Adverse factors on nonenhanced abdominal CT for long-term continuous ambulatory peritoneal dialysis: a comparative study between patients who withdraw from and maintain long-term peritoneal dialysis

Abstract

Purpose To investigate the imaging features of patients with long-term continuous ambulatory peritoneal dialysis (CAPD) on nonenhanced abdominal CT and to identify adverse factors for long-term CAPD. Methods A total of 109 patients with less than 5 years of CAPD for peritoneal ultrafiltration failure who switched to hemodialysis (withdrawal group) and 23 patients with more than 10 years of CAPD (long-term group) were retrospectively enrolled. Nonenhanced CT manifestations in both groups were compared, including thickening and calcification of the parietal peritoneum, calcification of the mesangial margin and free margin of the small intestine wall, and calcification of the mesentery and abdominal aorta. A risk stratification model was proposed based on CT manifestations with statistically significant differences. Results The presence of the following CT findings was significantly different between two groups: extensive thickening of the parietal peritoneum (78.9% vs. 21.7%, P < 0.01); severe calcification of the parietal peritoneum (60.6% vs. 8.7%, P < 0.01); calcification of the mesentery (32.1% vs. 4.3%, P < 0.05); and calcification of the free margin of the small intestine wall (49.5% vs. 13.0%, P < 0.05). However, there was no significant difference in calcification of the mesangial margin of the small intestine wall (40.3% vs. 30.4%) or in abdominal aortic calcification (56.9% vs. 61.1%) ( P > 0.05). The area under the receiver operating characteristic curve (AUC) was 0.906 (sensitivity 87.6% and specificity 82.6%). Conclusion Extensive thickening of the parietal peritoneum, severe calcification of the parietal peritoneum, and calcification of the mesentery and the free margin of the small intestine wall are adverse factors for long-term CAPD.

Peritoneal Imaging may be the Last Piece of the Puzzle for Precision Evaluation of Peritoneal Function

“…Advances in imaging techniques are gradually being applied to the field of PD. Peritoneal morphological changes revealed by imaging are found to be relevant to peritoneal function, and are expected to be an important complement to the evaluation of peritoneal function, as exemplified recently by the study reported by Zhang et al [4]. This commentary summarizes previous applications of peritoneal imaging in the assessment of peritoneal function and provides a prospect on the future of an accurate evaluation of peritoneal function.…”

“…Zhang et al [4] retrospectively included patients who had been converted to hemodialysis with less than 5 years on continuous ambulatory peritoneal dialysis (CAPD) and patients with CAPD for more than 10 years. They found extensive thickening of the parietal peritoneum, severe calcification of the parietal peritoneum, the mesentery and the free margin of the small intestine wall were adverse factors for long-term PD by analyzing their non-enhanced abdominal CT imaging features.…”