The management of peritoneal dialysis (PD) is fraught with challenges, and among the most serious is peritonitis—a complication that threatens not only patient outcomes but also the viability of PD as a modality. Delayed diagnosis of peritonitis can lead to poor outcomes, including infection-related hospitalization, transfer to hemodialysis, and increased mortality (1). Periplex, a novel rapid point-of-care test that detects inflammatory biomarkers, interleukin-6 (IL-6), and matrix metalloproteinase-8 (MMP-8), offers hope for improved early detection and monitoring of this critical complication.
A recent single-center study was conducted at the Singapore General Hospital for 3 years (2019–2022) and included 120 patients with suspected peritonitis (2). The researchers measured outcomes using traditional laboratory parameters, including leukocyte counts, cultures, and differential counts, providing a comprehensive analysis of the Periplex test's effectiveness against conventional diagnostic standards. Periplex demonstrated a sensitivity of 100% in detecting infective peritonitis. Its ability to rule out infection is underscored by a negative predictive value of 100%. However, the test's specificity of 50%, driven by false positives in cases of eosinophilic peritonitis, highlights the need for clinical discernment when interpreting results.
The utility of Periplex extends beyond diagnosis.
When used in the recovery phase of peritonitis, it achieved a specificity of 93.6%, demonstrating its capability to confirm infection resolution after treatment.
This dual functionality underscores its potential to streamline the diagnosis and management of peritonitis. One key finding was the superior sensitivity of MMP-8 over IL-6 in detecting peritonitis, providing insights into biomarker-driven diagnostic strategies.
Additionally, Periplex performed consistently across different PD solutions, enhancing its applicability in diverse patient populations.
Practical implications for clinical practice
The implementation of Periplex could transform the management of peritonitis in patients undergoing PD by facilitating earlier detection and intervention. In current practice, diagnosing peritonitis relies on presenting symptom, effluent cloudiness, and laboratory analyses, which can be delayed and are resource intensive. A point-of-care test like Periplex could empower patients to self-test at home, which is particularly beneficial for those with limited access to health care facilities or for those who are uncertain about the presence of peritonitis due to subtle symptoms.
In the recovery phase, Periplex could serve as a reliable confirmation of infection clearance, reducing the need for repeated in-center visits and allowing patients to resume regular PD without prolonged disruptions. For patients living in remote areas, this could mean fewer hospital admissions, lower health care costs, and a better quality of life.
Key points for current practice
1. Enhanced diagnostic speed.
Periplex enables rapid detection of peritonitis, supporting timely treatment decisions and potentially reducing hospitalizations.
2. Reliable in-home settings.
The test's high sensitivity and negative predictive value make it a suitable tool for patient-administered testing, fostering patient autonomy and reducing health care visits.
3. Utility in confirming recovery.
High specificity in the recovery phase offers reassurance that the infection has resolved, streamlining post-treatment care.
4. Focused biomarker performance.
The superior sensitivity of MMP-8 over IL-6 could guide future point-of-care test development for inflammation markers in PD effluent.
Footnotes
References
- 1.↑
Bello AK, et al. Epidemiology of peritoneal dialysis outcomes. Nat Rev Nephrol 2022; 18:779–793. doi: 10.1038/s41581-022-00623-7
- 2.↑
Htay H, et al. Rapid point-of-care test for diagnosis of peritonitis in peritoneal dialysis patients. Perit Dial Int 2024; 44:413–418. doi: 10.1177/08968608241234728
