bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1116IS DIALYSIS ADEQUACY AMELIORATED AFTER INCREASING DIALYSATE FLOW RATE IN CHRONIC HEMODIALYSIS? - ONE YEAR FOLLOW-UP
Authors: Barbatsi Aggeliki , Karakou Eugenia , Chiras Theodoros , Skarakis Jacob , Trakas Nikolaos , Sonikian Makrouhi 
Published: June 2020

Abstract

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

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

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

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

Abstract

Background and Aims
Dialysate flow rate (Qd) has minimal effect in removal of molecules in hemodialysis, allowing to use lower amounts of dialysate with no effect in clearance of molecules. According to recent literature, Expanded hemodialysis (HDx) improves the clearance of middle size molecules, diminishing the effect of Qd in adequacy. We found no data about clearance at different dialysate flow rates in HDx.
Our aim is to evaluate the clearance of middle molecules (beta 2 microglobuline [Mβ2], interleukin-6 [IL-6], interleukin-10 [IL-10 light chains (CLL-κ -λ) with HDx at different Qd using membranes TheranovaMR in patients with body weight less than 70 Kg.

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

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

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

Abstract

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

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

Results
There were 26 patients with an average age of 51,4 years. Sex ratio was 3,33 . Average period spent in HD was 73,7 months. Vascular access was a native arteriovenous fistula in 24 patients, and a catheter in 2 patients. Seven patients had residual diuresis. Average ultrafiltration rate was 2,82 L (10 mL/Kg/h).
Before DS, 20 patients had no clinical signs of fluid overload. Unconformity with BIA was noted in 12 patients, with a subclinical overload in all cases. Six patients had clinical signs of fluid overload (including hypertension (HT) in 5 cases), which was concordant with BIA.
After DS, 22 patients reached their DW with a correct hydration status, 2 patients still had clinical signs of fluid overload, and 2 had isolated HTA. BIA revealed the persistence of fluid overload in 10 patients contrasting with the absence of clinical signs of hypervolemia in 8 patients. Patients who kept only HT had a normal hydration status.

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

Abstract

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

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

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

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

Abstract

Background and Aims
Peritoneal dialysis (PD) practice is not universally homogeneous, best clinical practices are not completely understood as reference values are often obtained from small sized populations and/or frequently based on chronic kidney disease (CKD) and/or hemodialysis data.
To evaluate two years of follow up of compliance with PD-related quality indicators (QIs) following definition of new targets in an international PD network.

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

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

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

Abstract

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

Method
We studied 95 stable PD patients, 51 men 44 women, with a mean age of 63 ±14 years. Data analyzed included patients demographics, clinical and biochemical data. Univariate and multivariate regression analysis were used to test the associations of variables related to MPV.
Results: . The mean platelet (PLT) volume was 9.4 ±1.5 (median: 9.2) fl. The mean platelet (PLT) count was 235 ± 69 (median: 233) [x103μ/L]. The mean sMg was 2.25 ± 0.47 (median: 2.2) mg/dl. MPV was associated positively (p=0.303; p&lt;0.01) with C-reactive protein (CRP) and negatively with sMg (r= -0.246; p&lt;0.05), use of Renin Angiotensin System (RAS) Inhibitors (r=-0.273; p&lt;0.05), PLT count (r=-0.360; p&lt;0.001) and white blood cell (WBC) count (r=-0.254; p&lt;0.05). The results of our multiple regression model (Table) showed that all the above mentioned factors that were included in the model, except WBC, were independent determinants of MPV.

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

Abstract

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

Method
We evaluated 36 PD patients whose characteristics are reassumed in Tab1. In these patients, dialysis adequacy was assessed by Kt/v and nutritional status through biochemical parameters and the following scores (Tab.2):
• PCR (Protein catabolic rate)
• PEW (Protein energy waste)
• GNRI (Geriatric nutritional risk index)
• CONUT (Controlling nutritional status score)

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

Conclusion
Almost three-quarters of our sample started PD less than 72 hours after catheter insertion. The lack of difference in the measured outcomes compared to patients that had therapy initiated after this period encourages the use of PD when urgent dialysis is needed.