Abstract: Objective  To investigate the predictive value of plasma D-dimer on the treatment failure of peritoneal dialysis-associated peritonitis (PDAP).  Methods  The clinical data of 161 patients diagnosed with PDAP were retrospectively analyzed. They were divided into cured group and treatment failure group according to the treatment effect. The clinical data were compared between the two groups. Logistic regression was used to analyze the risk factors for the treatment failure of PDAP. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of the risk factors for the treatment failure.  Results Serum albumin (t=3.359, P=0.002) and the first episode of PDAP (χ2=6.155, P=0.013) were significantly higher in the cured group than in the treatment failure group, while dialysis duration (Z=-3.314, P=0.001), leukocyte count in effluent dialysate at the 3rd day (Z=-3.951, P＜0.001), hs-CRP (Z=-3.093, P=0.002), procalcitonin (PCT, Z=-2.344, P=0.019), fibrinogen (Z=-2.197, P=0.024) and D-dimer (Z=-4.152, P＜0.001) were significantly lower in the cured group than in the treatment failure group. Univariate logistic regression showed that longer dialysis duration (OR=1.025, 95% CI:1.011～1.039, P＜0.001), higher hs-CRP (OR=1.007, 95% CI:1.002～1.012, P=0.008), higher PCT (OR=1.018, 95% CI:1.002～1.034, P=0.029), higher fibrinogen (OR=1.568, 95% CI:1.052～2.336, P=0.027), higher D-dimer (OR=1.523, 95% CI:1.165～1.991, P=0.002) and lower serum albumin (OR=0.915, 95% CI:0.840～0.997, P=0.043) were the risk factors for treatment failure of PDAP. Multivariate logistic analysis showed that longer dialysis duration (OR=1.023, 95% CI:1.008～1.039, P=0.003) and higher D-dimer (OR=1.419, 95% CI:1.064～1.893, P=0.017) were the independent risk factors for treatment failure of PDAP. ROC curve showed that D-dimer level to predict the treatment failure of PDAP had the area under the curve of 0.801, the sensitivity of 72.2% and the specificity of 76.2%, better than the levels of hs-CRP, PCT, fibrinogen and serum albumin to predict the treatment failure.  Conclusions Longer peritoneal dialysis duration and higher D-dimer before treatment were independently correlated with the treatment failure of PDAP. Plasma D-dimer level was a better indicator to predict treatment failure of PDAP.

Key words: Peritoneal dialysis, Peritonitis, D-dimer