Ultrasound-based peritoneal membrane thickness as a marker of inflammation and technique failure in peritoneal dialysis.

BACKGROUND: Peritoneal membrane thickening is a structural feature of chronic peritoneal stress in long-term peritoneal dialysis (PD). Its non-invasive evaluation remains limited. This study explored the associations between ultrasound-based peritoneal membrane thickness assessment, inflammatory markers, and technique outcomes in PD patients. METHODS: In this prospective study, 106 PD patients underwent standardized ultrasonographic measurements of peritoneal membrane thickness across four abdominal quadrants. Serum and dialysate levels of interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1) were analyzed as markers of systemic and local inflammation. Relationships between peritoneal membrane thickness and clinical parameters were examined. Patients were followed for 24 months to evaluate technique failure. RESULTS: Median peritoneal membrane thickness was 0.30 mm (Interquartile range [IQR]:0.28-0.37). Peritoneal membrane thickness showed positive correlations with serum and dialysate IL-6 (r = 0.42 and 0.39; P < .01) and dialysate MCP-1 (r = 0.36; P < .05). Thicker membranes were observed in patients with longer PD duration and higher glucose exposure (P < .01). Individuals with prior peritonitis had greater peritoneal membrane thickness (0.45 mm vs 0.29 mm, P < .001). Patients with low transport status tended to have greater peritoneal membrane thickness, largely related to longer PD vintage. In multivariable Cox regression analysis, greater ultrasonographic peritoneal membrane thickness (modeled as a continuous variable) was independently associated with a higher risk of technique failure (Hazard ratio [HR] 31.3, 95% confidence interval [CI] 2.54-385.33). CONCLUSIONS: Ultrasonographic peritoneal membrane thickness appears to reflect both local and systemic inflammation and may indicate cumulative peritoneal stress. Its assessment could provide a feasible, non-invasive approach to monitor peritoneal integrity and identify patients at risk of technique failure.