Baseline Uric Acid–to–HDL Cholesterol Ratio Predicts Peritoneal Membrane–Related Technical Failure in Peritoneal Dialysis Patients

Peritoneal membrane–related technical failure remains a major limitation of peritoneal dialysis (PD), yet simple predictive biomarkers are lacking. The uric acid–to–HDL cholesterol ratio (UHR) is an integrative marker of metabolic-inflammatory burden. This retrospective cohort study included 214 adult patients who initiated PD between 1997-2025 at a tertiary center. Baseline UHR was calculated from laboratory measurements obtained within three months after PD initiation. The primary outcome was peritoneal membrane–related technical failure, defined as permanent transfer to hemodialysis due to ultrafiltration failure, inadequate solute clearance, or progressive membrane dysfunction. Among 214 patients, 62 (29%) developed membrane failure during follow-up. A UHR cut-off value of 14 was identified by ROC analysis (AUC 0.644). In multivariable Cox regression, UHR >14 was independently associated with increased risk of membrane failure (HR 1.836, 95% CI 1.040–3.241, p = 0.036). A history of kidney transplantation prior to PD initiation also emerged as a strong independent predictor (HR 3.971, 95% CI 1.668–9.455, p = 0.002). Elevated baseline UHR is independently associated with peritoneal membrane–related technical failure. As a simple, inexpensive, and routinely available biomarker, UHR may support early risk stratification and individualized management in PD patients.