Objective Exit-site infection (ESI) can increase the risk of peritonitis and technical failure. This study analyzes the correlation between peripheral blood eosinophil count(EC) and ESI. Methods Clinical data of 345 PD patients was retrospectively collected from January 2016 to December 2021. Patients were groups by tertiles of the EC at 3 months of peritoneal dialysis catheter: low EC3M group (EC＜130cells/μL, n=110), mid EC3M group (EC=130-240cells/μL, n=115), and high EC3M group (EC≥240cells/μL, n=120). The relationship between eosinophil count and ESI, all-cause mortality, technique failure, and PD-related peritonitis was analyzed using a multifactorial COX model after adjusting for confounding factors. Results The age of the patients was (56.1±15.8) years old. The median follow-up duration was 38(29,46) months. The Kaplan-Meier survival curves with the log-rank test showed that there were significant differences in the risk of ESI incidence among the high, medium, and low EC3M groups (χ²=11.648, P=0.003). Post-hoc pairwise comparisons revealed that the medium EC3M group (χ²=4.313, P=0.038) and the high EC3M group (χ²=11.939, P＜0.001) had significantly higher ESI risks compared to the low EC3M group. Multivariate COX analysis revealed that after adjusting for confounding factors, the EC at three months after the operation was independently associated with ESI (HR=2.028, 95%CI 1.060-3.881, P=0.033). Conclusion Elevated peripheral eosinophil counts at 3 months post-PD catheterization are independently associated with ESI. Monitoring EC may aid in early identification of high-risk ESI patients.
Key words
Peritoneal dialysis /
Exit-site infection /
Eosinophils count /
Death /
Peritonitis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Van Diepen AT, Jassal SV. A qualitative systematic review of the literature supporting a causal relationship between exit-site infection and subsequent peritonitis in patients with end-stage renal disease treated with peritoneal dialysis[J]. Perit Dial Int, 2013, 33(6):604-610.
[2] Chan MK, Chow L, Lam SS, et al. Peritoneal eosinophilia in patients on continuous ambulatory peritoneal dialysis: a prospective study[J]. Am J Kidney Dis, 1988, 11(2):180-183.
[3] Uchiyama K, Washida N, Kusahana E, et al. Eosinophilic reaction at the time of catheter insertion predicts survival in patients initiating peritoneal dialysis[J]. Blood Purif, 2021, 51(4):10-11.
[4] Yang J, Fan J, Fan L, et al. Higher eosinophils predict death-censored technique failure in peritoneal dialysis patients[J]. Int Arch Allergy Immunol, 2020, 181(10):1-9.
[5] Patel UO, Fox SR, Moy JN, et al. Pruritic rash and eosinophilia in a patient receiving peritoneal dialysis[J]. Semin Dial, 2011, 24(3):338-340.
[6] Hatchome N, Shido K, Kikuchi K, et al. Subcutaneous granulomatous reaction with eosinophil infiltration to a silicone continuous ambulatory peritoneal dialysis Tenckhoff catheter[J]. Contact Dermatitis, 2020, 82(2):114-116.
[7] Wen T, Rothenberg ME. The regulatory function of eosinophils[J]. Microbiol Spectr,2016,4(5)：10.
[8] Szeto CC, Li PK, Johnson DW, et al. ISPD catheter-related infection recommendations: 2017 update[J].Perit Dial Int, 2017, 37(2):141-154.
[9] Fried L, Bernardini J, Piraino B. Charlson comorbidity index as a predictor of outcomes in incident peritoneal dialysis patients[J]. Am J Kidney Dis,2001, 37(2):337-342.
[10] Yang Y, Zhou H, Zhang P, et al. Evaluation of objective nutritional indexes as predictors of worse outcomes in peritoneal dialysis patients[J].Nutrition,2020,79-80:110963.
[11] 阿比囡扎, 董捷.腹膜透析患者腹水嗜酸性粒细胞增多的研究现状[J].中华肾脏病杂志,2022,38(3):241-246.
[12] Acharya KR, Ackerman SJ. Eosinophil granule proteins: form and function[J]. J Biol Chem, 2014, 289(25):17406-17415.
[13] Ishioka T, Kimura H, Kita H, et al. Effects of respiratory syncytial virus infection and major basic protein derived from eosinophils in pulmonary alveolar epithelial cells (A549)[J]. Cell Biol Int, 2011, 35(5):467-474.
[14] Amber KT, Chernyavsky A, Agnoletti AF, et al. Mechanisms of pathogenic effects of eosinophil cationic protein and eosinophil-derived neurotoxin on human keratinocytes[J]. Exp Dermatol. 2018, 27(12):1322-1327.
[15] Leitch VD, Strudwick XL, Matthaei KI, et al. IL-5-overexpressing mice exhibit eosinophilia and altered wound healing through mechanisms involving prolonged inflammation[J]. Immunol Cell Biol, 2009,87(2):131-140.
[16] Leiferman KM, Peters MS. Eosinophil-related disease and the skin[J]. J Allergy Clin Immunol Pract, 2018, 6(5):1462-1482.e6.
[17] See EJ, Johnson DW, Hawley CM, et al. Risk predictors and causes of technique failure within the first year of peritoneal dialysis: an Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) study[J]. Am J Kidney Dis, 2017, 72(2):188-197.
[18] Chidambaram M, Bargman JM, Quinn RR, et al. Patient and physician predictors of peritoneal dialysis technique failure: a population based, retrospective cohort study[J]. Perit Dial Int, 2011,31(5):565-573.
