To study the association of peritoneal membrane thickness on USG with duration and effectiveness of peritoneal dialysis

Background: Peritoneal dialysis (PD) is a type of renal replacement therapy that has been successfully used for patients with End stage renal disease (ESRD). The peritoneal membrane is the most important tissue for determining the effectiveness of peritoneal dialysis. Peritoneal membrane functions are directly related to quality of life in peritoneal dialysis patients. The integrity of peritoneal membrane is necessary for adequate filtration in peritoneal dialysis. However, long-term application of dialysis solutions is followed by structural change in the peritoneal membrane. Although peritoneal membrane is of vital importance for determining the effectiveness of peritoneal dialysis, only few studies that investigate peritoneal membrane morphology have been published. Most of these studies used peritoneal biopsy, which can be a compromising procedure due to its invasiveness. We use ultrasound to determine the morphological changes that occur in peritoneal dialysis subjects and correlate these changes with adequacy parameters of the peritoneal dialysis. Aim: To study association of peritoneal membrane thickness on ultrasound with duration and effectiveness of peritoneal dialysis. Materials and Methods: This cross-sectional study was conducted over 15 months on patients undergoing peritoneal dialysis in dialysis unit, tertiary care teaching hospital. In this study, patients were divided into two groups based on their duration of peritoneal dialysis. Group 1 includes patients on peritoneal dialysis with duration less than 24 months, and group 2 includes patients on peritoneal dialysis duration more 24 months. We examined the parietal peritoneum of fasting patients in the supine position through transabdominal ultrasound. Measurements are taken at the midclavicular line in the right upper quadrant (RUQ), the left upper quadrant (LUQ), the right lower quadrant (RLQ), and the left lower quadrant (LLQ) of the abdomen. Ultrasonographic measurable peritoneal thickness was determined as submesothelial collagen zone which is a measurable hyperechoic layer. The mean of the four measurements was calculated for each patient and recorded as the mean peritoneal thickness (MPT). All data obtained from ultrasound imaging were compared with PD duration and parameters of dialysis adequacy such as Kt/V, PET type, dialysate/plasma creatinine ratio (D/P creatinine ratio), and D4/D0 glucose. Results: The study included 39 participants, with a male predominance (66.6%). Most participants were between 41 and 60 years. Significant difference in ultrasound measurement of peritoneal membrane thickness between two groups in all four quadrants. The mean peritoneal thickness of group A is 0.57 mm and group B is 0.87 mm with statistically significant correlation between two groups. An overall negative correlation was observed between the mean peritoneal thickness and the Kt/V, residual urine output, and D4/D0 glucose. Conclusion: In conclusion, our study revealed that increase in duration of peritoneal dialysis is positively correlated with peritoneal membrane thickness and decrease in kt/v, D4/D0 glucose, and residual urine output. This increased peritoneal membrane thickness can be the cause for ineffective PD. Ultrasound imaging is a simple, noninvasive technique for the evaluation of peritoneal membrane thickness. Ultimately, peritoneal membrane thickness may be considered as a dialysis parameter for evaluating dialysis efficiency in the chronic peritoneal dialysis programme.