bluuebunny/crossref_metadata_2025 huggingface dataset:
P1057UNTARGETED 1H NMR-BASED SERUM METABOLIC PROFILE ANALYSIS OF PATIENTS TREATED WITH HIGH VOLUME HEMODIAFILTRATION (HDF)
Authors: Flores Andressa , Manfron Schiefer Elberth , Sassaki Guilherme , Menezes Leociley , Fonseca Renato , Cunha Regiane , Canziani Maria Eugenia , Guedes Murilo , Moreno-Amaral Andrea N , Souza Wesley , Silva Pecoits Filho Roberto Flavio , Stinghen Andréa E M
Published: June 2020

Background and Aims

Uremic toxins (UTs) accumulate in the circulation of patients with chronic kidney disease (CKD), contributing to poor outcomes. One of the main objectives of renal replacement therapies is the removal of UTs, and while HD is restricted to the clearance of low molecular weight UTs, hemodiafiltration (HDF) adds efficiency to the removal of medium molecular weight UTs through the association of diffusion and convection methods. Metabolomic analysis from nuclear magnetic resonance (NMR) spectra offers efficient data about metabolites profile, indicating the main features of HDF, and possibly highlighting the positive effects of this modality. Thus, the aim of the present study is to evaluate the profile of metabolites in the circulation of a cohort of patients undergoing HDF.

Method

From 97 individuals participating in the HDF arm of a randomized control trial (ClinicalTrials.gov Identifier: NCT02787161), we randomly (using Python language; NumPy library) selected 6 patients (mean age 49, 6 males, 44% diabetics, average duration of 245 minutes, blood flow of 400 mL/min, target convective volume of 22 L per treatment). Patient’s serum samples were collected in the beginning of the study (baseline) and 6 months. The samples were prepared with deuterium oxide, sodium trimethylsilylpropanesulfonate as internal standard (ð=0.0 ppm), and further submitted to 1H NMR spectra recorded with Bruker 600 MHz AVANCE III spectrometer in order to identify the patient’s metabolomic profile. Data was evaluated with t-test and results were then compared with the Human Metabolome Database (HMDB) for descending order of the Jaccard similarity score.

Results

A total of 50 metabolites were investigated. Interestingly, 2 metabolites were significantly (P<0.05) reduced in the serum after 6 months compared to baseline, acetate (3.3 ± 0.1) % and dimethylglyoxal (7.6 ± 0.1) % (Figure 1). In order to confirm the presence of these metabolites in human serum, further studies will be conducted with 2D 1H-13C-HSQCed NMR.

Conclusion

We observed a reduction of acetate and dimethylglyoxal levels after six months of HDF treatment, in comparison to baseline, most likely as a consequence of the increase in clearance of these molecules. Hypothetically these changes in solute removal could explain the positive effects of HDF on clinical outcomes, and further studies should address this potential benefit of the modality.
P1067CONDUCTIVITY BASED ONLINE MONITORING OF PREDIALYTIC HYPONATREAMIA AS DIAGNOSTIC TOOL IN HEMODIALYIS
Authors: Harlos Joachim , Maierhofer Andreas , Canaud Bernard
Published: June 2020

Background and Aims

Hyponatremia in dialysis patients is a strong indicator of poor outcome in dialysis patients that requires early detection to facilitate clinical workup and management. However, plasma sodium concentration as determined by lab methods (Na-Lab) is measured at the best monthly in clinical practice.

Recently, online monitoring of predialytic plasma Na (pPlNa) as estimated from dialysate conductivity using an electrolyte model has become available at every hemodialysis session, thus providing an unprecedented close and almost continuous monitoring of this crucial indicator. This could be used as diagnostic tool to identify changes in patient status and alert earlier the physician.

Method

In a monocentric retrospective clinical study in 114 patients on maintenance hemodialysis (>90% online postdilution HDF) for whom online pPlNa was available for a period of at least 12 months at least once a week, kinetics of pPlNa were analyzed. For 10 patients with hyponatremic episodes as manifested in pPlNa, the agreement between time course of pPlNa and Na-Lab and the correlation to the manifestation of clinical findings was explored.

Results

Time course of pPlNa and Na-Lab showed very good agreement. Hyponatremia onset was clinically related to diagnoses such as fluid overload and congestive heart failure, diarrhea secondary to inflammatory bowel disease, sepsis, liver cirrhosis, cancer and use of loop diuretics.

Conclusion

The clinical examples show that due to the good agreement of the time course of online monitoring of pPlNa and Na-Lab, pPlNa can be used as adjuvant diagnostic tool for the early detection of onset and progression of morbid events. Due to its routine availability variations in pPlNa could be used to timely trigger clinical workup and investigations.
P1077PERSISTENCE OF CIRCULATING RESIDUAL HEPARIN IN ESRD PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS
Authors: Bansal Vinod , Mazariegos Melissa , Grewal Arjun , Bajwa Jasdeep , Bontekoe Emily , Hoppensteadt Debra , Iqbal Omer , Fareed Jawed
Published: June 2020

Background and Aims

ESRD patients who receive routine maintenance hemodialysis are administered with unfractionated heparin to prevent thrombotic complications. The hemostatic dysregulation along with detectable levels of circulating heparin may cause them to be in a hypocoagulable state. The purpose of this study is to determine the circulating levels of heparin in ESRD patients and its characterization using heparinase digestion methods.

Method

Blood plasma samples collected at routine pre-dialysis sessions from 95 ESRD patients undergoing maintenance hemodialysis were analyzed for the presence of residual heparin utilizing standard laboratory methods such as aPTT, Anti-Xa and Anti-IIa activities On a centrifugal analyzer (ACL-Elite: Instrumentation Laboratory, Bedford, MA). The levels of heparin were calculated in terms of units per ml relative to the USP reference standard. Heparinase digestion was used to confirm the presence of heparin.

Results

Blood plasma samples collected at routine pre-dialysis sessions from 95 ESRD patients undergoing maintenance hemodialysis were analyzed for the presence of residual heparin utilizing standard laboratory methods such as aPTT, Anti-Xa and Anti-IIa activities On a centrifugal analyzer (ACL-Elite: Instrumentation Laboratory, Bedford, MA). The levels of heparin were calculated in terms of units per ml relative to the USP reference standard. Heparinase digestion was used to confirm the presence of heparin.

Conclusion

The presence of residual heparin was demonstrated by both clot- based and amidolytic assays in the plasma samples collected from ESRD patients prior to their next-dialysis session. Since these samples were obtained 3 days following the last dialysis session the presence of significant levels of heparin was surprising. Upon heparinase treatment of these samples, the aPTT and the anti-Xa and IIa tests were restored to near normal levels. Our studies confirm the presence of residual heparin in pre-dialysis plasma samples obtained from ESRD patients. The Anti-IIa activity was greater pre-heparinase and it was not decreased to the same extent as Anti-Xa after heparinase digestion. These results suggest that heparin found in ESRD patient’s plasma is of high molecular weight origin with delayed clearance.
P1080INCREASE OF POST DIALYSIS HEMOGLOBIN CONCENTRATION IS MORE APPROPRIATELY EXPLAINED BY PLASMA VOLUME CHANGE THAN INTRADIALYTIC WEIGH LOST
Authors: Babalj Banskolieva Elena , Grozdanovski Risto , Spaseska Gjurovska Katerina , Ilievski Marko , Filipovska Biljana , Gelev Sasho , Oncevski Angel
Published: June 2020

Background and Aims

It is well known that haemoglobin significantly increases after haemodialysis and it is associated with the rate of weight loss during dialysis. However, it has been shown that the increase in haemoglobin is not always proportional to the rate of body weight loss during haemodialysis (ultrafiltration). The purpose of the study was to investigate the correlation between haemoglobin changes, body weight loss and plasma volume changes during haemodialysis

Method

A prospective study was performed on 92 patients in mid-week treatments. Pre-dialysis and post-dialysis haemoglobin and weight were measured. 27 patients were excluded because clinical instability, no change or a decrease in Hb and low pre-dialysis haemoglobin (< 9 g/dL). The correlation was statistically significant between %ΔPV and ΔHb in both groups (R2=0.59), whereas the correlation between %ΔBW and ΔHb was lower (R2=0.19). So, analysis show that only 19% of the variability in haemoglobin is explained by %ΔBW, and that 59% of the variability in haemoglobin is explained by %ΔPV.

Results

The mean age was 61.16 ± 13.11 year. The men were 52 (56%). The mean pre-dialysis Hb was 11.31 ± 1.16 g/dL, the mean post-dialysis Hb level was 12.53 ± 1.47 g/dL. The mean absolute change of haemoglobin (ΔHb g/dL) and percent of change of haemoglobin (%ΔHb) were 1.22 ± 0.76 and 9.44 ± 5.31, respectively. Average percent of weight change (%ΔBW) was - 2.44 ± 1.01. Percent of plasma volume change was - 9.22 ± 5.46. The patients were divided in two groups according post-dialysis haemoglobin level: Group A with haemoglobin Hb < 13 g/dL (64 patients) and group B with Hb ≥13 g/dL (28 patients).

The mean time average haemoglobin concentration (TAC Hb) in all patients was 11.68 ± 1.11 g/dL.(Predicted Hb TAC was calculated according Krisper′s formula)

In both groups there was an increase in %ΔHb, but in the group with post dialysis Hb ≥ 13 g/dL, %ΔHb was greater than in group B with post dialysis Hb < 13 g/dL (13.08 ± 5.11 versus 7.87± 4.61, P = 0.000) despite the relatively small difference of %ΔBW between the two groups (- 2.85 ± 0.95 versus - 2.23 ± 1.02; P = 0.010). However, the difference in %ΔPV between the two groups was significant (- 12.90 ± 5.63 versus - 7.61 ± 4.57; P < 0.000).

Conclusion

The intradialytic changes in haemoglobin levels are predominantly determined by changes in plasma volume. Changes in body weight are of little predictive value in evaluation of variation of haemoglobin levels. TAC Hb determination should be performed in patients with large variations in plasma volume, because the plasma volume has very little effect on TAC Hb.
P1087HOME HEMODIALYSIS THROUGH THE YEARS
Authors: Todorov Sakic Verica , Djuric Zivka , Djuric Petar , Bulatovic Ana , Tosic Dragovic Jelena , Naumovic Radomir , Dimkovic Nada
Published: June 2020

Background and Aims

Outcome of dialysis patients differ considerably across the globe and many studies confirmed that home-based treatments offer some advantages, not only in regard of quality of life but also regarding of patients’ outcome. History of home hemodialysis (HOHD) in our country dates from 1971. and since that time many patients were treated with this dialysis modality. HOHD changed over the time together with general improving of dialysis techniques and we aimed to analyze the results of treatment of our population treated by HOHD during different time points.

Method

We analyzed patients characteristics, dialysis and uremia-related complications and survival of patients on HOHD during three different time points: 2001. (No=70), 2011. (No=29) and 2019. (No=22).

Results

The most frequent reason for ESRD in 2001, 2011 and 2019. was glomerulonephritis (48%, 45%, 36% respectively), followed by polycystic kidney disease 24% in 2011. and 36% in 2019. Diabetes mellitus (DM) was rarely cause of ESRD: in 2001. 2.1%; 4.5% in 2019. and none in 2011. In 2001. the patients were more frequently treated using high flux membranes (HF) as compared to HDF (87.1% vs.12.9%), and through years this changed in favor of HDF (48% vs. 52% in 2011, and 13.6% vs. 86.4% in 2019). Anti HCV prevalence was 27.4%, 38%, 27%, in 2001, 2011. and 2019. respectively. Anemia status was better controlled in recent years revealed by Hb level: 10.5±2.0 g/dl in 2001, 12.1±1.6 in 2011. and 11.9±2.3 in 2019. with almost similar percentage of patients treated with ESA (31%, 28% and 36% respectively). In 2001, parathyroid hormone level (iPTH) was 379±236 pmol/l and only 20% of patients underwent parathyroidectomy while in 2011. and in 2019. parathyroidectomy was performed in 69% and 59% of patients respectively. Therefore, in 2011. and in 2019. mean iPTH level was 33.8±48.5 and 40±46.2pmol/l respectively. Kaplan-Mayer analysis confirmed ten-year survival of 42% for period 1982-2001, and the most frequent reasons for death were infection and cardiovascular diseases. During the period 2011. to 2019., ten-year survival was 88% and cardiovascular diseases led to death in most of the cases.

Conclusion

our results have shown that HOHD treatment improved through the years considering patients’ survival, anemia status and secondary hyperparathyroidism treatment. Apart from HDF, the other factors have to be taken into consideration.
P1120QUANTIFICATION OF ACID-BASE TRANSPORT IN HEMODIALYZERS
Authors: Mauro Pietribiasi , Waniewski Jacek , Leypoldt John (Ken)
Published: June 2020

Background and Aims

Quantification of bicarbonate and dissolved carbon dioxide (CO2) transport in hemodialyzers can be described by the product of a dialysance (D) and their respective concentration differences between dialysate and plasma. It is typically assumed that D values are constant for a given hemodialyzer and flow conditions; however, this approach neglects the chemical interconversion of bicarbonate and dissolved CO2 within blood. We assessed the validity of this approach by developing a comprehensive mathematical model of acid-base transport in hemodialyzers.

Method

Mass balance relationships in a hemodialyzer were defined using a one-dimensional model with counter-current flows of blood and dialysate. The molecular biochemistry of bicarbonate, dissolved CO2, and non-bicarbonate buffer in both plasma and erythrocytes, together with carbaminohemoglobins within erythrocytes, was assumed to be in equilibrium as described by Rees and Andreassen (Crit Rev Biomed Eng 2005). The model equations were solved numerically, and optimal mass transfer-area coefficients for bicarbonate and dissolved CO2 were determined by comparing model predictions with the data from Sombolos et al (Artif Organs 2005). The latter data included measured concentrations of bicarbonate and dissolved CO2 in plasma and dialysate inlet and outlet flows at a blood flow rate of 300 mL/min, dialysate flow rate of 700 mL/min, and dialysate bicarbonate concentration of 32.5 mEq/L. Base excess of blood was assumed as -5 mEq/L. Model simulations then evaluated the effect of the plasma bicarbonate concentration at the blood inlet (assuming constant mass transfer-area coefficients and flow rates) on D for both bicarbonate (Dbic) and dissolved CO2 (DCO2). D values were calculated as the loss of the molecule from the dialysate divided by the difference in inlet concentrations of dialysate and plasma.

Results

Optimal mass transfer-area coefficients for bicarbonate and dissolved CO2 were 396 and 1360 mL/min, respectively. Simulation results at different plasma bicarbonate concentrations at the blood inlet ([Bicarbonate]) as expected during a typical hemodialysis treatment are tabulated:

Conclusion

Quantification of acid-base transport in hemodialyzers requires dialysance values for bicarbonate and dissolved CO2 that are not constant but instead are dependent on the plasma bicarbonate concentration at the blood inlet for a given hemodialyzer at fixed blood and dialysate flow rates.
P1122VIRAL INFECTIONS :VHC, VHB AND VIH IN HEMODIALYSIS
Authors: MADIOU Ali
Published: June 2020

Background and Aims

Viral infections, especially those caused by hepatitis B and C viruses are common in chronic hemodialysis patients. The hepatitis C virus is the main cause of post-transfusion hepatitis. The main objective of this study is to determine the prevalence of hepatitis B and C and HIV in chronic hemodialysis patients at the TIZI OUZOU University Hospital Center, as well as the main risk factors for contamination, in chronic hemodialysis patients treated at the from our center.

Method

This retrospective study carried out on 149 chronic hemodialysis patients consisted in searching for anti-HCV, anti-HIV antibodies and the HBs antigen and in determining the possible causes of contamination, in particular the age of the hemodialysis and history of blood transfusion. The characteristics studied for all patients are: demographic characteristics, initial nephropathy, seniority on hemodialysis, the concept of hemodialysis outside our center at the time of dialysis or for a limited period during follow-up ( vacation…), the notion of transfusion; patients are considered to be multi-transfused when they have received more than four transfusions, the search for hepatitis B and C virus infection by ELISA, the concept of hepatic cytolysis: a transaminase level that exceeds 1.5 times normal, vaccine status, HIV serology

Results

The average age of our 149 patients varies between 19 and 82 years with a male predominance (92 men and 57 women) and an average duration of dialysis of 90 months. The predominant etiology of IRCT is vascular nephropathy. We also note other causes including glomerular, diabetic and tubulointerstitial nephropathies. The etiology was largely undetermined. Hepatic serology C is positive in 5% of patients. None of our patients tested positive for HBS. No case of HIV infection has been noted.

The prevalence of hepatitis B and C in hemodialysis patients varies from country to country but remains higher than in the general population (HCV: 2.7-22.2% in the DOPPS register). In our series the prevalence is around 5% lower than that reported in other regional and international studies.

Conclusion

In hemodialysis, the risk of infection is very high, on the one hand due to access to regular blood and on the other hand due to the alteration of the immune defenses induced by chronic renal failure. Nosocomial transmission plays a very important role. It is strongly linked to the age of dialysis. Compliance with hygiene measures is a very essential element; isolation of the infected patient is no longer recommended
P1123HEMOPERFUSION COMBINED WITH CRRT IN SEPTIC SHOCK AKI PATIENTS CAUSED BY OSTEOFASCIAL COMPARTMENT SYNDROME
Authors: Sheng Xiaohua , Wang Niansong , Huang Weifeng , Yu Gang , Bao Hongda , Liu Yumei , Fei Yang
Published: June 2020

Background and Aims

Although Osteofascial compartment syndrome is rare, it can cause severe complications, including septic shock and acute kidney injury. Most commonly found on the palmar side of the forearm and lower leg. This article reported two cases of septic shock with acute kidney injury caused by osteofascial compartment syndrome, and explored the application of hemoperfusion combined with continuous renal replacement therapy in these two severe patients.

Method

Two young men, patient A was 38 years old and patient B was 44 years old. Hospitalized in June 2016 and February 2018, respectively. Previous healthy, after questioning, patient A had a history of type 1 diabetes and patient B had a history of gout. Patient A had a history of being beaten by his wife, patient B has no clear history of injury. Patient A showed swelling and pain in the right forearm and patient B showed swelling and pain in the right lower leg. After admission, they quickly developed shock, oliguria, acute kidney injury, multiple organ dysfunction. They were received fluid resuscitation, vasopressors, anti-infectives, respiratory support, nutritional support, and vital signs monitoring. Blood culture of patient A showed a case of group A hemolytic streptococcus, patient B showed streptococcus pyogenes and staphylococcus hemolytic. Patient A was performed CRRT for 3 days, combined with two hours hemoperfusion (HA-330, Jafron, Zhuhai City, China) on the first day of CRRT, once every 24 hours for two days. Patient B was performed CRRT for 16 days. combined with two hours hemoperfusion (HA-330, Jafron, Zhuhai City, China) on the first day of CRRT, once every 24 hours for two days. Both patients underwent multiple orthopaedic surgeries. Patient A underwent right upper limb amputation and patient B underwent right thigh amputation.

Results

After hemoperfusion, the amount of norepinephrine was significantly reduced, and the circulation became stable. Finally, two patients improved and were discharged from the hospital, and their renal function returned to normal.

Conclusion

Once the osteofascial compartment syndrome is diagnosed, the fascia should be decompressed immediately. After local incision and decompression, blood circulation is improved, and a large number of toxins from necrotic tissue enter the blood circulation, which can lead to serious complications such as sepsis, shock, acute kidney injury, and multiple organ failure. Renal replacement therapy and amputation surgery may save lives. Hemoperfusion can reduce the amount of norepinephrine, improve circulation and win surgical opportunities.
P1124A NOVEL ALGORITHM TO IDENTIFY PRESUMABLY FLUID OVERLOADED HEMODIALYSIS PATIENTS
Authors: Preciado Rojas Priscila , Zhang Hanjie , Kotanko Peter
Published: June 2020

Background and Aims

Adequate volume control is a major challenge in hemodialysis (HD) patients, as both fluid overload and depletion are associated with increased morbidity and mortality. In many cases, fluid overloaded patients may require further interventions, e.g. increasing ultrafiltration volume, treatment time or additional HD sessions to achieve their prescribed target weight. Relative blood volume (RBV) monitoring is widely used in HD patients, and past evidence suggests that flat RBV slopes indicate fluid overload [1,2]. The goal of this study was to develop an algorithm that would allow clinicians to identify presumably fluid overloaded HD patients based on a small number of consecutive RBV recordings.

Method

We based our analysis on the 842 prevalent HD patients enrolled in our previously published multicenter study [1], where RBV (Crit-Line®, Fresenius Medical Care, Waltham, MA) was assessed over a 6-month baseline period and all-cause mortality recorded during a median follow-up of 30.8 months; we found in this study that attainment of a RBV between 86 and 92% three hours into the HD session was associated with significantly better patient survival.

The goal of our current research was to develop an algorithm that would require an observation period much shorter than 6 months yet yield clinically meaningful sensitivity and specificity to identify (presumably fluid overloaded) patients with flat RBV profiles (“flat” being defined as RBV > 92% at 3 hours.) We categorized patients in study [1] as either “positive” (their mean RBV at 3 hours was >92%) or “negative”. We computed sensitivities and specificities relative to the “positive” and “negative” cases for 1 to 15 HD sessions and various rates of treatments with flat RBV curves (30, 40, 50 and 60%).

Results

Sensitivities, specificities, and Youden’s indices (= sensitivity + specificity – 1) for 1 to 15 treatments and across the different rates of “positive” RBV curves are shown (Figure 1). We found a sensitivity of 92%, a specificity of 80%, and a Youden’s index of 73% when >=50% of 10 preceding treatments were “positive”. Based on these results we propose an RBV based algorithm to identify “positive” cases (i.e. patients with a flat RBV profile) (Figure 2).

Conclusion

Our algorithm requires only a small number (10) of RBV readings to identify presumably fluid overloaded patients with a clinically acceptable sensitivity (92%) and specificity (80%). It would be of interest to compare the performance of this algorithm with volume status as determined by bioimpedance; however, bioimpedance has not yet been approved for use in HD patients in the U.S.
P1142DICHLOROACETATE AND L-CARNITINE REDUCED TGF-BETA-INDUCED MESOTHELIAL-TO-MESENCHYMAL TRANSITION
Authors: Masola Valentina , Arduini Arduino , Bonomini Mario , Gambaro Giovanni , Zaza Gianluigi
Published: June 2020

Background and Aims

Mesothelial to Mesenchymal Transition (MMT) plays a main role in the induction of peritoneal fibrosis in long term peritoneal dialysis. Mesothelial cells exposed to high glucose produce great amount of TGF-beta that plays a pivotal role in MMT. Recent findings suggest that TGF-beta controls mesothelial fibrosis via the activation of hyperglycolysis, thus we suppose that coupling glycolysis with Krebs cycle may improve mesothelial cells tolerance to TGF-beta.

Method

To test this hypothesis, we assessed the effects of Dichloroacetate (DCA), a pyruvate dehydrogenase kinase inhibitor, and L-carnitine (which sustains the production of Acetyl-CoA in multiple ways) on mesothelial cells treated with TGF-beta. Recent findings, in fact, highlight the potential anti-fibrotic effects of DCA and L-carnitine (through energy metabolic balancing) in different organs. Particularly, human peritoneal mesothelial cells (HMrSV5) were cultured in Dulbecco's Modified Eagle Medium (DMEM; Gibco) containing 10% fetal bovine serum. Then, cells, cultured to confluence, were pre-treated for one hour with or without 10mM DCA, 1 or 5 mM L-Carnitine and then with 10ng/ml TGF-beta for 4 hours. Gene expression of alpha-SMA and vimentin (markers of MMT) and IL1-beta and IL-6 (inflammatory markers) was evaluated by real-time PCR.

Results

Our results revealed that TGF-beta significantly increased the gene expression level of alpha-SMA (2.04±0.3, p<0.05 versus control) and vimentin (1.61±0.23, p<0.05 versus control) as well as the expression level of the pro-inflammatory cytokines IL1-beta (3.44±0.87, p<0.05 versus control) and IL-6 (2.56±0.51, p<0.05 versus control). Pre-treatment with DCA and L-carnitine (at 1 or 5 mM) significantly reduced these effects. In detail, pre-treatment with DCA reduced alpha-SMA expression (0.97±0.24, p<0.05), vimentin (1.03±0.1, p<0.05), IL1-beta (1.47±0.16, p<0.05) and IL-6 (0.88±0.28, p<0.05) respect to TGF-beta treated cells. Pre-treatment with 1 and 5 mM L-carnitine reduced respectively alpha-SMA expression at 0.96±0.09 (p<0.05) and 0.98±0.06 (p<0.05), vimentin 1.01±0.12 (p<0.05) and 1.02±0.1 (p<0.34), IL1-beta 1.02±0.15 (p<0.05) and 1.68±0.33 (p<0.05), and IL-6 0.72±0.04 (p<0.05) and 0.85±0.01 (p<0.05) respect to TGF-beta treated cells.

Conclusion

These preliminary results suggest, for the first time, that the use of both Dichloroacetate and L-carnitine, coupling glycolysis with Krebs cycle and oxidative phosphorylation, could restore physiological energy metabolism in mesothelial cells and control fibrosis.
P1143REDOX PROFILING IN MESOTHELIAL CELLS IN EXPERIMENTAL PERITONEAL DIALYSIS
Authors: Herzog Rebecca , Wagner Anja , Kratochwill Klaus
Published: June 2020

Background and Aims

PD-fluids lead to generation of reactive oxygen species (ROS) in the peritoneal cavity. The caused oxidative stress, defined as a cellular oxidant-antioxidant imbalance impairs not only peritoneal cell viability but also contributes to progression of local and systemic PD-related pathomechanisms. We aim to analyze the impact and specific targets of ROS during PD and the anti-oxidative mechanism of supplementation of PD-fluid with alanyl-glutamine (AlaGln) on a global proteome-wide level.

Method

To establish a redox-proteomics workflow for studying oxidative stress in peritoneal mesothelial cells we used a gold-standard model of redox-stress (H2O2) and PD-fluid induced stress. Levels of oxidative stress were first validated by increased intracellular ROS and superoxide dismutase activity with PD-fluid and H2O2 treatment and a reduction of these parameters by the addition of AlaGln. To detect alterations of the redox proteome, cysteine residues were either directly or indirectly labeled with fluorescent dyes (redox-2D-DiGE) or isobaric tags (iodo-TMT).

Results: The gel-based approach allowed global visualization of the reduced and oxidized cysteines and revealed redox profiles of 540 protein spots. Compared to control, we found an increase in oxidized and decrease in reduced cysteines in all PD treatments. The development of a highly sensitive LC/MS-based redox proteomics workflow allowed identification of ∼950 proteins affected by redox-stress in mesothelial cells and confirmed the quantitative levels seen on cysteine oxidation. The addition of AlaGln reduced the overall redox status (intracellular ROS and superoxide dismutase activity) but further showed different proteins to be affected by redox modifications. Conclusion: Redox proteomics of peritoneal cells could represent a novel approach for the identification of mediators of PD-induced pathomechanisms, but also to evaluate effects of novel anti-oxidant therapeutical or pharmacological interventions.
P1148THE ASSOCIATION WITH LOWER SYSTOLIC BLOOD PRESSURE AND ALL-CAUSE MORTALITY IN PATIENTS UNDERGOING PERITONEAL DIALYSIS
Authors: Kurahashi Motoyasu , Harada Kenji , Kanai Hidetoshi
Published: June 2020

Background and Aims

Previous observational studies have been reported that a U-shaped association between systolic blood pressure (SBP) and mortality in patients undergoing hemodialysis. However, the optimal blood pressure in patients undergoing peritoneal dialysis (PD) remains unclear.

Method

The present study is observational and conducted in a single center. Four hundred and sixteen patients undergoing PD managed in our hospital from April 2010 to December 2017 were participated in this study. The patients were divided into four groups depended on office SBPs, as follows; group1: SBP <110 mmHg (n=60), group2: SBP 110-139 mmHg (n=187), group3: SBP 140-159 mmHg (n=113) and group4: SBP ≧160 mmHg (n=56). When using the Cox proportional hazards model, group 2 was regarded as a reference. Hypertension was defined as SBP ≧140 mmHg, diastolic blood pressure ≧90 mmHg, or use of any anti-hypertensive drugs. The association between SBP with several outcomes such as the risk of all-cause deaths, cardiovascular events and these composite events were estimated using cox proportional hazards model. Adjusted factors were age, sex, comorbidities, laboratory covariates, left ventricle ejection fraction and medications such as renin-angiotensin system blockades and statins.

Results

The mean follow-up period was 29.2 months. The prevalence of hypertension was 90.4% (n=376) of all patients. The risk of all-cause deaths with multivariate cox proportional hazards regression analysis was significantly higher in the group 1 (hazard ratio 2.08, 95% CI 1.23-3.51, p=0.006). While the risk of CV events with univariate analysis tended to be higher in group 4, there was no significant association between SBP and the risk of CV events with multivariate analysis. The risk of the composite events with multivariate analysis was significantly higher in group 4 (hazard ratio 1.61, 95% CI 1.01-2.57, p=0.047).

Conclusion

This study indicated that lower SBP was independently associated with all-cause mortality in patients undergoing PD. Moreover, higher SBP might be involved with composite events.
P1155REMOVAL OF PHOSPHATE AND CREATININE DURING PD WITH DIFFERENT GLUCOSE CONCENTRATIONS
Authors: Stachowska-Pietka Joanna , Teixido-Planas Josep , Troya Maria-Isabel , Leypoldt John (Ken)
Published: June 2020

Background and Aims

Adequate removal of creatinine and phosphate is one of the key objectives in peritoneal dialysis (PD). Whereas the mechanism of creatinine removal is well known, there are gaps in understanding regulation of phosphate removal. Clinical studies show that although the size of both molecules is similar, their removal might behave differently (Badve et al CJASN 2008). Several, but not all, studies have suggested that peritoneal phosphate clearance is larger when using CAPD than APD prescriptions, suggesting the dwell time or duration is an important determinant of phosphate clearance. The aim of the study was to investigate specifically the effect of dwell duration at the level of single PD exchange with different glucose concentrations on peritoneal phosphate clearance.

Method

A prolonged 8-hour PET was carried out in 32 clinically stable PD patients with each of three glucose-based solutions: 1.36% (G1), 2.27% (G2), and 3.86% (G3) with temporary drainage at 1 and 4 hours of peritoneal dwell. Dialysate and blood samples were taken to measure infused and drained volume and concentration of phosphate and creatinine in dialysate and blood. Clearances were calculated for a single exchange for each solution and for 4-hour (4H) and 8-hour (8H) dwell periods. For each patient, the 4-hour creatinine D/P ratio for G3 was calculated. The clearance ratio, ClR, defined as the ratio of solute clearance for particular solution to its clearance for the G1 solution, was calculated for both solutes and each solution and dwell durations.

Results

The obtained values of 4H creatinine D/P ratio for G3 solution were 0.67±0.11 (mean±SD). The values of solute clearances per single exchange expressed in mL/min, are presented in table below.

Creatinine and phosphate clearances were found to be solution and dwell duration dependent with p<0.001. The clearances of both solutes were correlated for the same dwell duration or solution (not for creatinine G2 for 4H vs 8H) with p<0.05. Moreover, solute clearances were also correlated with creatinine D/P for 4H but not for 8H. The clearances of phosphate were also correlated with that for creatinine each solution at both dwell durations with p<0.001. Both calculated ClR were found to be dependent on the solution (p<0.001) but not dwell duration. Similar dependence on solution and correlations are valid in one analyze solute mass removal.

Conclusion

Phosphate and creatinine clearances were found to be well correlated during a long, 8-hour PET proving similarities in their transport. Interestingly, the dependence of both clearances and ClR on solution glucose concentration suggest that the removal of phosphate as well as creatinine depends on the ultrafiltration induced by glucose concentration in dialysis solution.
P1157IMPACT OF MODE OF DIALYSIS ON COMPLICATIONS AFTER SIMULTANEOUS PANCREAS- KIDNEY TRANSPLANTATION
Authors: Martinez Adoración , Lanuza Manuel , Manzano Diana , Lopez Francisca , Carceles Eulalia , Valda de Miguel M Teresa , Navarro Julian , Domingo Julio , Cabezuelo Juan Bernardo
Published: June 2020

Background and Aims

Simultaneous pancreas-Kidney transplantation (SPKT) has established its position in treating patients with type 1diabetes and end-stage renal disease. Infections in the early post-transplantation period are one of the most significant causes of the high morbidity and mortality rates associated with SPKT. Pre-transplant dialysis modality may affect evolution and it has suspected that peritoneal dialysis (PD) is associated whit more surgical complications, especially intra-abdominal infections.

The aim: evaluate whether pretransplant dialysis modality affects the risk for postoperative complications in SPKT transplant recipients

Method

retrospective and descriptive study of a series of patients who underwent SPKT from 2000 to 2018 in our hospital. We studied complication occurring during the first 3 months after transplantation

Results

From 2000 to 2019 we performed 38 SPKT in 22 men and 16 women. The mean age of the patients was 35.3(28-44) years. Of the 38 SPKT patients, 44.7% on hemodialysis before transplantation, 26.3% were on peritoneal dialysis and 28.9% had not received any substitutive renal therapy. Were similar regarding baseline characteristics.

The complications of the post-transplant period are shown in graph 1. The most frequent complications were infectious in almost 2/3 of the patients and within them the intra-abdominal infections affected almost half, 18, of the patients. Were 3 thrombosis of the pancreas that caused the loss of the graft but none of the kidney.

All early postoperative complications are compared in table 1.Whit no significant difference between groups of intraabdominal infection (p. 0.5) and graft thrombosis (p 0.7). There were also no differences in relaparotomy, acute rejection and delayed graft function

During the follow-up 4 patients died, one case due to a heart attack while the other 3 in relation to intraabdominal infectious processes and need for reintervention

Conclusion: Despite improvements in the outcomes of STKP infectious complications remain a significant cause of morbidity and mortality Peritoneal dialysis is not a risk factor postoperative complication after STPK
P1161CUTANEOUS MICROCIRCULATORY DYSFUNCTION IN PERITONEAL DIALYSIS PATIENTS
Authors: Williams Jennifer , Gilchrist Mark , Fraser Donald , Strain David , Shore Angela
Published: June 2020

Background and Aims

Microvascular impairment is an early step in cardiovascular disease (CVD), the major cause of morbidity and mortality in patients with CKD. Changes in skin microvascular reactivity have been shown to reflect more widespread changes in the systemic and coronary microcirculation. Microvascular function is attenuated by advancing age and conditions that commonly coexist with CKD such as diabetes and hypertension. We investigated whether skin microvascular reactivity is impaired in peritoneal dialysis (PD) patients compared with healthy controls and whether this impairment is independent of comorbidity.

Method

Forearm skin vasculature was examined in 27 healthy controls, 27 patients on PD and 27 controls matched to the PD patients for age, gender, diabetes and previous CV events. Microvascular function was assessed using laser Doppler flowmetry in combination with post-occlusive reactive hyperaemia (a test of generalised microvascular function) and iontophoretic application of acetylcholine (ACh) and sodium nitroprusside (SNP) to investigate endothelium dependant and non-endothelium dependant vasodilation respectively.

Results

Peak post-occlusive flow was lower in the PD patients than in both the healthy controls and the co-morbidity matched group; 90.45 AU (60.9-128.35) in healthy controls, 73AU (58.8-134.4) in matched controls and 56.95AU (45.1-89.8) in PD patients (p=0.0239 healthy controls versus patients, p=0.0373 matched controls versus patients). SNP-mediated vasodilatation was statistically lower in the PD group compared with healthy controls (p= 0.016), ACh response was lower but did not reach statistical significance (p= 0.076). ACh and SNP-mediated vasodilatation trended towards being lower in PD patients than matched controls but did not reach statistical significance.

Conclusion

The PD patients were characterised by a generalised dysfunction of the skin microcirculation compared with healthy controls and controls matched for factors known to affect the microcirculation. This appears to be the result of impaired endothelium dependant and independent vasodilatory mechanisms.
P1172IS PERITONEAL PROTEIN LOSS A CONSEQUENCE OF OVERHIDRATATION?
Authors: Malho Guedes Anabela , Domingos Ana , Calças Roberto , Silva Ana , Bernardo Idalécio , Neves Pedro , Rodrigues Anabela
Published: June 2020

Background and Aims

Peritoneal protein loss (PPL) in peritoneal effluent is a well-recognised detrimental result of peritoneal dialysis treatment since its inception. Hydrostatic convection is a major drive for peritoneal protein transport; therefore venous congestion may have a role in peritoneal protein loss (Krediet RT et al Perit Dial Int. 2019 ). The aim of this study was to explore the importance of overhydration on the magnitude of peritoneal protein clearance in incident PD patients.

Method

A total of 97 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 and linear multivariable regression was done.

Results

Statistically significant univariable relationships for 24h PPL were found for continuous ambulatory PD technique (CAPD) and, with a correlation coefficient >0.20, for age, pulse pressure, 4-hour dialysate/plasma creatinine and extracellular water/total body water. On multivariable analysis, type of PD technique (β=0.327, p=0.011), 4-hour dialysate/plasma creatinine (β=0.247, p=0.037), and extracellular water/total body water (β=0.304, p=0.016) were significant independent predictors of peritoneal protein loss.

Conclusion

Overhydration revealed the most important connection with peritoneal protein loss. Mortality has been associated with PPL in some studies, but not others. This could be a result of this relationship, as volume overload has been strongly related with lower survival.
P1175INTESTINAL MICROBIOME, METABOLOME AND BACTERIALLY-DERIVED UREMIC TOXINS IN PD-PATIENTS - DISPARITIES IN CHRONIC KIDNEY DISEASE AND ACUTE KIDNEY INJURY
Authors: Daniel-Fischer Lisa , Herzog Rebecca , Aufricht Christoph , Kratochwill Klaus
Published: June 2020

Background and Aims

Recent evidence suggests a bidirectional relationship between the intestinal microbiome and CKD. CKD and concomitant uremia lead to loss of integrity of the intestinal barrier, causing increased intestinal permeability and potentially contributing to systemic inflammation. Uremia itself has been speculated to cause a selection of certain microorganisms, known as dysbiosis. The alteration of the intestinal microbiome may favor the formation of specific uremic toxins. We hypothesized that the composition of the microbiome is altered between patients with CKD and AKI. The aim was to investigate the effect of CKD (with already established uremic dysbiosis) and AKI (without established uremic dysbiosis) and the exposure to PD-fluids on the intestinal microbiome and on a local (peritoneal) and systemic metabolome level of patients treated with PD.

Method

Patients on PD therapy with CKD and AKI were included. Stool samples were analyzed by 16S rRNA sequencing, 188 systemic (serum) and local (PD-effluent) metabolites as well as 10 uremic toxins (including p-cresyl sulfate and indoxyl sulfate) were analyzed using a mass spectrometric approach. Clinical standard parameters in serum and PD-effluent were measured by routine laboratory techniques.

Results

Changes in relative abundances of intestinal bacteria and differences in gut microbiome composition at the phylum level were associated with chronic disease. Patients with CKD and AKI had significantly increased levels of uremic toxins and revealed a distinct metabolomic pattern. Cross-omics correlation between bacterial phyla and metabolites was performed to obtain functional information on differentially abundant species and molecules.

Conclusion

Patients with CKD on PD are characterized by an altered intestinal microbiome, local and systemic metabolome changes in contrast to patients with AKI. PD-patients with CKD and AKI have increased serum levels of bacterially-derived uremic toxins. Further investigations are required to obtain deeper understanding of reciprocal influences of the uremic status and intestinal microbiome.
P1178FEASIBILITY OF UNPLANNED START IN PERITONEAL DIALYSIS (PD)
Authors: López Melero Eva , Sosa Barrios R Haridian , Burguera Vion Víctor , Ortego Pérez Sofía , Fernandez Lucas Milagros , Rivera Maite
Published: June 2020

Background and Aims

Chronic kidney disease (CKD) is increasing worldwide and there is a rising need for renal replacement therapies (RRT). PD has multiple advantages over hemodialysis (HD), but in most patients requiring an unplanned start HD is the selected RRT.

Method

We retrospectively analyzed all patients started on unplanned PD in our unit from January 2006 until April 2019. Demographics, blood test parameters and complications were collected. Unplanned start on PD was defined as initiating PD less than 4 weeks after PD catheter implantation.

Results

Of 14 patients, 8 were referred from ACKD clinic, 3 were failing renal transplants and 3 previous PD patients that required catheter replacement due to severe peritonitis. Fluid overload with rapid decline in kidney function was the acute trigger for RRT in 4 patients and 1 had a nephrectomy. Late referral with uremic symptoms was the reason for unplanned start in 5 patients. Two patients (14.2%) had mechanical complications that did not require surgical intervention. None had infections related to technique. PD was performed by our PD unit nursing staff in all cases and technique was well tolerated. Results are summarized in table 1.

Conclusion

PD is a safe and valid option even when an unplanned start on RRT is required. It did not show higher morbidity nor mortality in our series, allowing avoidance of central lines in our patients and preserving vascular capital. Furthermore, PD is a less expensive technique than HD. Nursing staff support is key to develop it.
P1179PREDICTIVE FACTORS OF PERITONITIS IN PERITONEAL DIALYSIS PATIENTS AFTER TENCKHOFF CATHETER IMPLANTATION : A META-ANALYSIS
Authors: Makrufardi Firdian , Safika Erri Larene , Galayudha Aulia Sigra , Wijayanto Rachmat Aldhi
Published: June 2020

Background and Aims

Chronic kidney disease is one of the leading cause of years living with disability. Peritoneal dialysis has been an effective treatment for end-stage renal disease (ESRD). Unfortunately, there are infectious and non-infectious complication after tenckhoff catheter implantation in patients. Peritonitis has been the most common major clinical problem and is often the cause for failure of peritoneal dialysis. Many researchers have studied the predictive factors of peritonitis in peritoneal dialysis patients after tenckhoff catheter implantation, but their conclusion were not always consistent. Therefore we performed a meta-analysis to make a more integrated and precise estimation.

Method

Multiple databases were searched for comparative studies without language or date restrictions. Gray literature was sought. The meta-analysis study was conducted using Revman 5.3, with p <0.05 considered significant. Aspects investigated included age at implantation, diabetes mellitus, and gender. Two reviewers independently assessed study eligibility and the quality of included studies.

Results

A total of 7 studies were identified and analyzed, and 3 were multi-institutional. Reporting standards were highly variable. Overall, 7730 patients with ESRD were incorporated in this study. Meta-analysis demonstrated there was signiﬁcant difference in the incidence of peritonitis with age at implantation, (OR= 1.98 [1.81, 2.17], p=0.00001). Significant difference was not seen in the incidence of peritonitis with diabetes mellitus, (OR= 1.03 [0.23, 4.55], p=0.97). Meta-analysis showed that there was no association between gender with incidence of peritonitis (OR= 1.57 [0.62, 3.97], p=0.35), while male had a higher peritonitis incidence (See figure). No publication bias was noted in this study

Conclusion

Peritonitis is still a major problem in patients with peritoneal dialysis. Age at implantation is the predictive factors that affect peritonitis incidence in peritoneal dialysis patients after tenckhoff catheter implantation, while gender and diabetes mellitus do not appear to be correlated with peritonitis incidence.