Mesenteric elasticity assessed by shear wave elastography and its relationship with peritoneal function in peritoneal dialysis patients

Lay Summary Long-term peritoneal dialysis (PD) leads to structural and functional changes of the peritoneum. Accurate assessment of PD-related peritoneal damage can help predict PD technique failure and develop timely interventions. In this study we used shear wave elastography (SWE) to detect the morphology and texture changes of the peritoneum. A total of 218 patients were enrolled with a median follow-up of 16.1 months. We measured the stiffness of the mesentery by SWE, which was closely related to the small solute transport and fluid clearance functions of the membrane. High mesenteric SWE values, which indicate low peritoneal elasticity, may predict PD technique failure. This study provides a new and non-invasive method for assessing PD-related peritoneal changes. Background We evaluated the mesenteric elasticity in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) using shear wave elastography (SWE) and investigated its relationships with peritoneal function. Methods Patients were recruited in our peritoneal dialysis (PD) centre between 15 July 2019 and 31 December 2021 and followed up to 31 March 2022. Twelve chronic kidney disease (CKD) patients and nineteen healthy people were included as controls. Correlation, linear regression and Cox regression analyses were applied. Results Of the 218 PD patients, 104 (47.8%) were male. Their mean age was 48.0 +/- 13.2 years and the median PD duration was 59.0 months [interquartile range (IQR) 17.0-105]. The median mesenteric SWE value was 8.15 kPa (IQR 5.20-16.1). The mesenteric SWE values of patients with a PD duration of <3 months [5.20 kPa (IQR 3.10-7.60)] were not significantly different from those of CKD patients [4.35 kPa (IQR 2.63-5.20), P = .17] and healthy controls [3.60 kPa (IQR 2.90-5.10), P = .13] but were lower than those of patients with a PD duration of 3 months-5 years [6.40 kPa (IQR 4.10-10.5), P < .001], 5-10 years [11.9 kPa (IQR 7.40-18.2), P 10 years [19.3 kPa (IQR 11.7-27.3), P < .001]. Longer PD duration (beta = 0.58, P < .001), high effluent interleukin-6 (beta = 0.61, P = .001) and low effluent cancer antigen 125 (beta = -0.34, P = .03) were independently associated with low mesenteric elasticity. The mesenteric SWE value was independently correlated with the dialysate:plasma creatinine ratio (beta = 0.39, P = .01) and negatively correlated with the total daily fluid volume removed (beta = -0.17, P = .03). High mesenteric SWE values were an independent risk factor for death-censored technique failure [adjusted hazard ratio 4.14 (95% confidence interval 1.25-13.7), P = .02). Conclusions SWE could be used to non-invasively characterize peritoneal textural changes, which were closely associated with changes in peritoneal function.