Abstract: SA-PO461
High Effluent Lactic Acid Levels Predict the Adverse Outcomes of Peritoneal Dialysis-Associated Peritonitis: A New Role for an Old Marker
Session Information
- Home Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Yu, Xiao, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi, China
- Ma, Ying, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
Background
Peritonitis remains the major complication of peritoneal dialysis(PD). Acute inflammation promotes glycolysis and increases the production of lactic acid by increasing the NADH-NAD+ ratio. The role of monitoring effluent lactic acid levels during treatment of peritoneal dialysis-associated peritonitis(PDAP) deserves attention.
Methods
We retrospectively collected effluent and serum lactic acid levels, and other laboratory and clinical characteristics, as well as treatment outcomes of PDAP occurred between November 2022 and October 2023. Adverse outcomes of PDAP were defined as no cure, including recurrent, relapse, catheter removal, transfer to hemodialysis and death. According to treatment outcomes, PDAP episodes were divided into cure group and no cure group. Characteristics at the beginning of PDAP were compared between the 2 groups. Factors associated with clinical outcome were analyzed using logistic regression modeling.
Results
Totally, 80 PDAP episodes were recorded in 67 PD patients. Their baseline average age was 52.4±13.8 years old, among which 64.2% were men. As for the clinical outcomes of the PDAP, 60 episodes were cured, while 20 episodes experienced adverse outcomes (no cure), among which relapse was the leading one (n=12, 15.0%), followed by catheter removal. No difference was observed in age, gender, Charlson’s Comorbidity Index, blood pressure, BMI, PD duration, peritoneal membrane transport type or Kt/V microbiologic cause between cure group and no cure group. Effluent lactic acid levels was significantly higher in no cure group[7.95(6.43,12.1) Vs 6.45(3.13,8.9), p=0.006], accompanied by a higher Day-5 effluent WCC. Multiple Logistic regression analysis showed higher effluent lactic acid levels was the independent risk factors for peritonitis adverse outcomes(odds ratio(OR)=0.822, p=0.012). ROC analyses of effluent lactic acid levels yielded a moderate discriminative capacity for adverse outcomes (area under curve(AUC)=0.71, p=0.006). The threshold values with the highest Youden’s index were 5.25 mg/L (sensitivity=100%, specificity=45%). Calibration for the ROC curve of effluent lactic acid concentration in diagnosing adverse outcome of PDAP was 0.291(Hosmer-Lemeshow goodness-of-fit test:x2=13.667, p=0.091).
Conclusion
Higher effluent lactic acid levels could predict adverse outcome of PDAP independently.