Ultrasound-based peritoneal membrane thickness as a marker of inflammation and technique failure in peritoneal dialysis.

BACKGROUND

Peritoneal membrane thickening is a structural feature of chronic peritoneal stress in long-term peritoneal dialysis (PD). Its non-invasive evaluation remains limited. This study explored the associations between ultrasound-based peritoneal membrane thickness assessment, inflammatory markers, and technique outcomes in PD patients.

METHODS

In this prospective study, 106 PD patients underwent standardized ultrasonographic measurements of peritoneal membrane thickness across four abdominal quadrants. Serum and dialysate levels of interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1) were analyzed as markers of systemic and local inflammation. Relationships between peritoneal membrane thickness and clinical parameters were examined. Patients were followed for 24 months to evaluate technique failure.

RESULTS

Median peritoneal membrane thickness was 0.30 mm (Interquartile range [IQR]:0.28-0.37). Peritoneal membrane thickness showed positive correlations with serum and dialysate IL-6 (r = 0.42 and 0.39; P < .01) and dialysate MCP-1 (r = 0.36; P < .05). Thicker membranes were observed in patients with longer PD duration and higher glucose exposure (P < .01). Individuals with prior peritonitis had greater peritoneal membrane thickness (0.45 mm vs 0.29 mm, P < .001). Patients with low transport status tended to have greater peritoneal membrane thickness, largely related to longer PD vintage. In multivariable Cox regression analysis, greater ultrasonographic peritoneal membrane thickness (modeled as a continuous variable) was independently associated with a higher risk of technique failure (Hazard ratio [HR] 31.3, 95% confidence interval [CI] 2.54-385.33).

CONCLUSIONS

Ultrasonographic peritoneal membrane thickness appears to reflect both local and systemic inflammation and may indicate cumulative peritoneal stress. Its assessment could provide a feasible, non-invasive approach to monitor peritoneal integrity and identify patients at risk of technique failure.