Eosinophilic Reaction at the Time of Catheter Insertion Predicts Survival in Patients Initiating Peritoneal Dialysis

INTRODUCTION

Despite excellent biocompatibility, insertion of silicone peritoneal dialysis (PD) catheters can induce minor foreign body reaction, affecting long-term patient outcomes. We evaluated the effect of eosinophilic reaction associated with PD catheter insertion on outcomes of patients initiating PD.

METHODS

Eosinophilic reaction to PD catheter insertion was defined as the ratio of peripheral blood eosinophil count at 1 week after insertion (E1W) to pre-insertion eosinophil count (E0), and the association of E1W/E0 with technique survival, peritonitis-free survival, and heart failure (HF)-related hospitalization-free survival was analyzed.

RESULTS

This retrospective cohort study included 116 patients (89 male patients) who underwent PD catheter insertion between January 2008 and June 2018 (61.3 ± 12.9 years). The follow-up duration was 46.2 (23.8-75.3) months. E1W was significantly higher than E0 (median, 333 vs. 234/μL, p < 0.001), with a median E1W/E0 of 1.54. The log-rank test showed that technique survival, peritonitis-free survival, and HF-related hospitalization-free survival were significantly better in patients with E1W/E0 < 1.54 than in those with E1W/E0 ≥ 1.54 (p = 0.002, <0.001, and <0.001, respectively). By the Cox regression analysis adjusted for age, sex, the Charlson comorbidity index, the estimated glomerular filtration rate, and the geriatric nutritional risk index, E1W/E0 remained a significant risk factor for technique failure, peritonitis, and hospitalization for HF (hazard ratio (HR) 1.68, p = 0.01; HR 2.19, p < 0.001; HR 2.15, p < 0.001, respectively).

CONCLUSION

Eosinophilic reaction at the time of PD catheter insertion is a novel marker that may predict outcomes in patients initiating PD.

Vancomycin-related eosinophilic peritonitis

Eosinophilic peritonitis (EP) is a well-described complication of peritoneal dialysis and is often associated with either a reaction to a constituent of the dialysis system (tubing, sterilant, or solution) or an underlying bacterial or fungal reaction. EP has also been described in the setting of icodextrin use. We report a case of EP associated with intraperitoneal vancomycin used in the treatment of peritonitis secondary to methicillin-resistant Staphylococcus epidermidis. Causation was based upon temporal association, negative cultures, concomitant peripheral eosinophilia, and resolution with cessation of vancomycin. Vancomycin allergy should be considered in the differential diagnosis of EP in the right clinical context. Negative bacterial and fungal cultures are essential to exclude other etiologies.