Clinical characteristics, pain trajectories, and outcomes of peritoneal dialysis-related peritonitis: a multicenter...

Peritoneal dialysis-related peritonitis (PDRP) is a common complication of peritoneal dialysis that can lead to inadequate dialysis, technical failure, or death. The distinct clinical characteristics and outcomes of gram-negative, gram-positive, and culture-negative PDRP remain unclear, limiting the development of optimal management strategies and prognostic assessment for these subtypes.

This multicenter retrospective study included 156 hospitalized patients with PDRP from three centers between January 2020 and June 2025. Demographic, clinical, laboratory, and treatment data were collected and analyzed.

In the early phase of PDRP, patients with gram-negative infections showed more severe inflammation than those with gram-positive or culture-negative infections, including higher peritoneal dialysate white blood cell counts on day 1, 3, and 5 (P < 0.05); higher C-reactive protein (142.4 vs. 95.1 vs. 77.1 mg/L; P < 0.05) and procalcitonin (8.9 vs. 1.7 vs. 1.2 ng/mL; P < 0.05) levels, altered iron metabolism (higher serum ferritin: 425 vs. 388 vs. 223 ng/mL, P < 0.05; lower serum iron: 4.6 vs. 7.7 vs. 6.2 ng/mL, P < 0.05); and consistently higher abdominal pain scores from days 2 to 12 (4.5 vs. 3.8 vs. 4.0 to 1.0 vs. 0.4 vs. 0.3, P < 0.05). Mortality did not differ significantly among the three groups. However, treatment failure, defined as catheter removal or death, was significantly more frequent in the gram-negative group than in the other two groups (22.7% vs. 10.9% vs. 0%; P < 0.05). Multivariable analysis revealed that hypoalbuminemia was the only factor associated with mortality, whereas gram-negative infection, elevated C-reactive protein, and hypoalbuminemia were associated with treatment failure.

Gram-negative infections are associated with greater inflammation, more severe pain, and higher rates of treatment failure. Although mortality did not differ among the three groups, treatment failure was related to infection type, inflammatory burden, and nutritional status. Further prospective studies are required to confirm these findings.