Elevated effluent lactate independently predicts the adverse outcomes of peritoneal dialysis associated peritonitis
Abstract Peritonitis is the primary complication associated with peritoneal dialysis (PD). The acute inflammatory response is promoted by glycolysis, thereby enhancing lactate production. Lactate level has been identified as a prognostic factor of many acute inflammatory disease, however with no obs...
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Nature Portfolio
2025-07-01
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| author | Xiao Yu Jingyuan Wang Changna Liang Zhao Li Wanhong Lu Jing Lv Ying Ma |
| author_facet | Xiao Yu Jingyuan Wang Changna Liang Zhao Li Wanhong Lu Jing Lv Ying Ma |
| author_sort | Xiao Yu |
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| description | Abstract Peritonitis is the primary complication associated with peritoneal dialysis (PD). The acute inflammatory response is promoted by glycolysis, thereby enhancing lactate production. Lactate level has been identified as a prognostic factor of many acute inflammatory disease, however with no observation in peritoneal dialysis associated peritonitis (PDAP). Therefore, the need to monitor lactate levels of PDAP patients should be emphasized. Retrospective data on effluent and serum lactate levels and other clinical and laboratory characteristics for PDAP (2022-Nov to 2024-Jul) were analyzed. No-cure was defined as adverse outcomes like recurrence, relapse, catheter removal, hemodialysis transfer ≥ 30 days or death. We used logistic regressions and receiver operating characteristic curve (ROC) analysis to assess factors linked to outcomes and the lactate level predictive accuracy for PDAP adverse outcomes, respectively. The total number of PDAP episodes enrolled was 118, involving 100 PD patients. Regarding the clinical outcomes of the PDAP, 84 episodes were cured, while 34 episodes were no-cure. Catheter removal and transfer to hemodialysis were the leading adverse outcomes (n = 22, 64.7%), followed by relapse and recurrence. Compared with the cure group, no-cure group showed significantly lower serum albumin levels, higher effluent white cell count (WCC) on day 5, and higher percentage of gram-negative bacteria infections. The effluent lactate levels in no-cure group were statistically higher than those of cure group (8.50 [5.48, 13.1] versus 5.4 [3.18, 8.25] mmol/L, p < 0.001). Patients with higher effluent lactate levels (odds ratio [OR] = 1.419, p < 0.001) and gram-negative peritonitis (OR = 6.444, p = 0.009) had a higher risk of adverse outcomes. A moderate discriminative capacity for adverse outcomes was observed in the effluent lactate levels through ROC analyses (area under curve [AUC] = 0.752, p < 0.001), and with a threshold values of 10.2 mmol/L yielding the highest Youden’s index. Elevated levels of lactate in the effluent may independently indicate adverse outcomes in PDAP. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-07-01 |
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| spelling | doaj-art-7f8deb4b9014471da4dc2109b9c060032025-08-20T04:01:24ZengNature PortfolioScientific Reports2045-23222025-07-0115111010.1038/s41598-025-09876-1Elevated effluent lactate independently predicts the adverse outcomes of peritoneal dialysis associated peritonitisXiao Yu0Jingyuan Wang1Changna Liang2Zhao Li3Wanhong Lu4Jing Lv5Ying Ma6Department of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Clinical Laboratory, The First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi’an Jiaotong UniversityDepartment of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi’an Jiaotong UniversityAbstract Peritonitis is the primary complication associated with peritoneal dialysis (PD). The acute inflammatory response is promoted by glycolysis, thereby enhancing lactate production. Lactate level has been identified as a prognostic factor of many acute inflammatory disease, however with no observation in peritoneal dialysis associated peritonitis (PDAP). Therefore, the need to monitor lactate levels of PDAP patients should be emphasized. Retrospective data on effluent and serum lactate levels and other clinical and laboratory characteristics for PDAP (2022-Nov to 2024-Jul) were analyzed. No-cure was defined as adverse outcomes like recurrence, relapse, catheter removal, hemodialysis transfer ≥ 30 days or death. We used logistic regressions and receiver operating characteristic curve (ROC) analysis to assess factors linked to outcomes and the lactate level predictive accuracy for PDAP adverse outcomes, respectively. The total number of PDAP episodes enrolled was 118, involving 100 PD patients. Regarding the clinical outcomes of the PDAP, 84 episodes were cured, while 34 episodes were no-cure. Catheter removal and transfer to hemodialysis were the leading adverse outcomes (n = 22, 64.7%), followed by relapse and recurrence. Compared with the cure group, no-cure group showed significantly lower serum albumin levels, higher effluent white cell count (WCC) on day 5, and higher percentage of gram-negative bacteria infections. The effluent lactate levels in no-cure group were statistically higher than those of cure group (8.50 [5.48, 13.1] versus 5.4 [3.18, 8.25] mmol/L, p < 0.001). Patients with higher effluent lactate levels (odds ratio [OR] = 1.419, p < 0.001) and gram-negative peritonitis (OR = 6.444, p = 0.009) had a higher risk of adverse outcomes. A moderate discriminative capacity for adverse outcomes was observed in the effluent lactate levels through ROC analyses (area under curve [AUC] = 0.752, p < 0.001), and with a threshold values of 10.2 mmol/L yielding the highest Youden’s index. Elevated levels of lactate in the effluent may independently indicate adverse outcomes in PDAP.https://doi.org/10.1038/s41598-025-09876-1Effluent lactateAdverse outcomesPeritoneal dialysisPeritonitisPeritoneal dialysis associated peritonitis |
| spellingShingle | Xiao Yu Jingyuan Wang Changna Liang Zhao Li Wanhong Lu Jing Lv Ying Ma Elevated effluent lactate independently predicts the adverse outcomes of peritoneal dialysis associated peritonitis Scientific Reports Effluent lactate Adverse outcomes Peritoneal dialysis Peritonitis Peritoneal dialysis associated peritonitis |
| title | Elevated effluent lactate independently predicts the adverse outcomes of peritoneal dialysis associated peritonitis |
| title_full | Elevated effluent lactate independently predicts the adverse outcomes of peritoneal dialysis associated peritonitis |
| title_fullStr | Elevated effluent lactate independently predicts the adverse outcomes of peritoneal dialysis associated peritonitis |
| title_full_unstemmed | Elevated effluent lactate independently predicts the adverse outcomes of peritoneal dialysis associated peritonitis |
| title_short | Elevated effluent lactate independently predicts the adverse outcomes of peritoneal dialysis associated peritonitis |
| title_sort | elevated effluent lactate independently predicts the adverse outcomes of peritoneal dialysis associated peritonitis |
| topic | Effluent lactate Adverse outcomes Peritoneal dialysis Peritonitis Peritoneal dialysis associated peritonitis |
| url | https://doi.org/10.1038/s41598-025-09876-1 |
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