P11
VIRUSES IN THE PERITONEUM OF PATIENTS ON PERITONEAL DIALYSIS –
AN UNKNOWN QUANTITY
Summers, A, Russell, K, Hurst, H, Klapper, P, Brenchley, P
Renal Research Labs, Manchester Royal Infirmary
BACKGROUND: Peritonitis from bacterial, and occasionally fungal, infections is one of the
most common causes of morbidity in PD patients. Viral infections have rarely been
investigated in the context of peritoneal fibrosis and documented viral peritonitis in PD
patients is rare, although up to 20% of cases are culture negative (non-fungal, non-bacterial).
The impact of viral infection on membrane function and peritoneal morphology is unknown.
AIMS: We aimed to screen stored PD effluent samples for presence of several viruses to
assess the incidence of viral positivity in a cross sectional cohort of patients on peritoneal
dialysis.
PATIENTS: The group comprised 55 males and 52 females and was 89% Caucasian. The
mean age at the time of screening was 56yrs (IQR46-66) and the patients had been on PD for
a mean of 295 days (IQR 54-2991).
METHODS: Nucleic acids in PD samples (n = 107) were extracted using the Qiagen
Biorobot MDx system with QIAamp blood MDX extraction to efficiently purify both DNA
and RNA. Extracts were examined using sensitive polymerase chain reaction test (PCR)
procedures for human cytomegalovirus (CMV), Epstein Barr virus, Varicella-Zoster virus,
adenoviruses, enteroviruses, human polyomaviruses JC and BK, norovirus, rotavirus, and
astrovirus.
RESULTS: 7/107 PD effluent samples were positive for virus giving an incidence of 6.5% in
this initial pilot screen. 1 patient was positive for CMV alone, 2 were positive for BK, with 1
patient showing positivity for CMV and BK. One patient was positive for EBV and 2 patients
were positive for Merkel cell polyoma virus. The mean age of the viral positive patients was
59yrs (IQR 43-73) and mean time on PD was 796 days (IQR 186-1113).
6/7 of the viral positive patients were clinically well at the time of PD effluent collection
although one patient who tested positively for CMV and BK was diagnosed with sterile
peritonitis at this time.
CONCLUSIONS: In this pilot study we have demonstrated virus to be present in the
peritoneum in a small percentage of patients on PD. The clinical implications of these
infections are unknown and further investigation in longitudinal studies are needed to assess
whether these viruses, which may cycle between latent and active virus over time, may cause
damage to the peritoneum and indeed be a source of infection post transplantation. The
potential for viral infection to be linked with sterile peritonitis or promote encapsulating
peritoneal sclerosis needs further investigation.