Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis

Glucose and insulin blood levels are well known altering factors for 18F-fluoro-2-deoxy-2-d-glucose positron emission tomography–computed tomography ([18F]-FDG PET-CT) interpretability in peritoneal dialysis (PD) patients. A potential influence of glucose-based solutions and Icodextrin in PD patients has not been studied. The aim of this study was to assess PET-CT interpretability in PD patients according to the osmotic agent used in the dialysis fluid (Icodextrin vs. glucose) and the timing of dialysate infusion before imaging.

We searched for all PET-CT performed on individuals receiving PD between January 2020 and March 2024 at Cliniques universitaires Saint-Luc, Brussels, Belgium. Peritoneal membrane characteristics, data regarding dialysis solutions, PET-CT parameters and results were collected. We analyzed available data regarding insulinemia and glycemia during a PD exchange.

Fourteen PET-CTs were available for study of which four were performed on PD patients with a glucose-based solution dwell at imaging, six with Icodextrin, and three with an empty abdomen. Data regarding the presence or absence of PD fluid was missing for one patient. The only uninterpretable exam was performed on a patient injected with [18F]-FDG 86 min after an exchange with a glucose-based solution. All other exams in the glucose-based group were interpretable with a mean PD fluid infusion to [18F]-FDG injection time of 186 min. All PET-CTs in patients with an Icodextrin dwell were interpretable.

In this small PD cohort, PET-CT interpretability appears preserved with Icodextrin dwells and may be adequate with glucose-based solutions if sufficient time elapses, requiring confirmation in larger studies.

Peritoneal dialysis induces an intraperitoneal inflammatory reaction, which causes damage to the peritoneum. Inflammation also accelerates cellular senescence. We studied in vitro effect of the dialysates from peritoneal dialysis patients on the senescence of the peritoneal mesothelial cells (MCs). The effect of N-acetylcysteine (NAC) on that process was studied.

Replicative senescence was induced in MC cells exposed to culture medium, medium mixed with the dialysate ± NAC 0.025 mmol/L. After 10 passages, markers of the cellular senescence and secretory activity of the cells were measured. Additionally, the effect of NAC on the senescent cells was studied.

Exposure of MC to the dialysate accelerated, more than in medium alone, their senescence as reflected by elongation of the population doubling time, increased expression of p21, p53 genes and β-galactosidase activity. Secretion of IL6 and transforming growth factor β (TGFβ) was increased, and fibrinolytic activity, as reflected by the tissue plasminogen activator/plasminogen activator inhibitor-1 ratio, was reduced. NAC slowed down the process of senescence in MC treated with the dialysate. NAC suppressed the proinflammatory properties of the senescent MC.

The proinflammatory properties of the peritoneal dialysate accelerate the senescence of MC. Decreased fibrinolytic activity of MC, increased secretion of IL6 and TGFβ may accelerate fibrosis of the peritoneum. Supplementation of NAC in patients treated with peritoneal dialysis may help preserve the peritoneum as the dialysis membrane.

Compared to conventional, maintenance hemodialysis, peritoneal dialysis (PD) better preserves residual kidney function (RKF) in patients with kidney failure. However, few studies have investigated long-term prognosis of PD patients with anuria. This study aimed to investigate the long-term outcomes of anuric PD patients.

In this retrospective single-center cohort study, we included patients who received continuous ambulatory peritoneal dialysis (CAPD) and developed anuria between 2006 to 2020. The primary outcome was all-cause mortality. Secondary outcomes included technique survival and cardiovascular (CV) mortality. Cox proportional hazards regression, competing risk analysis, and subgroup analyses were performed to identify prognostic factors.

A total of 615 anuric CAPD patients were included in the study, with a mean age of 47.8 ± 14.8 years at the onset of anuria. Prior to anuria onset, patients had received PD for a mean of 30.5 ± 23.0 months; following anuria onset, the median follow-up time was 40.3 months (interquartile range, 23.8–68.3). The 5- and 10-year patient survival rates following anuria onset were 68.2% and 37.1%, respectively, with corresponding technique survival rates of 75.4% and 50.6%. Cox regression analysis identified older age (cause-specific hazard ratio (cHR) 1.05; 95% confidence interval (CI) 1.04–1.06), lower serum albumin (cHR 0.97; 95% CI 0.94–1.00), diabetes (cHR 1.74; 95% CI 1.27–2.39), and cardiovascular disease (cHR 1.64; 95% CI 1.15–2.34) as independent predictors of all-cause mortality. Competing risk analysis revealed that higher glucose exposure (per 30 g/day increase) (subdistribution HR (sHR) 1.24; 95% CI 1.06–1.46) and peritonitis episodes (sHR 1.82; 95% CI 1.31–2.55) were independently associated with technique survival. Subgroup analyses revealed that the adverse prognostic effect of diabetes on all-cause mortality was more pronounced in patients aged <65 years than in those aged ≥65 years (P for interaction = 0.019).

This study demonstrates that PD patients who developed anuria can still achieve favorable long-term clinical outcomes, with a 5-year patient survival exceeding 68% and technique survival rates above 75%. These findings support the continued use of PD as a viable dialysis modality even after complete loss of RKF.

Peritoneal dialysis (PD)—associated peritonitis remains a leading cause of hospitalization, technique failure, and transfer to in-center hemodialysis, with touch contamination during connections accounting for many episodes. Although shrouded connectors and “flush before fill” mechanisms reduce contamination risk, most automated peritoneal dialysis (APD) systems incorporate recessed fluid paths on only one side of the tubing–bag interface, potentially allowing bacterial transfer. We evaluated whether bilateral shrouded connectors with recessed fluid paths reduce bacterial contamination during simulated APD therapy.

In vitro microbiological testing was performed using three APD systems: Vantive/Baxter Claria™ (System A), Fresenius Liberty™ (System C), and Simergent Archimedes™ (System B). Connectors were deliberately contaminated with Staphylococcus aureus to simulate touch contamination, followed by a simulated APD treatment. Bacterial growth was quantified from pre-therapy flush fluid and the first patient fill (“mock peritoneum”). Agar imprinting was used to assess bacterial distribution relative to connector geometry.

Bacterial growth adjacent to the fluid path was observed with contaminated System A connectors but not with System B or System C, where growth was confined to the shroud. Quantitative cultures demonstrated markedly higher bacterial transfer with System A compared with System B and System C across both flush and mock peritoneal samples. Systems B and C employing bilateral shrouded, recessed connectors showed bacterial counts several orders of magnitude lower. All aseptic controls were sterile.

Bilateral shrouded connectors with recessed fluid paths substantially reduce transfer of touch contaminants during simulated APD therapy. This design may mitigate a major mechanism of PD-related peritonitis, warranting clinical evaluation.

Patients receiving peritoneal dialysis (PD) often report problems with constipation. Constipation in PD is associated with increased risks of mechanical and infectious complications, such as poor drainage and fluid removal, catheter migration and peritonitis. A natural fibre supplement, psyllium husk, has been identified as a potential alternative therapy to minimise the risk of constipation for patients receiving PD.

FIBRE-PD is a prospective parallel-arm open-label feasibility study in which patients on PD were 1:1 randomly assigned to receive either psyllium husk (intervention group) or continue routine Movicol^® (control group) for four weeks (28 days). The primary outcome was feasibility, defined as successful recruitment of 60 patients, representing 70% of eligible PD patients. Secondary outcomes included adherence, retention, safety, bowel frequency and patient-reported outcomes (e.g., gastrointestinal symptom burden, quality of life).

Overall, 96 patients were screened for eligibility. Sixty-six (69%) were deemed not eligible, mainly due to non-adherence to prescribed regular Movicol (n = 41, 62%). Among 30 eligible patients, 20 patients (67% of eligible population) were successfully recruited into the study. The intervention group demonstrated high retention (77%), adherence rates (78%) and significant improvement in gastrointestinal symptoms and quality of life compared to patients in the control group. No adverse outcomes were reported.

The FIBRE-PD did not meet its original recruitment target due to an unexpectedly high number of ineligible patients. The recruited proportion almost reached the pre-specified target of 70% of eligible patients, and participants in the intervention group demonstrated high retention and adherence rates with observed benefits in gastrointestinal symptom burden and quality of life.

The aim of this study was to clarify the current status of assisted peritoneal dialysis (PD) implementation in Japan.

A nationwide, cross-sectional, questionnaire survey was conducted by the Working Group of the Academic Committee of the Japanese Society for Peritoneal Dialysis. A paper-based questionnaire of 22 items was developed based on a literature review and clinical experience. The questionnaires were sent to all 310 facilities that were members of the Japanese Society for Peritoneal Dialysis (JSPD).

Responses were received from 209 facilities (response rate 67.4%). It was found that assisted PD is already being implemented in approximately two-thirds of PD facilities, accounting for 15.9% of all PD patients. Cognitive decline and muscle weakness were the leading reasons for starting assisted PD. Family members, particularly spouses and adult children, were the main caregivers in this cohort, either alone or in collaboration with visiting nurses; cooperation with general practitioners was relatively limited. Facilities with a large number of PD patients made use of collaboration with visiting nurses and respite care facilities, remote monitoring, and medical care-specific social networking sites.

This nationwide survey demonstrates that assisted PD is widely practiced in Japan and plays a critical role in sustaining PD therapy for elderly and functionally impaired patients. However, substantial heterogeneity in implementation and insufficient integration with broader medical and social care systems remain major challenges. Addressing these issues through standardization, multidisciplinary collaboration, and policy reform will be essential to meet the needs of Japan's rapidly aging dialysis population.

Socioeconomic deprivation is an established determinant of adverse health outcomes. However, UK-specific data examining its impact on peritoneal dialysis (PD) outcomes remains generally unknown. This study evaluated associations between socioeconomic deprivation and clinical outcomes among patients receiving PD at a single UK center over a 10-year period.

This retrospective observational study included 648 adult patients who underwent PD catheter insertion between January 2015 and December 2024. Socioeconomic deprivation was assessed using the Index of Multiple Deprivation (IMD), with study cohorts categorized into quintiles from the least to the most deprived. Primary outcomes included all-cause mortality, transfer to hemodialysis (HD), and kidney transplantation. Secondary outcomes included cardiovascular events and PD-related infections, that is, peritonitis and exit-site infections. A 1:1 propensity score matching was performed to match for age, ethnicity, and smoking history to compare between the most deprived quintiles (MDQ) (i.e., quintiles 1 and 2) and the least deprived quintiles (LDQ) (i.e., quintiles 4 and 5). Cox proportional hazards models were used to evaluate associations between socioeconomic deprivation and outcomes.

Of the 648 patients included, 41.7% resided in quintile 1. Patients in LDQ were significantly younger (median = 54 [IQR 42–67] vs. 64 [51–74] years, p < 0.001) and more likely to belong to ethnic minority backgrounds (24% vs. 7.7%, p < 0.001) compared to those in MDQ. Across all quintiles, no significant associations were observed between deprivation and all-cause mortality, transfer to HD, or kidney transplantation. In the propensity-matched cohort (n = 298), all-cause mortality was significantly higher among patients from MDQ compared to the LDQ (39.6% vs. 24.8%, p = 0.006). Social deprivation was noted to be an independent risk factor associated with all-cause mortality in the matched cohort (adjusted HR 2.08, 95% CI 1.37–3.10, p = 0.001). No significant associations were identified in relation to cardiovascular events, transfer to HD, kidney transplantation, or PD-related infections.

In a propensity score-matched cohort from this single-center study, socioeconomic deprivation was independently associated with increased mortality among patients receiving PD. No significant associations were observed between socioeconomic deprivation with transfer to HD or kidney transplantation and PD-related infection complications.

To describe the risk of post-procedural peritoneal dialysis (PD) peritonitis episodes following gastroscopy and colonoscopy over a 15-year period in Australia and New Zealand.

The risk of post-procedural PD peritonitis is well recognised following colonoscopy and current ISPD guidelines recommend prophylactic antibiotics. Current guidelines do not recommend this prior to gastroscopy alone due to low level evidence.

Data linkage between hospital admission datasets and ANZDATA was performed in all jurisdictions in Australia and New Zealand, to identify all incident and prevalent patients on PD who underwent either gastroscopy or colonoscopy. ANZDATA reporting of peritonitis was interrogated to describe the risk of peritonitis occurring within seven days of either type of endoscopic procedure. The risk of permanent dialysis modality change at 30 days was estimated using competing risk analysis, as well as a description of the microbiology of these episodes.

In total, 4433 admissions for gastroscopy (2447) colonoscopy (1191) or both (795) were identified amongst 3674 unique patients. In total there were 106 episodes of peritonitis, 51 of which occurred after gastroscopy alone. The event rate of post-procedure peritonitis was similar following gastroscopy (2.1%) and colonoscopy (2.4%) alone. Risk of peritonitis was similar when considering gastroscopy with and without intervention: 1.7% (95% CI 1.1–2.3) and 2.2% (95% CI 1.3–3.1), respectively. A similar trend was also present for colonoscopy with and without intervention: 2.8% (95%CI 1.0–4.7) and 2.7% (95%CI 1.5–4.0), respectively. The most important predictor of dialysis modality change after either procedure was having a polymicrobial infection (sHR 78.98, 95%CI 35.3–176.7). Regardless of procedure type, organisms of enteric origin along with coagulase negative staphylococcus were the most commonly identified.

There was a similar risk of peritonitis following either gastroscopy or colonoscopy over the time period. Further studies evaluating the effect and role of prophylactic antibiotics prior to gastroscopy alone are required.

Across Latin America (LA), accessibility and affordability of kidney replacement therapy varies, but the prevalence of treated kidney failure generally lags behind higher income regions. Hemodialysis (HD) is more common than peritoneal dialysis (PD) in most LA countries. Expanding PD may help increase dialysis access in acute and chronic kidney disease. This study explored trends in existing kidney replacement therapy programs in LA and the opportunities and challenges for improving PD services from the perspective of physicians.

Qualitative data were collected using open-ended, semistructured interviews. Physician participants were recruited from trainees attending a Saving Young Lives workshop on acute kidney injury and acute PD. Thematic analysis was used to identify emergent themes.

There were 15 study participants. We identified and explored two main themes: (1) Physicians face many barriers to adequately caring for all dialysis patients, including high costs, geography, equipment and supply limitations, and lack of specialists; and (2) Increasing dialysis access through PD presents opportunities and challenges.

While there are some dialysis programs in LA in which all patients have access to adequate care and dialysis is fully funded, there are many programs with inadequate capacity and funding. PD presents an opportunity to improve dialysis access in LA, particularly for currently underserved patient populations, but challenges related to staff training, supply access, and patient factors must be addressed for PD programs to be sustainable.

Peritonitis is a severe complication in peritoneal dialysis (PD), necessitating prompt diagnosis and treatment. A key diagnostic indicator is elevated white blood cells (WBC) in spent PD effluent. Laboratory-based WBC testing can be slow, costly, and infrastructure-dependent, potentially delaying treatment. Urine dipsticks, commonly used for urinary tract infections, include a leukocyte esterase (LE) test that may serve as a rapid and low-cost point-of-care alternative. We evaluated the effectiveness of using an LE test of urine dipsticks to detect WBC in PD effluent for diagnosing PD-associated peritonitis.

Our research comprised a clinical and a laboratory part. Clinically, we analyzed data from Khartoum, Sudan, where LE dipsticks are routinely given to PD patients for point-of-care testing of PD effluent. In a laboratory, we compared dipstick results with WBC counts in stored, freeze–thawed PD effluents from Australia and the United States, and evaluated smartphone imaging of dipstick coloration.

The clinical evaluation comprised 56 pediatric PD patients providing 530 PD effluent samples. Dipstick LE testing of freshly collected effluents demonstrated 100% sensitivity and 100% specificity for peritonitis diagnosis. In the laboratory study, testing of 352 freeze–thawed PD effluents showed reduced sensitivity (78%) and specificity (95%) after 1 month of refrigerator storage. Smartphone imaging reliably supported visual inspection and enabled semi-quantitative color assessment.

When used on freshly collected PD effluents, the LE test on urine dipsticks is a rapid, reliable, and affordable tool for diagnosing PD-associated peritonitis. This approach is particularly valuable in low-resource settings, home-based care, and telehealth.