Peritoneal Dialysis Watch — Sep 24, 2026

This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.

Welcome to your bi-weekly update in Peritoneal Dialysis. This period is dominated by three currents. First, evidence on stretching peritoneal dialysis into populations where it has traditionally been avoided — refractory cardiorenal congestion and combined liver and kidney failure — with a randomised trial and a long single-centre series pulling in opposite directions on how confident we should be. Second, benchmarking: the most comprehensive global picture of peritonitis rates yet assembled, alongside a new metabolic risk marker that behaves differently in women and men. And third, the patient-facing side of PD — pruritus and environmental sustainability — where the gaps are less about biology and more about what we fail to deliver.

Start with the question of who peritoneal dialysis can actually serve. In ESC Heart Failure, Schleef and colleagues report UF-CARE, a multicentre open-label randomised trial across fifteen French centres asking whether adding ultrafiltration — by peritoneal dialysis, haemodialysis, or isolated ultrafiltration — to optimised medical therapy improves outcomes in type 2 cardiorenal syndrome with persistent congestion. Of a hundred and eight patients screened, only forty-six were randomised, and that recruitment failure is the story. The composite of death or unplanned heart failure admission at twelve months occurred in roughly two thirds of the ultrafiltration group versus nearly ninety percent of controls — a numerically large gap that did not reach statistical significance in a trial the authors themselves describe as underpowered. Quality of life improved in both arms, slightly more durably with ultrafiltration, and one death was attributed to the technique. So this neither establishes benefit nor excludes it; what would settle it is an adequately powered trial with a single modality, and the screening-to-randomisation ratio here suggests that will be hard to run.

Against that cautious picture, a retrospective single-centre study in Clinical Nephrology from Khan and colleagues looks considerably more encouraging. Over two decades, twenty-seven patients with chronic liver and kidney failure — mean MELD-3.0 score of twenty-five, most of them requiring repeated large-volume paracentesis — initiated PD. Peritonitis ran at about one episode every five patient-years, better than the global average, hospitalisation and mortality looked comparable to the general PD population, and strikingly, none of these patients needed large-volume paracentesis again after starting PD. Seven went on to transplant, so PD did not compromise candidacy. The obvious caveat is that twenty-seven highly selected patients at one experienced centre over twenty years cannot tell us about the patients who were never offered PD. The authors conclude PD is a viable modality in this group; that is a reasonable reading of observational data, not a demonstration of superiority over haemodialysis.

Which brings us to benchmarks — because without them, an infection rate like that has no reference point. In Medical Sciences, Nochaiwong and colleagues pooled one hundred and fifty-three study populations, over a hundred and thirty-two thousand PD patients across thirty-seven countries, all using International Society for Peritoneal Dialysis criteria. The global incidence came out at 0.31 episodes per patient-year, but the regional spread is the finding: close to one episode per patient-year in the African region against roughly 0.2 in the Western Pacific, with ten of the thirty-seven countries sitting above the ISPD benchmark of 0.4. Gram-positive organisms dominated, with culture-negative peritonitis the second most common category — itself a marker of laboratory capacity rather than biology. Heterogeneity was substantial and the review was restricted to English-language reports, so under-representation of the highest-burden settings is likely. Still, this gives quality programmes a defensible external comparator for the first time in years.

Risk stratification within PD gets a different lens in Renal Failure, where Tang and colleagues followed three thousand four hundred and seventy-one incident PD patients across multiple Chinese centres and examined the metabolic score for insulin resistance. Patients in the highest quartile had meaningfully higher all-cause and cardiovascular mortality — but when split by sex, the association held only in women, where the top quartile carried roughly double the all-cause mortality risk, and vanished in men. That is a large, long-followed cohort, but it is observational, the score is derived rather than measured insulin resistance, and sex-stratified subgroup findings of this kind need external replication before they anchor risk models.

Turning to what patients actually experience, two papers say the burden lies in delivery rather than discovery. Also in Renal Failure, Yao and colleagues surveyed nine thousand five hundred and eighty-nine dialysis patients across thirty provincial-level divisions in China and found chronic kidney disease-associated pruritus in about sixty percent of them — and, importantly, no meaningful difference between haemodialysis and peritoneal dialysis, which cuts against the assumption that PD patients itch less. Only about three percent of affected patients were receiving a potentially effective agent. It is cross-sectional, so the associations with phosphorus, calcium and dialysis vintage are hypothesis-generating, but the treatment gap is descriptive and hard to argue with.

Alongside that, in the Journal of Nephrology, Trigo and colleagues surveyed ninety PD patients at two centres on green nephrology. Most patients recycled something, but only about a fifth recycled solution and drainage bags, which are classified as hospital waste; most patients preferred monthly deliveries and in-person visits, while younger patients were more open to digital information. Ninety patients from two centres is a small, culturally specific sample, and the authors are careful to conclude that transport emissions need system-level solutions rather than patient behaviour change.

If you read only one paper from this period, make it the global peritonitis meta-analysis in Medical Sciences. It converts peritonitis from a local audit number into a benchmarked quality indicator with regional expectations attached, and it reopens the uncomfortable question of how much of the variation reflects practice rather than population.

Here is what this period adds up to. Peritonitis rates now have a contemporary global reference point, and the variation between regions is larger than most of us assumed. The case for PD in combined liver and kidney failure is strengthened but remains observational and single-centre. In refractory cardiorenal syndrome, the randomised evidence is neutral and underpowered rather than negative — that question is still open. Insulin resistance as a mortality marker in PD appears sex-specific, which is intriguing and unreplicated. And pruritus is as common in PD as in haemodialysis, with treatment reaching almost no one.

That's your Peritoneal Dialysis update for this period. Until next time.

This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.