bluuebunny/crossref_metadata_2025 huggingface dataset:
P1146ENHANCED EXPRESSION OF THIOREDOXIN-INTERACTING-PROTEIN (TXNIP) MAY REGULATE OXIDATIVE DAMAGE IN PERITONEAL DIALYSIS PATIENTS
Authors: Oberacker Tina , Schricker Severin , Schanz Moritz , Alscher Dominik M , Ketteler Markus
Published: June 2020

Background and Aims

Glucose-based solutions used as peritoneal dialysis fluids influence the peritoneal membrane. Exposure to high glucose-based peritoneal dialysis solutions induces reactive oxygen species (ROS) production due to upregulation of TXNIP as shown by several studies in rats as well as in human primary cells. Enhanced expression of TXINP also regulates oxidative damage. Therefore the aim of this study was to investigate the expression of TXNIP and the extent of oxidative damage in human peritoneal biopsies.

Method

Human peritoneal biopsies of healthy controls, PD patients and patients with EPS were collected. TXNIP and thioredoxin-1 (TRX) mRNA expression was determined by qPCR. Protein expression and the extent of oxidative damage were examined by immunohistochemistry.

Results

Biopsies from the peritoneum of 7 healthy controls, 36 patients on PD without signs of EPS as well as of 12 patients with EPS were collected. The age of the healthy controls was higher (median 64.00 years, IQR: 53.00-70.00) than in the other subgroups (PD: median 60.50 years, IQR: 46.00-69.00 and EPS: median 51.00 years, IQR: 38.00-58.75). Furthermore, compared to the PD- (39 %) and EPS-group (33 %), there were more female participants in the control-group (86 %). Time on PD was longer in EPS patients (median 70.00 months) than in PD patients (median 33.50 months).

In a preliminary study, exposure to high glucose-based peritoneal dialysis solutions did not markedly influence the mRNA expression of TXNIP and TRX.

However, on protein level a significant glucose-related upregulation of TXNIP could be observed especially in PD patients. Interestingly, there was no glucose-related change in protein expression of its interacting partner and cellular anti-oxidant TRX.

To study the effect of TXNIP expression on the generation of oxidative damage, pH2AX positive nuclei were counted on peritoneal membrane sections. A slight increase of pH2AX positive nuclei upon exposure to dialysis solutions could be observed in the cohort analysed.

Conclusion

Here, we show for the first time a clear tendency for upregulation TXNIP in human peritoneal tissue after exposure to high glucose-based peritoneal dialysis solutions especially in PD patients. This increase in TXNIP expression may correlate with the accumulation of oxidative damage of macromolecules. Therefore, manipulation of TXNIP expression may be a promising therapeutic target to improve peritoneal membrane function.
P1149PERITONEAL MEMBRANE CHARACTERISTICS OVER TIME: A LONGITUDINAL STUDY
Authors: Balafa Olga , DUNI ANILA , Tseke Paraskevi , Rapsomanikis Karolos Pavlos , Oikonomou Margarita , Pappas Haralambos , Theodorou Ioanna , Ntounousi Evangelia
Published: June 2020

Background and Aims

Modified PET (use of 3.86% glucose dialysate instead of 2.27%) and temporal drainage at one hour allows a more complete study of peritoneal membrane transport, as it provides information about sodium sieving, free water transport (FWT) and ultrafiltration failure (UFF). Longitudinal data using this PET are sporadic. Aims of our study were a) longitudinal follow-up of the membrane function using modified PET b) evaluation of UFF and association with clinical and membrane characteristics.

Method

We analyzed all modified PET tests performed in our unit during the last 9 years. Patients who underwent the first test during the first year of treatment and then once a year were included. We estimated classic peritoneal transport parameters like D/P creatinine, D/D0 glucose and ultrafiltration (UF) at 4 hours. Moreover we calculated sodium seiving expressed as Dip/DPNa= (Dialysate sodium time 0/plasma sodium)-(Dialysate sodium time 1 hour/plasma sodium)], sodium removal (in one hour) and FWT. We collected clinical and lab data of the patients too.

Results

A total of 219 PETs were performed in 85 PD patients, (median age 64 years (range 18-45). The baseline membrane characteristics of the patients were: DP creatinine=0.74±0.11, D/D0glucose=0.28±0.08, DipDPNa=0.05±0.04, sodium removal=29,804 ±26,894 (mmol/L), FWT=214.9±194.7 ml and UF =655.1±265.5 ml. On multivariate regression analysis D/P creatinine, FWT and sodium removal were significant independent covariates accounting for 50% of the variability of ultrafiltration . The patients were followed-up for a median of 36 months (range 2.4-143).For the repeated measurements, the analysis showed that the observed values of D/Pcre,D/D0, Dip/DPNa, FWT and UF remained rather stable across the different time measurements. During the study, 23 out of 85 pts developed peritoneal UF failure (UFF). Analysis was performed using univariate random effects logistic time-series models and only D/D0 (OR=0.84, P=0.001), D/P Cre (OR=1.15, p<0.001), urine volume (OR=1.26, p=0.027) and sodium removal (OR=0.99, p=0.003) were significantly associated with relative risk of UFF development.

Conclusion

Surprisingly, our patients present a stable membrane function over time. Possible explanations could be the low peritonitis rate and strict use of hypertonic glucose dialysates. Ultrafiltration failure was correlated with higher D/P creatinine and lower D/D0 glucose values, higher baseline urine volume and lower sodium sieving.
P1150BURDEN OF SYMPTOMS EVALUATION AND DETERMINANTS IN PERITONEAL DIALYSIS PATIENTS USING ESAS-R AND IPOS RENAL SCORE
Authors: Cacheira Eunice , Leite de Sousa Luís , Martins Ana Rita , Matias Patricia , Branco Patricia
Published: June 2020

Background and Aims

CKD patients are known to have a substantial burden of symptoms. Effort towards treatment modifications aiming to improve the quality of life in ESRD patients is growing among clinicians. ESAS-r and IPOS renal score are well known among conservative and palliative care physicians, used to evaluate the burden of symptoms in their renal patients. However, there are few studies including patients in chronic peritoneal dialysis. Using these tools, we aim to evaluate the symptoms and determine patient and treatment-related conditions associated with their burden in a PD population.

Method

We have conducted 73 phone interviews to the prevalent PD population in our centre. ESAS-r and IPOS renal (3-days patient version) questionnaires were answered by each patient/family caregiver. The population was then characterized according to gender, race, age, PD technique and duration, number of daily exchanges, patient autonomy, diabetes mellitus and cancer status, Charlson score and number of cardiac events and hospitalizations since PD beginning. Statistical analysis of data was carried out using SPSS®.

Results

We obtained a total of 63 answers to both questionnaires. Three were answered by a family caregiver. 60.3% of the patients were male, mean age 53 (±14.9) years. 15.9% were on automated PD, with mean number of daily exchanges of 3.45 (±0.7) and mean PD duration of 25.7 (±33.5) months. 38,1% were diabetic, six (9.5%) patients had cancer and mean Charlson score was 4.24 (±1.8). Only 3 patients were caregiver dependent for treatment. 31.3% had at least one hospitalization since PD beginning. Each patient reported a mean 3.1 (±2) number of symptoms on ESASr: renal. Mean IPOS-renal score was 9.5 (±6.4). In univariate analysis (t-student test), greater IPOS-renal score was associated with female gender only (p = 0.056; CI -0.07-6.1). In multivariate analysis (linear regression) the number of symptoms reported by each patient on ESASr renal was associated with number of hospitalizations during PD time (B = 0.46; CI(95%) 0.18-0.75; p = 0.02) in model adjusted to time of PD.

Conclusion

The majority of variables analysed do not have an association with IPOS renal score. The number of hospitalizations was associated with greater burden of symptoms, adjusted to PD time. Oddly, Charlson score, diabetes mellitus and cancer status had no relation to the symptoms reported or IPOS renal score. More modifiable patient and treatment-related variables can be studied to better characterize which interventions may ease the burden of symptoms in PD patients. Patients can answer these questionnaires periodically to help clinicians understand weather treatment modifications have a positive impact on their well-being.
P1164INTERVENTIONAL NEPHROLOGY SERVICE ENHANCES PERITONEAL DIALYSIS UTILISATION AND UPTAKE: EXPERIENCE FROM A SINGLE CENTRE IN SINGAPORE
Authors: Liu Yan Lun Allen
Published: June 2020

Background and Aims

Interventional nephrology (IN) is not having a well-defined role in peritoneal dialysis (PD) service provision. Impact to PD catheter outcomes, PD utilisation and uptake on integrated care approach under IN service was not known. Here we report the experience and outcomes of IN practice in PD service from a single centre in Singapore.

Method

We postulated an IN-led, multidisciplinary collaborative model of care for end stage renal failure patients, who transited through a seamless care pathway from pre-dialysis counselling to insertion of PD catheter, could improve utilisation and increase uptake of PD as dialysis modality of choice. This approach was based on: 1. Interventional nephrologist-led PD catheter insertion service, 2. coordination of care (figure 1) and 3. early start of PD. Outcomes of IN involvement in PD access management and coordination of care were included in this study.

Results

From January 2015 to May 2019, a total of 140 PD catheter insertions were performed by interventional nephrologist (table 1). The prevalence of PD patients in our program was increased by 217% after initiation of IN service (figure 2). Annually, incident ESRF patients who chose PD as dialysis modality increased from 10% to 28% (figure 3). We had a very low PD catheter-related complication rate in reference to international standards (table 2). Catheter adjustment-free survival was 94% and 83% at 12 months and 36 months respectively (figure 4).

Conclusion

The multifaceted and holistic role of IN in PD translated into remarkable outcomes on PD utilisation and uptake. It also confirms the safety and efficacy of IN procedures in PD when performed by appropriately trained nephrologists.
P1168ABDOMINAL AORTIC CALCIFICATION SCORE MODIFIES THE PROGNOSTIC VALUE OF SERUM MAGNESIUM LEVELS ON ALL CAUSE MORTALITY IN PERITONEAL DIALYSIS PATIENTS
Authors: Giannakopoulos Panagiotis , Fokas Stavros , Drosataki Eleni , Tsotsorou Ourania , DUNI ANILA , Theodoridis Marios , Stylianou Kostas , Ntounousi Evangelia , Passadakis Ploumis , Katsoudas Spyros , Kyriazis Periklis , Bacharaki Dimitra , Vlahakos Demetrios
Published: June 2020

Background and Aims

Low serum Mg (s-Mg) concentration has been associated with an increased risk of death in both the general and dialysis populations. In peritoneal dialysis (PD) patients, an inverse correlation between s-Mg and abdominal aortic calcification (AAC), estimated by plain lateral lumbar x-rays, as Leena Kauppila (LK) score (range 0-24), is well documented. LK score of 0-4 has been associated with the best event free survival (CORD study CJASN 2011). Here, we explored the possibility whether AAC could modify the relationship between s-Mg and all-cause mortality in PD patients.

Method

We studied 95 stable PD patients, 51 men 44 women, with a mean age of 63 ±14 years. The degree of AAC was evaluated with on plain lateral abdominal radiographs, as LK score. After completion of baseline assessment, including s-Mg measurements, patients were followed up for all-cause mortality.

Results

The mean of s-Mg and AAC in the whole group were 2.25±0.47 mg/dl and 6.65 ± 5.94 respectively. There was an strong inverse correlation (rho = -0.225; p=0.029) between s-Mg and AAC. During a median follow-up period of 23 months, 16 (17%) deaths occurred. There was a 78% reduction of all-cause mortality for every 1 mg/dl of increase in s-Mg {crude HR: 0.22 (95% CI, 0.06 - 0.78)}. An interacting effect between s-Mg and AAC was significant (p=0.005) after controlling for main effects. Then, the association between s-Mg and all-cause mortality by subgroups of AAC: higher tertile vs all lower, was examined (cut-offs of the tertiles for AAC were 3 and 9). In patients grouped in the lower tertiles, s-Mg was a significant predictor of all-cause mortality, even after adjustment for univariate significant predictors of all-cause mortality: age, cardiovascular disease, PD vintage and malnutrition-inflammation score (MIS) {adjusted HR: 0.14 (95% CI, 0.02-0.0.98)}. On the contrary, patients with AAC in the higher tertile of the baseline distribution, s-Mg levels were not predictive of outcome in either crude or the adjusted models.

Conclusion

The predictive value of s-Mg in all-cause mortality in PD patients appears to be critically dependent on AAC score. Thus, sustaining higher sMg levels, as by using higher Mg dialysate concentration, may have beneficial effects on clinical outcomes only in patients without AAC or at least in those with early lesion development.
P1174STUDY ON THE RELATIONSHIP BETWEEN HYPOCHLOREMIA AND ALL-CAUSE DEATH IN PATIENTS RECEIVING CONTINUOUS AMBULATORY PERITONEAL DIALYSIS
Authors: Xu Tao , Wang Niansong , Qiao Cheng
Published: June 2020

Background and Aims

To investigate the relationship between hypochloremia on all-cause death in patients receiving continuous ambulatory peritoneal dialysis (CAPD).

Method

300 CAPD patients from January 2013 to December 2019 in the Sixth People's Hospital affiliated to Shanghai Jiaotong University. According to the serum chloride level, the patients were divided into two groups: hypochloremia group (serum chlorine ≤ 96mmol / L, n = 135) and normal chloride group (106mmol / L < serum chlorine > 96mmol / L, n = 165). The endpoint was all-cause death. We used the receiver-operating characteristic (ROC) curve to analysis the diagnostic value and logistic regression to assess the predictive value in relation to serum chloride with all-cause death in CAPD patients. Kaplan Meier curve was used to evaluate the effect of serum chloride on all-cause death survival analysis. All statistics were analyzed by SPSS 20.0 software, P < 0.05, indicating significant difference.

Results

114 cases of all-cause death occurred in CAPD patients during follow-up (62.1 ± 11.1 months). The results of correlation analysis showed that serum chloride was positively correlated with serum sodium and potassium (r=0.721,0.199, P=0.001) and the negative correlation between serum chloride and dialysis age and serum phosphorus (r=-0.321, - 0.300, P=0.001). ROC curve analysis showed that serum chloride was statistically significant in predicting all-cause death in CAPD patients (AUC = 0.666, 95% Cl = 0.601-0.730, sensitivity / specificity = 64.6% / 59.8%, best threshold = 95.5mmol/l). Kaplan Meier analysis of all-cause death risk curve shows that the incidence of all-cause death in the low chloride group is higher than that in the normal serum chloride group. Logistic regression analysis showed that low chloride level was an independent risk factor for all-cause death in CAPD patients.

Conclusion

Hypochloremia is an independent risk factor for all-cause death in CAPD patients.
P1176DECLINING PERITONEAL HOST DEFENCES REVEALED BY EX-VIVO CYTOKINE RELEASE ASSAY OF PERITONEAL DIALYSIS EFFLUENT CELLS
Authors: Herzog Rebecca , Vychytil Andreas , Aufricht Christoph , Kratochwill Klaus
Published: June 2020

Background and Aims

Infectious complications occur in a significant proportion of patients treated with peritoneal dialysis (PD), limiting its long-term applicability. Reduced peritoneal immune-competence, caused by the continuous exposure to PD-fluids, has been described as a therapy-related pathomechanisms, prompting the need for a tool to assess the functional peritoneal immune status. We established an ex-vivo stimulation assay to test host defence mechanisms in only 9ml of crude PD-effluent. The assay was used in two randomized clinical trials investigating immune-modulatory effects of a novel additive (alanyl-glutamine) to PD-fluid. Here we aimed to evaluate the assay as a method to assess peritoneal immune-competence in the general PD-population and linking it to PD vintage and outcome parameters.

Method

462 PD-effluent samples, originating from 148 adult and paediatric PD patients, were stimulated ex-vivo (24h, 37°C) with toll-like receptor (TLR)-agonists lipopolysaccharide (LPS) and Pam3Cys. Unstimulated samples of each effluent were used as controls. Interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) concentrations and the predictive value of the assay for clinical outcome parameters were analyzed using Wilcoxon matched-pairs signed rank test and a mixed model logistic regression analysis.

Results

Ex-vivo stimulation of peritoneal cells resulted in a dwell-time dependent increase of cytokine release, with a significant lower cytokine released at the 1h PET time point (normalized to unstimulated controls). Ratios between stimulated PDE-samples and unstimulated controls, accounting for a potential increase in basal inflammation, significantly declined with PD therapy duration. Correlation of the cytokine levels with the predefined clinical parameters revealed predictive potential of the assay for the occurrence of infectious complications, as well as of ultrafiltration and technique failure.

Conclusion

In summary, the current study provides evidence of a correlation of declining local host defence and duration of PD-therapy. These data support the hypothesis of PD-duration dependent progressive impairment of the ability of the peritoneal immune cells to secrete cytokines in response to a pathogenic stimulus and thereby dampening the global peritoneal immuno-competence. The results suggest the utility of this clinically feasible ex-vivo induced cytokine-release assay in crude peritoneal effluent as a surrogate of the functional peritoneal immune competence. Future analyses will have to evaluate the assay as a tool to predict common clinical outcomes and define reference values to facilitate stratification of patient populations, clinical staging and to guide novel therapeutic interventions.
P1177THE INFLUENCE OF PERITONEAL GLUCOSE LOAD ON LEAN AND ADIPOSE TISSUE MASS IN PERITONEAL DIALYSIS PATIENTS USING A NOVEL AND QUANTITATIVE INDEX
Authors: Hassan Kamal , Khatib Nihal , Hassan Fadi
Published: June 2020

Background and Aims

There is now widespread consensus among nephrologists to increase the number of patients on peritoneal dialysis (PD). Most of the PD dialysis solutions are based on glucose as an osmotic agent. The peritoneal glucose load can damage the peritoneal membrane, increases its permeability to water, glucose and electrolytes leading to the development of fluid overload, hypertension, stimulation of the inflammatory process and metabolic disturbances. This study aims to verify the influence of glucose exposure load on lean and adipose tissue mass in PD patients using a novel and quantitative index.

Method

This is a retrospective and analytical study based on the medical records. The study examined the entire population of PD patients who were treated at the Peritoneal Dialysis Unit at the Galilee Medical Center in north of Israel during the last eight years (from January 1, 2010 through December 31, 2017). The clinical and laboratory data of these patients were collected from their medical records and analyzed. The main variables examined included peritoneal glucose load index (PGLI), lean tissue index (LTI) and Fat Tissue Index (FTI).

LTI was calculated as the quotient of LTM/Height?(kg/m? and FTI was defined as the quotient of ATM/Height?(kg/m?. LTI and FTI were assessed using the Fresenius Medical Care Body Composition Monitor (BCM) device, based on Bio-impedance technology

Results

187 assessments of the nutritional status in PD patients, using the BCM device, were evaluated. Among PD patients, 52.4% were men, 54% were treated with continuous ambulatory peritoneal dialysis (CAPD) and 46% had diabetes mellitus as primary renal disease. The average age was 57.8 ± 11.3 years, peritoneal dialysis vintage 31.36 ± 16.69 months, body mass index (BMI) 28.1 ± 4.4 kg/m2, daily urinary output 1040.0 ± 649.8 ml/day, hemoglobin 10.84 ± 1.02 g/dl, HbA1c 7.05 ± 1.09 %, Kt/V 1.89 ± 0.17, PGLI 3.11 ± 1.13 g/kg/day, residual renal function 6.68 ± 2.46 ml/min/1.73m2. A significant and positive correlation between the PGLI and FTI (r=0.28, p<0.001) and, a significant and negative association between PGLI and LTI (r=-0.24, p<0.001) were found.

Conclusion

Peritoneal glucose load may adversely influence the nutritional status of PD patients by increasing the adipose tissue mass and decreasing lean tissue mass.
P1181URGENT START OF PERITONEAL DIALYSIS: OUTCOMES AND EXPERIENCE FROM NORTHERN INDIA
Authors: Meena Priti , Bhargava Vinant , Bhalla A K , Gupta Ashwani , Malik Manish , Gupta Anurag , Rana Devinder Singh
Published: June 2020

Background and Aims

Peritoneal dialysis (PD) widely practiced as the first-line modality for renal replacement therapy in end-stage renal disease (ESRD) patients. Urgent-start PD (use of the PD catheter within 14 days of insertion) is an effective approach to prompt initiation of PD after catheter insertion. However, there is a paucity of data regarding complications of urgent-start PD. We investigated the outcomes of urgent-start PD in our subset (Indian population).

Method

All patients in whom PD was initiated between 01 January 2015 and 31 July 2019 (54 months) were included. Patients were grouped according to the initiation of PD (break-in period) as <8 days (PD1), 8 to 14 days (PD2), and >14 days (PD3).

Results

In 100 patients included in the study, 57.5% were males. Among them, 75%, 10%, and 15% patients were in the PD1, PD2, PD3 break-in groups respectively. The most common cause of ESRD was diabetes mellitus. Functional catheter malfunction was the most frequent complication in PD1. The incidence of mechanical complications during the first six months was similar in all three groups (p = 0.06). No significant differences with respect to the catheter dysfunction requiring surgical intervention (p > 0.05) were observed. In PD1 group, catheter patency rate at the end of the 1-month and 1-year was 98.6% and 95.4% respectively. No significant differences were found in the rate of peritonitis among the three groups. Female sex, low haemoglobin, and low albumin levels were independent risk factors for peritonitis.

Conclusion

Early break-in period of less than seven days is a feasible option for patients requiring urgent dialysis with no increased risk of mechanical or infectious complications. It offers a safe and efficacious option for unplanned ESRD patients.
P1182PROGNOSTIC VALUE OF CHARLSON COMORBIDITY INDEX IN PERITONEAL DIALYSIS PATIENTS
Authors: Panuccio Vincenzo Antonio , Tripepi Rocco , Tripepi Giovanni Luigi , Parlongo Giovanna , Mallamaci Francesca
Published: June 2020

Background and Aims

Mortality risk is very high in the dialysis population and the Charlson Comorbidities Index (CCI) is considered as an useful risk stratification tool in these patients. The purpose of this study was to examine the accuracy of CCI for predicting mortality in peritoneal dialysis (PD) patients and to compare the prognostic power of CCI with that of a risk prediction model jointly including a clinical score of malnutrition and the NYHA classes.

Method

We analyzed this problem in a series of 66 consecutive PD patients on follow-up in our unit. Their mean age was 69±14 years, 64% were male, 36% were diabetic. The median dialysis vintage was 39 months (Interquartile range 23-67 months).

Results

During follow-up period, 37 patients died. On univariate Cox regression analysis, CCI largely failed to predict mortality [Hazard ratio (HR): 1.08, 95% CI: 0.94-1.24, P=0.30) and this relationship did not improve (HR: 0.93, 95% CI: 0.79-1.08, P=0.32) also after data adjustment for malnutrition and NYHA classes. In the same model, malnutrition (HR: 1.98, 95% CI 1.20-3.27, P=0.007) and NYHA classes (HR: 3.15, 95% CI 1.67-5.94, P<0.001) were strongly and significantly related to the risk of death. Of note, the prognostic accuracy of the model based on malnutrition and NYHA classes (ROC curve area: 74%) was higher than that provided by CCI alone (ROC curve area: 54%) and did not materially differ from that of an expanded model including CCI, malnutrition and NYHA classes (ROC curve area: 78%)

Conclusion

In this study, CCI did not predict survival in PD patients whereas malnutrition and NYHA score displayed a relevant prognostic accuracy for death in the same patient-population. These results generate the hypothesis, to be confirmed in a larger PD population, that CCI solely for risk stratification is unwarranted in PD patients.
P1200PERITONEAL PROTEIN LOSSES: WHAT DO WE MEAN
Authors: Malho Guedes Anabela , Domingos Ana , Calças Roberto , Silva Ana , Bernardo Idalécio , Neves Pedro , Rodrigues Anabela
Published: June 2020

Background and Aims

The report of peritoneal protein loss should be related with a timely collection (24-hour measurement or 4-hour PET assessment) or concentration. Standardized and reproducible estimation of peritoneal protein transport is obtained during PET. The 24-hour measurements estimate the real amount of PPL, but may be affected by other factors unrelated to the prognosis of PD patients, as inconsistencies in collection and management of the samples. Overall, PET protein loss quantification may be a more specific marker of peritoneal large-pore dysfunction and is seemingly more convenient than 24-hour measurements. The aim of this study was to compare the results of both sampling methods.

Method

A total of 144 adult incident PD patients were included. A standard peritoneal equilibration test, 24-hour urine and dialysate collection, and multifrequency bioimpedance analysis were performed. Independent-samples t test and Pearson correlation coefficient were performed to evaluate relevant clinical associations.

Results

Statistically significant univariable relationships for 24h PPL were found for continuous ambulatory PD technique (CAPD) and, with a correlation coefficient >0.20, for pulse pressure, 4-hour dialysate/plasma creatinine and extracellular water/total body water. Studying 240 min PPL, only with 4-hour dialysate/plasma creatinine, creatinine clearance and bicarbonate levels were statistically significant. In both samples there was no significant association with age, gender, type of effluent (biocompatible solutions or lactate plus bicarbonate comparing with bicarbonate), comorbidity Charlson Index, or presence of diabetes. Correlation between 240 min PPL and 24h PPL ensues, but it is not strong (p<0.001; r=0.365).

Conclusion

The weak correlation between 24h and 240 minutes show that these two measurements should not be considered equivalent. Measurements of a 24h sample might be more close to patients’ clinical status and prognosis, despite more frequent sampling errors. PET protein loss quantification should be regarded as a marker of peritoneal large-pore dysfunction.
P1205ESTABLISHMENT OF HYPOCHLORITE-INDUCED PORCINE MODEL OF PERITONEAL FIBROSIS
Authors: Chao Chun-Yuan , Wu Chin-Ho , Chen Yi-Ting , LIN SHUEI-LIONG , Tsai Pei-Shiue
Published: June 2020

Background and Aims

Patients with kidney failure rely on life-saving peritoneal dialysis to facilitate waste exchange and maintain homeostasis of physical conditions. However, peritoneal dialysis often results in peritoneal fibrosis and organ adhesion that subsequently compromise the efficiency of peritoneal dialysis and normal functions of visceral organs. Despite rodent models provide clues on the pathogenesis of peritoneal fibrosis, no current large animal model which shares high degree of physiological and anatomical similarities to human is available, limiting their applications on the evaluation of pre-clinical therapeutic efficacy.

Method

In this study, we established for the first time, porcine model of peritoneal fibrosis by the use of a bleach-like chemical, sodium hypochlorite. We demonstrated that intraperitoneal injection of 30ml/kg B.W., 0.1%-0.2% (0.1mM-0.2mM) hypochlorite induced peritoneal fibrosis and visceral organ adhesions in 5-week-old piglets.

Results

A dose- and time-dependent severity of peritoneal fibrosis characterized by mesothelium fragmentation, αSMA+ myofibroblasts accumulation, organ surface thickening and type I collagen deposition were observed. We also demonstrated that hypochlorite-induced overexpression of IL1β, CX3CL1 and TGFβ on the peritoneal mesothelium mimicked the mechanism of peritoneal dialysis-induced peritoneal fibrosis in human patients.

Conclusion

This pig model could not only be used as a platform for studying fibrosis/scar formation, but can also be used to evaluate the efficacy of potential candidates on the prevention (e.g. compounds) and treatments (e.g. stem cells) for regenerative medicine.
P1206ARTERIAL STIFFNESS AND PERIODONTITIS IN PERITONEAL DIALYSIS PATIENTS: ARE THEY RELATED?
Authors: Orešković Josip , Kovačević Katja , Vučković Marijana , Raos Hrvoje , Roguljić Marija , Gelemanović Andrea , Radic Josipa
Published: June 2020

Background and Aims

Arterial stiffness is an important risk factor for cardiovascular disease (CVD) in patients with end-stage renal disease (ESRD). However, little is known about risk factors that contribute to arterial rigidity in peritoneal dialysis (PD) patients. The periodontal diseases are highly prevalent among patients with ESRD. The aim of this study was to evaluate the dental status, incidence and severity of periodontitis among Dalmatian PD patients and to investigate possible correlations with arterial stiffness.

Method

24 PD patients, 12 (50 %) men and 12 (50 %) women, aged 54.9 (range 21–79) years were included. Arterial stiffening was estimated by using pulse wave velocity (PWV). To measure PWV Agedio B900 device was used. Oral periodontal status included full mouth plaque score, full mouth bleeding score, periodontal probing depth and clinical attachment loss (CAL), all measured at six sites of each tooth. Also periodontitis stage was determined for each patient.

Results

Out of 24 PD patients 17 (70.1 %) was suffering from periodontitis. Among those with periodontitis 1 patient (5.9 %) was classified as periodontitis stage I (mild), 6 (35.3 %) as stage II (moderate), 10 (58.8%) as stage III and IV (severe). Significantly positive correlation between PWV, average interdental CAL and average total CAL, among all PD patients were found (R= 0.764, P=0.001), (R= 0.738, P=0.001), respectively, Also, in those PD patients statistically negative correlations between PWV and number of teeth were found (R= -0.565, P=0.012). Among those PD patients with periodontitis statistically positive correlation between PWV, periodontitis stage, interdental CAL, average total CAL and dental plaque were found (R= 0.73, P=0.002),(R= 0.731, P=0.00¸5), (R= 0.72, P=0.005), (R= 0.558, P=0.047), respectively.

Conclusion

The incidence of peritonitis is high in Dalmatian PD patients and more than half of PD patients had severe stage of periodontitis. Despite small sample size, we showed that those PD patients with more severe periodontitis stage had significantly higher arterial stiffness. Routine dental examination should be suggested for all PD patients. A prospective cohort study needs to link the association of severe periodontitis and CVD and confirm desirable survival outcome on successful treatment of periodontal diseases.
P1207ANALYSIS OF OUTCOME AND FACTORS ASSOCIATED WITH MAINTENANCE OF PERITONEAL DIALYSIS
Authors: Rroji (Molla) Merita , Seferi Saimir , Shehaj Larisa , Barbullushi Myftar
Published: June 2020

Background and Aims

Peritoneal dialysis (PD) is generally associated with a good survival rate and with great preservation of residual renal function (RRF). The various causes of technique failure are responsible for the relative short time staying in PD.

Objectives: This study aimed to analyze the outcome and factors correlated with maintenance peritoneal dialysis (PD) to guide for improving prognosis.

Method

In a retrospective way we examined our PD-cohort concerning mortality, technique survival, peritonitis rate, and other complications.

Results

From 2005 to 2019 the number of PD patients who have been treated in PD program for more than 3 months was around 199 patient, 29.1% diabetics, mean age 53.3±15.03 years old and meantime in therapy 32.39± 27.34 months. The PD was seen as an alternative for younger patients in the transplant list and elderly patients with comorbidity. Around 7.5% of the PD patients were transplanted and 8.5 % of patients were transferred from HD due to vascular access failure. Around 88.9% of patients were on PD for more than 1 year, 37.7% from 3 up to 5 years and 19.8% percent of the patients have stayed on PD for more than 5 years.

Cardiovascular mortality was the main cause of mortality with 53% of the cases. Higher comorbidity index, lower albumin levels, and lower residual renal function were the main risk factors for lower survival. The technical survival of patients was 92.3% during the first year, 79.5% and 69.6% in the second and the fifth year, respectively. There was not found a difference in technical survival between diabetics and nondiabetics patients. Ultrafiltration failure followed by peritonitis was the main reason for transfer patients with more than 24 months in therapy in hemodialysis probably linked with the no availability of icodextrin. Peritonitis rate was 1:41 patient months.

Conclusion

PD program in our center is organized based in the concept of integrated care in RRT. The outcome of our patients was at least comparable to those reported by larger registries Although we have done good progress in the prevention of infection the nonavailability of icodextrin is an important factor for a technical failure. RRF is an important factor and we need to be more focused to maintain it longer in the future.
P1210EFFECT OF ICODEXTRIN OR GLUCOSE PERITONEAL DIALYSIS (PD) SOLUTIONS ON TRIGLYCERIDE AND OLEIC ACID LEVELS IN PD PATIENTS (EXIT TRIAL)
Authors: Lee Sumi , Jeong Yu In , Choi DongHo , Lee Chungsik , Son Young Ki , Kim Seong Eun , An Won Suk
Published: June 2020

Background and Aims

Dyslipidemia is a major cause of cardiovascular disease (CVD) and CVD incidence is definitely increased according to peritoneal dialysis (PD) vintage. The PD solutions contained glucose may affect on dyslipidemia including hypertriglyceridemia. The oleic acid (OA) content in the erythrocyte membrane was increased in patients with acute coronary syndrome and is significantly higher in PD patients than hemodialysis patients. We conducted this trial for comparing effect of icodextrin or glucose PD solutions on triglyceride and oleic acid levels in PD patients.

Method

This EXIT trial is an open label, randomized, cross-over multi-center trial. Twenty-two patients were enrolled and 15 patients finished this trial. Glucose group was initially exposed to glucose PD solutions for 6 months and then exposed to icodextrin PD solution for 3 months. Extraneal group was initially exposed to icodextrin PD solution for 3 months and then exposed to glucose PD solutions for 6 months.

Results

The enrolled patients were aged 63.6 ± 9.5 years old and mean PD duration was 10.8 ± 5.9 months. There were no significant differences of baseline clinical and laboratory data between glucose group and extraneal group. There was no significant decrease of triglyceride levels, erythrocyte membrane OA and monounsaturated fatty acid (MUFA) contents after 3 months exposure of icodextrin PD solution compared to baseline. However, there was a tendency of triglyceride levels decrease (p=0.093) after 3 months exposure with icodextrin PD solution and there was a tendency of triglyceride levels increase (p=0.078) after 3 months exposure with glucose PD solutions compared to baseline levels. Continuous 6 months exposure with glucose PD solution significantly increased triglyceride levels (p=0.041), LDL cholesterol levels, erythrocyte membrane OA (p=0.009) and MUFA compared to baseline levels.

Conclusion

Continuous exposure of glucose PD solutions may negatively affect on triglyceride and erythrocyte membrane OA contents. Combined use of icodextrin and glucose PD solutions may prevent lipid derangement (ClinicalTrial.gov number, NCT NCT02166359).
P1213ROLE OF PERITONEAL PHOSPHORUS TRANSPORT IN PERITONEAL DIALYISIS REGIMEN FOR THE MANAGEMENT OF HYPERPHOSPHATEMIA
Authors: Xipell Marc , Guillen Olmos Elena , Rodas Lida , Broseta Jose J , Mayordomo Angeles , Bonache Debora , Maduell Francisco , Vera Manel
Published: June 2020

Background and Aims

The ratio D/P-Creatinine (DP-Cr) obtained by the peritoneal equilibrium test (PET) is the most widely used parameter to characterize the type of peritoneal membrane transport, and it is used to determine the dialysis regimen for ultrafiltration (UF). It has been suggested that net UF influences the final clearance of solutes, so guiding ultrafiltration by D/P-Phosphorus (DP-P) instead of DP-Cr could have some added value in the management of hyperphosphatemia. The objective of this study is to define if there is a correlation between DP-P and DP-Cr, and if these are related to the clearance of phosphorus (P) and creatinine (Cr).

Method

retrospective analysis of PETs performed during 2016 and 2017 in our center. DP-Cr and DP-P were calculated, and in patients with 24h effluent sample the day of the PET, it was also analyzed weekly Kt/V-urea, and peritoneal Cr and P clearance (CrCl and PCl, respectively). Statistical analysis was done using t-Student test for independent data and Pearson correlation coefficient, with SPSS Statistical Package program v.23, establishing a significance level of p<0.05.

Results

68 PETs were analyzed in 54 patients, mean age 60.4 years (SD 17), predominantly men (69% vs 31%). The mean plasma P, DP-Cr and DP-P were respectively 4.5 mg/dL (SD 1.2), 0.74 (SD 0.12) and 0.71 (SD 0.17). The correlation coefficient DP-P/DP-Cr showed a significant relationship (r=0.84, p<0.001), which was maintained when analyzing patients according to phosphorus levels: DP-P/DP-Cr with P<5 mg/dL (r=0.81); and P≥5 mg/dL (r=0.93) (p<0.001).Patients in DP-P ≥50th percentile had P levels of 4.2 (± 1.05), and those in<50th percentile had levels of 4.88 (± 1.38) (p <0.031). Moreover, in patients with 24h effluent analyzed the day of the PET (n=35), the average PCl and CrCl was 4.1 and 2.85 ml/min, with statistical significant correlation (r=0.92, p<0.001).However, in these patients no relationship was found between DP-Cr and CrCl (r=0.068, p=0.7), nor between DP-P and PCl (r=0.052, p=0.7).

Conclusion

The DP-P/DP-Cr high correlation suggests that both parameters could be useful to classify the type of peritoneal transport. However, although patients with higher DP-P had better control of hyperphosphatemia, thus suggesting a direct positive relationship between DP-P and PCl, our data showed no correlation between them.
P1215INVERSE ASSOCIATION BETWEEN DIALYSATE OXALATE REMOVAL AND INTRAPERITONEAL INFLAMMATION IN PERITONEAL DIALYSIS PATIENTS
Authors: Stepanova Natalia , Driianska Victoria , Snisar Lyudmyla , Lebid Larysa
Published: June 2020

Background and Aims

Due to inadequate oxalate removal, hyperoxalemia is a well-established feature in end-stage renal disease (ESRD) patients. Considering the fact that oxalate is primarily removed by kidneys in healthy individuals, we hypothesized that oxalate elimination in peritoneal dialysis (PD) patients could be compensated by PD effluent (PDE). In addition, its dialysate concentration could be associated with intraperitoneal inflammation.

In the present study, we investigated oxalate excretion in PDE and its association with intraperitoneal inflammation in PD patients.

Method

We performed a cross-sectional single-center observational study involving 30 PD patients (17 women and 13 men). The average age was 48.3 ± 9.2 years. Among them, there were 11 (37%) diabetics and 19 (63%) non-diabetic patients. The mean time on PD was 32 [18.5-47] months.

Parameters of dialysis adequacy, cytokines concentration and oxalate removal levels with PDE were determined. The spectrophotometric method was performed for determining oxalate concentration in PDE using oxalate oxidase/peroxidase reagent (BioSystems, Spain). The ELISA method was used for the determination of interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1) measurements in dialysate.

For the statistical analysis, we used Kruskal-Wallis’s t-test and Spearman's rank correlation test. The median (Me) and interquartile ranges [Q25 - Q75] were calculated according to abnormal distribution. All statistical analyses were performed using MedCalc.

Results

No differences in peritoneal oxalate, IL-6, and MCP-1 excretion between diabetics and non-diabetic patients were observed (Table 1).

However, the higher dialysate oxalate concentration was, the lower residual renal function was observed (r = - 0.69; p < 0.0001). Surprisingly, increased dialysate oxalate level was associated with low IL-6 (r = - 0.54; p = 0.002) (Fig. 1) and MCP-1 (r = - 0.7; p < 0.0001) (Fig. 2) concentrations in PDE.

Conclusion

To the best of our knowledge, the association between PDE oxalate excretion and proinflammatory mediators’ concentrations in PD patients has never been reported before. We suppose that peritoneal oxalate excretion might be involved in the intraperitoneal inflammation process. Further studies are needed to determine the possible pathogenetic role of dialysate oxalate removal in the conditions of intraperitoneal inflammation in PD patients.
P1223PATIENT REMOTE MONITORING IN AUTOMATED PERITONEAL DIALYSIS: 2017-2019 CLINICAL EXPERIENCE IN A SINGLE CENTER
Authors: Amici Gianpaolo , Lo Cicero Antonina , Zuccolo Mery , Ferraro Mortellaro Rosella , Romanini Dino , Irlando Antonio , Celik Loijze , Velardita Alfonso
Published: June 2020

Background and Aims

We conducted an observational study in a group of patients in automated peritoneal dialysis (APD) to evaluate the impact of the introduction and the long-term use of a telemedicine system for remote patient monitoring (RPM, Claria Sharesource Baxter).

Method

From April 1 2017 to December 31 2019 (33 months) we followed 42 APD patients with RPM, sex F 20 M 22, age 70±14 years, on PD treatment for median 10 (IQR 3-23) months, distance from the center 18±14 km in mountain and hill area. Have been studied 505 months of RPM overall, per patient median 9 (IQR 3-19) months, corresponding to 11685 APD sessions overall, per patient median 206 (IQR 52-457) sessions.

Results

Have been registered 1125 alarms (red flags) overall, per patient median 9 (IQR 1-45) alarms, rate 2.2 alarms patient-month (0.1 alarms per session). Analyzing the causes of the alarms: “dwell time lost” (>45 min) 1006 (89%), “drain anticipation” (>2 times) 22 (2%), “fill or dwell bypass” (>3 times) 15 (1%), “various causes” (>10 times) 86 (8%). “Various causes” alarm group sums mainly slow drain for set kinking and insufficient drain volume. We count 195 remote modifications of dialysis program overall, median per patient 3 (IQR 1-7), rate 0.02 patient month with a ratio 0.2 modifications per alarm. Looking to program modification, the alarm type specifically linked to modifications has been insufficient drain volume of the “various causes” group (36 events, 18% of all modifications). We found a positive correlation between the number of treatments and alarms (r=0.534, p<0.001). In the observation period the overall hospitalization days were 403, rate 0.8 days patient month, ratio 0.02 hospitalization days per APD RPM session and ratio 0.4 hospitalization days per alarm.

Conclusion

The study shows that APD with RPM improves patients’ follow-up changing the organization of the center. In the long term the telemedicine system shows the advantages of a careful and daily monitoring. The rates of alarm, change of prescription and hospitalization resulted very low in our experience.
P1228IMPROVEMENT OF BODY WEIGHT MANAGEMENT, BETA2-MICROGLOBULIN LEVEL AND RESISTANCE TO ERYTHROPOIESIS-STIMULATING AGENTS BY HYBRID PERITONEAL DIALYSIS PLUS HEMODIALYSIS THERAPY
Authors: Fukasawa Kanako , Fukasawa Mizuya
Published: June 2020

Background and Aims

Peritoneal dialysis (PD) has the advantages of not causing rapid changes in the body fluid levels or solute contents in the blood due to the continuous treatment on all days of the week, and of not needing the patients to visit the hospital 3 times a week or lie on a bed for 4 hours to receive treatment. PD alone can, however, not adequately remove all the uremic toxins and excess water, and the patients are likely to be resistant to erythropoiesis-stimulating agents (ESA). These drawbacks could be potentially improved if PD and hemodialysis (HD) were used together. The aims of the present study were to clarify the changes in the body weight, serum β2-microglobulin (β2MG) level, and resistance to ESA in PD patients switched from PD alone to PD-HD hybrid therapy (hybrid therapy).

Methods

The data of seven patients who were switched from PD alone to PD-HD hybrid therapy at our hospital were retrospectively analyzed to determine the changes in the body weight, serum β2MG level, dose of ESA (Darbepoetin Alfa) and the hemoglobin level before and at 3 months after the switch to hybrid therapy; in hybrid therapy, the patient received HD once a week and did not receive PD on that day. We also carried out a questionnaire survey to determine the changes in the feeling of well-being and quality of life of the patients after the switch to hybrid therapy.

Results and Discussion

The body weight decreased significantly from 67.4 ± 11.8 kg to 63.7 ± 8.7kg (p = 0.0345) after the switch from PD alone to PD-HD hybrid therapy, indicating that the control of the body fluids was much easier with hybrid therapy than with PD alone. The mean serum β2MG level in the patients decreased from 37.3 ± 11.6 μg/mL to 32.6 ± 5.9 μg/mL (p = 0.1607, not significant), ; in particular, in those patients in whom the serum β2MG levels were over 30 μg/mL, the level decreased significantly from 42.5 ± 8.7 μg / mL to 34.4 ± 6.1 μg / mL (p = 0.0337). The dose of ESA decreased significantly in all patients from 193 ± 74 μg/month to 69 ± 38 μg/month (p = 0.006), while the hemoglobin level remained unchanged (from 10.2 ± 1.7 g/dL to 11.2 ± 1.2 g/dL, p = 0.1406). In the questionnaire survey, almost all the patients expressed positive feelings about the switch of the treatment modality, such as “it became easier to go up the stairs,” “improved working efficiency,” and “comfortable feeling.” Since the peritoneum was allowed to rest once in a week, on the day of the HD, it could also preserve peritoneal functions. Therefore, hybrid therapy was also considered to be effective from the viewpoint of performing PD over the long term.

Conclusion

We can expect easier management of the body fluid, efficient β2MG removal, and improvement of ESA resistance by switching the dialysis treatment modality from PD alone to HD-PD hybrid therapy.