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Abstract: PO1319

The Utility of Point-of-Care Reagent Strips for Rapid Rule out of Peritonitis in Patients on Peritoneal Dialysis

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Ramakrishnan, Madhuri, Washington University in Saint Louis, Saint Louis, Missouri, United States
  • Chuu, Andy, Washington University in Saint Louis, Saint Louis, Missouri, United States
  • O Brien, Frank J., Washington University in Saint Louis, Saint Louis, Missouri, United States
Background

10% of all end stage renal disease (ESRD) patients in the United States use peritoneal dialysis (PD). An important complication in this population is PD-related peritonitis, which is a risk factor for hospitalizations, mortality and is the most common cause of transition to hemodialysis. The diagnosis of PD-related peritonitis requires the presence of white blood cell count of > 100/µL or positive culture from the effluent dialysate in the setting of abdominal pain and cloudy effluent dialysate. This method requires time and access to a diagnostic facility, which may not be easily available to all patients on PD. Point-of-care strips that utilize colorimetric changes in leukocyte esterase reagent can be used to provide a quick, presumptive diagnosis of peritonitis. We evaluate the specificity or true negative rate of two reagent strips – PeriScreen and Multistix 10 SG.

Methods

We are conducting a diagnostic test study in a prospective cohort at the home dialysis clinic at Washington University in Saint Louis. We plan to include 100 patients to achieve a power of 80% to be able to obtain a 95% specificity. We are including patients who are asymptomatic i.e. without abdominal pain or cloudy dialysate effluent. We will be obtaining four 20 mL aliquots of their effluent dialysate, taken at the time when their dialysis kinetics are being measured. Two samples will be sent to the laboratory to obtain white blood cell count, and bacterial culture. PeriScreen and Multistix 10 SG reagent strips will then be dipped in the remaining two samples. The results from all four tests are reported as positive or negative, and the results of the reagent strips will be compared to the gold standard of white blood cell count and culture. Specificity will then be calculated.

Results

Data from 10 patients has been obtained to-date. The average age of these patients was 60.1 (± 14.7) years, with 50% of them being females, and 50% of them were Caucasians. In these patients, the Periscreen was found to have specificity of 100% and the Multistix 10 SG was found to have specificity of 100%.

Conclusion

Based on preliminary results, both PeriScreen and Multistix 10 SG reagent strips appear to have specificity >95%. Using this data, we aim to create a protocol for patients to use these strips at home to help rule out PD-related peritonitis in a more efficient manner.