnutrition, inflammation, and severe coexisting comorbidities, which thus are suspected of being potential confounders. This study was aimed at testing whether hypokalemia was independently associated with the occurrence and prognosis of PD-associated peritonitis., Methods: A national-level dataset from the Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study was used to explore the independent association of serum potassium with PD-associated peritonitis. Unmatched and propensity score-adjusted multivariate competing risk models, as well as univariate competing risk models following 1:1 propensity score matching, were conducted to balance potential biases between patients with and without hypokalemia. The association between potassium levels prior to peritonitis and treatment failure due to peritonitis was also investigated., Results: During a median follow-up of 25.7 months in 7220 PD patients, there was a higher incidence of peritonitis in patients with serum potassium below 4.0 mmol/L compared to those with higher serum levels (677 [0.114/patient-year] vs. 914 [0.096/patient-year], P = 0.001). After adjusting for demographics, laboratory tests, residual renal function, and medication use, baseline potassium levels below 4.0 mmol/L were not linked to an increased risk of peritonitis, with a hazard ratio of 0.983 (95% CI 0.855-1.130, P = 0.810). This result remained consistent in both the propensity score adjusted multivariate competing risk regression (HR = 0.974, 95% CI 0.829-1.145, P = 0.750) and the univariate competing risk regression after 1:1 propensity score matching (Fine-Gray test, P = 0.218). The results were similar when analyzing patients with serum potassium level above or below 3.5 mmol/L. Lastly, hypokalemia before the occurrence of peritonitis was not independently associated with treatment failure., Conclusion: Hypokalemia was not found to be an independent risk factor for PD-associated peritonitis or treatment failure of peritonitis in China., (© 2024. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The penetration of a peritoneal dialysis catheter into the intestinal cavity is a clinically rare complication. In the present retrospective clinical case series, 11 patients with uraemia who received continuous ambulatory peritoneal dialysis and attended hospital between 2019 and 2023 are described. The median patient age was 61.91 ± 11.33 years. All patients had previously experienced peritoneal dialysis-related peritonitis and were clinically cured by infusing sensitive antibiotics into the abdominal cavity. Colonoscopy was utilised to locate the penetrating catheter and close the perforation with a titanium clip once the catheter had been removed via an external approach. Following a 2-4-week fast, the perforations healed in all 11 patients. The present authors' experience illustrates that directly removing the catheter and clamping the perforation opening under the guidance of colonoscopy is simple to operate with few complications compared with traditional open surgery., Competing Interests: Declaration of conflicting interestThe authors declare that there is no conflict of interest.

Background: Children with severe chronic kidney disease receiving maintenance peritoneal dialysis (PD) are often malnourished and may require nutritional supplementation. Recent PD guidelines address laparoscopic and open surgical gastrostomy as safe approaches in children established on PD, while existing evidence on percutaneous endoscopic gastrostomy (PEG) is still lacking; as well as the role of perioperative antibiotic and antifungal prophylaxis. Hence, this study aimed to report our experience with PEG placement in patients on PD and compare it with the available literature., Methods: We retrospectively reviewed the medical records from patients on PD, who underwent PEG placement at a tertiary referral centre between 2000 and 2020. Data on perioperative management, complications and outcomes were retrieved. An extensive literature search was performed; studies describing PEG placement and perioperative prophylaxis in patients on PD were used as a comparison. Descriptive statistical analysis was conducted., Results: Seven patients (five males) were included. Perioperative antibiotic and antifungal prophylaxis were standard practice. At a median follow-up of 27 months (10-75), the peritonitis rate was 0.2 patient/years. No statistical significance was found between the peritonitis rate before and after PEG placement ( p = 0.2). Patients' demographics and postoperative complications were comparable to the reported studies., Conclusions: Based on our experience, our technique of PEG insertion with antimicrobial prophylaxis is feasible and associated with an acceptable complication risk in patients on PD. Further multicentric studies about surgical technique in patients on PD will be necessary to verify the feasibility of PEG and standardise the perioperative protocol., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Green nail syndrome is an infectious nail disorder caused most commonly by Pseudomonas aeruginosa . We report a rare case of peritoneal dialysis (PD) exit site infection (ESI) accompanied by P. aeruginosa -associated green nail syndrome. The patient was treated with oral and topical antibiotics without the need for PD catheter removal. We aim to emphasise the importance of nail assessment for ESI in patients undergoing PD., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Cardiovascular disease (CVD) represents the primary cause of mortality in patients afflicted with end-stage renal disease and undergoing peritoneal dialysis (PD) treatment. Galectin-3 (Gal-3), a molecule known to exhibit a correlation with CVD mortality garners considerable interest. The objective of this study was to explore the potential association between serum Gal-3 levels and other CVD risk factors among PD patients., Methods: In this cross-sectional study, a total of 114 PD patients with a minimum of 3 months of PD treatment were enrolled. Serum Gal-3 levels were quantified using an enzyme-linked immunosorbent assay. The data of patients with Gal-3 levels higher and lower than 26.744 pg/ml were compared using Mann-Whitney U tests or t tests. Pearson's correlation or Spearman's correlation analysis and multivariate regression were used to assess the associations between the known risk factors for CVD and Gal-3., Results: In comparison to the inter-group baseline data, the low Gal-3 group exhibited a higher glomerular filtration rate (GFR). Gal-3 levels correlate positively with PD duration, B-type natriuretic peptide (BNP), growth differentiation factor 15 (GDF-15), interventricular septal thickness in diastolic (IVST), and left ventricular mass index (LVMI). Conversely, Gal-3 exhibited a negative correlation with albumin levels. Multivariate linear regression analysis demonstrated a positive correlation between Gal-3 levels and BNP, GDF-15, PD duration, IVST and LVMI. Gal-3 levels were negatively correlated with albumin levels., Conclusions: Gal-3 was strongly associated with BNP, GDF-15, IVST and LVMI in patients undergoing PD treatment. Prospective studies should be carried out to determine whether Gal-3 can be a promising biomarker in predicting increased risk of adverse cardiovascular events in PD patients., (© 2024. The Author(s).)

We reported a rare case of peritoneal dialysis-associated peritonitis caused by Weissella confusa. In this case, the symptoms of peritonitis were insidious and atypical, with only turbid peritoneal dialysis effluent and no fever or abdominal pain. The peritoneal dialysis effluent showed slightly elevated leukocytes (predominantly lymphocytes). Weissella confusa was confirmed through repeated peritoneal dialysis effluent cultures. Gastroscopy revealed erosive gastritis with a hookworm infection. The patient recovered after antibiotic and deworming treatments. Our report highlights the unusual and atypical symptoms, characterized by insidious onset, turbid peritoneal dialysis fluid, and an absence of typical signs such as fever or abdominal pain., (© 2024 Wiley Periodicals LLC.)

Background: This study aimed to investigate the clinical characteristics and prognosis of refractory peritoneal dialysis (PD)-associated peritonitis as well as the risk factors of its occurrence and treatment failure., Methods: A single-center retrospective cohort study was conducted among 519 patients undergoing PD from January 2007 to October 2021. According to the International Society for Peritoneal Dialysis guidelines, all episodes occurred in our center were divided into two groups: refractory and nonrefractory. Demographic, biochemical, and pathogenic bacteria and treatment outcome data were collected., Results: During the 15-year period, 282 episodes of peritonitis occurred in 166 patients undergoing PD. The refractory rate was 34.0% (96/282). Gram-positive organisms were the leading cause of peritonitis (47.9%); however, gram-negative organisms were predominant in refractory peritonitis (34.4%, p = 0.002). Multiple logistic regression revealed that gram-negative organism-based peritonitis, longer PD duration, and female sex were the significant independent predictors of refractory peritonitis. Among 96 refractory episodes, white blood cell (WBC) count, dialysate WBC on Day 3, and PD duration ≥5 years were the independent risk factors of treatment failure., Conclusions: Gram-negative organism-based peritonitis, longer PD duration, and female sex were the independent risk factors of refractory peritonitis. Refractory peritonitis with higher WBC count, higher dialysate WBC on Day 3, and PD duration ≥5 years increased treatment failure risk and required immediate PD catheter removal. The timely identification of refractory peritonitis with high risk of treatment failure as well as timely PD catheter removal is important., (© 2024 The Authors. Seminars in Dialysis published by Wiley Periodicals LLC.)

Epithelial-to-mesenchymal transition (EMT) is considered as one of the senescence processes; reportedly, antisenescence therapies effectively reduce EMT. Some models have shown antisenescence effects with the use of sodium-glucose cotransporter 2 (SGLT2) inhibitor. Therefore, our study investigated the antisenescence effects of empagliflozin as an SGLT2 inhibitor in a peritoneal fibrosis model and their impact on EMT inhibition. For in vitro study, human peritoneal mesothelial cells (HPMCs) were isolated and grown in a 96-well plate. The cell media were exchanged with serum-free M199 medium with d-glucose, with or without empagliflozin. All animal experiments were carried out in male mice. Mice were randomly classified into three treatment groups based on peritoneal dialysis (PD) or empagliflozin. We evaluated changes in senescence and EMT markers in HPMCs and PD model. HPMCs treated with glucose transformed from cobblestone to spindle shape, resulting in EMT. Empagliflozin attenuated these morphological changes. Reactive oxygen species production, DNA damage, senescence, and EMT markers were increased by glucose treatment; however, cotreatment with glucose and empagliflozin attenuated these changes. For the mice with PD, an increase in thickness, collagen deposition, staining for senescence, or EMT markers of the parietal peritoneum was observed, which, however, was attenuated by cotreatment with empagliflozin. p53, p21, and p16 increased in mice with PD compared with those in the control group; however, these changes were decreased by empagliflozin. In conclusion, empagliflozin effectively attenuated glucose-induced EMT in HPMCs through a decrease in senescence. Cotreatment with empagliflozin improved peritoneal thickness and fibrosis in PD. NEW & NOTEWORTHY Epithelial-to-mesenchymal transition (EMT) is considered one of the senescence processes. Antisenescence therapies may effectively reduce EMT in peritoneal dialysis models. Human peritoneal mesothelial cells treated with glucose show an increase in senescence and EMT markers; however, empagliflozin attenuates these changes. Mice undergoing peritoneal dialysis exhibit increased senescence and EMT markers, which are decreased by empagliflozin. These findings suggest that empagliflozin may emerge as a novel strategy for prevention or treatment of peritoneal fibrosis.

Patients affected by chronic kidney disease, especially those requiring maintenance dialysis therapy, are particularly susceptible to infections, including reactivation of herpes zoster and are also at increased risk of herpes zoster complications. Postherpetic abdominal pseudohernia is a rare sequela of the infection, caused by motor neuropathy with muscle paresis, that manifests as an abdominal protrusion. In patients receiving peritoneal dialysis who may often present slight abdominal distension, the diagnosis of this complication may be challenging. We present a case of this rare neurological complication in a patient on peritoneal dialysis and discuss its etiology and management. To the best of our knowledge, this is the first report of postherpetic abdominal pseudohernia in a patient receiving kidney replacement therapy., (© 2024. The Author(s).)

Background: Peritoneal dialysis (PD) is a widely-used renal replacement therapy while low ultrafiltration volume usually results in technique failure. Retroperitoneal leakage has been reported to be one of the causes of acquired decline in ultrafiltration. The present study investigated retroperitoneal leakage in PD patients and explored related risk factors., Methods: This study was designed as a prospective, observational study. A total of 420 PD patients regularly followed up at our center were enrolled from May 2011 to July 2021 and followed until December 2021. Retroperitoneal leakage was determined by magnetic resonance peritoneography and was used as the endpoint. Patients with retroperitoneal leakage were given intermittent PD or temporary hemodialysis (HD) as therapy. Cox regression models were used to identify risk factors for retroperitoneal leakage., Results: The cohort was followed up for up to 125.0 months (median: 46.4 months; interquartile range: 16.6 months). During the follow-up, 68 patients developed retroperitoneal leakage, with 31 (45.6%) cases occurring within the first year after PD initiation. A total of 62 (91.2%) patients recovered from retroperitoneal leakage and resumed their original PD regimen. Multivariate Cox regression analysis revealed that age and gender were independent predictors for retroperitoneal leakage. Younger males were more likely to develop retroperitoneal leakage. In females, waistline and body mass index (BMI) were found to be risk factors for retroperitoneal leakage., Conclusions: Retroperitoneal leakage was common in PD patients with ultrafiltration insufficiency and was usually reversible after appropriate treatment. Age and gender were independent risk factors for retroperitoneal leakage., (© 2024. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Background: Dialysis is lifesaving for acute kidney injury (AKI), but access is poor in less resourced settings. A "peritoneal dialysis (PD) first" policy for paediatric AKI is more feasible than haemodialysis in low-resource settings., Methods: Retrospective review of modalities and outcomes of children dialysed acutely at Red Cross War Memorial Children's Hospital between 1998 and 2020., Results: Of the 593 children with AKI who received dialysis, 463 (78.1%) received PD first. Median age was 9.0 (range 0.03-219.3; IQR 13.0-69.6) months; 57.6% were < 1 year old. Weights ranged from 0.9 to 2.0 kg (median 7.0 kg, IQR 3.0-16.0 kg); 38.6% were < 5 kg. PD was used more in younger children compared to extracorporeal dialysis (ECD), with median ages 6.4 (IQR 0.9-30.4) vs. 73.9 (IQR 17.5-113.9) months, respectively (p = 0.001). PD was performed with Seldinger soft catheters (n = 480/578, 83%), predominantly inserted by paediatricians at the bedside (n = 412/490, 84.1%). Complications occurred in 127/560 (22.7%) children receiving PD. Overall, 314/542 (57.8%) children survived. Survival was significantly lower in neonates (< 1 month old, 47.5%) and infants (1-12 months old, 49.2%) compared with older children (> 1 year old, 70.4%, p < 0.0001). Survival was superior in the ECD (75.4%) than in the PD group (55.6%, p = 0.002)., Conclusions: "PD First for Paediatric AKI" is a valuable therapeutic approach for children with AKI. It is feasible in low-resourced settings where bedside PD catheter insertion can be safely taught and is an acceptable dialysis modality, especially in settings where children with AKI would otherwise not survive., (© 2024. The Author(s).)

Background: Peritonitis is a common and serious complication of peritoneal dialysis and is one of the main causes of peritoneal dialysis technique failure and long-term hemodialysis conversion., Objectives: The aim of the review was to identify and clarify peritonitis risk factors and learn about strategies employed at international level to prevent and reduce the occurrence of peritoneal dialysis associated infections and their complications., Design: A scoping review., Participants: Adults in pertitoneal dialysis., Measurements: The methodology framework of Arksey and O'Malley and PRISMA for Scoping Reviews guidelines were applied. A search was conducted of PubMed, Scopus and CINAHL using terms to identify peritoneal dialysis -associated risk factors and interventions carried out for the prevention and reduction of peritonitis in adult persons living at home., Results: The 17 studies selected were based on work carried out in nine different countries. Eleven articles analysed modifiable risk factors (low educational level, being a foreigner and low adherence to aseptic technique) and non-modifiable risk factors (age and comorbidities) that predispose to peritonitis in peritoneal dialysis. The other six studies applied an intervention to improve the prevalence of peritonitis considering educational practices adapted to patient characteristics and the application of retraining., Conclusions: Personalised patient training and the identification of risk factors for peritonitis are key to reducing complications and enhancing the survival of peritoneal dialysis patients and the effectiveness of the technique., ( © 2024 The Authors. Journal of Renal Care published by John Wiley & Sons Ltd on behalf of European Dialysis & Transplant Nurses Association/European Renal Care Association.)

Background: Oxidative stress (OxSt) and inflammation are common in CKD and are known CV and mortality risk factors. In peritoneal dialysis (PD) OxSt and Inflammation even increase due to the use of glucose-based solutions., Patients and Methods: This study analyzed in 15 PD patients the effect of 3 and 6 months of treatment with icodextrin-based glucose-free solutions on OxSt and inflammation, evaluating p22 phox protein expression (Western blot), NADPH oxidase subunit, essential for OxSt activation, MYPT-1 phosphorylation state, marker of RhoA/Rho kinase pathway (ROCK) activity, involved in the induction of OxSt (Western blot) and Malondialdehyde (MDA) production (fluorimetric assay). Interleukin (IL)-6 blood level (chemiluminescence assay) has been measured and used as a marker of inflammation., Results: p22 phox protein expression, MYPT 1 phosphorylation, and MDA were reduced after 3 months from the start of icodextrin (1.28 ± 0.18 d.u. vs. 1.50 ± 0.19, p = 0.049; 0.89 ± 0.03 vs. 0.98 ± 0.03, p = 0.004; 4.20 ± 0.18 nmol/mL vs. 4.84 ± 0.32 nmol/mL, p = 0.045, respectively). In a subgroup of 9 patients who continued the treatment up to 6 months, MYPT-1 phosphorylation was further reduced at 6 months compared to baseline (0.84 ± 0.06 vs. 0.99 ± 0.04, p = 0.043), while p22 phox protein expression was reduced only at 6 months versus baseline (1.03 ± 0.05 vs. 1.68 ± 0.22, p = 0.021). In this subgroup, MDA was reduced at 6 months versus baseline (4.03 ± 0.24 nmol/mL vs. 4.68 ± 0,32, p = 0.024) and also versus 3 months (4.03 ± 0.24 vs. 4.35 ± 0.21, p = 0.008). IL-6 level although reduced both at 3 and 6 months, did not reach statistical significance., Conclusions: The reduction of OxSt with icodextrin-based PD solutions, although obtained in a small patients cohort and in a limited time duration study, strongly supports the rationale of using osmo-metabolic agents-based fluids replacing glucose-based fluids. Ongoing studies with these agents will provide information regarding preservation of peritoneal membrane integrity, residual renal function, and reduction of CVD risk factors such as OxSt and inflammation., (© 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Purpose: Gastrointestinal bleeding is an important gastrointestinal complication among peritoneal dialysis patients and correlated with a higher risk of mortality. Increased uric acid levels are a significant complication for peritoneal dialysis patients and have been associated with an increased risk of hemorrhagic stroke. The objective of the present study was to investigate the relationship between serum uric acid levels and gastrointestinal bleeding in peritoneal dialysis patients., Methods: A total of 2498 peritoneal dialysis patients were recruited. Based on the optimal uric acid cutoff value, two groups of patients were divided. We constructed a propensity-score-matched population of 1762 patients by matching sex, age, and body mass index. Survival outcomes between the two groups were compared using adjusted Kaplan-Meier curves. We constructed the restricted cubic splines regression to assess the correlation between levels of uric acid and gastrointestinal bleeding. A multivariate Cox proportional hazards regression was performed to test whether higher levels of uric acid are an independent risk factor for gastrointestinal bleeding. We performed a forest plot to show interaction effects in different subgroups., Results: According to restricted cubic splines regression, uric acid levels were positively correlated with the risk of gastrointestinal bleeding events. After adjusted different confounding factors, patients with high levels of uric acid were prone to experience gastrointestinal bleeding (HR 1.868, 95%CI 1.001-3.486). In subgroups, the interaction between higher levels of uric acid and utilizing proton pump inhibitors was significant (P for interaction = 0.034). Further research found that taking proton pump inhibitors could decrease the risk of gastrointestinal bleeding in peritoneal dialysis patients accompanied high levels of uric acid., Conclusion: The baseline high levels of uric acid are an independent risk factor for gastrointestinal bleeding in patients undergoing peritoneal dialysis.

Background: The quality of life of patients receiving long-term peritoneal dialysis (PD) is significantly impacted by the onset of peritoneal fibrosis (PF), and one of the pathological changes is mesothelial-mesenchymal transition (MMT). In this study, we investigated the potential roles of miR-454-3p and signal transducer and activator of transcription 3 (STAT3) in the progression of peritoneal MMT and the underlying mechanisms., Methods: Peritoneums were collected to detect morphology via hematoxylin-eosin staining and differentially expressed miRNAs were detected via RT-qPCR. PD effluent-derived cell populations in the peritoneal cavity were isolated from the effluents of 20 PD patients to determine miR-454-3p, STAT3, and MMT markers via Western blotting and RT-qPCR. The relationship between miR-454-3p and STAT3 was examined via a dual-luciferase reporter assay. Western blotting and RT-qPCR were utilized to evaluate the expression of STAT3, MMT markers, and glycolytic enzymes. Immunofluorescence staining revealed the localization and expression of MMT markers and STAT3., Results: MiR-454-3p was downregulated in the peritoneums and PD effluent-derived cell populations of long-term PD patients. High glucose (HG) treatment promoted HMrSV5 cell MMT and glycolysis. MiR-454-3p overexpression alleviated HG-induced MMT and suppressed the expression of STAT3 and glycolytic enzymes. In contrast, the miR-454-3p inhibitor exacerbated HG-induced MMT and promoted the expression of glycolytic enzymes and STAT3. Moreover, STAT3 was the target of miR-454-3p., Conclusions: This study demonstrated the protective role of miR-454-3p in HG-induced MMT and glycolysis in HMrSv5 cells, suggesting that miR-454-3p may prevent MMT by suppressing glycolytic enzymes via the STAT3/PFKFB3 pathway in the HG environment.

Background: The aim of our study was to evaluate the effectiveness of Global Leadership Initiative on Malnutrition (GLIM) criteria in assessing malnutrition within the peritoneal dialysis (PD) population. Methods: We conducted a retrospective analysis involving 1057 PD patients across multiple institutions, characterized by an age of 56.1 ± 14.4 years, 464 (43.9%) female, and a median follow-up of 45 (25, 68) months. Malnutrition was diagnosed according to GLIM criteria. The endpoint event was overall mortality. The survival rate and hazard ratio (HR) of death between malnutrition and well-nourished were analyzed in all patients and various subgroups. Receiver operator characteristic curve and integrated discrimination improvement (IDI) were used to distinguish the efficacy of the nutritional tools prediction model. Results: According to the GLIM criteria, the prevalence of malnutrition among the study population was 34.9%. The adjusted HR of overall mortality was 2.91 (2.39 - 3.54, p  < 0.001) for malnutrition versus well-nourished. In sensitivity analyses, the HR remained robust except the cardiovascular disease subgroup. The area under the curve of GLIM predicting 5-year mortality was 0.65 (0.62-0.68, p  < 0.001). As a complex model for forecast the long-term mortality, the performance of adjusted factors combined with GLIM was poorer than combined malnutrition inflammation score (MIS) (IDI >0, p  < 0.001), but fitter than combined geriatric nutritional risk index (GNRI) (IDI <0, p  < 0.001). Conclusions: The GLIM criteria provide a viable tool for nutritional assessment in patients with PD, and malnutrition defined according to the GLIM can predict prognosis with an acceptable performance.

Backgrounds: The malfunction of peritoneal dialysis (PD) catheter is still an intractable problem. A modified open surgical revision technique with suturing fixation and without catheter removal for malfunctioning catheter was developed to evaluated the efficacy and safety between simultaneous catheter replacement technique., Methods: A total of 167 PD patients with malfunctioning catheter were retrospectively reviewed. For the salvage of PD catheters, patients underwent modified open surgical revision (group A) or simultaneous catheter replacement (group B). The baseline characteristics before operation, perioperative condition, complications and outcomes were compared between both groups., Results: Patients of group A showed significantly shorter operative time (67.4 ± 22.1 versus 82.8 ± 21.1 min, p  = 0.009), less postoperative pain score within 24 h (median 0.0 versus 2.0, p  < 0.001), quicker start of PD (1.06 ± 0.31 versus 1.89 ± 0.89 days, p  < 0.001), shorter length of stay (9.89 ± 5.11 versus 12.55 ± 7.37 days, p  = 0.020) than group B. In terms of complications, the incidence of recurred catheter malfunction in group A was significantly lower than those in group B (1/114 versus 12/53, p  < 0.001). There were no significant differences in mechanical complications (bloody effluent, dialysate leakage, and hernia) and early peritonitis between the groups. The group A patients had a favorable catheter survival rate compared with group B (log-rank, p  = 0.004)., Conclusions: Our modified open surgical revision technique is a safe, simple and fast method, and offers a better outcome with minimal risk of recurrence of catheter malfunction without additional cost and equipment. This technique is worthy of clinical application.

Introduction: Peritoneal dialysis (PD) - associated peritonitis is a serious complication of peritoneal dialysis (PD). The 2022 International Society of Peritoneal Dialysis (ISPD) guidelines do not recommend intraperitoneal (IP) ampicillin for treatment of Enterococcal PD - associated peritonitis. To date, there is no in vivo data to support use of IP ampicillin for the treatment of Enterococcus faecalis . Case Description: A 69-year-old man with a past medical history of end stage kidney disease (ESKD) requiring continuous cycling peritoneal dialysis (CCPD) was admitted to the hospital and treated for peritonitis with E. faecalis . The patient's CCPD prescription was 2.5% Dianeal with 5 total exchanges. IP ampicillin was added to the first 4 exchanges and additional ampicillin was added to the last fill. The patient successfully completed the treatment course with clinical cure. Discussion: The use of IP ampicillin for E . faecalis peritonitis is controversial and previously lacked compelling clinical evidence for or against its use. This case demonstrates treatment of peritonitis using a modified dosing strategy with ampicillin added to each CCPD exchange and last fill. The loss of ampicillin antimicrobial activity reported in vitro with E. faecalis was not supported by this case., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: This study aims to establish a simplified and effective animal model of catheter malfunction caused by omental wrapped using negative pressure suction., Method: The peritoneal dialysis catheter outlet was linked to a negative-pressure (0-75mmHg) suction pump to intensify the negative pressure. Different negative pressures were tested for model construction in vitro. In vivo , a model of peritoneal catheter malfunction caused by omental wrapped was constructed in five beagles after catheter placement. Catheter drainage conditions and related complications were monitored before and after the model establishment., Results: In the vitro experiment, the overall success rate of constructed models was 90% (36/40). The total malfunction rate was higher in 62.5 mmHg (10/10) and 75 mmHg (10/10) than in 12.5 mmHg (8/10) and 37.5 mmHg (8/10). The outflow velocity of dialysate at 62.5 mmHg was significantly lower than that at 12.5 mmHg and 37.5 mmHg, without a statistically significant difference compared to 75 mmHg. In the in vivo experiment, catheter outflow velocity increased, and residual fluid volume decreased after omental wrapped (99.6 ± 6.7 ml/min vs. 32.6 ± 4.6 ml/min at initial five minutes, p  < 0.0001; 69.2 ± 16.3 ml vs. 581.0 ± 109.4 ml, p  < 0.001). And the outflow velocity was finally below 2 ml/min. No severe related complications (such as infection, organ damage, or bleeding) were observed through laparoscopic examination and dialysate tests seven days post-operation., Conclusion: Utilizing negative pressure suction to increase negative pressure around catheter tip is a simple, safe, and effective method for establishing an animal model of omental wrapped leading to catheter malfunction.