bluuebunny/crossref_metadata_2025 huggingface dataset:
P1101A BIFUNCTIONAL ADSORBER PARTICLE FOR THE REMOVAL OF HYDROPHOBIC UREMIC TOXINS FROM WHOLE BLOOD OF RENAL FAILURE PATIENTS
Authors: Sternkopf Marieke , Speer Thimoteus , Göttsch Claudia , Jankowski Vera , Jankowski Joachim , Noels Heidi
Published: June 2020

Background and Aims

Hydrophobic uremic toxins accumulate in patients with chronic kidney disease, contributing to a highly increased cardiovascular risk. The clearance of these uremic toxins using current hemodialysis techniques is limited due to their hydrophobicity and their high binding affinity to plasma proteins. Adsorber techniques may be an appropriate alternative to increase hydrophobic uremic toxin removal.

Method

We developed an extracorporeal, whole-blood bifunctional adsorber particle consisting of a porous, activated charcoal core with a hydrophilic polyvinylpyrrolidone surface coating. The adsorption capacity was quantified using analytical chromatography after perfusion of the particles with an albumin solution or blood, each containing mixtures of hydrophobic uremic toxins.

Results

A time-dependent increase in hydrophobic uremic toxin adsorption was depicted and all toxins showed a high binding affinity to the adsorber particles. Further, the particle showed a sufficient hemocompatibility without significant effects on complement component 5a, thrombin-antithrombin III complex, or thrombocyte concentration in blood in vitro, although leukocyte counts were slightly reduced.

Conclusion

In conclusion, the bifunctional adsorber particle with cross-linked polyvinylpyrrolidone coating showed a high adsorption capacity without adverse effects on hemocompatibility in vitro. Thus, it may be an interesting candidate for further in vivo studies with the aim to increase the efficiency of conventional dialysis techniques.
P1116IS DIALYSIS ADEQUACY AMELIORATED AFTER INCREASING DIALYSATE FLOW RATE IN CHRONIC HEMODIALYSIS? - ONE YEAR FOLLOW-UP
Authors: Barbatsi Aggeliki , Karakou Eugenia , Chiras Theodoros , Skarakis Jacob , Trakas Nikolaos , Sonikian Makrouhi
Published: June 2020

Background and Aims

Hemodialysis (HD) adequacy, as measured by single pool (sp) Kt/V and urea reduction rate (URR), has been reported to be ameliorated after increasing dialysate flow rate (DFR). However, this is a matter of controversy as no benefit has been observed with dialyzers incorporating features to enhance dialysate flow distribution. We investigated the effect of increasing DFR on dialysis adequacy and on various laboratory parameters.

Method

Twenty-three patients, M/F=20/3, aged 65(44-89) years, dialyzed thrice weekly for 50(6-274) months, using polysulfone low flux dialyzers, participated in an annual randomized cross-over study. Patients were dialyzed with DFR of 500 ml/min and 700 ml/min for 6 consecutive months respectively, according to their usual dialysis prescription and with ultrafiltration volumes according to clinical need. Blood was sampled before and at the end of midweek sessions at the beginning of the first, 7th and 13rd month for urea, creatinine, potassium, sodium, albumin, total Ca and phosphate (sP). URR, spKt/V, corrected for albumin Ca(sCa) and sCa x sP product (CaxP) values were calculated.

Results

Under both 500 and 700 ml/min DFRs used, the expected post-dialysis alterations were found: decreased values in serum urea (respectively 161,5±38,0 to 49,9±20.1-p<0,001 and 140,3±30 to 56,0±20.4 mg/dl-p<0,001), creatinine (respectively 10,2±2 to 3.9±1,2-p<0,001 and 10,2±3,3 to 4,1±1,6 mg/dl-p<0,001), potassium (respectively 5,2±0,7 to 3,7±0,3 mM-p<0,001 and 5,3±0,6 to 3,9±0,3mM-p<0,001) and phosphate (respectively 5,4±1,7 to 2,9±0,6-p<0,001 and 5,7±1,6 to 2,6±0,6 mg/dl-p<0,001); increased values in serum albumin (respectively 4,3±0,4 to 4,7±0,4 g/dl-p=0,001 and 4,2±0,3 to 4,7±0,4 g/dl-p<0,001) and sCa (9,1±0,7 to 11,3±0,9 mg/dl-p<0,001 and 8,7±0,6 to 9,9±0,7 mg/dl-p<0,001). After increasing DFR from 500 to 700 ml/min we observed no reductions in pre-dialysis serum urea and creatinine levels or URR (68,6±8,1% to 69,9±7,9%-p=NS) and Kt/V (1,41±0,4 to 1,42±0,3-p=NS) values. However, under DFR of 700ml/min post-dialysis sCa, sP and sCa x sP product values were always lower compared with those under DFR of 500 ml/min (respectively 9,9±0.7 vs 10,8±0.8 mg/dl-p<0,001, 2,6±0,6 vs 2,9±0,6 mg/dl-p=0,02 and 25,6±6,2 vs 30,9±6,7 mg2/dl2-p<0,001).

Conclusion

DFR increase from 500 to 700 ml/min did not lead to favorable effects on dialysis adequacy but resulted in post-dialysis amelioration of serum calcium and phosphate levels and may be useful in cases of hypercalcemia, hyperphosphatemia and calcifications. DFR increase utility needs further investigation in patients with disorders of calcium-phosphate metabolism.
P1117EXPLORATORY COMPARISON OF DIALYSIS EFFICIENCY AT DIFFERENT DIALYSATE FLOW (QD) IN EXPANDED HEMODIALYSIS IN TWO CENTERS IN COLOMBIA
Authors: Molano Trivino Alejandra , Zúñiga Eduardo , Sanabria Mauricio , Vesga Jasmin , Ramos Carolina , Gutiérrez Juan Felipe , Tran Ha , Ronco Claudio , Rivera Angela
Published: June 2020

Background and Aims

Dialysate flow rate (Qd) has minimal effect in removal of molecules in hemodialysis, allowing to use lower amounts of dialysate with no effect in clearance of molecules. According to recent literature, Expanded hemodialysis (HDx) improves the clearance of middle size molecules, diminishing the effect of Qd in adequacy. We found no data about clearance at different dialysate flow rates in HDx.

Our aim is to evaluate the clearance of middle molecules (beta 2 microglobuline [Mβ2], interleukin-6 [IL-6], interleukin-10 [IL-10 light chains (CLL-κ -λ) with HDx at different Qd using membranes TheranovaMR in patients with body weight less than 70 Kg.

Method

We performed an observational retrospective analysis of clearance of Mβ2, IL-6, IL-10, CLL-κ; CLL-λ in HDx using TheranovaMR filters with Qd 400 mL/min and 500 mL/min. We performed variance analysis, T student test and Wilcoxon test. Data were extracted from an HDx multicentric trial performed in Bogotá, Colombia in 2018.

Results

11 (47%) patients received Qd 400 mL/min and 12 (52.1%) patients with Qd 500ml/min. Demographic data are included in table 1. We found no differences in reduction rate of mid-molecules. (Table 2) We found that lower water consume in the Qd 400 mL/min group, with water savings of 24 Liters/patient (13824 L in 12 weeks of follow up). (Table 3)

Conclusion

Expanded hemodialysis seems to allow diminishing Qd rate without changes in mid-size molecules clearance.
P1127BIOELECTRIC IMPEDANCE IN ESTIMATION OF DRY WEIGHT IN CHRONIC DIALYSIS PATIENTS
Authors: Fattoum Safa , Jebali Hela , Nessrine Braiek , Ben Kaab Badr , Mami Ikram , Smaoui Wided , Beji Soumaya , Fathi Ben Hmida , Raies Lamia , Zouaghi Mohamed Karim
Published: June 2020

Background and Aims

Fluid status evaluation is essential to adjust the dry weight(DW) in chronic hemodialysis (HD) patients. Bioelectric impedance is a non invasive technique. Its contribution in HD population is well demonatrated. The aim of this study is to compare evaluation of fluid status clinically and by bioimpedance analysis.

Method

It’s a transversal study conducted in December 2018.We included chronic dialysis patients( for more 3 months) having 3 dialysis sessions(DS) a week. Bioimpedance analysis (BIA) was performed before and after DS.

Results

There were 26 patients with an average age of 51,4 years. Sex ratio was 3,33 . Average period spent in HD was 73,7 months. Vascular access was a native arteriovenous fistula in 24 patients, and a catheter in 2 patients. Seven patients had residual diuresis. Average ultrafiltration rate was 2,82 L (10 mL/Kg/h).

Before DS, 20 patients had no clinical signs of fluid overload. Unconformity with BIA was noted in 12 patients, with a subclinical overload in all cases. Six patients had clinical signs of fluid overload (including hypertension (HT) in 5 cases), which was concordant with BIA.

After DS, 22 patients reached their DW with a correct hydration status, 2 patients still had clinical signs of fluid overload, and 2 had isolated HTA. BIA revealed the persistence of fluid overload in 10 patients contrasting with the absence of clinical signs of hypervolemia in 8 patients. Patients who kept only HT had a normal hydration status.

Conclusion

Fluid status is an important adequacy issue in the treatment of renal failure. It’s a modifiable risk factor associated to mortality. Bioimpedance analysis is a great help to precise dry weight that must be integrated into our daily practice.
P1147SEQUENTIAL ULTRASOUND BASED APPROACH IN PERITONEAL CATHETER MALFUNCTION: THE COMBINATION OF B-MODE AND DOPPLER ULTRASOUND
Authors: Zeiler Matthias , Federico Antonio , LENTINI PAOLO , Dell'Aquila Roberto , Granata Antonio , Santarelli Stefano
Published: June 2020

Background and Aims

The clinical approach to peritoneal catheter malfunction consists usually in laxative prescription, abdominal radiography, brushing of the catheter lumen, guide-wire manipulation or catheter fluoroscopy. Only specialized centers apply videolaparoscopy for catheter rescue interventions. Up to now, limited experience is present regarding the evaluation of the intraperitoneal tract of the peritoneal catheter in adult patients. The aim of the study was to evaluate the diagnostic capability of B-mode ultrasound (US) followed by colour Doppler US (Doppler US) in persistent peritoneal catheter malfunction.

Method

US followed by Doppler US of the intraperitoneal part of the catheter was performed prior to videolaparoscopy intervention in 40 adult patients presenting persistent peritoneal catheter malfunction despite non-invasive therapy such as laxative prescription and brushing of the catheter lumen. US and Doppler US diagnosis were compared to the corresponding at videolaparoscopy intervention, and the causes of mismatch analyzed. In all patients US was performed after filling of the abdominal cavity with peritoneal dialysis solution of at least one liter. Doppler US along the intraperitoneal segment of the catheter was performed by flushing with dialysis fluid.

Results

In US, causes of persistent malfunction were catheter dislocation combined with omental wrapping in 21 cases, omental wrapping without dislocation in 11 cases, dislocation only in 4 cases, adherences to non-omental structures in 3 cases and entrapment in the lateral inguinal fossa in one case. The correspondence of US and videolaparoscopy diagnosis was 90%, respectively in 36 of 40 cases. The discrepancies were due to improper visualization of the catheter caused by constipation and embedding of the catheter between intestinal loops, resulting in an erroneous US diagnosis of omental wrapping, whereas videolaparoscopy showed encasement of the catheter between intestinal loops in three cases and presence of adherences to tubal structures in one case. Doppler US clarified the functional aspects of the catheter, thus increasing the correspondence to videolaparoscopy up to 39 out of 40 cases (97.5%)

Conclusion

US combined with Doppler US is helpful in making a correct pre-operative diagnosis of persistent peritoneal catheter malfunction and in planning of the videolaparoscopy rescue intervention.
P1156TWO YEAR FOLLOW UP QUALITY INDICATORS COMPLIANCE IN A LARGE INTERNATIONAL PERITONEAL DIALYSIS INSTITUTION
Authors: Marrón Belén , Pearce Suzanne , Martín Claudia , Munteanu Dan , Roesch Michael , Ostrowski Janusz , Torok Marietta , Pérez Daniel , Orosz Attila , Kochman Pawel , Wollheim Charlotta , Lucas Carlos , Macário Fernando
Published: June 2020

Background and Aims

Peritoneal dialysis (PD) practice is not universally homogeneous, best clinical practices are not completely understood as reference values are often obtained from small sized populations and/or frequently based on chronic kidney disease (CKD) and/or hemodialysis data.

To evaluate two years of follow up of compliance with PD-related quality indicators (QIs) following definition of new targets in an international PD network.

Method

All English and Spanish language CKD and PD guidelines were reviewed. Twelve Qis were considered being of significant relevance and targets for these QIs were defined (see table). Retrospective data analysis.

Results

Achievement of QI targets for years 2017-2018 is shown in table. Variability among countries not shown.

Conclusion

There was a significant increase in QIs achievement in 2018 vs. 2017. ≥75% of patients met the target for the following variables: total weekly Kt/Vurea, 24 h fluid removal, mean arterial blood pressure and serum albumin. Peritonitis rates are clearly over International objectives and were improving. Due to the lack of referral source data, these series may help to understand PD practice and outcomes in a global setting.
P1167SERUM MAGNESIUM IS INVERSELY CORRELATED WITH MEAN PLATELET VOLUME IN PERITONEAL DIALYSIS PATIENTS
Authors: Dermitzaki Eleutheria-Kleio , Giannakopoulos Panagiotis , Georgoulidou Anastasia , Tsotsorou Ourania , Nikolopoulos Petros , Balafa Olga , Ntounousi Evangelia , Stylianou Kostas , Katsoudas Spyros , Kyriazis Periklis , Bacharaki Dimitra , Vlahakos Demetrios
Published: June 2020

Background and Aims

Higher Mean Platelet Volume (MPV), as an indicator of larger and hyper-reactive platelets and low serum Mg levels (sMg) have emerged as cardiovascular risk markers, in the general and dialysis population. Magnesium deficiency is linked to platelet hyper-reactivity. Since HypoMagnesemia is common and associated to increased mortality among Peritoneal Dialysis (PD) patients, we aimed to investigate the association of sMg with MVP in PD patients.

Method

We studied 95 stable PD patients, 51 men 44 women, with a mean age of 63 ±14 years. Data analyzed included patients demographics, clinical and biochemical data. Univariate and multivariate regression analysis were used to test the associations of variables related to MPV.

Results: . The mean platelet (PLT) volume was 9.4 ±1.5 (median: 9.2) fl. The mean platelet (PLT) count was 235 ± 69 (median: 233) [x103μ/L]. The mean sMg was 2.25 ± 0.47 (median: 2.2) mg/dl. MPV was associated positively (p=0.303; p<0.01) with C-reactive protein (CRP) and negatively with sMg (r= -0.246; p<0.05), use of Renin Angiotensin System (RAS) Inhibitors (r=-0.273; p<0.05), PLT count (r=-0.360; p<0.001) and white blood cell (WBC) count (r=-0.254; p<0.05). The results of our multiple regression model (Table) showed that all the above mentioned factors that were included in the model, except WBC, were independent determinants of MPV.

Conclusion

Our results show a significant inverse correlation of serum Magnesium with Mean Platelet Volume in Peritoneal Dialysis patients. Given the emerging role of Mg in platelet reactivity, sustaining higher sMg levels, along with minimizing inflammation and using RAS inhibitors may improve cardiovascular outcomes in PD patients via modulation of MPV.
P1169NUTRITIONAL STATUS OF PATIENTS IN PERITONEAL DIALYSIS: TWO METHODS COMPARED
Authors: Paribello Giuseppe , Di Gruttola Oto , Paduano Immacolata Gaia , Migliaccio Silvia , Argentino Gennaro , Sannino Giuseppina , Russo Domenico
Published: June 2020

Background and Aims

Nutritional status and survival are closely related: a state of undernutrition favors the onset of fatal and non-fatal events. This association becomes even more important in the dialysis patient in which a vicious circle is generated in which undernutrition worsens the basic condition. The issue of our study is to evaluate the nutritional status of patients on peritoneal dialysis (PD) comparing the two methods (CAPD-APD).

Method

We evaluated 36 PD patients whose characteristics are reassumed in Tab1. In these patients, dialysis adequacy was assessed by Kt/v and nutritional status through biochemical parameters and the following scores (Tab.2):

• PCR (Protein catabolic rate)

• PEW (Protein energy waste)

• GNRI (Geriatric nutritional risk index)

• CONUT (Controlling nutritional status score)

Results

The data collected shows that 29 patients have a dialysis adequacy compliant with that proposed by the international guidelines (Kt/v ≥ 1.7), of the 7 patients who do not achieve this adequacy 4 are in CAPD and 3 in APD. From a nutritional point of view we consider the ideal PCR of about 1.2 g/kg weight, but this value is difficult to reach by many patients; therefore, a value of at least 0.8 g/Kg/day is considered acceptable. This target is reached by 26 patients; of the 10 patients who do not reach it, 3 are in CAPD and 7 in APD. Analyzing the two methods separately, we can observe that in the CAPD patients the PCR is significantly higher (p <0.002). As regards GNRI, a score <92 is considered as an indicator of an unfavorable prognosis; in this case we can observe that only 3 patients have a score <92, all in APD without however a significant difference between the two methods (p <0.36). Taking into account the reference values for PEW (Tab2) we can highlight the difference between the two methods in the number of patients with a moderate/severe undernutrition status: 13 in APD vs 6 in CAPD. The same can be said for CONUT where an important state of undernutrition is observed in 4 patients in APD vs 1 single patient in CAPD.

Conclusion

The study shows how the combined use of multiple parameters is fundamental in managing of patients nutritional status in peritoneal dialysis. The overall analysis of the scores used has shown a greater risk of malnutrition in APD patients in which is necessary to monitor carefully nutritional status, eating habits and lifestyle.
P1184TRANSVERSUS ABDOMINIS PLAIN BLOCK RELIEVES PERIOPERATIVE PAIN ON PERITONEAL DIALYSIS CATHETER INSERTION: A RANDOMISED CONTROLLED STUDY
Authors: Harada Kenji , Kanai Hidetoshi
Published: June 2020

Background and Aims

The effectiveness of Transversus Abdominis Plain (TAP) block has been reported in the pain control at abdominal operation. However, its usefulness in pain management remains unclear in peritoneal dialysis (PD) patients undergoing catheter insertion. We investigated the effectiveness and safety of TAP block for perioperative on PD catheter insertion.

Method

The present study is a single-centred, prospective, randomised study of initiated PD patients between from October 2017 to January 2020. VAS (Visual Analogue Scale), which is often used around anesthesiology and pain management area, was measured as pain assessment. VAS was measured at five points, right after and 1, 3, 6, 24 hours after operation, using t-test with P values.

Results

Overall, 106 PD patients were included (mean age; 63.8 years old, male/female; 81/25, average eGFR 7.54±2.64). Patients were divided into two groups TAP block (n=50) and non-TAP block (n=56). There were significantly low VAS in TAP block group right after operation (1.39 vs 2.88, p=0.0035) and 1 hour after operation (1.86 vs 3.19, p=0.0078). Furthermore, total five points of VAS were significantly low VAS in TAP block group (10.59 vs 13.85, p=0.028). There were no cases needed for ventilation and anesthetic drug such as morphine. TAP block-related adverse events were not found.

Conclusion

TAP block technique was significantly associated with relief from post-operative pain in PD catheter insertion. This treatment procedure might be a minimally invasive and effective therapeutic option for perioperative pain management on PD catheter insertion.
P1190OXIDATIVE STRESS AND INFLAMMATION IN PERITONEAL DIALYSIS: DANGEROUS AND TO BE SOLVED
Authors: Innico Georgie , Bertoldi Giovanni , Alessi Marianna , Pagnin Elisa , Simeone Monica , Baboci Gresa , Bonfante Luciana , Calò Lorenzo
Published: June 2020

Background and Aims

Cardiovascular disease is the leading cause of excess mortality in chronic kidney disease (CKD) and dialysis patients with oxidative stress (OxSt) and inflammation playing a pivotal role, as non-traditional risk factors and OxSt and inflammation have been shown to increase in peritoneal dialysis. Rho kinase (ROCK) activation is deeply involved in the induction of OxSt and inflammation and is closely linked to cardiovascular-renal remodeling. We aimed to evaluate in peritoneal dialysis patients with a molecular biology approach OxSt, in terms of phosphorylation state of MYPT-1 (marker of ROCK activity), the protein expression of p22phox (subunit of NADPH oxidase, essential for the generation of ROS), and inflammation state, in terms of acute-phase proteins level (Interleukin 6 (IL-6), ultra-sensitive C-reactive protein (US-CRP), Ferritin, Albumin and Transferrin).

Method

9 male ESRD patients (39-81 years old) were enrolled and analyzed before (baseline) and after three and six months of peritoneal dialysis treatment (CAPD 7 patients, APD 2 patients). Mononuclear cells (PBMCs) MYPT-1 phosphorylation state and p22phox protein expression were determined by Western Blot. Specific acute-phase proteins as IL-6, US-CRP, Ferritin, Albumin and Transferrin were assessed through blood chemistry tests.

Results

MYPT-1 phosphorylation was increased after six months of treatment with peritoneal dialysis compared with three months and predialysis (1.03±0.07 vs 1.02±0.04 vs 1.57±0.16 d.u., p<0.0001). p22phox protein expression (0.72±0.05 vs 0.73±0.10 vs 1.28±0.12 d.u., p<0.0001) and ferritin level (101.4±15.3 vs 173.6±11.5 vs 189.0±20.3 µg/l, p=0.002) increased as well. Albumin was decreased after six months of peritoneal dialysis treatment compared with three months and predialysis (43.38±0.10 vs 40.00±1.59 vs 36.46±1.43 g/l, p=0.007). IL-6 and US-CRP remained unchanged at a high level.

Conclusion

The increase of OxSt and inflammation during peritoneal dialysis is confirmed also at molecular biology level and may lead in the medium-long term to dangerous consequences. The necessary improvement of OxSt status in peritoneal dialysis needs a multitarget approach. It might include the use of neutral pH, low glucose degradation products, low lactate and iso-osmolar peritoneal dialysis solutions, strict glycemic control, optimal volume management and, likely, a supplementation with antioxidants as N-acetylcysteine.
P1193URGENT X EARLY START PERITONEAL DIALYSIS: PATIENTS´ PROFILE AND OUTCOMES
Authors: Calice-Siva Viviane , Ferreira Helen , Tonial Bruna , Ribeiro Izabel , Daudt Pedro , NERBASS FABIANA
Published: June 2020

Background and Aims

In the last ten years, peritoneal dialysis (PD) has been considered a safe option to start renal replacement therapy (RRT) in end-stage renal disease patients in need to start dialysis urgently. The definition applied to the Urgent Start PD (US-PD) varies widely worldwide. Recently, it was proposed that US-PD definition should be according to patients’ necessity of starting dialysis, considering “urgent start” when PD started up to 72 hours of catheter placement and “early start” PD when it is starts between 3 and 14 days after catheter placement. Considering this new definition, we aimed to compare demographical and clinical characteristics of patients´ that started PD therapy as urgent and early starts as well as 30-day complications, 6-month hospitalization and dropout rate.

Method

All adult patients that started PD therapy up to 14 days after catheter insertion in our institution between October 2016 and February 2019 were included in the analyses. Patients were placed on urgent-start (US-PD) group if therapy started until 72-h after catheter insertion or early-start (ES-PD) group if PD initiated between 3 and 14 days. Dialysis records were reviewed to obtain clinical and demographic data, fill volume prescribed for the first PD session, 30-days complications (leakage, bleeding, catheter tip migration and peritonitis) and 6-month hospitalization and dropout rate.

Results

In our study, 72 patients were analyzed (US-PD=52, ES-PD=20), mean age was 53.2 ± 15.2 years old. No differences between US-PD and ES-PD regarding demographic characteristics, 30-day complications and 6-month hospitalization and dropout events were found. The most frequent short-term complication in patients who started PD urgently was leakage (US-PD 6 (11%) x ES-PD 2(10%) patients). The most common cause of patient’s dropout was transfer to HD.Only patients from the US-PD group needed to switch to that modality (5 (10%)).

Conclusion

Almost three-quarters of our sample started PD less than 72 hours after catheter insertion. The lack of difference in the measured outcomes compared to patients that had therapy initiated after this period encourages the use of PD when urgent dialysis is needed.
P1201THE AGING OF THE IMMUNE SYSTEM AND FRAGILITY: TWO FEATURES IN PERITONEAL DIALYSIS AND END-STAGE RENAL DISEASE PATIENTS
Authors: Caro Espada Paula Jara , Ceprian Costoso Noemi , YUSTE CLAUDIA , Valero Gemma , Fernandez-Vidal Maria , Seroukh Nadia , Morales Enrique , Vida Carmen , Carracedo Julia
Published: June 2020

Background and Aims

Chronic kidney disease (CKD) is associated with premature immune aging and increased inflammatory activity leading into endothelial damage and macrophage senescence (CD14+CD16+).

Objective. To evaluate the influence of CKD in senescent immune cells, and its relationship with fragility in patients with nondialysis CKD (ND-CKD) and Peritoneal Dialysis (PD).

Method

A descriptive transversal study analysing lymphocyte absolute counts and subpopulations in 74 CKD patients (36 DP, 38 ND-CKD) compared with 10 healthy subjects (HS). We also assessed immunoglobulin levels, C3 and C4 fragment complement, Edmonton fragility score and the percentage of proinflammatory blood monocytes with the CD14+CD16+ phenotype.

Results

PD patients presented more absolute lymphopenia compared with LCC and HS (PD 1194,2, 1589 ND-CKD and 1802 HS; p <0,001, respectively). This lymphopenia is also maintained in CD3, CD4, CD8 and NK cells. Lower CD4 lymphocytes levels were significantly correlated with higher fragility and incidence of peripheral vascular disease in uremic patients. Senescent macrophage was correlated with CD3 and CD4 lymphocytes all the cohorts (ND-CKD, PD and HS).

Conclusion

PD patients presented changes in immune system compared with healthy population, that could explain accelerated senescence. Accelerated senescence is associated with more fragility and endothelial damage. There are necessary more studies to identify the role premature aging in ND-CKD and to establish the differences between renal replacement modalities.
P1203DEGREE OF FUNCTIONAL DEPENDENCE IN PATIENT IN SUBSTITUTE RENAL TREATMENT IN HGUCR
Authors: CASTRO FERNÁNDEZ MARIA PAZ , PICCONE SAPONARA LUIS GUILLERMO , Carreno Agustin , Siedel Diego , URIBE HEREDIA NANCY GIOVANNA , VALLE DOMINGUEZ CASIMIRO , OLAZO GUTIERREZ ELIANA , SANCHEZ ESCUDERO PATRICIA , VILLABON OCHOA PAOLA , VOZMEDIANO POYATOS MARIA DEL CARMEN
Published: June 2020

Background and Aims

Elderly patients and comorbidity present more frequently deterioration of their cognitive and / or functional capacity, and consequently worse quality of life related to health and the need for help to perform their basic activities. It has been described in the literature that peritoneal dialysis (PD) is a protective factor in the patient's survival against hemodialysis (HD). Quality of life is an important parameter in patients undergoing renal replacement therapy, which influences the choice of dialysis modality. We analyzed and compared the degree of functional dependence of patients on PD versus HD.

Method

Descriptive and cross-sectional study. A total of 84 patients belonging to the General University Hospital of Ciudad Real were included. Demographic variables (age, sex), associated comorbidity, etiology of CKD, among others, were collected. To assess the degree of dependence, the Barthel index and Lawton and Brody were performed. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and have been compared using the Chi2 test. Quantitative variables are expressed as mean +/- standard deviation, and the T-student was used to compare them. Statistical significance for a value of p <0.05.

Results

Of the 84 patients, 40.5% received PD and 59.5% HD. 60.7% were male and 39.3% female, with an average age of 60.90 years. 75% were hypertensive, 38.1% diabetic, 61.9% dyslipidemic, 27.4% obese and 61.9% had peripheral vasculopathy. The most frequent causes of CKD were diabetic nephropathy (22.6%), glomerular etiology (21.4%), unfiltered (20.2%) and nephroangiosclerosis (14.3%), among others. The degree of functional dependence according to the Barthel index was 63.1.9% for total independence, 29.8% mild dependence, 4.8% moderate dependence and 1.2% total dependence; and for the Lawton and Brody index, 42.9% total independence, 14.3% mild dependence, 27.4% moderate dependence, 11.9% severe dependence and 3.6% total dependence. When comparing the degree of functional dependence between both dialysis techniques, we observed that patients in PD had a lower degree of functional dependence compared to patients in HD, these differences being statistically significant (Lawton and Brody 73.5% in PD vs. 22% in HD, p <0.001 and Barthel index 85.3% in PD vs 48% in HD, p = 00.4).

Conclusion

In our experience, the degree of functional dependence in patients in PD is lower compared to patients in HD with less comorbidity, being able to condition the choice of the technique of renal replacement therapy.
P1204PHROPHYLATIC GENTAMICIN - A THERAPEUTIC WEAPON IN THE COMBAT OF EXIT SITE INFECTIONS IN PERITONEAL DIALYSIS
Authors: Abrantes Ana , Ferrer Francisco , Martins GonÇAlves HernÂNi Ricardo , Vila Lobos Ana
Published: June 2020

Background and Aims

Infection-related complications, such as exit-site infection (ESI) and peritonitis, are one of the main causes of technique failure and dropout in patients under peritoneal dialysis. Several studies have demonstrated the positive effect of daily topical antibiotics (AB) in preventing ESI. The aim of this study is to demonstrate the impact of topical gentamicin (TG) in preventing ESI, between 2009 and 2019, in a single-center of a medium-sized hospital in Portugal.

Method

Descriptive and retrospective analysis was performed. Demographic data, comorbidities, type of catheter placement and PD prescription were collected. For each patient, it was determined the time free of prophylactic AB (NTG) and under topical gentamicin (ophthalmic formula, once a day, applied on exit site). ESI cases were identify.

Results

Eighty-five patients were included, with a mean age of 53.2 ± 14.6 years; 69.5% were male. Cardiovascular comorbidities, like arterial hypertension and diabetes, were highly prevalent (88.2% and 76.5% respectively). Chronic glomerulonephritis and diabetes were the main causes of CKD (19; 22.4%; 15; 17.6%). More than 80% of the patients had previous Nephrology follow up. Percutaneous approach was the first option to catheter placement in 70.6% of the cases and DPA was performed in 53,0%. Every patient started the PD program free of prophylactic AB (n=85); 35 patients started TG at some point. Forty episodes of ESI were recorded, 39 (97.5%) in the NTG group. Staphylococcus aureus was the most frequently identified organism (16; 41.0%), followed by Staphylococcus epidermis (5; 12.5%) and Corynebacterium (5; 12.5%). The Kaplan-Meier analysis demonstrated that patients in TG were associated with better free-time of first peritonitis ((705 vs 985 days; p=0.001). The multivariate Cox regression model confirmed a 14 times higher risk of ESI in NTG group (HR 14.4; 95% CI 1.97-105.45; p=0.001).

Conclusion

Although mupirocin is still the first option in many centers, some studies have demonstrated a benefic role of gentamicin in reducing ESI, not only by Pseudomonas species but also Staphylococcus aureus. The results of our study confirmed that topical daily gentamicin is highly effective preventing ESI in PD patients. Despite of the concern with the gentamicin-resistant infections, just one patient developed ESI under gentamicin, and the identified microorganism was the Staphylococcus epidermidis.
P1216EPIDEMIOLOGY OF HYPERTENSION IN PERITONEAL DIALYSIS USING CLINIC AND AMBULATORY BLOOD PRESSURE MONITORING
Authors: Vaios Vasilios , Georgianos Panagiotis , Vareta Georgia , Karpetas Antonios , Ntounousi Evangelia , Dimitriadis Chrysostomos , Papagianni Aikaterini , Zebekakis Pantelis , Liakopoulos Vassilios
Published: June 2020

Background and Aims

Earlier studies that were based on routine clinic blood pressure (BP) recordings suggested that the prevalence of hypertension is lower in patients on peritoneal dialysis (PD) than in those receiving maintenance hemodialysis. These studies, however, did not incorporate the “gold-standard” method of ambulatory BP monitoring (ABPM). The aim of the present study was to quantify the prevalence and control of hypertension in a cohort of 81 peritoneal dialysis (PD) patients using clinic and ambulatory BP recordings.

Method

Triplicate BP recordings were obtained after a 5-minute seated rest at clinic with the validated monitor HEM-705 CP (Omron, HealthCare). 24-hour ABPM was subsequently performed with the Mobil-O-Graph device (IEM, Germany). Hypertension was defined as (i) average clinic BP ≥140/90 mmHg or antihypertensive drug use and (ii) 24-hour BP ≥130/80 mmHg or current use of antihypertensive drugs.

Results

The prevalence of hypertension was 92.6% with clinic BP recordings and 93.8 with ABPM. In all, 75 participants (92.6%) were receiving therapy with an average of 2.4 antihypertensive medications. The rates of adequate control of hypertension were 49.3% with the use of clinic BP recordings and 39.5% with ABPM, respectively. In all, 6.2% of participants were classified as normotensives, 33.3% had concordant control of hypertension with both techniques, 40.7% had concordant lack of control confirmed by both techniques, 5% had “white coat” hypertension and 14.8% had masked uncontrolled hypertension.

Conclusion

This study suggests that the burden of hypertension among patients on PD is very high and that the wider use of ABPM is important to confirm the BP control status of these patients.
P1229PREVALENCE OF LIPID DISORDERS IN PERITONEAL DIALYSIS PATIENTS
Authors: Fattoum Safa , Samia Barbouch , Mariem Hajji , Mesbahi Tasnim , Nessrine Braiek , Gorsane Imen , Amel Harzallah , Fathi Ben Hmida , Mondher Ounissi , Taieb Ben Abdallah
Published: June 2020

Background and Aims

Lipid disorders are common in end stage renal disease patients. Renal replacement therapies and especially peritoneal dialysis (PD) results in further alteration rather than correction of lipidemia. The aim of this study is to precise the prevalence of the different lipid disorders of PD patients.

Method

It’s a retrospective study conducted in our PD unit in December 2019. We collected all data concerning clinical characteristics of all patients currently in PD, as well as incidence of different lipid disorders.

Results

There were 90 patients with an average age of 45 years (extremes: 20.5 years and 80.6 years). The sex ratio is 1.25. Fourteen were diabetic (15.5%). All patients were on Automated PD (APD) except one on Continuous Ambulatory PD (CAPD). The average duration of PD was 40.5 months. The causal nephropathy was glomerular in 26,6 % (diabetic in 14 patients (15,5%)), hypertensive 13,3%,, interstitial in 16,66%., and undetermined in 27,7%. The average Charlson score was 3,2.

The average serum level of total cholesterol (TC) was 4,96 mmol/L, of triglycerides (TG) was 1,7mmol/L, of HDL-cholesterol(HDLc) was 0,93 mmol/L, and of LDL-cholesterol(LDLc) was 3,05 mmol/L.

Fifty one patients had dyslipidaemia: 13 had isolated hypercholesterolemia, 19 had isolated hypertriglyceridemia, and 19 had hypercholesterolemia and hypertriglyceridemia.

All dyslipidemic patients were on hypolipemic diet. Twelve (13,3%) were taking statin, no one was taking fibrate.

Conclusion

Chronic dialysis patients have several cardiovascular risk factors due to renal failure and comorbidities often associated. Dyslipidemia is a modifiable risk factor. It must be screened and treated to reduce morbidity and mortality.
P1231ASSISTED PERITONEAL DIALYSIS IN ESRD PATIENTS
Authors: Tosic Dragovic Jelena , Dimkovic Nada , Majster Zdenka , Damjanovic Tatjana , Bulatovic Ana , Naumovic Radomir
Published: June 2020

Background and Aims

Peritoneal dialysis is an important form of treatment for patients with end stage chronic kidney failure requiring renal replacement therapy but its use may be limitted by growing number of elderly and disabled patients. Often, they choose an assisted peritoneal dialysis (assCAPD) as first option, that can be performed by relative or a nurs. The aim of this research was to analyse differences between two groups of patients (CAPD vs. assCAPD) in order to establish if two variants are comparable in regard of patients outcome.

Method

We analysed 61 patient divided into two groups (ass CAPD, N= 16 and CAPD, N= 45) who were dialysed in Zvezdara University hospital for more than 3 months and correlated number of peritonitis, exit site infections and overall mortality rates between two groups during the period of 60 months. Assistance was provided on the volontary basis by family member.

Results

Patients in assCAPD group were unsignificantly older (68+11vs. 60 + 12 years) and had higher comorbidity score. The groups were homogeneous according the presence of diabetes mellitus, CRP and PTH levels. There were no significant difference between the two of groups in the number of peritonitis (p=0,77), exit site infections (p=0,37) and overall survival (p= 0,74, Figure 1.).

Conclusion

Family member provides very good assistance in peritoneal dialysis giving the results that are comparable to that of self-performing CAPD patients. This is therefore very successful treatmen option for a special population of ESRD patients who can not performe CAPD on their own.
P1232COMPUTED TOMOGRAPHIC PERITONEOGRAPHY - GUARANTYING SAFER SURGICAL STRATEGIES
Authors: Alves Pedro , Domingos Ana , Patrício Henrique , Ildefonso João , Malho Guedes Anabela , Bernardo Idalécio , Leão Neves Pedro
Published: June 2020

Background and Aims

Peritoneal Dialysis (PD) is currently the first option as renal replacement therapy to many patients, for several reasons, as personal flexibility, volemic management in cardiorenal patients, poor vascular access to dialysis, among others. Mechanical complications can be a drawback in these patients, which may occur during or after catheter placement. Abdominal wall hernias and dialysate leaks are relatively common and highly related to chronically increased intraperitoneal pressure. In this setting CT peritoneography is the technique of choice as it allows differentiation between a true hernia or a wall leakage.

Method

We describe a case of a 69-year-old man, with a personal history of polycystic kidney disease, colonic diverticulosis and hypertension, which opted for PD. The patient later developed a mechanical complication for which a proper diagnostic approach, namely through specific imaging, and surgical planning were essential.

Results

After 15 months without complications, it was detected a bulging in the periumbilical area, exacerbated by orthostatism. Changes in dialytic prescription included lower dialytic volumes during orthostatic period, with some improvements. The limitation of volumes and difficulty of drainage were limiting dialytic prescription and insufficient kt/V. An ultrasound (figure 1) and CT peritoneography (figure 2) were performed, revealing an hernial sac with peritoneal liquid leak, without any intestinal loop, approachable by minimally invasive surgery and local anesthesia.

Mini-laparotomy was performed, hernial sac was removed, without peritoneum aperture, with only a 4-day pause on PD technique.

Conclusion

CT peritoneography allowed the differentiation between this true hernia and a wall leakage, by providing accurate anatomical detail, allowing proper planning of surgical intervention. In this case, the patient had additional predisposing factors, namely polycystic kidney disease. Moreover, only a short pause on PD was necessary. Although some limitations exist, such as the use of iodinated contrast material and ionizating radiations, CT peritoneography is currently the gold standard for the evaluation of mechanical complications in PD; in addition to those mentioned, it is also useful for complications related to the catheter (kinking, entrapment, malposition), intrabdominal adhesions or loculated fluid collections.
P1247INTERDIALYTIC WEIGHT GAIN IN HEMODIALYSIS: EPIDEMIOLOGY AND OUTCOMES
Authors: Al Salmi Issa , Al Maimani Yacoub , Magdy Fady , Hannawi SUAD
Published: June 2020

Background and Aims

Interdialytic weight gain (IDWG) has been linked to various complications in hemodialysis (HD) patients, especially cardiovascular (CV) complications. We aimed to evaluate the effect of IDWG in HD patients on the rate of hospital admissions over a 12-month period, and the impact of high IDWG on the frequency of IDH.

Method

The study included 120 patients; who had been receiving HD for at least 3 months. The presence of various comorbidities has been recorded including. Laboratory data included; serum creatinine, serum albumin, and hemoglobin level. The estimated IDWG was calculated based on the average between pre- and post- dialysis weights that were recorded on 3 consecutive dialysis sessions.

Results

Among those who had IDWG ≥ 4%, 81% of these patients had at least one hospital admission due to volume overload or the need for extra HD session(s). On the other hand, only 19% of those having IDWG < 4% had been admitted or got extra HD sessions (p<0.001). Of those who were admitted (over 12 months) due to volume overload; 74.1 % had IDWG ≥ 4%, while 25.9% had IDWG < 4% (p< 0.001). Regarding IDH, 87% of patients having IDWG ≥ 4% had at least one episode of IDH/week. On the other hand, only 22.5% of those with IDWG < 4% had one episode of IDH/week (p<0.001). When analyzing those who had at least one IDH episode/week; 72.9% of them had IDWG ≥ 4%, while only 27.1% had IDWG < 4% (p<0.001).

Conclusion

In HD patients, the frequency of hospital admission due to volume overload and the need for extra HD sessions is strongly related to the amount of IDWG (> 4% in our patients), the same stands for the frequency of IDH. Thus, a control of IDWG in HD patient is of great importance, keeping in mind the importance the nutrition status of HD patients that may also impact IDWG.
P1257SERTRALINE ADMINISTRATION TO PREVENT INTRADIALYTIC HYPOTENSION: A RANDOMIZED, DOUBLE-BLINDED, PLACEBO-CONTROLLED, CROSSOVER STUDY (SLATAN STUDY)
Authors: Kusirisin Prit
Published: June 2020

Background and Aims

Intradialytic hypotension (IDH) is the most common intradialytic complication ranging from 15-50% in chronic hemodialysis patients and increases morbidity and mortality in this population. According to pathophysiology, various strategies have been applied to treat this condition. Autonomic dysfunction is the one of the factors leading to IDH and is commonly found in elderly and diabetes patients. The use of sertraline to improve autonomic function was done in some small studies but the benefits was inconclusive, especially in diabetic patients. This study aimed to clarify an efficacy of sertraline regarding IDH in hemodialysis patients.

Method

We conducted a single-center, randomized, double-blinded, placebo-controlled, crossover study on chronic hemodialysis patient who had IDH in at least 25% of their dialysis sessions. Each patient received either sertraline or placebo for 4 weeks and were crossed to the other group after washout period for 4 weeks. Sertraline was started at the dose of 50 mg/day during the first week and was increased to 100 mg/day from week 2 to week 4. Matching placebo was adjusted using the same protocol as sertraline. The primary outcome was an incidence of IDH. Secondary outcomes included an incidence of IDH in subgroup of the patients with and without diabetes, the changes of blood pressure during hemodialysis session, and incidence of adverse events. Intention-to-treat analysis was applied to all data analyses.

Results

A total of 37 patients were enrolled into the study (48.6% males, mean age of 64.0±15.5 years, mean dialysis vintage of 2.4±2.4 years). All patients in sertraline group completed the study; however, 4 patients in placebo group dropped out due to adverse effects. Baseline characteristics did not differ between both groups. By analysis of crossover design, an incidence of IDH in sertraline group was significantly lower than placebo group (2.5±2.3 episodes versus 4.2±2.7 episodes during study period of 4 weeks, p for treatment effect <0.001, p for period effect = 0.802, and p for sequence effect = 0.811). In subgroup of diabetes patients, an incidence of IDH in sertraline group was 2.5±2.2 episodes versus 4.4±2.8 episodes in placebo group (p for treatment effect = 0.001, p for period effect = 0.491, and p for sequence effect = 0.382). However, there was no difference in incidence of IDH between the two groups in non-diabetes patients. There was no significant difference of adverse events between the two groups.

Conclusion

Among patients undergoing chronic hemodialysis with intradialytic hypotension, administration of sertraline significantly decreases intradialytic hypotension episodes. In addition, diabetes patients may confer more benefit from the treatment compared with non-diabetes status.
P1260INTRA CRANIAL AND HEART VALVES CALCIFICATIONS IN HEMODIALYSIS PATIENTS - INTERRELATIONSHIP AND CLINICAL IMPACTS
Authors: COHEN HAGAI KEREN , Fanadka Feda , Grumberg Tania , Topaz Guy , Nacasch Naomi , Greenberg Meidad , Zitman-Gal Tali , Benchetrit Sydney
Published: June 2020

Background and Aims

Arterial calcification is an integral component of active atherosclerosis and is an independent risk factor for cardiovascular disease. Intra-cranial calcification (ICC) in hemodialysis (HD) patients has a prevalence of about 90%, and its severity is correlated with age, hemodialysis vintage and mineral bone disease.

Heart valves calcifications are also considered as a local manifestation of atherosclerosis and have been associated with poor cardiovascular outcomes.

This study assessed the correlation between valvular and ICCs in hemodialysis patients and its clinical impact on mortality.

Method

A blinded neuroradiologist graded ICC of all HD patients who underwent non-contrast brain computerized tomography (CT) from 2015 to 2017 in our institution. Valvular calcifications were recorded according to echocardiography study. Only hemodialysis patients with available echocardiography and brain CT were included.

Results

This retrospective study included 119 hemodialysis patients (mean age 70.6±12.6 years, 57.1% male). Of the total cohort, 19 (16%) had no cardiac or brain calcifications and 65 (54.6%) had both valvular and intracranial calcifications. Considering the patients with no calcification as the reference group yielded adjusted odds ratios for all-cause mortality of 3.68 (95%CI 1.55-8.75) among patients with any brain calcifications, p=0.002. ICC was the most important predictor of mortality in the study cohort.

Conclusion

We found an independent association between ICC and the risk of death among hemodialysis patients. Assessing ICC in non-contrast CT may contribute to the risk stratification of HD patients. These calcifications are no less important than valvular calcifications are. Additional studies are needed to confirm these findings.