bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO671: Should We Undergo Peritoneal Dialysis in Malnourished Chronic Kidney Disease Patients?
Authors: Donato Beatriz , Mateus Catarina , Adragao Teresa , Matias Patricia , Branco Patricia 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The implementation of peritoneal dialysis (PD) in end-stage renal disease has been associated with various long-term pathophysiologic changes, which result in adverse consequences, such as malnutrition, occurring in 30–50% of patients. Specific factors to PD might be associated with poor oral intake as continuous absorption of glucose from PD solutions and abdominal fullness induced by the dialysate can suppress appetite.
There are several accepted strategies for stratifying malnutrition in PD, such as laboratory markers [serum albumin and normalized protein catabolic ratio (nPCR)] and the recent use of bioimpedance spectroscopy (BIS) (with low lean tissue index).
We aimed to evaluate if PD patients with a poor nutritional status at the beginning of the technique had worse outcomes (peritonitis, PD failure, hospitalizations, and death).

METHOD
We studied a cohort of incident patients from a single PD unit between 1 July 2011 and 31 August 2021, who had one BIS measurement and a peritoneal equilibration test in the first 3 months after the start of PD. We also collect laboratory data within 6 months from the BIS evaluation (serum albumin). Besides demographic parameters, we evaluated established endpoints (peritonitis, PD failure, hospitalizations and death).

RESULTS
There were included 91 PD patients. The mean age of patients was 65.40 $ \pm $ 13.88 years with a median dialysis vintage of 24 (IQR 14–31.61) months; 59.3% were male and 28% had diabetes. During the follow-up period, 5.5% of the cohort died, 56% were hospitalized and 47.3% had at least one episode of peritonitis. Furthermore, the transfer to hemodialysis occurred in 18 cases (19.8%) and 15 (16.5%) received a renal transplant.
There was no difference in nutritional markers median in patients that had clinical endpoints versus those who had not (Table 1). In a multivariable analysis, neither nPCR, nor albumin nor lean tissue index were predictors of peritonitis, PD failure or hospital admissions.

CONCLUSION
In this study, we found that malnourished patients, prevalent in PD, did not have worse clinical endpoints (higher rate of infections, hospital admissions and PD failure). Although adequate nutrition has been deemed vital to the success of PD, this modality of renal replacement therapy did not result in worse outcomes, despite the malnutrition markers at the beginning of PD. Further studies are warranted to evaluate the positive impact of PD in nutrition status.
MO677: Prevalence and Characteristics of Chronic Kidney Disease-Associated Pruritus in Home Hemodialysis Patients Compared to Dialysis Peritoneal and in-Center Hemodialysis
Authors: Montesa Marín María , Molina Pablo , Vizcaíno Belén , Gandía Paula , Parra Manuel , González Moya Mercedes , Valero Alejandro , Quilis Aina , Osma July , Sancho Asunción 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Chronic kidney disease-associated pruritus (CKD-aP) is a very common symptom in dialysis patients and can significantly limit their quality of life and survival. While the prevalence of CKD-aP in peritoneal dialysis (PD) and in-center hemodialysis (HD) patients has been studied, little data are known for home HD (HHD) patients. The objective of this study was to analyse the prevalence of pruritus in HHD patients, and the factors associated with its presentation, as compared to PD and in-center HD patients.

METHOD
Cross-sectional, single-center study that included all patients on chronic dialysis treated at our center in November 2021. The patients were divided into three groups according to the dialysis modality (HHD, PD and in-center HD). All the patients answered a validated questionnaire on CKD-aP that evaluated the presence of itching, its intensity, frequency and location; the moment of appearance; the effect on quality of life, emotional state, cognitive function, sexual activity and quality of sleep. Likewise, it was assessed whether they had previously been diagnosed and treated for CKD-aP. The visual analogue scale (VAS) was used to define the intensity of itching as absent (VAS = 0), mild (VAS = 1–2), moderate (VAS = 3–6) or severe (VAS = 7–10). Clinical and analytical variables were compared between the groups, and the factors associated with the presence of pruritus were analysed using binary logistic regression.

RESULTS
Nighty-nine patients (41% women) were included, with a mean age of 64 ± 15 years and a median stay on dialysis of 57 (IQR: 17–159) months. The proportion of patients on HHD, PD and in-center HD was 20%, 41% and 39%, respectively. A total of 36% of the patients had some degree of pruritus, being mild, moderate, and severe in 8%, 13%, and 13% of the patients, respectively. The prevalence of pruritus and its intensity was similar in all the dialysis modalities (Figure 1). In the logistic regression analysis, the dialysis modality was not associated with presence of CKD-aP.

CONCLUSION
In our experience, the prevalence and intensity of pruritus was similar in HHD, PD and in-center HD patients. These data suggest that the type of dialysis techniques does not influence CKD-aP prevalence.
MO686: Effectiveness of SARS-CoV-2 Vaccination in Peritoneal Dialysis Patients
Authors: Donato Beatriz , Mateus Catarina , Matias Patricia , Branco Patricia 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Chronic kidney disease (CKD) patients, especially those on renal replacement therapy, have a higher risk of infection and worse clinical outcomes after coronavirus disease 2019 (COVID-19) than the general population. Thus, this population must be promptly immunized against COVID-19. We aimed to assess the humoral response after two doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccine in peritoneal dialysis (PD) patients. We also aimed to identify potential factors associated with vaccine response and the prevalence of COVID-19 in a PD unit.

METHOD
We conducted a single-center, retrospective study to evaluate the immunogenicity in terms of antibody response after COVID-19 vaccination. Three types of vaccine [BNT162b2 messenger RNA vaccine (Pfizer-BioNTech), messenger RNA-1273 (Moderna) and ChadOx1 nCoV-19/AZD1222 (AstraZeneca)] were administered in the PD unit. The detection of anti-spike IgG antibodies (with a cutoff of 0.8 U/mL) was done at least after 21 days of the two vaccine doses. We also evaluated the presence of COVID-19 infections, hospital admissions (including in intensive care unit) and deaths.

RESULTS
This study enrolled 70 prevalent patients. We excluded patients with only one vaccine dose (n = 4), those who did not consent to the collection (n = 5) or were vaccinated before starting PD (n = 11). Among the 50 patients included, the mean age was 59 $ \pm $ 15 years, 60% were male and the dialysis vintage was 22.1 (IQR 6–34.3) months. Six (12%) patients were receiving immunosuppressive therapy and 16 (32%) had diabetes. The mean interval between administration of the second vaccine dose and antibodies evaluation was 7.2 $ \pm $ 0.7 months. Overall, after two doses, there was a significant increase in antibody level, with median of 1495 (IQR 37.8–546.8) U/mL. Only two (4%) patients did not increase their antibody level (remained seronegative). History of immunosuppressive therapy was associated with no response after two doses (91.7% versus 8.3%, P = 0.012). There were two COVID-19 infections after the complete vaccination, with mild symptoms (one with hospital admission). Furthermore, there were no intensive care unit admissions or deaths.

CONCLUSION
We found that immunization against COVID-19 was effective in generating an overall humoral response and in preventing severe disease in CKD patients on PD, which emphasizes the importance of the vaccination against COVID-19 in this population. These results also suggest the impact of the immunosuppressive therapy on vaccine response in PD patients.
MO695: Phase Angle: Clinical and Prognostic Value in Peritoneal Dialysis
Authors: Calças Marques Roberto , Morgado Nuno , Borges Henrique , Afonso Rita , Malho Guedes Anabela , Bernardo Idalécio , Silva Ana 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Malnutrition–inflammation–atherosclerosis syndrome is common in chronic kidney disease and is associated with high mortality, particularly in dialysis patients. Bioimpedance analysis (BIA) is a simple and non-invasive method for nutritional assessment. The aim of this study was to evaluate the relationship between phase angle (PA) and other nutritional parameters and establish its role as predictor of mortality in peritoneal dialysis (PD) patients.

METHOD
Prevalent PD patients were enrolled in the longitudinal prospective study in a single tertiary center between 2015 and 2020, with a simultaneous BIA assessment and a modified peritoneal equilibration test. Spearman's correlation test was used to assess relevant clinical associations. Survival analysis was performed using the Kaplan–Meier test and univariate and multivariate Cox analysis to determine the predictive factors of all-cause mortality.

RESULTS
A total of 49 PD patients were included with mean age 55.9 ± 16.2 years, 57.1% male, Charlson comorbidity index 4.9 ± 2.3, Kt/V 2.5 ± 0.7, with a mean follow-up of 39.9 ± 26.3 months. The Spearman's correlation test showed a very strong positive association between PA and extracellular mass/body cell mass (r = 0.939, P &lt; 0.001). It also showed a moderate positive association between PA and albumin (r = 0.524, P &lt; 0.001) and normalized protein catabolism rate (r = 0.437, P = 0.002). Furthermore, PA was negatively correlated with age (r = −0.477, P = 0.001). In the Kaplan–Meier analysis, patients with PA &lt; 4.9° had a lower survival rate (log rank = 4.77; P = 0.029). Using the multivariate Cox regression, forward model, PA (HR = 0.243; 95% CI 0.079–0.753), the number of cardiovascular events (HR = 11.236; 95% CI 1.286–98.211) and neutrophil–lymphocyte ratio (HR = 1.360; 95% CI 1.033–1.790) were predictors of all-cause mortality.

CONCLUSION
Lower PA appears to be associated with a decline in nutritional status, so monitoring it can be useful to identify patients at higher risk of malnutrition. PA was also validated as an independent predictor of mortality in our PD patients.
MO697: FGF-21 Correlates with Overhydration: Is There a Role for Peritoneal GLUT-1?
Authors: Ribeiro Brigitte , Malho Guedes Anabela , Fernandes Mónica , Faísca Marília , Calças Marques Roberto , Silva Ana , Bragança José , Rodrigues Anabela , Krediet Raymond 
Published: May 2022

Abstract

BACKGROUND AND AIMS
FGF-21 is a hepatokine that stimulates glucose uptake through GLUT-1. The presence of this glucose transporter in peritoneal fibroblasts is driven by peritoneal glucose exposure and is related to impaired ultrafiltration, predisposing to overhydration. The study was designed to determine FGF-21 levels in peritoneal effluent and serum, and its possible association with overhydration.

METHOD
Prevalent and incident peritoneal dialysis (PD) patients without diabetes were included. FGF-21 (dialysate and serum) was obtained during a 3.86% glucose peritoneal equilibration test. Peritoneal glucose load was calculated. The presence or absence of local peritoneal production was assessed by comparing the dialysate to plasma (D/P) ratio of FGF-21 (MW 32 kD) with that of albumin (MW 67 kD). Hydration status was assessed by bioimpedance. Spearman's correlations were performed.

RESULTS
A total of 58 patients (38 incident, 20 prevalent) were included, mean age 54 years, 67% males, PD duration from 1 to 75 months, mean 10.4. Residual GFR was 6.4 ± 3.5 mL/min/1.73 m2 and D/P creatinine 0.65 ± 0.12. Peritoneal glucose load was 110.5 g/day (range 40.8–226.9). Dialysate FGF-21 was 42.5 ± 47.0 pg/mL and serum FGF-21 943.9 ± 1164.8 pg/mL, giving a D/P ratio of 0.07. D/P albumin was 0.009, indicating that dialysate FGF-21 concentrations can be explained by transport from the circulation, without local peritoneal production. Serum FGF-21 was positively correlated with dialysate FGF-21, extracellular water excess and total peritoneal glucose load (all P &lt; 0.01). Some association was present with PD duration (P &lt; 0.05). No relationship was found between plasma FGF-21 and plasma insulin, D/P creatinine, or residual kidney function.

CONCLUSION
FGF-21 in peritoneal effluent is likely not locally produced, but caused by transport from the circulation. The associations between plasma FGF-21 levels with PD duration, peritoneal glucose load and overhydration, all indicate an effect of peritoneal glucose absorption from the peritoneal cavity into the interstitium with an insulin-independent storage into interstitial adipocytes, where it may stimulate the expression of GLUT-1.
MO702: Etiology and the Impact of Refractory Peritonitis on Clinical Outcomes of Patients on Peritoneal Dialysis—12 Years’ Single-Center Experience from Turkey
Authors: Berke Mentese Ilay , Barutcu Atas Dilek , Hakki Arikan Izzet , Tugcu Murat , Velioglu Arzu , Asicioglu Ebru 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The outcomes of refractory peritonitis in peritoneal dialysis (PD) patients have been reported to be inferior to those of solitary peritonitis. The current study aimed to examine the factors associated with treatment failure in PD patients experiencing refractory peritonitis.

METHOD
This single-center retrospective study included all episodes of refractory peritonitis in adult PD patients in Marmara University Hospital, Turkey, between 2009 and 2020. Patient characteristics, microbiological data, outcomes and factors associated with refractory peritonitis were analysed. The primary outcome was peritonitis-related catheter loss. Secondary outcomes were hospitalization and peritonitis-related death.

RESULTS
Overall, 236 episodes of refractory peritonitis occurring in 135 patients were included. Gram-positive, gram-negative and fungal infections accounted for 44.1%, 20.4% and 2.4% of all peritonitis episodes, respectively. Forty-seven patients (34.8%) needed catheter removal, 2 patients (1.5%) died due to peritonitis complications and 59 episodes (25%) needed hospitalization. Mean fifth day PD fluid cell count was significantly greater among patients who required PD catheter removal (3621.3 $ \pm $ 3144.1 versus 1589.4 $ \pm $ 2316.6 P &lt; 0.001). Furthermore, patients with &gt;1000/mm3 cell count on the fifth day had higher rate of catheter removal (72.3% versus 37.6%, P &lt; 0.001) as compared to patients with cell count under 300/mm3. Treatment failure was more common in peritonitis episodes caused by gram (−) organisms (31.9% versus 14.8%, P:0.012). Pseudomonas and fungi-associated peritonitis were also significantly correlated with catheter loss (P:0.001 and P: &lt;0.001) (Table 1). When peritonitis episodes with more and &lt;1000 cells/mm3 on the fifth day were compared, there were more episodes with gram (−) bacteria (29.7% versus 12.9%, P:0.003) and hospitalization (41.9% versus 11.4%, P: &lt;0.001) in the group with more than 1000 cells/mm3. In the multivariate analysis, factors associated with catheter loss were a cell count of &gt;1000 on the fifth day and hospitalization, while presence of gram (+) bacteria related peritonitis was inversely correlated with catheter loss (Table 2).

CONCLUSION
Our study shows that the PD cell count on the fifth day of peritonitis can be used as a prognostic tool to determine the prognosis of refractory peritonitis episodes. Although we were unable to show the adverse prognostic effect of gram (−) bacteria related peritonitis, gram (+) bacteria related peritonitis was associated with better outcome. Prospective studies are needed to assess the risk factors for adverse outcomes of patients with refractory peritonitis, as the evidence in this area is sparse.
MO704: Prognostic Factors of Serological Response to the Sars-Cov 2 Vaccine in Peritoneal Dialysis: Our Experience
Authors: Burguera Vion Víctor , Haridian Sosa Barrios R. , Sánchez Iglesias Jorge , Campillo Trapero Cristina , Gutiérrez Martín Yolanda , Viera Ramírez Elizabeth , Fernandez Lucas Milagros , Rivera Maite 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic has had a massive impact in health systems worldwide, taking an important toll on dialysis patients as they are more comorbid, have higher mortality and an impaired immune system. Vaccines against SARS-Cov-2 proved to reduce mortality and hospitalization, but serological response in the dialysis population is weaker. Therefore, predictors of response would be useful to assess their level of protection and evaluate the need for further booster doses of the vaccine.

METHOD

RESULTS

CONCLUSION
In our experience, PD patients have an adequate serological response to the SARS-Cov-2 vaccines, being previous COVID exposure the main predictor of a good response. Conversely, longer duration of PD treatment was a prognostic factor of seroconversion failure. We believe this should be kept in mind to assess the need for booster vaccination doses in those patients.
MO710: Longitudinal Effects of Different Biocompatible Peritoneal Solutions on Membrane Function
Authors: Balafa Olga , Duni Anila , Tseke Paraskevi , Pavlos Rapsomanikis Karolos , Alekos Ioannis , Pavlakou Paraskevi , Oikonomou Margarita , Tatsis Vasileios , Ntounousi Evangelia 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Peritoneal biocompatible dialysates (low GDPs, neutral pH) seem to sustain more steady peritoneal membrane characteristics compared to conventional ones. However, various brand biocompatible dialysates have different composition (e.g. in lactate concentration) and there is no published study comparing their effects on membrane characteristics in long peritoneal dialysis (PD). Our PD unit has been using solely two brands of biocompatible dialysates (Balance, Fresenius© and Physioneal, Baxter©) since 2000. The aim of our study was to compare longitudinal data on peritoneal membrane function between these two different brand solutions

METHOD
Membrane characteristics were assessed by uni-peritoneal equilibration test (uni-PET, a combination of modified and mini PET), which is performed at least annually on every patient. Patients with no less than two PETs were included. We estimated dialysate to plasma (D/P) creatinine, ultrafiltration (UF) at 4 h, sodium seiving expressed as Dip/DPNa = [(dialysate sodium time 0/plasma sodium)–(dialysate sodium time 1 h/plasma sodium)], sodium removal (in 1 h) and free water transport (FWT). We collected clinical and lab data of the patients too.

RESULTS
A total of 85 patients (age 61.1 ± 15.1 years) were included—38 patients on Balance and 47 on Physioneal. The main characteristics of the patients are shown in Τable 1. Baseline membrane characteristics presented no differences between the two groups (D/Pcre 0.75 ± 0.125 versus 0.745 ± 0.11, P = 0.71—UF 660 ± 285 mL versus 651 ± 252 mL, P = 0.86—DipDPNA 0.05 ± 0.03 versus 0.047 ± 0.046 P = 0.54—sodium removal 30 (15.7, 42.3) mEq versus 38 (17.3, 46)mEq, P = 0.31—FWT 149 ± 85 mL versus 140 ± 109 mL, P = 0.69).
The patients were followed up for a median of 36 months (range 2.4–143). A total of 219 PETs were performed. Analysis for repeated PET tests was performed by using generalized linear regression models. The membrane characteristics (D/Pcre, Dip/DPNa, FWT and UF) of both groups remained stable longitudinally and overall no differences between the two different solutions were observed (Fig. 1). Only at the fourth year of follow-up, patients on Balance solutions had lower D/Pcre compared to Physioneal (0.62 versus 0.72, P = 0.003).

CONCLUSION
Different biocompatible solutions had no differences on peritoneal membrane characteristics longitudinally.
MO723: Ankle-Brachial Index is Associated with Subendocardial Viability Ratio in Chronic Hemodialysis Patients
Authors: Piko Nejc , Bevc Sebastjan , Hojs Radovan , Petreski Tadej , Knehtl Masa , Ekart Robert 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Ankle-brachial index (ABI) is a marker of peripheral arterial disease and is associated with increased cardiovascular morbidity and mortality. Structural alterations in the arterial walls lead to functional central haemodynamic changes, potentially impacting pulse wave reflection and, consequently, myocardial perfusion.
The aim of this study was to determine the association between ABI and subendocardial viability ratio (SEVR) as a non-invasive measure of coronary perfusion in chronic haemodialysis patients.

METHOD
We measured ABI using an automated non-invasive waveform analysis device (MESI®, Slovenia) and SEVR using applanation tonometry (Sphygmocor, Atcor Medical, Sydney, Australia). All the measurements were performed on a non-dialysis day and SEVR on the non-arteriovenous fistula (non-AVF) hand. ABI was calculated as the ratio between systolic blood pressure on the non-AVF hand and systolic blood pressure on the calves of both legs. Mean ABI of both sides was used in the statistical analysis.

RESULTS
A total of 29 patients (mean age 63.6 ± 10.5 years, 69.0% male) were included. In Table 1, descriptive parameters are presented.
Of those, 4 patients (13.8%) have an ABI &lt;0.9 and the other 25 patients (86.2%) have a normal ABI between 0.9 and 1.3. Using the independent-samples T-test, patients with a lower ABI have a statistically significant lower SEVR compared with patients with normal ABI (109 versus 142%; P = 0.039).

CONCLUSION
Low ABI is independently associated with decreased subendocardial perfusion in chronic haemodialysis patients, suggesting that both methods of ABI and SEVR measurement may reflect an atherosclerotic process in peripheral and coronary arteries.