Abstract: Objective  To investigate the effect of malnutrition-inflammation-atherosclerosis (MIA) syndrome on the poor prognosis of patients with peritoneal dialysis associated peritonitis (PDAP) after recovery.  Methods  Clinical data of the patients developed PDAP and then cured in the Peritoneal Dialysis Center of Peking University First Hospital between January 1, 2008 and December 31, 2021 were retrospectively analyzed. These patients were divided into MIA0, MIA1 and MIA ≥2 groups according to whether or not they had cardiovascular disease, serum albumin＜35g/L or C-reactive protein (CRP) >3mg/L within 3 months after recovery from PDAP. With MIA0 group as the reference, multivariate COX proportional risk model and competitive risk model were used to analyze whether MIA score was a predictor of death, transferred to hemodialysis, and recurrent peritonitis.  Results   During the study period, a total of 716 PDAP episodes occurred in 483 patients, of which 397 (82.19%) patients continued to maintain PD after recovery from the first PDAP. Excluding 96 patients with missing data, 301 patients were finally incorporated in this study, including 74 patients (24.58%) in MIA0 group, 112 patients (37.21%) in MIA1 group, and 115 patients (38.21%) in MIA ≥2 group. The results suggested that the patients with higher MIA score had lower albumin level and higher CRP level at baseline (P＜0.05). COX proportional risk model found that death risks of the patients in MIA1 and MIA ≥2 groups increased by 137% (HR 2.369, 95% CI:1.127~4.979, P=0.023) and 448% (HR 5.480, 95% CI:2.590~11.590, P＜0.001), respectively, as compared with that of the patients in MIA0 group. The competitive risk model showed that MIA score had no significant effects on the risks of transferred to hemodialysis and recurrent peritonitis.  Conclusion  MIA syndrome has a continuous adverse effect on patients after recovery from PDAP. The more the items of MIA syndrome, the higher the risk of mortality in the PDAP patients after recovery.

Key words: Peritoneal dialysis associated peritonitis, Malnutrition, Inflammation, Cardiovascular disease, Outcome