The Clinical Value Of Intestinal Barrier Function Evaluation In Peritoneal Dialysis Associated Peritonitis

Peritoneal dialysis associated peritonitis(PDAP)is a common complication of peritoneal dialysis(PD).Impaired peritoneal function and peritoneal fibrosis can be caused by repeated peritonitis,which eventually leads to the termination of peritoneal dialysis.Therefore,early diagnosis and effective treatment of peritonitis is the key to maintain peritoneal dialysis.Intestinal barrier dysfunction can affect dialysis efficacy and catheter stability in PD patients.Previous studies indicated that serum d-lactic acid,diamine oxidase(DAO)and bacterial endotoxin could reflect the intestinal barrier function,but the significance of intestinal barrier function evaluation in PDAP is not clear.Objective: To measure the intestinal barrier function of PD patients in our hospital,and investigate the clinical value of intestinal barrier function evaluation in PDAP.Methods : From September 2016 to January 2018 in our hospital,50 PD patients(PD group),of whom 29 were PDAP patients(PDAP group)and 21 were PD non-peritonitis patients(PDNP group),and 20 healthy volunteers in the same period(NPD group)were enrolled.We measured age,gender,dialysis duration,history of hypertension and diabetes,serum D-lactic acid,diamine oxidase(DAO),endotoxin,hemoglobin,albumin,high-sensitive C-reactive protein(hs-CRP),etc.And we analyzed the relationship between the above indicators and the incident of PDAP.Results: The levels of DAO and bacterial endotoxin in peripheral blood of PD group were significantly higher than those of NPD group(P=0.003,0.040,respectively).Compared with PDNP group,patients in PDAP group had lower DAO(P=0.033),higher hemoglobin and hs-CRP(P=0.028,0.000,respectively),and lower serum albumin and uric acid(P=0.015,0.031,respectively).There was no significant difference in D-lactic acid and endotoxin in PDAP patients.DAO was negatively correlated with PDAP(P=0.006)and positively correlated with uric acid(P=0.043).In the PD group,there was no significant difference in D-lactic acid and endotoxin in the subgroups,and the DAO was significantly higher in the patients without previous peritonitis than those with previous peritonitis(P=0.000).In the PDAP group,there was no significant difference between D-lactic acid and bacterial endotoxin in the subgroups.And compared with those patients with previous peritonitis,the DAO was reduced in patients without previous peritonitis(P=0.026).D-lactic acid,DAO and bacterial endotoxin were not risk factors for PDAP,but hs-CRP was an independent risk factor(P=0.004).Conclusion: Compared with healthy volunteers,the intestinal barrier function of PD patients in our hospital is significantly decreased.The intestinal barrier function in PDAP patients was different from that in PDNP patients and was associated with a history of peritonitis.D-lactic acid,DAO and bacterial endotoxin were not risk factors for PDAP,but hs-CRP was an independent risk factor.