Factors influencing diagnostic imaging in peritoneal dialysis-associated peritonitis

Abstract

Background

Peritoneal dialysis (PD)—associated peritonitis is a major complication in PD and may require abdominal imaging to identify the intra-abdominal pathology, though its clinical utility remains unclear.

Methods

This retrospective, single-center study included all episodes of PD-associated peritonitis that occurred between January 2013 and July 2024. The primary objective was to identify factors predicting the use of abdominal imaging during peritonitis episodes.

Results

A total of 691 episodes of peritonitis occurred in 376 PD patients during the study period. Of these, 354 episodes (51%) were subjected to abdominal imaging, which revealed 102 episodes (29%) suggestive of enteric or other secondary peritonitis. The most common abnormal imaging findings were colitis or enteritis, followed by ileus or intestinal obstruction. Imaging findings indicating the need for urgent medical or surgical attention were observed in 27 episodes of peritonitis (7.6%). Imaging was more frequently performed in peritonitis episodes caused by polymicrobial enteric bacteria (adjusted odds ratio [AOR]: 4.49; 95% CI [2.13–9.48]), single enteric bacteria (AOR: 2.02; 95% CI [1.31–3.13]), and fungi (AOR: 7.77; 95% CI [2.48–24.29]), compared to nonenteric bacteria. Hypotension (AOR: 6.19; 95% CI [2.81–13.66]), cloudy effluent (AOR: 1.91; 95% CI [1.30–2.80]), and higher PD effluent cell counts at presentation (AOR: 1.03; 95% CI [1.01–1.05]) were all significantly associated with imaging. Only polymicrobial infection involving enteric bacteria (AOR: 2.65; 95% CI [1.28–5.50]) was significantly associated with abnormal imaging findings suggestive of secondary or enteric peritonitis. Furthermore, polymicrobial infections with enteric bacteria (AOR: 9.17; 95% CI [3.29–25.50]), fungal infections (AOR: 5.25; 95% CI [1.26–21.96]), and hypotension (AOR: 2.77; 95% CI [1.08–7.07]; p = .03) were significantly associated with critical imaging findings.

Conclusion

Imaging in PD peritonitis was primarily performed based on causative organisms or clinical features. Only polymicrobial enteric peritonitis, fungal infections, and hypotension were significantly associated with critical imaging findings. Future prospective studies are required to improve diagnostic accuracy and guide imaging decisions in PD-related peritonitis.