bluuebunny/crossref_metadata_2025 huggingface dataset:
P1089REGIONAL CITRATE ANTICOAGULATION VERSUS LOW MOLECULAR WEIGHT HEPARIN ANTICOAGULATION FOR CONTINUS VENOVENOUS HEMOFILTRATION IN PATIENTS WITH SEVERE HYPERCALCEMIA: A RETROSPECTIVE CASE-CONTROL STUDY
Authors: Sun Shiren , Bai Ming , Yu Yan , Zhang Wei , Li Yangping
Published: June 2020

Background and Aims

Severe hypercalcemia, poor conservative treatment effect, or combined with renal dysfunction, heart failure, intermittent hemodialysis treatment is recommended. But calcium-free hemodialysis could cause rebound of serum calcium, hypovolemia and hypotension. Continuous renal replacement therapy (CRRT) is the most commonly used treatment in critically ill patients with severe AKI. Some case reports showed that CRRT successed control calcium with stable hemodynamics, no rebound hypercalcemia, but there was only one case used continuous venovenous hemofiltration (CVVH). During CVVH treatment, clotting in the extracorporeal circuit shortens the filter and catheter lifespan, causes blood loss, and decreases solute clearance, consequently, reduces the effectiveness of CVVH and increases the treatment cost and medical stuff’s workload. So how to safely decrease calcium level and how to choose appropriate anticoagulants during CVVH in esvere hypercalcemia patients is a challenging work. We conducted a retrospective study to evaluate the efficacy and safety of regional citrate anticoagulation (RCA) versus low molecular weight heparin (LMWH) anticoagulation for CVVH in severe hypercalcemia patients.

Method

Between January 2014 and May 2019, severe hypercalcemia patients requiring CVVH were screened and divided into the RCA and LMWH-anticoagulation group according to the CVVH anticoagulation strategy they accepted. Serum calcium reduction rate (RRSeCa), filter lifespan, bleeding, totCa/ionCa ratio, citrate accumulation, and catheter occlusion were evaluated as outcomes.

Results

Of the 33 included patients, RCA and LMWH-anticoagulation were employed for CVVH in 14 and 43 filters, respectively. The serum calcium reduction rate (RRSeCa) was not significantly different between the LMWH-anticoagulation and RCA group (P = 0.320). Compared to LMWH-anticoagulation, RCA significantly prolonged the filter lifespan (> 72 hours vs. 24.0 hours [IQR, 15.0-26.0], P = 0.012). The incidence of filter failure was 55.8% (24/43) in the LMWH -anticoagulation group and 21.4% (3/14) in the RCA group (P = 0.033), respectively. The adjusted results demonstrated that RCA could significantly reduce the risk of filter failure (P = 0.028, 95% CI 0.076-0.859, HR = 0.255). No citrate accumulation was observed in RCA-CVVH patients.

Conclusion

In patients with severe hypercalcemia who underwent CVVH, both RCA CVVH and LMWH-anticoagulation CVVH could effectively decrease calcium levels. RCA CVVH had better filter lifespan and no obvious adverse events, compared with the LMWH-anticoagulation CVVH. Further prospective, randomized, control studies are warranted to obtain robust evidences.
P1093BENEFITS OF HOME HEMODIALYSIS
Authors: Todorov Sakic Verica , Djuric Zivka , Djuric Petar , Bulatovic Ana , Popovic Jovan , Naumovic Radomir , Dimkovic Nada
Published: June 2020

Background and Aims

Home hemodialysis (HOHD) has been available as a modality of renal replacement therapy since the 1960s, in our center since 1972. Despite better patients’ outcome provided by HOHD comparing to hospital hemodialysis (HHD), its adoption has been limited worldwide. The aim of this study was to compare anemia, nutrition, mineral metabolism and morbidity in patients on HOHD and HHD.

Method

we analyzed dialysis and uremia related complications and morbidity in 19 HOHD patients in comparison with patients on HHD (N= 57). Each HOHD patient was previously matched with three patients on HHD by sex, age and reason for end stage renal disease (ESRD). Patients on HHD were on dialysis 3x4 h per week while patients on HOHD had dialysis on consecutive days in duration of 5-6 hours. Also, patients on HOHD were more frequent on hemodiafiltration (HDF), 89.5% of them, as compared to HHD patients (only 21.4%).

Results

All patients on HOHD were using AVF as vascular access for HD, and most of the analyzed HHD patients (only 5.3% used AVG). As revealed by hemoglobin level (Hgb) patients on HOHD had significantly better anemia control than HHD patients (12±2.3 vs. 10.2±1g/dl, p=0.004), despite the lower ferritin level (94±117 vs. 256±175ng/ml, p=0,001) and less frequent use of erythropoietin-stimulating agents (ESA), (and only 31% on HOHD vs 80% patients on HHD, p=0,001). By analyzing patients that used ESA therapy, we revealed that HOHD patients had lower weekly dose of ESA (5333±3265 IU vs. 6068±4145 IU). The values of intact parathyroid hormone (iPTH), did not differ significantly between HOHD (311±419pg/ml ; min 5,25, max 1529) and HHD (233±212pg/ml; min 19,25, max 926), but higher percentage of patients in HOHD group underwent parathyroidectomy (63% vs. 3.5%). The average values of calcium, and phosphorus did not significantly differ between HOHD and HHD patients (2.4±0.3 vs. 2.3±0.2mmol/l; 1.5±0.5 vs. 1.6±0.5mmol/l, respectively). HOHD patients had significantly higher albumin level (43±4.5 vs. 40.6±4g/l, p=0,035). There was no difference in annual hospital admission rate (0.4±0.5 vs. 0.6±0.7, p=0.35) between groups, but HHD patients had longer in-hospital stay. (4.8±5.3 days for HOHD vs. 7.3±9.3 days for HHD; p=0.16). Vascular access complications were most frequent reason for hospitalization in both groups (37%), followed by cardiovascular complications 13.6%, in HOHD group and infectious complications in HHD group 24%.

Conclusion

Our study has shown that HOHD provides some advantages over HHD including better quality of life and better anemia and nutrition control, better control of parathyroid function and shorter in-hospital stay. More frequent and longer dialysis sessions may be possible reason including HDF.
P1102EVALUATION THE EFFICACY OF MEDIUM CUT- OFF MEMBRANE DIALYZERS AND COMPARISON WITH HIGH FLUX DIALYZERS IN CONVENTIONAL HEMODIALYSIS
Authors: Rambabova Bushljetikj Irena , Trajcheska Lada , Pushevski Vladimir , Biljali Sefedin , Balkanov Trajan
Published: June 2020

Background and Aims

Hemodialysis (HD) is the most widely used modality of renal replacement therapy. The high-flux dialyzers in standard hemodialysis offer numerous benefits for ESRD patients, such as, increasing the uremic toxins removal and improving patients survival, reduced patients admission and morbidity. A new class of membranes, medium cut-off (MCO) membranes, has been designed to achieve better removal capacities for middle and large middle molecules, as well as to ensure the retention of albumin in hemodialysis (HD) treatments. We evaluated the removal efficacy of Theranova® in standard HD in comparison with standard high- flux HD.

Method

Four stable HD patients (M/F 1/4) were included in 12-weeks small observational pilot study in HD with Theranova® 400 (sup. 1.7 m2) and Theranova® 500 (sup. 2.0 m2) dialyzers. Each patient was assessed four times, T0 with standard high flux dialyzers, T1 at 1 month, T2 at second month and T3 at third month, by measuring pre and post-HD samples of: urea, creatinine, beta2-microglobilin (B2M), myoglobin, albumin and FLC-k, FLC-λ . Data are reported as mean ± standard deviation (SD). The removal rates of uremic toxins are expressed as percentages.

Results

The average removal rates for the uremic toxins with standard high-flux membranes were 18.4% for B2M, 14.3% for Myoglobin, 19.8 % for FLC-k and 17.4 % for FLC-λ. The data showed a higher average removal rate for all the uremic toxins with Theranova® dialyzers for B2M, Myoglobin, FLC-k and FLC-λ (62.7%, 56.9%, 63.5%, 54.6%, respectively) during the 3 months of follow up. The using of Theranova® dialyzers in standard HD was enough to significantly decrease the pre-dialysis value of Urea (17.72 ± 2.26 vs 13.75 ± 3.75, p=0.001), Creatinine (700.50 ± 315.07 vs 570.00 ± 206.64, p=0.021), B2M (40.90 ± 11.00 vs 29.00 ± 4.64, p=0.005), FLC-k (267.25 ± 113.28 vs 225.25 ± 100.62, p=0.018), FLC-λ (324.25 ± 116.12 vs 215.23 ± 64.44, p=0.011), Myoglobin ( 199.96 ± 124.41 vs 137.00 ± 83.14, p= 0.049). Finally, albumin retention was observed with Theranova® dialyzers, between T0 and T3 it increased significantly (40.50 ± 4.79 vs 42.25 ± 4.50, p=0.0001).

Conclusion

Compared to high-flux dialysis membranes, novel medium cut-off (MCO) membranes show greater permeability for larger middle molecules in mid -term report. But the long term analysis and larger number of patients is necessary to evaluate a clinical significance of this innovative therapy.
P1108FLUID DYNAMIC ASSESSMENT OF THERANOVA DIALYZER THROUGH CT IMAGING TECHNIQUE
Authors: Lorenzin Anna , Golino Gianlorenzo , Godi Llaria , De Cal Massimo , Ronco Claudio
Published: June 2020

Background and Aims

Inadequate removal of molecules between 5and50KDa, due to their restriction in diffusibility, may cause long-term complication in chronic hemodialysis patients. Medium Cut-off(MCO) is a new class of membranes with enhanced sieving properties and negligible albumin loss, thanks to its high molecular weight(MW) retention onset and MW cut-off value lower than albumin MW. MCO membrane used in HD allows to perform expanded hemodialysis (HDx), a technique based on high internal filtration(IF). Our previous study quantified the IF of Theranova dialyzer leveraging a nuclear imaging technique. In order to characterize the local distribution of the IF, an in vitro study assessing the fluid dynamics inside Theranova dialyzer was conducted through CT imaging technique.

Method

Dialyzers Theranova 400 and 500(Baxter, Deerfield, USA) were placed in vertical position in the CT gantry. Blood and dialysate were circulated in countercurrent at 300ml/min and 500 ml/min, respectively. The two compartments were analyzed separately, injecting the dye solution, for both filters. Longitudinal sections, 0.5cm thick, were recorded for 60seconds.

Results

In blood compartment, dye solution immediately after its entrance in the dialyzer demonstrates homogeneous progression, while different velocity profiles were observed among the fibers proceeding to the outlet port (Fig b). In dialysate compartment, dye solution is distributed in the periphery first (Fig d), then seeps in the fibers bundle and reaches the complete compartment filling.

Conclusion

The homogeneous dye profile immediately after its entrance in blood compartment demonstrated a good design of the inlet port; the optimal dye distribution reached in both blood and dialysate compartments ensure that IF phenomenon is equally achieved in both central and peripheral regions of the dialyzer.
P1111MULTI ORGAN SUPPORT WITH EXTRACORPOREAL CARBON DIOXIDE REMOVAL (ECCO2R) AND CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) WITH CITRATE ANTICOAGULATION IN THE CLINICAL SETTING OF DIFFICULT WEANING FROM MECHANICAL VENTILATION
Authors: Ricci Davide , Sagliocchi Alessandra , Siniscalchi Antonio , Ranieri Marco , Mancini Elena
Published: June 2020

Background and Aims

Prolonged mechanical ventilation is associated with the risk of difficult weaning due to the onset of muscle weakness. A disproportion occurs between the respiratory workload and the muscular force, which leads to failure of the ventilatory pump and hypercapnia. Some early experiences suggest that ECCO2R facilitates weaning from the ventilator in patients with a high risk of failure.

Method

Clinical case: a 49 year-old man with a) recent orthotopic liver transplantation (cryptogenic cirrhosis), b) acute renal injury (AKI) on continuous veno-venous hemofiltration (CVVH) and c) acute respiratory distress syndrome (ARDS) requiring prolonged mechanical ventilation. After unsuccessful attempts at weaning from the ventilator, a lung membrane was inserted in series, before the hemofilter, on the CRRT circuit in order to remove CO2 and so reduce the workload of the respiratory muscles (Fig. 1). The patient was then extubated. We used citrate anticoagulation due to the presence of contraindications to systemic heparin (high bleeding risk, thrombocytopenia).

Results

ECCO2R + CRRT treatment requires a relatively high blood flow (300-350 ml / min) in order to extract a significant amount of CO2, but, the more the blood flow increases, the more citrate must be infused, and the more the metabolic load increases. The patient developed mild alkalosis as an initial sign of citrate accumulation (Table 1), but it was self-limiting. During ECCO2R we actually obtained the desired decrease in respiratory muscle effort (decrease in respiratory rate from 24 to 18 per minute and a maximum negative value of esophageal pressure from -8 to -4 cmH2O) and the treatment was interrupted after 36 hours. Mechanical ventilation was restored due to a complication independent of ECCO2R (massive pneumothorax). The patient tolerated the treatment for 36 hours.

Conclusion

ECCO2R proved an efficient and relatively simple technology helping respiratory function recovery. Due to the very frequent association of AKI and ARDS, leading to a high mortality rate, nephrological care in intensive care units should include this new treatment. Moreover, reduction of the inflammatory pathway secondary to mechanical ventilation could also benefit the evolution of AKI.
P1119ASSOCIATION OF VARIOUS RISK FACTORS WITH HEMODIALYZER SET CLOT INCIDENCES WHEN USING LOW DOSE UF- HEPARIN OF 400 IU BOLUS AND 400 IU INFUSION IN MAINTENANCE DIALYSIS SESSION : A CASE CONTROL STUDY
Authors: Umair Farrukh , Aftab Azib , Awan Safia , Amin Imrana
Published: June 2020

Background and Aims

Efforts were made in the past to reduce the use of heparin as anticoagulation to escape from the its Sid effects like Bleeding and HIT among others. We use Low dose UF -heparin use with bolus of 400 IU and 400 IU/hour infusion as an anticoagulation in hemodialysis patients. Set clot incidences were comparable to other studies. The objectives of this study is to see aassociations of different risk factors with hemodialyzer set clot incidences using Low dose heparin Infusion protocol in maintenance haemodialysis session.

Method

Data were obtained from the outpatient haemodialysis unit at tertiary care Hospital in Karachi, Pakistan. UF-low dose heparin 400 I.U bolus and 400 I.U maintenance infusion protocol were given to all patient. Case to control ratio was approximately 1:4. 300 cases of set clot were taken and 1200 control sessions without set clot outcome were matched for heparin use taken from the dialysis unit. The crude odds ratios (OR’s) and adjusted ORs (aORs) for various risk factors were obtained using conditional logistic regression.

Results

In a prelimary part of the study the incidence of set clot was 7% (309/4000 sessions) Age, dialysis vintage, hemoglobin level, Blood flow rate and type of anti-platelet therapy were significantly associated to the incidence of set clot. Among patients having age > 40 yrs. the odds of set clot were 2.8 (95% CI= 1.8-4.3) as compare to the patients with age ≤ 40 yrs. The odds of set clot were 0.268(95% CI=0.081-.88) among patients with hemodialysis vintage less than 1 year as compare to those who have more than 1 year. Blood flow rate <350 ml/min have an odds of 1.03(95%CI=0.76-1.40) of set clot incident as compare to BFR>350 ml/min. Those patients with Hemoglobin < 9 gm/dl have odds of set clot of 0.67(95%CI =0.48-0.92) as compare to hemoglobin > 9 gm/dl. Off all patients ,60.36% patients were either on aspirin or clopidogrel while around 9.58% were on combine antiplatelets therapy. The odds of set clot were 4.6 (95% CI =1.9-10.8) among patients on Combine antiplatelet therapy as compare to no antiplatelet therapy.

Conclusion

Age, low Blood flow rate and combine antiplatelet therapy (aspirin and clopidogrel) are positively associated with set clot accidents in dialysis sessions. Dual anti platelet therapy patients are given in ischemic heart disease patients hence Blood flow pumps are kept at lower speed which can increase the risk of set clot. Lesser duration on Hemodialysis (i.e. less than 1 year) and low hemoglobin levels are protective for incidence of set clot in our study population.
P1125IS THE SURPRISE QUESTION USEFUL AS A PREDICTOR OF MORTALITY IN HEMODIALYSIS PATIENTS?
Authors: Estifan Kasabji Jorge , Lucas Cristina , Sastre Arancha , De León Benjamin , Barnes Carmen , Monfa Elena , Barcia Veronica
Published: June 2020

Background and Aims

among the predictors of hemodialysis mortality, the “surprise” question (SQ) (Would you be surprised if this patient died within the next 6 or 12 months?) is a subjective variable, based on the patient's medical history, experience and knowledge. Recognized as a useful tool to identify a patient with a high risk of early mortality in Hemodialysis.

Objective

to assess a prognostic model of early mortality, based on clinical - biochemical parameters and the prediction of the clinician attending the patient.

Method

SQ is performed on 4 nurses and 4 nephrologists of the hospital hemodialysis unit, the Karnofsky Performance Scale Index of the patients is collected (KPSI 0: normal activity, KPSI 1: Unable to work, frequent medical attention, KPSI 2 : Unable to self-care, requires special care), and prospectively analyzed mortality at 6 and 12 months.

Results

The prevalent population studied in Hemodialysis is 180 patients, average age 69 years ± 14.1 (R 27-94), According to sex (Male 69%-Female 31%), the follow-up of the study was 1 year, we had 11 deaths 6 months and 17 deaths at 12 months, total 28 patients (15.7%).

The distribution of patients according to nurses and nephrologists staff (table 1) and patients characteristics (Table 2)

Conclusion: T he surprise question is a specific and sensitive instrument to predict sort-term survival in dialysis population especially in those with older age, more comorbid illnesses, lower functional status and hypoalbuminemia. of the analyzed factors; Karnofsky Index, age, surprise question and albumin have significant predictive value for mortality at 6 and 12 months.

We observed that the surprise question for nephrologists Staff is closer to prediction than nursing, and with a high negative predictive value for the “group of NO surprise”
P1126PLASMAPHERESIS TREATMENT FOR SEVERE PEMPHIGUS: 10 YEARS' EXPERIENCE OF A SINGLE CENTER IN CHINA
Authors: Liu Yan , Ma Jie , Wang Haiyun , Fan Xiaohong , Zheng Ke , Chen Limeng , Li Xuemei , Li Xuewang , Qin Yan
Published: June 2020

Background and Aims

Pemphigus is a potentially life-threatening autoimmune bullous disorder. The pathogenesis involves with IgG antibodies against desmogleins (Dsg) (Dsg 1 and Dsg 3) on epithelial cell surface. Systemic corticosteroid is considered as the basis of the treatment for pemphigus. As an interventional treatment, plasmapheresis was introduced for treating severe or refractory pemphigus. The literature in this field is limited. This study aimed to review our 10 years’ experience in a single center.

Method

We retrospectively analyzed 17 patients with severe pemphigus who were unresponsive to high-dose prednisone and received double-filtration plasmapheresis (DFPP) treatment between January 2010 and January 2020. The information on demographic characteristics, clinical and laboratory data, treatment regimens, and clinical outcomes were collected.

Results

1. Clinical characteristics: Among 17 patients, 11 patients had pemphigus vulgaris (PV), 3 patients had pemphigus foliaceus (PF), 2 patients had paraneoplastic pemphigus (PNP) and 1 patient had pemphigus herpetiform (PH). The mean age of patients was 47.8±10.0 years; 8 male patients and 9 female patients. All seventeen patients were suffering from severe pemphigus and had a period of at least one week of high-dose prednisone (1∼1.5mg/kg/d), but they were unresponsive to corticosteroid and immunosuppressants treatment. 2. As an adjuvant therapy, they received DFPP treatment with 1 to 4 sessions for each patient. Most of the patients (7 patients) received 2 sessions every other day, 5 patients received 3 sessions, 4 patients just received 1 session and only one patient received 4 sessions. For each session, the exchange volume was 1∼1.5 plasma equivalent. After DFPP treatment, the titers of Dsg antibodies significantly decreased (p<0.001, Figure 1), Nikolsky’s sign became negative and no new blisters appeared. The erosions showed reepithelialization and started healing gradually. The dosage of corticosteroid could begin to taper down rapidly in 1 to 2 weeks. On discharge, the dosage of prednisone was 0.8-1mg/kg/d. 3. As to adverse events, 4 patients had transient hypotension during the procedure, but they could recover spontaneously after parameter adjustment. No major adverse events happened.

Conclusion

Plasmapheresis is an effective and relatively safe treatment for severe pemphigus. Plasmapheresis can also contribute to the dosage reduction of steroid to avoid more drug-related side effect.
P1133XYLITOL-BASED PERITONEAL DIALYSIS SOLUTIONS MITIGATED IN VITRO MESOTHELIAL AND ENDOTHELIAL TO MESENCHYMAL TRANSITION
Authors: Masola Valentina , Arduini Arduino , Bonomini Mario , Gambaro Giovanni , Zaza Gianluigi
Published: June 2020

Background and Aims

Fibrosis, angiogenesis and microvascular alteration are main pathogenetic mechanisms involved in the progressive loss of the peritoneal ultrafiltration capacity in patients undergoing peritoneal dialysis (PD). Main cause of this condition is the continuous peritoneal exposure to hyperosmotic and hyperglycaemic agents. High glucose level activates the Mesothelial to Mesenchymal Transition (MMT) and the Endothelial-to-Mesenchymal (EndMT) program, which are responsible for the development of fibrosis/chronic peritoneal damage. Moreover, the high glucose content of PD solution may induce the VEGF production with consequent neo-angiogenesis. Therefore, the introduction of more biocompatible solutions in clinical practice is necessary for preserving the long-term peritoneal membrane. To this purpose we tested the in vitro effects of a new commercially available PD solutions containing xylitol, carnitine and reduced glucose, at comparable osmotic strength (XyloCore).

Method

Human vein microvascular endothelial cells (HMVEC) were cultured in EGM™-2MV medium (Lonza) and Human peritoneal mesothelial cell line (HMrSV5) were cultured in Dulbecco's Modified Eagle Medium (DMEM; Gibco) containing 10% fetal bovine serum. Cells were cultured to confluence and then treated for 3 hours with serum free medium, XyloCore 0.7 (0.5% Glucose, 0.7% Xylitol and 0.02% L-carnitine), XyloCore 1.5 (0.5% Glucose, 1.5% Xylitol and 0.02% L-carnitine) and commercially available glucose-based solutions (Fixioneal) 1.36% and 2.27% Glucose. Gene expression of MMT/EndMT, apoptosis, inflammation, extracellular remodeling and angiogenesis markers was evaluated by real-time PCR. Cell viability was assayed by MTS assay.

Results

Our in vitro results demonstrated that XyloCore solutions, by influencing only partially the mesothelial and endothelial cells viability, demonstrated a good biocompatible profile. Then, gene expression analysis of HMVEC and HMrSV5 treated with XyloCore solutions revealed a significant down-regulation of transcripts encoding for MMT and EndMT biomarkers (Zinc finger protein SNAI1, TGF-beta, alpha-SMA and vimentin), and pivotal biological elements involved in apoptosis (Bcl-2), extracellular matrix remodeling (matrix metallopeptidases), inflammation (IL-1beta, IL-6) and angiogenesis (Vascular endothelial growth factor) compared to glucose-based solutions with comparable osmotic strength.

Conclusion

These in vitro results demonstrated, for the first time, that XyloCore solutions have a better biocompatible impact and less pro-fibrotic potentials compared to conventional glucose-based solutions. These effects, if confirmed in in vivo studies, could have interesting clinical potentials.
P1134HIGH PREVALENCE OF SLEEP-DISODERED BREATHING AND ITS ASSOCIATION WITH RENAL FUNCTION AMONG CHRONIC KIDNEY DISEASE PATIENTS (CKD1-5,HD AND PD) : A CROSS-SECTIONAL STUDY
Authors: Ota Kanji , Nakayama Yosuke , Yunosuke Yokota , Kodama Goh , Itou Sakuya , Fukami Kei
Published: June 2020

Background and Aims

Sleep-disordered breathing (SDB) is known as a novel risk factor for cardiovascular disease, and one of five adults suffer from SDB in general population. In non-dialysis chronic kidney disease (CKD) and hemodialysis (HD) patients, a high prevalence of SDB has been reported due to the excess accumulation of extracellular fluid. However, precise prevalence and associated factors of SDB in patients with peritoneal dialysis (PD) has not been known. This cross-sectional study aimed to investigate the prevalence and determinant factors associated with SDB in patients with CKD.

Method

This was a single-center retrospective cohort study recruited 334 patients with CKD stages 1-3a, 3b-5, HD, and PD enrolled from 2018 to 2020. All patients were hospitalized and received our CKD educational program, and did not have sleep complaints. The diagnosis and assessment of the severity of SDB were evaluated using PULSOX-Me300 and SAS2100 systems. The 3% oxygen desaturation index and SpO2 were measured during sleep. SDB was defined as 3% oxygen desaturation index (ODI)>15.0 and SpO2<92% in this study.

Results

Proportion of the patients with CKD1-3a, CKD3b-5, HD, and PD were 28%, 53%, 11%, and 8%, respectively. Thirty-one% of the patients were diagnosed with SBD in all CKD patients. In a generalized linear model, 3% ODI>15.0 and SpO2<92% were significantly correlated with apnea hypopnea index (p<0.05, r=0.87 and p<0.05, r=-0.45, respectively). Further, it became clear that the proportion of 3%ODI>15 and SpO2<92% was significantly higher in PD patients (50%) than in other CKD patients. Furthermore, 3% ODI was significantly correlated with BMI and HDL cholesterol levels in PD patients (p<0.05, r=0.67 and p<0.05, r=-0.54, respectively).

Conclusion

We reported for the first time that the prevalence of SDB was very high and that the severity of SDB was significantly associated with BMI in patients with PD. These findings suggest that the extracellular fluid overload and excess glucose exposure due to PD fluid might accelerate SDB in patients with PD. Further clinical studies are needed to determine whether PD-associated SDB might influence the development of cardiovascular disease in CKD patients.
P1139EXPRESSION OF TOLL LIKE RECEPTORS, CELL ADHESION MOLECULES AND PRO-INFLAMMATORY CYTOKINES IN ESRD PATIENTS
Authors: Singh Mantabya , Prasad Narayan , Fatima Nida , Gupta Amit , Sahu Chinmoy
Published: June 2020

Background and Aims

CAPD is well established modality of treatment for patients with end stage renal disease (ESRD). Peritonitis is a leading cause of technique failure and death in patients on CAPD. Studies on expressions of host factors like TLRs, CAMs and their relationship with inflammatory cytokines (IL-6, IL-12, TNF-alpha and IL-1 beta) involved in peritonitis and other co-morbidity and functional status are lacking throughout the world. Hence the present study has to be done to determine the expressions of TLR2 and TLR4, and CAMs in ESRD patients.

To compare the expression of TLR2, TLR4, ICAM 1 and Pro-inflammatory cytokines (IL-6, IL-12, TNF-alpha and IL-1-beta) in Peritonitis, CAPD and CRF group patients.

Method

A total of 85 ESRD patients recruited and sub-divided into 3 groups. Group1- CAPD patient (n=25), Group 2- Peritonitis patient (n=30), and Group 3- CRF (n=30 patients). mRNA expression of TLR-2, TLR-4 were examined at gene levels by RT PCR and cell adhesion molecule (ICAM-1) were examined at gene and protein levels by RT PCR and ELISA respectively in Serum and Pro-inflammatory cytokines level were also examined by ELISA in serum. We performed microbiological culture for bacterial and fungal pathogens using automated BACTEC culture system. Cell counts were routinely done on every dialysate.

Results

Out of 30 samples of peritonitis group 15 were culture positive and 15 were culture negative. We found that in peritonitis group the mRNA expression of TLR-2 and TLR-4 was higher as compared to CRF (4.183±2.857vs 3.633±2.41) (p=0.049), (4.314±2.91vs 4.14±1.99) (p=0.015) and CAPD (4.183±2.857vs3.683±2.85) (p=0.041), (4.314±2.91vs 3.88±1.91) (p=0.009) respectively. At gene and protein level ICAM-1 was higher in peritonitis patient compared to CAPD (mRNA expression 4.76±2.64vs 4.36±3.48) (level in sera 660±201.2vs 514±157) (p=0.003). The IL-6 and IL-12 expression was higher in Peritonitis group as compared to CAPD (66.87±64.51vs214.35±220.05) (p=0.04) and (230.17±153.45vs417.04±302.96) (p=0.028) respectively. The TNF-alpha and IL-1-beta expression was not significant among the groups.

Conclusion

TLRs activation by bacterial molecules leads to the induction of cytokines (IL-6 and IL-12) and chemokine through the activation of NF-ķB pathway and may be responsible for atherosclerosis, morbidity and mortality in ESRD patients. Elevated level of ICAM-1, IL-6 and IL-12 may be responsible for chronic inflammation in Peritonitis group patients.
P1151CLINICAL OUTCOMES IN REMOTE PATIENT MONITORING IN AUTOMATED PERITONEAL DIALYSIS : A COLOMBIAN EXPERIENCE
Authors: Corzo Leyder , Vesga Jasmin , Sanabria Mauricio , Rivera Angela
Published: June 2020

Background and Aims

Patients with remote monitoring are followed-up daily by clinical teams, allowing early detection and correction of problems, which could result in improvements in therapy outcomes.

Aims: To evaluate the association between Remoted Patient Monitoring (RPM) program and clinical outcomes (technique failure and peritonitis rates).

Method

A historical, multicenter, observational cohort study in Automatized Peritoneal Dialysis (APD) prevalent patients, included between October 1, 2016, and June 30, 2017 with follow-up until June 30, 2018, at Renal Therapy Services (RTS) network. Patients were older than 18 years, divided into two cohorts based on the RPM use: 1) APD-RPM cohort: patients using the HomeChoice Claria® device with Sharesource® technology (Baxter Healthcare, Deerfield, USA) and 2) APD-Without RPM cohort: patients using APD systems HomeChoice Legacy® without RPM. Socio-demographic and clinical characteristics of all patient were summarized descriptively. Propensity score matching 1:1 was used.

Results

558 patients met the inclusion criteria for data analysis. The mean age was 54 years, 40% were female, 26% had APD RPM, see Table 1. After propensity score matching, APD therapy with RPM (n=148) as compared to APD-Without RPM (n=148) was associated with significant reduction in technique failure, IRR= 0.46 95% CI: [0.24 - 0 .89], and a trend in peritonitis rate reduction, IRR= 0.87 [0.41 - 1.00], P= 0.051, see table 2. Main reasons of technique failure are presented in table 3.

Conclusion

The use of RPM program in APD patients is associated with lower technique failure rate, supporting the role of this technology as performance enhancer.
P1152USE OF URGENT START PERITONEAL DIALYSIS IN END STAGE RENAL DISEASE PATIENTS: A RETROSPECTIVE ANALYSIS IN A NORTH-INDIAN POPULATION
Authors: Parry Manzoor , MAZUMDER MASTAKIM AHMED , Alam Shahzad , Jeelani Hamad
Published: June 2020

Background and Aims

End-stage renal diseases (ESRD) that are referred late to dialysis usually need hemodialysis via central vein catheter (CVC). Urgent start peritoneal dialysis (PD) can be used in these patients to avoid need of CVC. Catheter patency and other complications related to urgent-start PD have not been thoroughly clarified. We evaluated the clinical outcomes of urgent-start PD in a North-Indian cohort.

Method

In this retrospective study, we enrolled ESRD patients who were started on urgent-start PD (starting PD within 14 days after catheter insertion) in our center from January 1, 2008 to December 31, 2017, and followed them up to 10 years. Catheter failure was primary outcome of study while as secondary outcomes included short-term and long-term complications related to urgent-start PD.

Results

In this study882 patients (60.3% male, mean age 47.28 ± 14.1years) were enrolled. There were few peri-operative complications with significant hemorrhage seen in 2 patients. Early peritonitis occurred in 8 (0.9%) patients. Within the first month of catheter insertion, abdominal wall complications (hernia, hydrothorax, hydrocele, and leakage) occurred in 24 (2.7%) patients while as functional catheter malfunction developed in 36 (4.1%) patients. On follow-up of the patients (median 35.7 months), 32 (3.6%) patients experienced catheter failure, and 141 (15.9%) had death-censoring technique failure. Catheter patency rate at the end of 1-month, 1 -year, 3-year, and 5-year, was 98.2, 94.9, 93.1,92.4%; and technique survival rate was 99.2, 96.9, 90.2, 82.8%, respectively. Every 5-year increase in age was associated with 17% decrease of risk for catheter failure (hazard ratio [HR]: 0.83, 95%confidence interval [CI]: 0.73–0.89). Risk factors for abdominal wall complications included male sex (HR: 1.45, 95% CI: 1.03–2.1), low hemoglobin levels (HR: 0.88, 95% CI: 0.79–0.98) and diabetic nephropathy (HR: 1.65, 95% CI:1.13–2.35).

Conclusion

Urgent-start PD is a safe option for ESRD who need urgent dialysis to avoid CVC insertion for HD. For a successful urgent start PD programs, a well-trained PD team, catheter insertion procedure by experienced personnel, and a well-designed PD prescription and a good follow-up care is needed.
P1159MILD BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH BETTER SURVIVAL IN PATIENTS WITH END STAGE RENAL DISEASE AND PERITONEAL DIALYSIS
Authors: Afghahi Hanri , Nasic Salmir , Alhomsi Khaled , Hadimeri Henrik , Rydell Helena , Svensson Johan
Published: June 2020

Background and Aims

Recently, variability in blood pressure (BP) has been recognized as a risk factor for mortality and cardiovascular events in the general population. However, most studies included patients with normal or near normal kidney function.

Aim

To study the association between BP variability and the risk of all-cause mortality in patients with end stage renal disease (ESRD) and peritoneal dialysis (PD) treatment.

Method

From 2008 until the end of 2017, 2329 patients with ESRD and at least three months of PD (mean age: 63.8 years, men: 67.5%) were followed for 16 months in median (interquartile range: 11-28 months). Data were extracted from the Swedish Renal Register (SNR).

The coefficient variation (CV = the ratio of the standard deviation (SD) to the mean value) was defined as BP variability in terms of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) [SBP(SD)/SBP(mean), DBP(SD)/ DBP(mean), and MAP(SD)/MAP(mean), respectively].

The relationships between BP variability and mortality were examined by time-dependent Cox models to estimate hazard ratios (HR) and 95% confidence intervals (CI) in univariate and multivariate analyses, with adjustment for demographics, laboratory findings and comorbidity.

Results

During the follow-up period, 1054 (45%) deaths occurred. The mean level of BP variability was CV=0.10± 0.1.

The highest rate of mortality was observed in the patients with the highest variability in SBP (CV>0.25; 64% of those patients died).

In the multivariate model, for each of the BP variables, we compared the risk of mortality in the lowest variability group (CV≤ 0.05) with that in the CV=0.10-0.15 group (reference):

SBP: (HR 1.74, 95% CI 1.44- 2.09; p<0.001); DBP: (HR 1.91, 95% CI 1.59- 2.23; p<0.001); and MAP: (HR 1.73, 95% CI 1.44- 2.06; p<0.001). Thus, for all BP variables, the lowest variability was associated with increased mortality risk.

We then compared the highest variability group (CV>0.25) with the CV=0.10-0.15 group (reference):

SBP: (HR 1.60, 95% CI 1.14- 2.25; p<0.001); DPB: (HR 1.74, 95% CI 1.44- 2.09; p<0.001); and MAP: (HR 1.98, 95% CI 1.21- 3.27; p<0.001). Thus, for all BP variables, the highest variability was related to increased mortality risk.

Conclusion

In this study, the association between BP variability and the risk of mortality was U-shaped in patients with ESRD and PD. Thus, both very low and high levels of BP variability were related to higher risk of mortality. Mild BP variability was associated with the lowest risk of mortality, which could suggest that, non-intensive and long duration of ultrafiltration (UF) with PD was probably beneficial in terms of survival
P1160INCREASED REMOVAL RATES OF FLUID AND SODIUM DURING STEADY CONCENTRATION PERITONEAL DIALYSIS COMPARED TO ICODEXTRIN AND PERITONEAL EQUILIBRATION TEST
Authors: Carlsson Ola , Heimbürger Olof , Johansson Ann-Cathrine , Martus Giedre , Wilkie Martin , Hegbrant Jörgen , Johansson Ann , De Leon Charlotte
Published: June 2020

Background and Aims

Removal of fluid and sodium may be a major challenge in PD, which can be addressed using icodextrin for the long dwells. Steady concentration PD (SCPD) with Carry Life® UF is a novel treatment modality where the intraperitoneal glucose concentration can be kept stable throughout the treatment maintaining ultrafiltration and sodium removal. This is performed by transferring a small volume of the dialysate into the device, where glucose is added and the dialysate returned to the patient. The present study was performed to compare the effect of SCPD with icodextrin and peritoneal equilibration test (PET) on ultrafiltration and sodium removal.

Method

Eight stable PD patients (high or high average transporters) were included in the study. Subjects were treated with three 5-hour Carry Life UF treatments using three different glucose doses (11, 14, 20 g/h). An initial fill with 1500 ml, 1.36% glucose PD solution was used. A small volume of dialysate was drained hourly to avoid overfill. An icodextrin 11-hour dwell (2000 ml, 7.5% Extraneal®), and a 4-hour PET (2000 ml, 2.27% glucose PD solution), were used as controls. Data expressed as mean ± SD, statistical analysis using one-way ANOVA, **p<0.01, ***p<0.001.

Results

The treatment time for icodextrin was 11.4±1.5 hours, for PET 4.1±0.1 hours, and for the Carry Life UF treatments 5.2±0.3 hours. Carry Life UF treatments generated increased ultrafiltration rates compared to icodextrin and PET (Figure a). The sodium removal rates with Carry Life UF treatments were also significantly increased compared to icodextrin and PET (Figure b). However, the total ultrafiltration volumes during Carry Life UF treatments were not significantly different compared to the icodextrin dwell (646±256, 739±312, 863±380, 595±239, ml/treatment for 11 g/h, 14 g/h, 20 g/h, and icodextrin, respectively). The ultrafiltration volume during PET was significantly lower than all other treatments (162±242 ml, p<0.001). Peritoneal sodium removal did not differ between Carry Life UF treatments and the icodextrin dwells (86±27, 92±33, 110±37, 88±34 mmol/treatment for 11 g/h, 14 g/h, 20 g/h, and icodextrin, respectively). Peritoneal sodium removal during PET was significantly lower than during the other treatments (22±33 mmol/treatment, p<0.01).

Conclusion

Treatments performed with Carry Life UF maintain a stable intraperitoneal glucose concentration during the entire dwell, resulting in higher ultrafiltration and sodium removal rates than for controls (PET and icodextrin). The fluid and sodium was removed during the 5-hour Carry Life UF treatments was comparable to the 11-hour icodextrin dwells.

In summary, the increased removal rates of fluid and sodium during SCPD result in a more efficient treatment than conventional CAPD or icodextrin.
P1162RED BLOOD CELL DISTRIBUTION WIDTH AND PERITONEAL DIALYSIS-ASSOCIATED PERITONITIS PROGNOSIS
Authors: He Peng , Hu Jinping , Huang Chen
Published: June 2020

Background and Aims

The red blood cell distribution width (RDW) is a parameter of the heterogeneity of circulating erythrocyte size. Recent researches have pointed out a link among RDW, chronic kidney disease and inflammation. We sought to investigate the prognostic value of baseline RDW in patients with peritoneal dialysis-associated peritonitis (PDAP), which remains unknown.

Method

Our study included 337 peritonitis episodes experienced by 202 patients who were undergoing continuous ambulatory peritoneal dialysis (CAPD) at a single center from 2013 to 2018. Episodes were categorized according to the tertiles of baseline RDW levels (T1, <13.2%; T2, 13.2 - 14.3%; T3, >14.3%). Routine logistic regression, generalized estimating equation and restricted cubic spline were used to estimate the association between RDW and treatment failure, which was defined as relapse or recurrent episodes, catheter removal, or death during peritonitis therapy. The predictive performance of multivariate models including RDW and other potential predictors were also evaluated.

Results

After adjusting for other potential predictors, RDW exhibited an incremental relationship with the risk of treatment failure. The baseline RDW of >14.3% (T3) indicated a 43% and 52% increased venture of treatment failure in logistic and GEE analyses, respectively, compared with < 13.2% (T1). As a continuous variable, the fitting curve based on restricted cubic spiline showed that the relationship was nolinearly but positively correlated. The multivariate model A (combined RDW with age, duration on PD, albumin and ferritin) showed an area under the curve (AUC) of 0.671 (95% CI, 0.592 to 0.749) for the prediction of treatment failure. In sensitive analyses, the predictive performances for other unfavourable outcomes were also reliable (AUC for catheter removal, 0.72, 0.62 to 0.81; for relapse or recurrence, 0.61, 0.48 to 0.74).

Conclusion

Higher levels of baseline RDW was significantly associated with greater rates of treatment failure among peritonitis episodes independent of other potential predictors.
P1165PERITONEAL DIALYSIS OR HAEMODIALYSIS FOR POLYCYSTIC KIDNEY DISEASE? TEN YEARS' EXPERIENCE IN A SINGLE CENTRE
Authors: Chan Zi , Chan Ka Lok , Lam Chi Kwan , Law Way Ping , Pak Wai Lun Will , Wong Yick Hei , Wong Sze Ho Sunny
Published: June 2020

Background and Aims

When polycystic kidney disease (PKD) progresses into end-stage renal disease (ESRD), the choice of dialysis modality is often not straight forward. It is believed that PKD may increase risk of complications and technique failure (TF) in peritoneal dialysis (PD) due to enlarged kidneys and/or liver. In this study, we looked at the long-term outcomes of PKD patients put on either PD or haemodialysis (HD).

Method

New cases of ESRD due to PKD that entered into the dialysis program of United Christian Hospital, Hong Kong from 1st December 2009 to 30th November 2019 were identified. Their baseline demographics, mean kidney size (mean size of right and left kidneys) and clinical outcomes were recorded. Hong Kong has a ‘PD first’ policy. But for PKD patients, the decision to start PD or HD is by the attending nephrologists’ clinical judgment. For the statistical analysis, chi-square test was used for comparison of categorical variables, while t-test was used for continuous variables. Kaplan-Meier curve was used to analyse survival.

Results

A total of 45 patients were identified. Thirty-one patients were put on PD, while fourteen were put on HD. Their baseline characteristics were shown in Table 1. HD patients had significantly higher mean kidney size to body weight ratio (0.32 ± 0.12 cm/kg) compared to PD patients (0.25 ± 0.08 cm/kg). The median survival between PD patient (7.1 years) and HD patients (7.2 years) was not significantly different.

For those PKD patients on PD, the 5-year TF rate was 0.22, which was similar to overall PD patients in our centre. Four patients had early TF (mean time 1.6 years) due to possible PKD related reasons. Two of them had significant pressure symptoms, the other two had inadequate dialysis. Further analysis showed that for those with TF, both the mean kidney size (20.0 ± 5.3 cm) and mean kidney size to body weight ratio (0.32 ± 0.08 cm/kg) were significantly higher than those without TF (15.0 ± 4.1 cm and 0.24 ± 0.07 cm/kg respectively) (Table 2).

Conclusion

This study showed that for PKD patients with moderate enlarged kidneys, PD could be a reasonable choice. However, for patients with very large kidneys, the early TF rate with PD was high, HD would be a better choice for these patients.
P1170ENCAPSULATING PERITONEAL SCLEROSIS: ARE CALCINEURIN INHIBITORS A RISK FOR PERITONEAL DIALYSIS PATIENTS UNDERGOING RENAL TRANSPLANTATION?
Authors: Vizzardi Valerio , Bertoni Diana , Terlizzi Vincenzo , Pola Alessandra , Tonoli MAttia , Moscato Marianna , Scolari Francesco
Published: June 2020

Background and Aims

Encapsulating peritoneal sclerosis (EPS) is a rare but severe complication of peritoneal dialysis (PD). Its prevalence, ranging from 0.7 to 3.3%, and its reported mortality is 25-55%. Post-transplantation encapsulating peritoneal sclerosis (PT-EPS) usually occurs within two years from PD interruption due to kidney transplantation. Calcineurin inhibitors are thought to be involved in the pathogenesis of PT-EPS.

Method

This is a retrospective, single-center study: all the patients who received PD for 2 or more months before kidney transplantation between 1979 and 2018 in our unit were enrolled. All PD patients diagnosed with EPS after transplantation were identified, and their data were compared with those of non-transplanted PD patients (NT-PD).

Results

Data from a total of 1014 PD patients were examined; 215 underwent kidney transplantation and 799 remained on PD. PT-EPS occurred in 5/215 patients (2.3%), a prevalence not significantly different from that of NT-PD (21/799= 2.6%; P = 0.39) (Table 1). Calcineurin inhibitors were administered to 178/215 (83%) patients without EPS and all 5 patients with PT-EPS (P = 0.68). Calcineurin inhibitors were associated with corticosteroids (41%), mycophenolate mofetil (34%), or both (42%). Inhibitors of mammalian targets of rapamycin were used in association with calcineurin inhibitors in 25%, with calcineurin inhibitors and steroids in 24% and steroids alone in 7%. Mortality due to PT-EPS was 4.3% vs 1.2% in NT-PD (P = 0.38) (Figure 1).

Conclusion

The prevalence of PT-EPS was similar to that of EPS in NT-PD. Therapy with calcineurin inhibitors did not appear to be a crucial risk key in the development of PT-EPS.