bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1174STUDY ON THE RELATIONSHIP BETWEEN HYPOCHLOREMIA AND ALL-CAUSE DEATH IN PATIENTS RECEIVING CONTINUOUS AMBULATORY PERITONEAL DIALYSIS
Authors: Xu Tao , Wang Niansong , Qiao Cheng 
Published: June 2020

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

Method
This is a retrospective and analytical study based on the medical records. The study examined the entire population of PD patients who were treated at the Peritoneal Dialysis Unit at the Galilee Medical Center in north of Israel during the last eight years (from January 1, 2010 through December 31, 2017). The clinical and laboratory data of these patients were collected from their medical records and analyzed. The main variables examined included peritoneal glucose load index (PGLI), lean tissue index (LTI) and Fat Tissue Index (FTI).
LTI was calculated as the quotient of LTM/Height?(kg/m? and FTI was defined as the quotient of ATM/Height?(kg/m?. LTI and FTI were assessed using the Fresenius Medical Care Body Composition Monitor (BCM) device, based on Bio-impedance technology

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

Background and Aims
Peritoneal dialysis (PD) is generally associated with a good survival rate and with great preservation of residual renal function (RRF). The various causes of technique failure are responsible for the relative short time staying in PD.
Objectives: This study aimed to analyze the outcome and factors correlated with maintenance peritoneal dialysis (PD) to guide for improving prognosis.

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

Results
From 2005 to 2019 the number of PD patients who have been treated in PD program for more than 3 months was around 199 patient, 29.1% diabetics, mean age 53.3±15.03 years old and meantime in therapy 32.39± 27.34 months. The PD was seen as an alternative for younger patients in the transplant list and elderly patients with comorbidity. Around 7.5% of the PD patients were transplanted and 8.5 % of patients were transferred from HD due to vascular access failure. Around 88.9% of patients were on PD for more than 1 year, 37.7% from 3 up to 5 years and 19.8% percent of the patients have stayed on PD for more than 5 years.
Cardiovascular mortality was the main cause of mortality with 53% of the cases. Higher comorbidity index, lower albumin levels, and lower residual renal function were the main risk factors for lower survival. The technical survival of patients was 92.3% during the first year, 79.5% and 69.6% in the second and the fifth year, respectively. There was not found a difference in technical survival between diabetics and nondiabetics patients. Ultrafiltration failure followed by peritonitis was the main reason for transfer patients with more than 24 months in therapy in hemodialysis probably linked with the no availability of icodextrin. Peritonitis rate was 1:41 patient months.

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

Abstract

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

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

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

Conclusion
Continuous exposure of glucose PD solutions may negatively affect on triglyceride and erythrocyte membrane OA contents. Combined use of icodextrin and glucose PD solutions may prevent lipid derangement (ClinicalTrial.gov number, NCT NCT02166359).