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Abstract: TH-PO398

Relative Dialysate White Blood Cell Change Can Predict Treatment Failure in Peritoneal Dialysis-Related Peritonitis: Development and Validation Studies

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Tantiyavarong, Pichaya, Department of Medicine, Thammsat University Hospital, Pathum thani, Thailand
  • Khumsiri, Natapol, Department of Medicine, Thammsat University Hospital, Pathum thani, Thailand
  • Somboon, Krittapong, Kalasin Hospital, Kalasin, Thailand
  • Chuengsaman, Piyatida, Banphaeo Hospital, Bangkok, Thailand
Background

Absolute dialysate white blood cell count (aWBC) can predict treatment failure; however, no study explores predictive ability of relative dialysate white blood cell count (rWBC).

Methods

In this study, there were 3 cohorts. The first (Development set) and second cohorts (Temporal validation set) were conducted in Banphaeo Hospital in different periods. The third cohort (Geographic validation set) was conducted in Kalasin Hospital. Treatment failure was defined as either peritonitis-associated death or transferring to hemodialysis according to physician’s judgment. Area under receiving-operating characteristics curve (AUC) of rWBC and aWBC on day 0, 3 and 5 after initial antibiotic treatment were compared. Finally, we defined a cut point of remaining rWBC on day 3 and 5 of ≥33% and ≥15% as a non-response criteria, and compared predictive probability to aWBC criteria (aWBC on day 3 and 5 of ≥1,090 and ≥100 cell/mm3).

Results

There were 316 (cohort 1), 202 (cohort 2) and 110 (cohort 3) episodes of PD-related peritonitis included for analysis. The majority of initial antibiotic regimens in all cohorts were intraperitoneal Cefazolin and Ceftazidime. Overall treatment failure rate was 19%, 24% and 32%, respectively. Discriminative ability showed similar AUC of rWBC and aWBC on day 3 and day 5 (Figure 1). Baseline WBC had poor AUC. Using a defined cut-off criteria, rWBC ≥15% on day 5 had a better predictive ability comparing to aWBC ≥100 cell/mm3 in the development set (52% vs 44%) and in two validation sets (61% vs 55% and 57% vs 51%).

Conclusion

rWBC ≥15% on day 5 showed a good predictive probability. We suggest to use this pattern as an alternative criteria to predict treatment failure in PD-related peritonitis.