Prognostic value of high intraperitoneal pressure in patients on peritoneal dialysis

Peritoneal dialysis (PD) is associated with an increase of intraperitoneal pressure (IPP) which can cause alterations in hemodynamic, abdominal wall, and peritoneal water transport. The hypothesis of this study is that elevated IPP in DP is related to technique failure; defined as death while on PD or switch to hemodialysis.

A prospective, single-center observational study was performed of incident patients on PD from January 2010 to December 2021. IPP was measured using the Durand method 3 months after initiating the technique and its relationship with PD outcome was studied, as well as the IPP value that best discriminates technique failure.

A total of 124 patients were included, 68% were males, mean age 62.1 ± 15.2 years, body mass index (BMI) 27.7 ± 4.8 kg/m², with a mean follow-up of 2.03 years (range:0.97-3.63). IPP in the supine position was 16.6 ± 4.6 cm H₂O for a mean intraperitoneal volume of 2047 ± 359 mL. Independent factors for technique failure were elevated IPP (OR = 1.133; p = 0.026), older age (OR = 1.082; p = 0.001), higher Charlson comorbidity index (OR = 1.65; p < 0.001), and the presence of peritonitis (OR = 3.745; p = 0.001). IPP ≥ 16 cm H₂O was the value that yielded the best sensitivity and specificity to predict technique failure; area under the curve 0.713 (95% confidence interval: 0.623-0.803, p < 0.001).

Elevated IPP is an independent factor of technique failure. The IPP valued that optimized sensitivity and specificity for predicting technique failure was 16 cm H₂O. The measurement of IPP should be considered in routine care in PD, as a prognostic value and to promote adjustments aimed at reducing IPP levels.