bluuebunny/crossref_metadata_2025 huggingface dataset:
P1173PERITONEAL DIALYSIS INFECTIONS IN MALTA - TRENDS OVER ELEVEN YEARS
Authors: Borg Cauchi Angela , Gauci Maria Angela , Dalli Theresia , Gauci James , Farrugia James , Farrugia Emanuel , Borg Michael A
Published: June 2020

Background and Aims

Infections related to peritoneal dialysis (PD) are still a cause of morbidity and mortality. We describe an overview of PD peritonitis and catheter-related infections (CRI) in Malta over a period of eleven years. We also describe trends in dialysis modality over the years.

Method

All patients undergoing PD in Malta during 2008 and 2018 were analysed. Data from 2008-2012 was retrospective, shown as mean, that from 2013-2018 prospective. International Society for Peritoneal Dialysis (ISPD) definitions were used.

Results for categorical responses were summarized using absolute numbers and percentages. Medians (range) were used to describe continuous non-normally distributed data.

Results

The total number of patients undergoing PD from 2008 till 2018 were 137 (2008-2012), 91, 80, 126, 117, 102, 103 respectively. There was an overall male predominance of 63.5% (61-67). Patient years at risk were 85.80, 85.25, 89.71, 83.70, 79.69, 72.88 since 2013 respectively.

The overall incidence of diabetes mellitus was 45.3% (41.8-50), cardiovascular disease 34.2% (33.8-35), hypertension 79.3% (73.8-84.6).

PD was used in 50% of dialysis modality prior to 2012, 39% in 2018. Initially 51% used Automated PD (APD), with 21% assisted PD, in 2018 39% used APD, with 6% assisted PD.

PD peritonitis rates from 2008 were 0.38, 0.31, 0.35, 0.46, 0.43, 0.57, 0.54, 0.43, 0.39, 0.40, 0.46 episodes/patient year respectively

There was marked dominance of Gram-positive peritonitis, mainly Staphylococcal, with a reduction of coagulase-negative-Staphylococcus from 0.26 episodes/patient in 2013 to 0.03 in 2017, 0.11 in 2018. Methicillin-resistant S. aureus (MRSA) peritonitis decreased from 0.03 episodes/patient to nil in 2016, 2017, 0.01 episodes/patient in 2018.

Amongst Gram-negative peritonitis, Pseudomonas rates decreased from 0.06 to 0.03 episodes/patient in 2018, nil in 2016. Escherichia coli rates decreased from 0.02 episodes/patient to nil in the last three years. Fungal rates from 0.03 to 0.01 episodes/patient/year, with nil in 2016, 2017.

Catheter-related infection rates were 0.39 (2008-2012), 0.35, 0.91, 0.37, 0.38, 0.25, 0.50 episodes/patient/year respectively. There was a higher incidence of recurrent infections in 2014, none in 2015 and 2016. Gram-negative organisms accounted for 57% of all CRI, predominantly Pseudomonas at 0.12 (2008-2012), 0.06, 0.09, 0.09, 0.14, 0.03, 017 episodes/patient/year respectively. Gram-positive CRI were mostly Staphylococcus aureus, peaking in 2014 at 0.38 episodes/patient/year. MRSA rates declined from 0.15 to 0.01 episodes/patient/year in 2018.

Conclusion

PD peritonitis rates in Malta between 2008 and 2018 were below the ISPD recommended threshold. There were no episodes of MRSA in 2016, 2017, no Pseudomonas in 2016, no E coli in the last three years and no fungal PD peritonitis in 2016, 2017.

CRI rates also declined, with an overall predominance of Gram-negative infections.
P1185LUNG COMETS AND EVALUATION OF HYDRATION STATUS IN PERITONEAL DIALYSIS PATIENTS
Authors: Ekart Robert , Lucic Srajer Lucijan , Marko Katharina , Hojs Nina , Bevc Sebastjan , Hojs Radovan
Published: June 2020

Background and Aims

Assessment of optimal hydration status in patients with end-stage renal disease (ESRD) on peritoneal dialysis (PD) is a challenge. Multiple diagnostic options to determine hydration status in PD patients are available. Multifrequency bioimpedance spectroscopy (MBIS) is a cheap, simple and non-invasive method of estimating body composition, including estimates of total body water (TBW), extracellular water (ECW), intracellular water (ICW) and the ratio between both spaces (ECW/ICW). Lung ultrasonography (LUS) and lung B-lines (lung comets) can be used for the evaluation of extravascular lung water. Ultrasound evaluation of inferior vena cava (UIVC) provides rapid, non-invasive assessment of a patient's hemodynamic and volume status. N-terminal pro-brain natriuretic peptide (NT-proBNP) is related to fluid status and fluid distribution. The aim of our study was to assess fluid status in PD patients comparing four different methods: MBIS, LUS, UIVC and NT-proBNP.

Method

We performed a single-centre cohort study in 19 PD patients. The body composition was measured using the portable whole-body MBIS device, Body Composition Monitor-BCM(®) (Fresenius Medical Care, Bad Homburg, Germany), LUS with portable US device (VScan, General Electrics Corporate), UIVC index with SonoSite US device. NT-proBNP was measured in a one-step sandwich chemiluminescent immunoassay (Dimension Vista® System 1500, Siemens Healthcare Diagnostics Inc., Newark, NJ, USA).

Results

The mean age of patients was 54 ± 10 years, mean dialysis vintage 53 (10-194) months, 63% were men. Thirteen (68.4%) patients had fluid overload (FO) > 1.1 L. Data of patients are presented in table 1. We found a statistically significant correlation between the number of lung comets and ECW/ICW ratio (r = 0.496, P = 0.031) and NT-proBNP (r = 0.759, P < 0.0001). In contrast, there was no significant correlation between the number of lung comets and UIVC (r = 0.221, P < 0.364).

Conclusion

According to our results, LUS with lung comets, MBIS with ECW/ICW ratio and NT-proBNP are useful and complementary methods for evaluation of fluid status in PD patients.
P1189OFFICE AND AMBULATORY RECORDING OF CENTRAL AORTIC PRESSURES, WAVE REFLECTION AND ARTERIAL STIFFNESS INDICES IN PERITONEAL DIALYSIS PATIENTS
Authors: Vaios Vasilios , Georgianos Panagiotis , Vareta Georgia , Geropoulou Evaggelia , Ntounousi Evangelia , Papagianni Aikaterini , Zebekakis Pantelis , Liakopoulos Vassilios
Published: June 2020

Background and Aims

Among peritoneal dialysis (PD) patients, aortic blood pressure (BP) and arterial stiffness indices are independent predictors of cardiovascular morbidity and mortality. Previous studies in PD patients recorded these parameters only in the office. The present study provides comparisons between office and ambulatory recordings of these parameters and explores the association of demographic, clinical and hemodynamic variables with high arterial stiffness.

Method

In 81 stable PD patients (mean age: 61.3±16.3 years; male gender: 64.2%), brachial and aortic BP, heart rate-adjusted augmentation index (AIx75) and pulse wave velocity (PWV) were recorded after a 5-minute seated rest in the office using the oscillometric device Mobil-O-Graph (IEM, Stolberg, Germany). Subsequently, all patients underwent ambulatory recording of these parameters with the same device for 24 hours. Logistic regression analysis was performed to identify factors independently associated with high ambulatory PWV.

Results

As expected, office brachial systolic BP (SBP) was higher than 24-hour brachial SBP (134.2±22.7 vs. 129.0±18.0 mmHg, P<0.01). Similarly, office aortic SBP was higher than 24-hour aortic SBP (122.5±20.1 vs. 117.1±16.1 mmHg, P=0.001). By contrast, office AIx75 did not differ from 24-hour AIx75 (23.4%±11.7% vs. 23.9%±9.3%, P=0.602), whereas office PWV was only slightly higher than 24-hour PWV (9.2±2.3 vs. 9.0±2.2m/sec, P=0.001). Participants stratified in the high PWV tertile were older, had higher 24-hour mean BP (MBP) and had more commonly history of diabetes, dyslipidemia and coronary heart disease. In multivariate analysis, older age (OR: 4.23; 95% CI: 1.59-11.24) and higher 24-hour MBP (OR: 1.31; 95% CI: 1.03-1.67) were the only independent determinants of high PWV.

Conclusion

Among patients on PD, brachial and central aortic pressures recorded in the office were higher than 24-hour ambulatory pressures, whereas this variation between office and ambulatory recordings was diminished for AIx75 and PWV. Future studies are warranted to explore the prognostic significance of these parameters in the PD population.
P1192METABOLIC SYNDROME IN PATIENTS UNDERGOING PERITONEAL DIALYSIS (PD): A SINGLE CENTER EXPERIENCE
Authors: Di Gruttola Oto , Paribello Giuseppe , Paduano Immacolata Gaia , Migliaccio Silvia , Argentino Gennaro , Sannino Giuseppina , Russo Domenico
Published: June 2020

Background and Aims

Metabolic syndrome (MS) is a set of alterations represents a cluster of risk factors that increase the probability of causing cardiovascular (CV) events by three times. The aim of our study was to analyze the prevalence of MS in patients with Chronic Renal Failure undergoing replacement treatment by peritoneal dialysis afferent to our center.

Method

We retrospectively studied 117 patients in PD (2015-2019 census period). The characteristics are reassumed in tab1. We assessed the prevalence and impact of MS considering hard outcome: death for IMA and cerebral death. Patients with at least 3 of the following diagnostic criteria (CD) were considered affected by MS: waist circumference> 102 cm in men or > 88 cm in women, high blood pressure (PA> 130/85 mmHg or under pharmacological treatment), HDL levels <40 mg/dl in men or <50 mg/dl in women, triglycerides> 150 mg/dl and fasting glucose> 100 mg/dl or under pharmacological treatment.

Results

The prevalence of MS in our cohort is 46% (54 patients), the patients who have 2 CD are 29% (34 patients), those with only 1 CD 25% (29 patients), no patient had 0 CD. Arterial hypertension represents the most represented risk factor (RF) (91.1%) in agreement with the literature and with the Framingham Offspring Study (non-dialysis patients). The others RF are distributed in this way: reduced HDL (55.8%), hypertriglyceridemia (40.2%), high waist circumference (38.2%), fasting hyperglycaemia (24.5%) (graph 1). Among the 54 patients with MS, 12 CV events occurred during the observation period, while among the 34 patients with two CD, 8 CV events occurred. Among the 29 patients with only 1 CD there was 1 death attributable to CV causes (graph 2). From these data it is clear that MS is a risk factor for CV events according to the literature. It is interesting to observe that comparing the group of patients with 2 CD and with 1 CD, it shows that the presence of 2 CD is a sufficient risk factor to increase the probability of CV events (OR = 8.6 & p <0.05 ).

Conclusion

The prevalence of MS in patients receiving peritoneal dialysis is elevated with a negative impact on the risk of CV events. At the same time, our data shows the importance of assessing each individual risk factor regardless of the presence of full-blown MS. In particular, we observed that the presence of 2 CD is sufficient to predispose CV events. This shows that timely treatment of RF, even in the absence of full-blown MS, could favor the reduction of the risk of CV events in patients in DP
P1197ASSISTED APD IN ITALY: TRENTO EXPERIENCE
Authors: Devoti Elisabetta , Venturelli Chiara , Laudon Alessandro , Brunori Giuliano
Published: June 2020

Background and Aims

End-stage renal disease (ESRD) is common in elderly and fragile patients with several comorbidities. Dialysis (Hemodialysis-HD or Peritoneal Dialysis-PD) is often required. The choice between HD or PD is sometimes not easy. PD prevalence is significantly lower than HD prevalence in old and fragile patients because they are less likely to complete PD assessment, and due to stress over performing self-therapy. In the last years, in order to overcome these problems, assisted PD programs have spread out in several countries.

Method

Since 2008 in Trento Province (area of 541.399 people in the North East of Italy) we developed a program for elderly non-self sufficient patients requiring dialysis in nursing home. Admission criteria in nursing home were: age>65 years, living in the province, PD therapy, non-self patient, no acute complications, no home caregivers. This patient had a priority access to nursing home. We selected HomeChoice Baxter APD as PD technique. Our nurses gave specific training of 6 hours to nursing home nurses. The patients were on APD during the night. Every 45 days patients had a clinical visit by nephrologists and hospital PD nurses, with a particular emphasis on clinical data and dialysis performances.

Results

From 1.1.2008 to 12.31.2018 we enrolled 36 patients (16 male and 20 female) in a population of 226 PD incident patient, age (M±DS) at PD start was 78 ± 7.3 years (range 65-91); break-in was 27 ± 20.4 days and time in PD was 374 ± 347 days (range 15-1257). The cumulative incidence of peritonitis was 1/75-patient/month. During these eleven-year period we trained 19 nursing home nurses.

Conclusion

Assisted APD in nursing home could be an appropriate therapy choice for non-self sufficient elderly patients requiring renal replacement therapy. These option is safe for patients and could increase PD incidence.
P1198CATHETER-RELATED INFECTIONS DUE TO SERRATIA SPECIES IN PATIENTS RECEIVING PERITONEAL DIALYSIS
Authors: Au Christy , Chan Jasper , Yip Terence , Yap Desmond , Chan Daniel Tak Mao
Published: June 2020

Background and Aims

Serratia species can cause catheter-related infections in peritoneal dialysis (PD) patients but data on this clinical entity remains limited. This study aims to investigate the clinical characteristics, antibiotics susceptibility/resistance profiles and treatment outcomes of Serratia catheter-related infections in PD patients.

Method

We retrospectively reviewed all PD patients who were followed up at Queen Mary Hospital and Tung Wah Hospital, Hong Kong between 2004 to 2017. Patients with Serratia exit site infection (ESI) or peritonitis were included for analysis.

Results

One hundred and seventy-three patients with Serratia catheter-related infections were included. 161 patients had ESI, of which 10 (6.2%) progressed to tunnel tract involvement and 11 (6.8%) developed PD peritonitis. Skin abnormalities surrounding the exit site were present in 58 patients (36%), and 40 patients (24.8%) were hospitalized within 1 month prior to Serratia ESI. 142 patients (88.2%) with ESI responded to medical therapy alone, and repeat ESI occurred in 56 patients (34.7%) at a median of 12 months. Twenty-two patients had Serratia peritonitis, which accounted for 1% of peritonitis during the study period. Concomitant intra-abdominal pathologies were detected in 12 patients (54.5%). Ten patients (45.5%) responded to medical treatment while the remaining 12 (54.5%) required catheter removal. Nine patients (36.4%) failed PD resumption and switched to chronic haemodialysis. Repeat peritonitis occurred in two patients at 2 months and 3 years after the initial episode respectively. While Serratia species in PD patients are generally susceptible to aminoglycosides, carboxy-/ureido-penicillins and carbapenems, they exhibit substantial rates of resistance to ampicillin, and 1st- and 2nd-generation cephalosporins.

Conclusion

Serratia ESI responds favourably to medical therapy and seldom progresses to tunnel tract infection or peritonitis. Serratia peritonitis is associated with considerable risk of catheter loss and peritoneal failure.
P1202EPIDEMIOLOGICAL AND EVOLUTIONARY PROFILE OF MECHANICAL COMPLICATIONS IN PERITONEAL DIALYSIS
Authors: Fattoum Safa , Samia Barbouch , Mariem Hajji , Nessrine Braiek , Tasnim Mesbahi , Imen Gorsane , Amel Harzallah , Fathi Ben Hmida , Mondher Ounissi , Taieb Ben Abdallah
Published: June 2020

Background and Aims

The success of peritoneal dialysis (PD) depends on a functional and sustainable peritoneal access. The mechanical complications of PD (MCPD) are a major cause of technique failure. The aim of the study was to determine the different types of these complications and to define their prevalence.

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, type, outcome of MCPD.

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 average body mass index (BMI) was 23,8 kg/m? All patients had a Tenckhoff 2 cuff catheter placed by a mini laparotomy.

Twenty six episodes of MCPD were noted in 17 patients (18,8%).The complications noted were early dialysate leakage in 2 patients(2,2%) spontaneously resolving before the beginning of the training, catheter obstruction in 8 patients(3 patients presented 3 episodes of obstruction each) (8,8%), umbilical hernia in 3 patients (3,3%), 2 patients had displaced repositioned catheter (2,2%). Five patients (5,5%) presented continued inflammation in the exit-site of the catheter: the outermost of the two Dacron cuffs spontaneously extruded in 2 patients, and was surgically extracted in 3 patients. Cuff externalization resolved the inflammation in all patients.

Conclusion

Successful access for PD placed by a trained operator is crucial in purpose to avoid MCPD. These complications must be treated on time to avoid technique failure.
P1208TREATMENT OUTCOMES IN PERITONEAL DIALYSIS PERITONITIS ARE NOT AFFECTED BY DEGREE OF RESIDUAL RENAL FUNCTION
Authors: Gleeson Sarah , Navaratnarajah Arun , Hisole Nora , McGrory Jacqueline , Chelapurath Titus , Galima Froilan , Zanovello Valentina , Bartholomew Carol , Punzalan Sally , Brown Edwina , Corbett Richard
Published: June 2020

Background and Aims

Early studies in peritonitis showed no difference in outcomes between anuric and non-anuric patients, despite pharmacokinetic studies showing the effect of residual renal function (RRF) on antibiotic clearance. Recent work identified a relationship between preserved RRF and treatment failure in gram-positive and culture-negative peritonitis. Our centre uses empiric vancomycin and gentamicin dosed by weight (both drugs) and by RRF (gentamicin). We sought to examine whether RRF is associated with treatment failure in our population.

Method

We retrospectively identified all episodes of PD peritonitis between January 2014 and July 2019 including demographic and clinical information. The RRF measured closest to the peritonitis episode was used. Treatment failure was defined as death, catheter removal or relapse.

Results

189 peritonitis episodes occurred in 128 patients (43% female, mean age 61.3±17.9). 80 episodes were caused by gram-positive bacteria, 49 gram-negative, 51 culture-negative, 5 fungal and 4 polymicrobial. 21, 88 and 61 episodes occurred in patients with a creatinine clearance <0.5, 0.5-5, and >5ml/min respectively. Creatinine clearance data was unavailable in 21 patients.

Treatment failure occurred in 72 cases (38%) (19 relapses, 52 catheter removals, 7 deaths). Treatment failure for all bacterial peritonitis episodes was not affected by RRF as compared to anuric patients: 0.5-5 (OR 0.41, 95% CI 0.12-1.35, p 0.14) or >5 (OR 0.90, 95% CI 0.22-3.67, p 0.88). There was no difference in outcome in sub-group analysis by type of organism. Antibiotic concentrations did not differ between the RRF groups.

Conclusion

Although limited by small numbers we found no association between the degree of RRF and outcome. We hypothesise this is because we monitor antibiotic concentrations and therefore dose antibiotics appropriate to the level of RRF. In PD peritonitis regimes that adjust for RRF there is no impact of RRF on treatment outcomes.
P1211IOT(INTERNET OF THINGS) FOLLOW-UP VS. CONVENTIONAL CARE IN PATIENTS WITH CONTINUOUS AMBULATORY PERITONEAL DIALYSIS: A RETROSPECTIVE, CASE-CONTROL STUDY
Authors: Li Aihua , Liang Mengjun , Jiang Zongpei
Published: June 2020

Background and Aims

Peritoneal dialysis (PD) has been accepted as a home-based, more cost-effective renal replacement therapy worldwide. Increasing evidence indicates that patients on PD have clinical outcomes that are not optimistic than those on hemodialysis. The reasons for these observations are multifactorial and include lack of experience on self health-care, limited modality of follow-up, belated prescription adjustments, and shortage of management of the various complications. Internet of things (IoT), a novel technology that would improve access to and compliance in PD patients, has been designed and deployed to PD patients in our center for the nursing follow-up.

Method

A retrospective, case-control study enrolled 30 patients on continuous ambulatory peritoneal dialysis (CAPD) in The Six Affiliated Hospital of Sun Yat-sen University from 2018.09 to 2018.10. The patients were categorized into IoT group (15 patients) and conventional group in which patients was selected by propensity score matching for the gender, age, dialysis age and basic nephropathy. All the patients had been followed up for 3 months to assess their quality and compliance of PD. IoT follow-up was defined as the framework of home-based sphygmomanometer, electronic scale, weighing scale and portable application description (PAD) via bluetooth and the nurses in PD group could review the data timely over the internet and provide care management advice. Conventional care was defined as telephone or outpatient follow-up monthly.

Results

There were no differences among gender, age, dialysis age, and basic nephropathy distribution between the two groups. After 3-month follow-up, the weight compliance rate in IoT group seemed better than that in conventional group, with rate of 100% and 80%, p=0.068; the blood pressure compliance rate in IoT group seemed higher than that in conventional group, with rate of 60% and 46.7%, p=0.464. Nine patients (the rate of 60%) in IoT group, while only 2 patients (13.3%) in conventional group, had got alterations of hypotensive drugs, p=0.008. Eight patients (53.3%) in IoT group had acquired adjustments of PD doses, while no patient in conventional group had any changes, p=0.001.

Conclusion

Our preliminary results had indicated that IoT technology could provide innovations and timeliness for basic nursing care in PD follow-up. IoT devices would help to improve the availability and effectiveness of peritoneal dialysis.
P1214RELATIONSHIP BETWEEN CHANGE IN DIALYSATE CONDUCTIVITY AND INTRAPERITONEAL VOLUME DURING PET
Authors: Rosales Merlo Laura , Zhu Fansan , Kotanko Peter
Published: June 2020

Background and Aims

Bioimpedance spectroscopy (BIS) has been widely applied to measure fluid volume in dialysis patients. A fundamentally important, yet unanswered question is how changes in fluid conductivity affects the accuracy of BIS measurements. The aim of this study was to investigate whether the change in intraperitoneal volume (IPV) is – as hypothesized - linearly correlated with the change in dialysate conductivity during a peritoneal equilibrium test (PET).

Method

Four PD patients (age 58±13 years, three males, weight 87.8±28 kg) were studied during a standard PET. Segmental BIS was continuously measured with eight electrodes placed between rib and buttock on both sides of the body using a Hydra 4200 (Xitron Technologies Inc ). IPV was calculated based on BIS recordings as recently published (Zhu, Kidney Blood Press Res 2019;44:1465–1475). Dialysate samples were collected hourly from baseline to the end of dwell. Dialysate conductivity was measured with a portable conductivity meter (CDH-280-KIT, Omega Engineering Inc, CT, USA).

Results

In all patients dialysate conductivity increased significantly (p<0.0001) from baseline (11.14±0.15 mS/cm) to the end of dwell (12.5±0.58 mS/cm) (Fig a). In 2 patients (Fig b and c) IPV and conductivity were linearly correlated; in one patient (Fig d) the relationship was nonlinear and absent in another one (Fig e).

Conclusion

Although the number of patients in this study was small, the results clearly indicated that dialysate conductivity increased linearly over time during PET. The correlation between dialysate conductivity and IPV is not linear and may be driven by other factors, such as dialysate electrolyte levels. In future studies measurements of dialysate electrolytes are necessary to better understand the drivers of the IPV / conductivity relationship.
P1217VALUE OF MYCOBACTERIUM TUBERCULOSIS SPECIFY ELISOPT IN THE DIAGNOSIS OF PERITONEAL DIALYSIS-ASSOCIATED TUBERCULOUS PERITONITIS PATIENTS
Authors: Fan Qiuxia , Huang Xiaoyan , Xiong Zibo , Zhang Jieyun , He Yan
Published: June 2020

Background and Aims

Patients with ESRD undergoing chronic dialysis are 6 to 25 times more likely to develop tuberculosis (TB) than the general population. Tuberculous peritonitis is the most common form of tuberculosis infection in peritoneal dialysis patients. However, diagnosing active TB infection can be challenging, early and rapid diagnosis of tuberculous peritonitis has always been a challenge for nephrologists. M.tuberculosis antigen-specific IFN-γ production by peripheral blood mononuclear cells (PBMC) was determined by using an in-house ELISPOT assay by Institute of Hepatology of Shenzhen Third Hospital.In this study, we evaluated diagnostic performance of an M.tuberculosis antigen-specific gamma interferon enzyme-linked immunospot (ELISPOT) assay in continuous ambulatory peritoneal dialysis (CAPD) patients with tuberculous peritonitis.

Method

There were nine patients (1.29%) with tuberculous peritonitis among 700 CAPD patients. M. tuberculosis accounted for 2.84 % of all peritonitis.IFN-γ response in peripheral blood and peritoneal fluid were determined in 9 patients with tuberculous peritonitis(TBP),at the same time, 13 cases diagnosed with non-tuberculous peritonitis(NTBP) were enrolled.All patients were examined for tuberculosis-specific IFN-γ ELISPOT in peripheral blood and peritoneal dialysis fluid.

Results

22 patients were recruited into this study, 9 were classified with confirmed tuberculosis peritonitis, 13 patients with bacterial or fungal peritonitis were enrolled as controls during the same period, in this patients, 3 were caused by Gram positive bacteria, 3 were caused by Gram negative bacteria, 3 were caused by fungus, 4 patients were negative athogenic bacteria culture .The AUC of ROC curve was 0.927 (95%CI:0.816–1.000,P=0.001) for ELISPOT on PFMC, which was higher than that of ELISPOT on PBMC (0.825,95%CI: 0.6490–1.000,P=0.011).When the cutoff value for the diagnosis of TBP was 40.5 SFCs/2 × 105 for ELISPOT on PBMC, with a sensitivity of 55.6%, a specificity of 92.3%,a diagnostic efficiency of 77.3%,The positive predictive value was83.3%, with negative predictive value of 75%,positive likelihood ratio of 7.2, and negative likelihood ratio of 0.48.The sensitivity, specificity,diagnostic efficiency,PPV, NPV, LR+, and LR- of the ELISPOT assay for the diagnosis of active TBP when performed on the PFMC were 77.8%, 84.6%, 81.8%, 77.8%, 84.6%, 5.05 and 0.26, respectively.Receiver operating characteristic(ROC) curves were used to estimate the diagnostic values of Elispot on PFMC and PBMC in 22 patients with confirmed TBP or NTBP.

Conclusion

IFN-γ release test can be used for early diagnosis of CAPD-related TBP; compared with peripheral blood, peritoneal dialysate may be a more effective and accurate way to diagnose CAPD complicated with tuberculous peritonitis.
P1224ROLE OF DIAGNOSTIC IMAGING DURING PERITONITIS IN PERITONEAL DIALYSIS PATIENTS
Authors: Lwin Khin Zar Li , Foo Marjorie , Htay Htay
Published: June 2020

Background and Aims

Peritonitis in peritoneal dialysis (PD) patients can be directly related to PD or secondary to intrabdominal infection (secondary peritonitis). The indication and role of imaging of abdomen during peritonitis in PD patients is unclear.

Method

This was a single center, retrospective study, including all the first episode of peritonitis in incident PD patients from the period of January 2013 to October 2017. Primary aim of the study was to identify the incidence of secondary peritonitis diagnosed by imaging of abdomen (defined as positive scan finding of intraabdominal lesions) in PD patients with peritonitis. Secondary outcomes were predictors for secondary peritonitis analyzed by multivariable logistic regression.

Results

There were total 527 incident PD patients during the study period. Of these, 153 patients (29%) developed at least one episode of peritonitis. The mean age of patients with peritonitis was 57.7 ± 3.4 years, 49 % were male, and 52% had diabetes mellitus. Out of 153, 78 patients (51%) underwent diagnostic imaging of abdomen to look for secondary peritonitis. Majority of them had contrast enhanced computed tomography (CT) scan (95%) and the remaining had non-contrast CT scan or ultrasound of abdomen. Of 78 patients who underwent scan, 12 patients (16%) were reported to have intra-abdominal lesions (secondary peritonitis) including colitis (n=2), pancreatitis (n=1), cholecystitis (n=4), appendicitis (n=1), intestinal obstruction (n=2), liver abscess (n=1), gastric cancer (n=1). According to the causative micro-organisms, the positive scan finding of intra-abdominal lesions was more commonly observed in Gram-negative peritonitis (n=7, 58%), followed by fungal/mycobacterial peritonitis (n=2, 17%), Gram-positive peritonitis (n=2, 17%), polymicrobial peritonitis (n=1, 8%), but none (0%) in culture negative peritonitis. Among patients with Gram-negative peritonitis who underwent the imaging of abdomen, only 12% (7/58) were reported to have intra-abdominal lesions. In multivariable logistic regression, the presenting symptoms including fever (odds ratio (OR) 1.51, 95% confidence interval (CI) 0.40 – 5.68), abdominal pain (OR 1.08, 95% CI 0.24 -1.78), presence of cloudy of effluent (OR 0.66, 95% CI 0.19 -2.29), hypotension on presentation (OR 3.61, 95% CI 0.75 -17.46) or effluent white cell counts on presentation (OR 0.99, 95% CI 0.93 -1.05) were not significantly associated with secondary peritonitis.

Conclusion

A considerable number of patients underwent imaging of abdomen during peritonitis regardless of causative organisms, only a few of them had intra-abdominal lesions. Future prospective study is needed to guide the role of imaging in PD patients during peritonitis.
P1227SURVIVAL OF PATIENTS TRANSFERRED FROM HEMODIALYSIS (HD) TO CHRONIC AMBULATORY PERITONEAL DIALYSIS (CAPD) DUE TO POOR ARTERIOVENOUS (AV) ACCESS
Authors: Qayyum Ahad
Published: June 2020

Background and Aims

This study was carried out to ascertain the 6 month survival of patients who were transferred from hemodialysis to peritoneal dialysis due to poor vascular access at tertiary care facility in Pakistan. PD remains an under-utilized and unpopular modality of renal replacement therapy. One of the major reasons for its unpopularity remains poor patient selection. Furthermore PD is used as a last resort when AV access for HD becomes impossible in Pakistan.

Method

This study was carried out over a 4 year period. All patients transferred from hemodialysis onto peritoneal dialysis were included in the study. A total of 23 patients of Pakistani decent were switched to peritoneal dialysis from hemodialysis because of poor AV access. All patients included in the study had undergone venograms and consultation with vascular surgeons to confirm that AV access henceforth was inadequate for hemodialysis to continue. After placement of the peritoneal dialysis catheter a 2 week rest period was given to each patient before CAPD was initiated. The 6 month survival of each patient from the point of being transferred to CAPD was noted.

Results

The mean age of patients included in the study was 58 years. 80% of the participants were known to have diabetes mellitus. 15 out of the 23 patients included in the study died within 6 months of starting peritoneal dialysis. 12 out of the 23 patients included had difficulties in achieving either required ultrafiltration or KT/V despite ensuring correct catheter placement and following standard CAPD good practices.

Conclusion

Patients being switched from hemodialysis to CAPD due to poor AV access carry a greater than 50% 6 month mortality rate. In a country where PD struggles to gain popularity, we need to be very selective in starting patients on this modality with a realization that PD cannot be kept as a last resort rather should be advocated as the first choice therapy. Only then can the true benefits of PD be exhibited.
P1236EFFECTS OF SACUBITRIL-VALSARTAN IN HEART FAILURE WITH PRESERVED EJECTION FRACTION IN PATIENTS UNDERGOING PERITONEAL DIALYSIS
Authors: Fu Sha , Xu Zhenjian , Lin Baojuan , Chen Junzhe , Huang Qiuyan , Xu Yanchun , Xu Anping , Chen Yangxin , Tang Ying
Published: June 2020

Background and Aims

Angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril–valsartan is a landmark drug in heart failure with reduced ejection fraction (HFrEF), however, it remains unclear in patients with heart failure with preserved ejection fraction (HFpEF), especially the data of ARNI treatment on peritoneal dialysis (PD) patients with HFpEF are lacking. The present study was designed to determine the efficacy and safety of sacubitril–valsartan in patients with HFpEF undergoing peritoneal dialysis.

Method

We assigned end stage renal disease (ESRD)patients, receiving peritoneal dialysis for 3 months, with New York Heart Association (NYHA) class II to IV heart failure, left ventricular ejection fraction ≥ 50%, and elevated level of N-terminal pro–B-type natriuretic peptide (NT-proBNP) to receive sacubitril/valsartan treatment. Patients were regularly followed up after medication treatment. Wilcoxon matched-pair signed-rank (2 samples) tests were applied to investigate the alterations in Clinical and biochemical parameters as the efficacy before and after taking sacubitril–valsartan, and safety was also assessed.

Results

Twenty-one patients were recruited in this study. Compared with baseline levels, NT-proBNP levels (p=0.002) and heart rate (p=0.031) were markedly decreased after treatment with sacubitril/valsartan, signs and symptoms of heart failure (21/21 versus 15/21, p=0.021) and NYHA classification were notably improved after 3-12 months follow-up.

Conclusion

The present data suggested that sacubitril/valsartan treatment in the patients with HFpEF undergoing peritoneal dialysis was effective and safe, which is the first study about sacubitril/valsartan treatment for the PD patients with HFpEF, and it may bring the hope for these patients due to no other effective methods at present.
P1239SHORT- AND LONG-TERM OUTCOME OF END-STAGE RENAL DISEASE PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Authors: Kida Hirota , Hikoso Shungo , Sunaga Akihiro , Bolrathanak Oeun , Kojima Takayuki , Dohi Tomoharu , Kitamura Tetsuhisa , Okada Katsuki , Suna Sinichiro , Nakatani Daisaku , Mizuno Hiroya , Sakata Yasushi
Published: June 2020

Background and Aims

End-stage renal disease (ESRD) patients frequently have the coronary artery disease. However, the short- and long-term outcome of ESRD patients with acute myocardial infarction (AMI) is little known. The aim of this study was to clarify it.

Method

Using the database of the Osaka Acute Coronary Insufficiency Study (OACIS), 8702 consecutive AMI patients (male: 75.2%, mean age: 66.9±12.2yrs) from 2002 to 2013 were analyzed. We classified these patients into two groups, those with ESRD [ESRD group (n=271)] and without ESRD [No-ESRD group (n=8431)] and examined in-hospital or long-term all-cause mortality. ESRD was defined as eGFR<15ml/min/1.73m2.

Results

ESRD group had higher frequency of diabetes (59.3% vs 37.8%, p<0.01), hypertension (90.1% vs 63.3%, p<0.01), Killip class≧2 (40.1% vs 21%, p<0.01), multi-vessel disease (69.3% vs 50.8%, p<0.01), and lower frequency of peak CK>3000 (21.7% vs 32.4%, p<0.01) than No-ESRD group. Mean follow-up period was 1041±721 days. In hospital mortality of ESRD group was 27% and No-ESRD group 7.2%. In patients who discharged alive (8027 patients), 1-year mortality of ESRD group was 12.2% and No-ESRD group 3.3%, 3-year mortality of ESRD group was 29.3% and No-ESRD group 8.7%. Kaplan-Meier analysis revealed that the all-cause mortality (log-rank p<0.01) was significantly higher in ESRD group than No-ESRD group. In ESRD patients who discharged alive (203patients), Cox univariate analysis after multiple imputation revealed that peak CK>3000 was significantly associated with an increased risk of mortality (Hazard ratio 2.67, 95% confidence interval 1.18to 6.07, p=0.031).

Conclusion

In patients with AMI, ESRD was significantly associated with worse short- and long-term outcome, suggesting that careful treatment might be required in ESRD patients with AMI, especially had peak CK>3000.
P1243ABSOLUTE BLOOD VOLUME VARIATIONS INFLUENCED BY DIALYSATE TEMPERATURE DURING HAEMODIALYSIS
Authors: Álvarez Nadal Marta , Martin Irene , Viera Ramírez Elizabeth , Fernandez Lucas Milagros
Published: June 2020

Background and Aims

Intradialytic hypotension is a common complication in haemodialysis. Vascular refilling occurs to preserve haemodynamic stability. Recent studies report a feasible and noninvasive method to determine absolute blood volume, which would allow us to estimate vascular refilling during haemodialysis. During years, it has been proposed that lowering the dialysate temperature could improve intradialytic hypotension outcomes in patients undergoing chronic haemodialysis. The objective of this study is to analyze if lowering dialysate temperature modifies variations in absolute blood volume during haemodialysis.

Method

The study was performed in 51 patients under haemodialysis treatment. During two different sessions, relative blood volume was assessed using dialysate temperatures of 35.5ºC (cool dialysate) and 36.5ºC (neutral dialysate). Absolute blood volume and vascular refilling were calculated using Kron et al methodology (Hemodial Int. 2016;20(3):484–91). Intradialytic hypotension was defined as a systolic blood pressure below 85 mmHg or a drop of pressure above 20 mmHg accompanied by symptoms. Statistical analysis was performed using paired t-Test or Wilcoxon rank sum.

Results

31 episodes of intradialytic hypotension were observed, 14 under cool dialysate and 26 during neutral dialysate. We did not found statistically differences in absolute blood volume or in refilling volume between cool and warm dialysate temperature. In the group of patients with intradialytic hypotension (Table 1) we observed lower drop in absolute blood volume in the 35.5ºC dialysate group (0.59 L) versus 36.5ºC group (0.72 L). Although no statistically significant differences were found in vascular refilling volumes, when cool dialysate was used refilling tended to be higher.

Conclusion

It seems that in selected groups of patients the use of cool dialysate could improve absolute blood volume stability during HD treatments, although further studies are needed.
P1244MILD DIFFERENCES IN CARDIAC CALCIFICATION BETWEEN WILD TYPE AND SCLEROSTIN KNOCKOUT MICE WITH CKD
Authors: De Maré Annelies , D'Haese Patrick , Verhulst Anja
Published: June 2020

Background and Aims

Ectopic soft tissue calcifications, especially cardiovascular calcifications, are frequently observed in patients with chronic kidney disease (CKD) and are associated with increased morbidity and mortality. Sclerostin, a well-known inhibitor of bone formation, shows significantly increased serum levels in CKD patients. Since the process of ectopic calcification shares many similarities with physiological bone formation, we investigated a possible role for sclerostin in ectopic calcification development.

Method

CKD was induced in wild type (WT) (n=21) and sclerostin knockout (Sost ko) mice (n = 21), both on a C57Bl6/J background, by the alternate administration of a 0.30% and 0.15% adenine supplemented diet, containing 1% phosphate. A normal renal function control group receiving standard mouse chow (WT C57Bl6/J n = 8) was also included in the study. Serum creatinine and phosphate levels were measured at the start and end of the study to assess CKD development. At sacrifice, the calcium content of the kidneys, heart and aorta was determined by flame atomic absorption spectrometry.

Results

The adenine-supplemented diet led to a clear induction of CKD in both the Sost ko and wild type mice, as reflected by increased serum creatinine (0.38 ± 0.09 mg/dL in control mice vs 0.65 ± 0.18 mg/dL in adenine-exposed mice, p<0.0001) and phosphate levels (9.12 ± 1.16 mg/dL in control mice vs 19.03 ± 3.11 mg/dL in adenine-exposed mice, p<0.0001). The Sost ko and WT mice receiving the adenine diet, developed the same degree of renal failure, since there were no differences in serum levels of creatinine (p=0.0507) and phosphate (p=0.4890). Significantly higher amounts of calcium were measured in the kidney (0.05 ± 0.01 mg/g wet tissue vs 3.70 ± 2.00 mg/g wet tissue, p<0.0001) and the heart (0.03 ± 0.01 mg/g wet tissue vs 0.07 ± 0.04 mg/g wet tissue, p<0.0001) of adenine-exposed mice, compared to mice receiving the control diet. Furthermore, Sost ko mice had a significantly higher calcium content in the heart compared to the WT mice with renal failure (0.05 ± 0.03 mg/g wet tissue in WT mice vs 0.08 ± 0.05 mg/g wet tissue in Sost ko mice, p = 0.0029). No differences were observed in aortic calcium content between control mice and mice with renal failure.

Conclusion

In this study we managed to develop a mouse model of CKD-induced soft tissue calcification in the heart and kidneys of the animals, however no calcifications developed in the aorta. The higher calcium content that was observed in the heart of Sost ko mice compared to WT mice, might be an indication of a protective function of sclerostin during ectopic cardiac calcification
P1245AORTIC ARCH CALCIFICATION AND PROGNOSIS IN HEMODIALYSIS PATIENTS
Authors: Hashiba Toyohiro , Honda Tomoko , Kishi Satoru , Takenaka Yuto , Furuse Satoshi , Nishio Kyosuke , Masaki Kazunobu , Kano Tatsuya , Mise Naobumi
Published: June 2020

Background and Aims

Aortic arch calcification (AAC) is associated with poor survival in dialysis patients, but long-term prognosis has not been examined well.

Method

In the present study, we investigated the prognostic impact of AAC among 321 chronic hemodialysis patients (211 males, 64±11 ages, dialysis history 10±8 years). ACC in chest X-ray was evaluated in 2012 and the patients were followed up for 7 years. The degree of AAC was classified into 4 categories as follows: Grade 0, no visible calcification; Grade 1, small spots of calcification or single thin calcification of the aortic knob; Grade 2, one or more areas of thick calcification; and Grade 3, circular calcification of the aortic knob.

Results

Calcification gravity was Grade 0 in 88 patients (27%), Grade 1 in 145 (45%), Grade 2 in 54 (17%) and Grade 3 in 34 (11%). All-cause mortality was significantly worse in patients with higher AAC grade (Grade 0: 19% (n=17), Grade 1: 35% (n=51), Grade 2: 46% (n=25), Grade 3: 71% (n=24); p < 0.0001). Univariate analysis showed AAC grade, age, cardiothoracic ratio, ischemic heart disease, cerebral vascular disease, albumin, hemoglobin, C-reactive protein and use of non-Ca phosphorus binders were significantly associated with all-cause mortality. In multivariate analysis, Grade 3 AAC, age and ischemic heart disease were independent risk factors for all-cause mortality.(Figure)

Conclusion

In our dialysis patients, higher gravity of AAC was independently associated with all-cause mortality. Gravity of AAC in chest X-ray is useful to predict prognosis of dialysis patients.
P1246CEREBRAL TISSUE REGIONAL OXYGEN SATURATION AND BLOOD PRESSURE IN HEMODIALYSIS PATIENTS
Authors: Spanos Georgios , Paschou Styliani , Dontsios Christos , Fragkidis Stylianos , Bantis Christos , Armentzoiou Livia Karmen , Tsantekidou Ellada , Bamichas Gerasimos
Published: June 2020

Background and Aims

Patients undergoing hemodialysis (HD) often develop cerebral disease complications. Cerebral tissue regional oxygen saturation (rSO2) through near-infrared spectroscopy (NIRS) is a non-invasive method for cerebral tissue oxygenation monitoring. The aim of the study was to investigate the relationship between rSO2 and hemodialysis in stable HD patients. Additionally, we wanted to investigate how blood pressure during HD is associated with rSO2.

Method

This is a single centre cross-sectional study in clinically stable HD patients. Cerebral rSO2 was monitored at the forehead 10min before, during and 10min after HD, using an INVOS 5100C device (Medtronic, United Kingdom).

Results

Thirty-nine stable HD patients (23 men and 16 women; mean age, 62.4 ± 14.6 years were recruited. Dialysis vintage was 65.7 ± 72.1 months, 9 patients had diabetes mellitus, 12 had vascular disease while 14 were smokers. The baseline rSO2 levels (49.6±9.1 %) were significantly lower in HD patients compared with historic results on healthy subjects. We found no difference in rSO2 results in patients with diabetes mellitus, vascular disease or smoking. Although we found a decrease (figure) in rSO2 when patients start dialysis (10min before vs 10min after starting dialysis 49.6±9.1 vs 48.1±9.9 %, p=0.021) rSO2 value returned to baseline after dialysis (10min before vs 10min after dialysis 49.6±9.1 vs 49.9±5.9 %, p=ns. Systolic blood pressure scientifically dropped during the first hour of dialysis (146.7 ± 21.1 vs 137.3 ± 24.6, p=0.03) and systolic blood pressure drop correlated with rSO2. Three patients developed hypotensive episodes requiring iv fluids but these hypotensive episodes had no correlation with rSO2 variations.

Conclusion

Cerebral rSO2 decreases while patients are on dialysis but return to baseline after dialysis. Blood pressure variations correlate with rSO2 levels but rSO2 do not forecast hypotensive episodes on dialysis.
P1266SERUM MALONDIALDEHYDE-MODIFIED LOW-DENSITY LIPOPROTEIN LEVEL IS A RISK FOR AORTIC STIFFNESS IN MAINTENANCE HEMODIALYSIS PATIENTS
Authors: Hou Jia-Sian , Lu Chia-Wen , Hsu Bang-Gee
Published: June 2020

Background and Aims

Circulating oxidized malondialdehyde LDL (MDA-LDL) induced macrophage apoptosis, the release of higher levels of matrix metalloproteinases and TNF-α, therefore, act as a marker of oxidative stress and are associated with atherosclerotic cardiovascular diseases. We evaluated the association between serum MDA-LDL levels and aortic stiffness in patients with hemodialysis (HD).

Method

A total of 155 patients with HD were enrolled in this study. Carotid-femoral pulse wave velocity (cfPWV) value was measured by a validated tonometry system (SphygmoCor). Patients with cfPWV >10 m/s were used to define the aortic stiffness group, while values ≤ 10 m/s were regarded as the control group, according to the ESH-ESC 2013. Serum MDA-LDL levels were measured using a commercial enzyme-linked immunosorbent assay.

Results

68 patients (43.9%) had aortic stiffness and higher percentages of diabetes (p < 0.001), hypertension (p = 0.017), and had older age (p = 0.038), higher systolic blood pressure (P = 0.021), serum MDA-LDL level (p < 0.001) compared to subjects with control group. After adjusting for factors significantly associated with aortic stiffness by multivariable logistic regression analysis revealed that serum MDA-LDL levels (odds ratio (OR): 1.014, 95% confidence interval (CI): 1.007–1.021, p < 0.001), diabetes (OR: 2.893, 95% CI: 1.300–6.437, p = 0.009), and hypertension (OR: 2.408, 95% CI: 1.066–5.436, p = 0.034) were the independent predictors of aortic stiffness in HD patients. Multivariable forward stepwise linear regression analysis also showed that serum logarithmically transformed MDA-LDL level (log-MDA-LDL, β = 0.404, adjusted R2 change = 0.265, p < 0.001), diabetes (β = 0.233, adjusted R2 change = 0.055, p = 0.001), and hypertension (β = 0.132, adjusted R2 change = 0.014, p = 0.048) were the independent predictors of cfPWV values in HD patients. The area under the receiver-operating characteristic (ROC) curve predicting aortic stiffness by serum MDA-LDL level in HD patients was 0.721 (95% CI: 0.643-0.790, p < 0.001).

Conclusion

In this study, high serum MDA-LDL level was positively associated with cfPWV values and thus was related to aortic stiffness in HD patients.