bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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&gt;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&lt;0.001); DBP: (HR 1.91, 95% CI 1.59- 2.23; p&lt;0.001); and MAP: (HR 1.73, 95% CI 1.44- 2.06; p&lt;0.001). Thus, for all BP variables, the lowest variability was associated with increased mortality risk.
We then compared the highest variability group (CV&gt;0.25) with the CV=0.10-0.15 group (reference):
SBP: (HR 1.60, 95% CI 1.14- 2.25; p&lt;0.001); DPB: (HR 1.74, 95% CI 1.44- 2.09; p&lt;0.001); and MAP: (HR 1.98, 95% CI 1.21- 3.27; p&lt;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

Abstract

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&lt;0.01, ***p&lt;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&lt;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&lt;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

Abstract

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, &lt;13.2%; T2, 13.2 - 14.3%; T3, &gt;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 &gt;14.3% (T3) indicated a 43% and 52% increased venture of treatment failure in logistic and GEE analyses, respectively, compared with &lt; 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

Abstract

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

Abstract

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

Abstract

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

Method
All patients undergoing PD in Malta during 2008 and 2018 were analysed. Data from 2008-2012 was retrospective, shown as mean, that from 2013-2018 prospective. International Society for Peritoneal Dialysis (ISPD) definitions were used.
Results for categorical responses were summarized using absolute numbers and percentages. Medians (range) were used to describe continuous non-normally distributed data.

Results
The total number of patients undergoing PD from 2008 till 2018 were 137 (2008-2012), 91, 80, 126, 117, 102, 103 respectively. There was an overall male predominance of 63.5% (61-67). Patient years at risk were 85.80, 85.25, 89.71, 83.70, 79.69, 72.88 since 2013 respectively.
The overall incidence of diabetes mellitus was 45.3% (41.8-50), cardiovascular disease 34.2% (33.8-35), hypertension 79.3% (73.8-84.6).
PD was used in 50% of dialysis modality prior to 2012, 39% in 2018. Initially 51% used Automated PD (APD), with 21% assisted PD, in 2018 39% used APD, with 6% assisted PD.
PD peritonitis rates from 2008 were 0.38, 0.31, 0.35, 0.46, 0.43, 0.57, 0.54, 0.43, 0.39, 0.40, 0.46 episodes/patient year respectively
There was marked dominance of Gram-positive peritonitis, mainly Staphylococcal, with a reduction of coagulase-negative-Staphylococcus from 0.26 episodes/patient in 2013 to 0.03 in 2017, 0.11 in 2018. Methicillin-resistant S. aureus (MRSA) peritonitis decreased from 0.03 episodes/patient to nil in 2016, 2017, 0.01 episodes/patient in 2018.
Amongst Gram-negative peritonitis, Pseudomonas rates decreased from 0.06 to 0.03 episodes/patient in 2018, nil in 2016. Escherichia coli rates decreased from 0.02 episodes/patient to nil in the last three years. Fungal rates from 0.03 to 0.01 episodes/patient/year, with nil in 2016, 2017.
Catheter-related infection rates were 0.39 (2008-2012), 0.35, 0.91, 0.37, 0.38, 0.25, 0.50 episodes/patient/year respectively. There was a higher incidence of recurrent infections in 2014, none in 2015 and 2016. Gram-negative organisms accounted for 57% of all CRI, predominantly Pseudomonas at 0.12 (2008-2012), 0.06, 0.09, 0.09, 0.14, 0.03, 017 episodes/patient/year respectively. Gram-positive CRI were mostly Staphylococcus aureus, peaking in 2014 at 0.38 episodes/patient/year. MRSA rates declined from 0.15 to 0.01 episodes/patient/year in 2018.

Conclusion
PD peritonitis rates in Malta between 2008 and 2018 were below the ISPD recommended threshold. There were no episodes of MRSA in 2016, 2017, no Pseudomonas in 2016, no E coli in the last three years and no fungal PD peritonitis in 2016, 2017.
CRI rates also declined, with an overall predominance of Gram-negative infections.