Kidney Week

Abstract: FR-OR009

Peritoneal Fluid Cell Free DNA Is a Versatile Analyte of Peritonitis

Session Information

• Advances in Home Dialysis Modalities
  October 26, 2018 | Location: 2, San Diego Convention Center
  Abstract Time: 06:06 PM - 06:18 PM

Category: Dialysis

• 703 Dialysis: Peritoneal Dialysis

Authors

• Lee, John Richard, Weill Cornell Medicine, New York, New York, United States

John Richard Lee, MD, MS, FASN



I am a transplant nephrologist at Weill Cornell Medicine and an academic physician scientist with expertise in translational microbiome research studies. I am currently funded by a K23 career development award from the NIH / NIAID (2016) and an R21 exploratory/development award from the NIH / NIAID (2017). My laboratory's current focus is establishing the relationship between the microbiome and complications in patients with kidney disease as well as kidney transplant recipients.

• Srivatana, Vesh, The Rogosin Institute, New York, New York, United States

Vesh Srivatana,

• Burnham, Philip, Cornell University, Ithaca, New York, United States

Philip Burnham,

• Renaghan, Amanda DeMauro, Weill Cornell Medicine, New York, New York, United States

Amanda DeMauro Renaghan,

• Guo, Xunxi Susan, Weill Cornell Medicine, New York, New York, United States

Xunxi Susan Guo,

• Westblade, Lars, Weill Cornell Medicine, New York, New York, United States

Lars Westblade,

• Edusei, Emmanuel Y., Weill Cornell Medicine, New York, New York, United States

Emmanuel Y. Edusei,

• Silberzweig, Jeffrey I., The Rogosin Institute, New York, New York, United States

Jeffrey I. Silberzweig,

• Albakry, Shady Y., Weill Cornell Medicine, New York, New York, United States

Shady Y. Albakry,

• Magruder, Matthew, Weill Cornell Medicine, New York, New York, United States

Matthew Magruder,

• Suthanthiran, Manikkam, Weill Cornell Medicine, New York, New York, United States

Manikkam Suthanthiran,

• De Vlaminck, Iwijn, Cornell University, Ithaca, New York, United States

Iwijn De Vlaminck,

Background

Culture negative peritonitis is common in peritoneal dialysis (PD) patients, especially in the setting of recent antibiotic use. We investigated whether sequencing cell free DNA (cfDNA) extracted from peritoneal fluid supernatants can identify the suspected causative agent(s) in cases of peritonitis.

Methods

We recruited 7 PD subjects: 3 subjects had peritonitis and 4 subjects did not have evidence of peritonitis; and we collected 16 peritoneal fluid specimens. cfDNA was isolated using a Qiagen Circulating Nucleic Acid Kit and a single stranded library preparation was constructed for each specimen. The library was sequenced using an Illumina Next-Seq instrument (75 base pair by 75 base pair). Pathogen identification was performed using the bioinformatics program, GRAMMy.

Results

We obtained approximately 10 million cfDNA reads per specimen. Three PD subjects had an episode of culture confirmed peritonitis (Klebsiella pneumoniae, Staphylococcus aureus, and Staphylococcus epidermidis). cfDNA profiling identified the organisms in all 3 cases and importantly on subsequent days after antibiotic administration which had corresponding same day cultures that were negative. One of the subjects subsequently developed another episode of suspected peritonitis. The subject was treated for peritonitis with intraperitoneal antibiotics, but the peritoneal fluid cultures on admission were negative. The subject continued to have abdominal pain despite intraperitoneal antibiotics. The subject was suspected to have cholecystitis and culltures from a percutaneous cholecystotomy 4 days after admission grew Enterococcus faecium and Parabacteroides distasonis. cfDNA profiling of peritoneal fluid detected Enterococcus faecium and Parabacteroides distasonis on admission.

Conclusion

Our pilot data support the use of cfDNA profiling of peritoneal fluid to investigate peritonitis, especially in the setting of antibiotic use, and potentially as a method to investigate occult infections in abdominal organs.

Funding

• Private Foundation Support