Clinical outcomes in peritoneal dialysis-related peritonitis: Association with biochemical but not hematologic...

Peritoneal dialysis-related peritonitis (PDRP) remains a significant cause of technical failure and mortality. Hematologic inflammatory indices (HIIs) have previously been associated with the incidence of peritonitis and long-term outcomes in peritoneal dialysis. Their prognostic usefulness in acute PDRP remains unclear. This study evaluated the relationship between HIIs and clinical outcomes in acute PDRP.

This retrospective single-center study included 114 PDRP episodes recorded between 2012 and 2024. Baseline biochemical parameters and HIIs (NLR, PLR, MLR, NPAR, PIV) were collected at diagnosis. Clinical outcomes included treatment response, catheter removal, transition to hemodialysis, mortality and length of hospital stay. Correlation analyses, receiver operating characteristic (ROC) curves, and univariate and multivariable logistic regression analyses were performed.

Treatment response occurred in 71.9% of episodes and peritonitis-related mortality was 10.5%. HIIs showed weak correlations with dialysate leukocyte count at diagnosis (r = 0.210-0.369) and were not associated with treatment response or mortality (all p > 0.05). Lower serum creatinine and parathyroid hormone (PTH) levels were independently associated with poor treatment response (creatinine (OR 2.43, 95% CI 1.00-5.91); PTH (OR 2.99, 95% CI 1.24-7.24)). For mortality, lower phosphate, creatinine, urea and LDL-C levels were significant in univariate analysis. ROC analysis demonstrated moderate discrimination (AUC range: 0.698-0.729). In multivariable analysis, low urea (OR 5.91, 95% CI 1.34-26.08), low creatinine (OR 6.07, 95% CI 1.35-27.20), and low LDL-C (OR 4.82, 95% CI 1.15-20.24) remained independently associated with mortality.

HIIs were not associated with clinical outcomes in PDRP. In contrast, lower creatinine and PTH levels were independently associated with treatment non-response, while lower urea, creatinine and LDL-C levels were independently associated with peritonitis-related mortality, suggesting that underlying nutritional and metabolic status may influence clinical outcomes.