Immune dysregulation drives the relapse of peritoneal dialysis-associated peritonitis: a single-center prospective study.

BACKGROUND

The diagnosis and management of relapsing peritoneal dialysis-associated peritonitis (PDAP) remains a clinical challenge. This study aimed to identify biomarkers associated with relapsing PDAP and discuss potential mechanisms.

METHODS

31 PDAP patients treated in 2023 were prospectively enrolled, including 23 cured patients and 8 with relapsing PDAP. Peritoneal dialysate samples were collected for conventional bacterial culture, 16S rDNA sequencing, and proteomic analysis.

RESULTS

The positivity rate for conventional culture was 64.5%, while that for 16S rDNA sequencing was 67.8%; combining both methods increased the detection rate to 83.9%. Microbiome analysis revealed that PDAP relapse may stem not only from exogenous pathogens but also from gut-derived bacterial translocation due to impaired local immunity. Proteomic profiling revealed that compared with the Cured group, the Relapse group showed downregulated levels of CCL28, CD40, and uPA, and upregulated NRTN. Bioinformatic analysis revealed dysregulation in pathways related to inflammation, fibrinolysis, and immune clearance, thus linking relapsing PDAP to a disturbed peritoneal immune microenvironment.

CONCLUSION

Relapsing PDAP is linked to peritoneal immune dysregulation, and 16S rDNA sequencing represents a complementary diagnostic tool. These findings may guide precise management and improve patient outcomes.