Eosinophilic Reaction at the Time of Catheter Insertion Predicts Survival in Patients Initiating Peritoneal Dialysis

Abstract

<b><i>Introduction:</i></b> Despite excellent biocompatibility, insertion of silicone peritoneal dialysis (PD) catheters can induce minor foreign body reaction, affecting long-term patient outcomes. We evaluated the effect of eosinophilic reaction associated with PD catheter insertion on outcomes of patients initiating PD. <b><i>Methods:</i></b> Eosinophilic reaction to PD catheter insertion was defined as the ratio of peripheral blood eosinophil count at 1 week after insertion (E1W) to pre-insertion eosinophil count (E0), and the association of E1W/E0 with technique survival, peritonitis-free survival, and heart failure (HF)-related hospitalization-free survival was analyzed. <b><i>Results:</i></b> This retrospective cohort study included 116 patients (89 male patients) who underwent PD catheter insertion between January 2008 and June 2018 (61.3 ± 12.9 years). The follow-up duration was 46.2 (23.8–75.3) months. E1W was significantly higher than E0 (median, 333 vs. 234/μL, <i>p</i> < 0.001), with a median E1W/E0 of 1.54. The log-rank test showed that technique survival, peritonitis-free survival, and HF-related hospitalization-free survival were significantly better in patients with E1W/E0 < 1.54 than in those with E1W/E0 ≥ 1.54 (<i>p</i> = 0.002, <0.001, and <0.001, respectively). By the Cox regression analysis adjusted for age, sex, the Charlson comorbidity index, the estimated glomerular filtration rate, and the geriatric nutritional risk index, E1W/E0 remained a significant risk factor for technique failure, peritonitis, and hospitalization for HF (hazard ratio (HR) 1.68, <i>p</i> = 0.01; HR 2.19, <i>p</i> < 0.001; HR 2.15, <i>p</i> < 0.001, respectively). <b><i>Conclusion:</i></b> Eosinophilic reaction at the time of PD catheter insertion is a novel marker that may predict outcomes in patients initiating PD.

Serum thymus and activation-regulated chemokine level is associated with the severity of chronic kidney disease-associated pruritus in patients undergoing peritoneal dialysis

“…31 –33 Moreover, patients with PD can have a relatively Th2-dominant immune profile compared with patients with HD and present with increased and activated eosinophils in the peritoneal fluid and the peripheral blood. 21,22,34 These findings suggested that the development of CKD-aP could be at least partially attributed to the Th2-type immune response. In this context, we presumed that Th2-associated markers could reflect the severity of CKD-aP in patients with PD.…”

Association between the geriatric nutritional risk index and clinical outcomes among peritoneal dialysis patients: A meta-analysis

“…Therefore, maintaining good nutritional status in PD patients is crucial for improving survival rates and preventing complications. Kang [16] 2013 486 Korea ESRD 89.6 1-169 mo 7 Lee [12] 2017 133 Korea ESRD 94.0 51.1 mo ③ 7 Li [17] 2019 447 China ESRD 90.5 19.5 (9.8-42.6) mo; 20.4 (12.3-41.9) mo ② 8 Ren [18] 2019 1804 China Mixed 94.55 39.3 (3-147.5) mo ① 7 Yang [19] 2020 252 China ESRD 91.83 1.9 (0.8-3.1) yr ①③ 6 Yang [20] 2021 276 China ESRD 85.77 2.5 (1.4-4.0) yr ④ 6 Uchiyama [13] 2022 116 Japan Mixed Continuous 46.2 (23.8-75.3) mo ④⑤ 6 Li [21] 2023 118 China Mixed 92.38 NR 6 Yabe [22] 2023 45 Japan ESRD 83.3 32 (18-51) mo 6 Yıldırım [23] 2023 220 Turkey ESRD 106. Malnutrition is also closely associated an increased risk of MACCEs.…”

“…Finally, after reviewing the full texts, 10 studies were included in our metaanalysis. [12,13,[16][17][18][19][20][21][22][23] The detailed process is presented in Figure 1.…”

Self‐assessment sheet submission rate predicts technique survival in patients initiating peritoneal dialysis

“…As a result, considering multicollinearity, age, sex, CCI, eGFR, GNRI and submission rate were included as independent variables. [12][13][14][15][16][17] The same variables were selected as candidate covariates for multivariate analysis to assess their association with the secondary outcomes, peritonitis-free survival, HF-related hospitalization-free survival and ESI/TI-free survival. In addition to the standard Cox regression model for cause-specific hazards, the Fine and Grey subdistribution hazard model was used in the multivariate model as a sensitivity analysis for technique survival, 12,17 because death and transplantation were competing risk events against technique failure.…”

“…In addition to the submission rate, variables associated with technique survival, the primary endpoint, were included in the multivariate regression. As a result, considering multicollinearity, age, sex, CCI, eGFR, GNRI and submission rate were included as independent variables 12–17 . The same variables were selected as candidate covariates for multivariate analysis to assess their association with the secondary outcomes, peritonitis‐free survival, HF‐related hospitalization‐free survival and ESI/TI‐free survival.…”