Automated Peritoneal Dialysis Patients Research Articles

Correlation of Serum Albumin Levels With Laboratory Parameters in Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis Patients: A Prospective Cohort Study.

Background Peritoneal dialysis (PD) is a treatment option for end-stage renal disease (ESRD) patients, with automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) being the two main modalities. APD has reported benefits such as reduced peritonitis rates, improved ultrafiltration, and enhanced quality of life. However, some studies have found potential negative consequences of APD, and the impact on survival outcomes is limited and contradictory. Selecting the appropriate PD modality for ESRD patients should be individualized based on various factors, including nutritional status, demographic factors, laboratory findings, and other outcomes. PD patients are at high risk of malnutrition, and serum albumin is commonly used as a marker of nutritional status. Continuous monitoring of laboratory values may be beneficial for identifying nutritional deficiencies in a timely manner. Methodology This prospective cohort study aimed to compare APD and CAPD modalities in relation to serum albumin levels, demographic factors, and other laboratory parameters. The sample consisted of patients with ESRD treated with PD, who were divided into two groups per baseline albumin level. The study collected data on demographic, clinical, and laboratory characteristics, as well as comorbidities. The data were analyzed using SPSS version 26 (IBM Corp., Armonk, NY, USA), and statistical tests, such as the chi-square test and repeated-measures analysis of variance (ANOVA), were conducted to determine significant associations and differences between variables. Results The study included a total of 85 patients with ESRD who required PD as a treatment modality. Among them, 71 patients were undergoing APD, and 14 patients were undergoing CAPD. The study found that there were no significant differences in demographic factors, laboratory parameters, or medical history parameters between APD and CAPD patients with different albumin levels. The patients were followed up for six months and laboratory parameters were evaluated. Repeated-measures ANOVA showed that there were no significant variationsin both APD and CAPD patients. However, Spearman's rank correlation test revealed statistically important correlations between albumin and some laboratory parameters in both APD and CAPD patients at different assessment stages, including hemoglobin, sodium, transferrin, uric acid, phosphate, total protein, cholesterol, and triglycerides (p < 0.05). Conclusions Serum albumin levels appeared to be unaffected by the choice of PD modality. There were significant correlations between serum albumin levels and specific laboratory findings, including total protein, across all assessment stages for both APD and CAPD patients. These findings underscore the importance of continuous laboratory monitoring for PD patients.

Severe infections in peritoneal dialysis and home hemodialysis patients: An inception cohort study.

Infections are the most common non-cardiovascular cause of death among dialysis patients. Earlier studies have shown similar or higher risk of infectious complications in peritoneal dialysis (PD) compared to hemodialysis (HD) patients, but comparisons to home HD patients have been rare. We investigated the risk of severe infections after start of continuous ambulatory PD (CAPD) and automated PD (APD) as compared to home HD. All adult patients (n = 536), who were on home dialysis at day 90 from starting kidney replacement therapy (KRT) between 2004 and 2017 in Helsinki healthcare district, were included. We defined severe infection as an infection with C-reactive protein of 100 mg/l or higher. Cumulative incidence of first severe infection was assessed considering death as a competing risk. Hazard ratios were estimated using Cox regression with propensity score adjustment. The risk of getting a severe infection during the first year of dialysis was 35% for CAPD, 25% for APD and 11% for home HD patients. During five years of follow-up, the hazard ratio of severe infection was 2.8 [95% CI 1.6-4.8] for CAPD and 2.2 [95% CI 1.4-3.5] for APD in comparison to home HD. Incidence rate of severe infections per 1000 patient-years was 537 for CAPD, 371 for APD, and 197 for home HD patients. When excluding peritonitis, the incidence rate was not higher among PD than home HD patients. CAPD and APD patients had higher risk of severe infections than home HD patients. This was explained by PD-associated peritonitis.

#3940 RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS ACCORDING TO DIALYSIS MODALITY

Abstract Background and Aims Among dialysis patients, cardiovascular events are the leading cause of death. Little is known about difference in the frequency of cardiovascular events between various dialysis modalities. Glucose load may contribute to a metabolic burden in peritoneal dialysis (PD). On the other hand, hemodialysis can cause intradialytic hypotension, cardiac stunning, and arrhythmias, which are associated with increased risk of death. We compared risk of major cardiovascular events in patients who started continuous ambulatory PD (CAPD), automated PD (APD) and home HD with in-center HD patients. Method We included 968 patients who entered dialysis in the Helsinki-Uusimaa healthcare district in Finland from 2004 to 2017, of whom 162 were on CAPD, 229 on APD, 145 on home HD and 432 on in-center HD at day 90 from the start of dialysis. Patients were followed up for 5 years or until the end of 2019. Major adverse cardiovascular event (MACE) was defined as acute myocardial infarction, stroke or death due to cardiovascular disease. The cumulative incidence of the first MACE was calculated by taking other causes of death into account as competing risk events and censoring at time of kidney transplantation. Cox regression was used to compare risk of MACE between dialysis modalities with adjustment for age, gender, primary renal disease, prior comorbidities (coronary heart disease, left ventricular hypertrophy, heart failure and stroke), and laboratory data (plasma albumin, phosphate and ionized calcium). Imputation was performed to replace missing values of comorbidities and laboratory data. Results Of all 968 patients, 195 (20%) experienced a MACE during the entire follow-up and 62 (6.4%) during the first year of follow-up. The cumulative incidence of first MACE was similar in in-center HD and CAPD patients and higher than that in APD and home HD patients (Figure 1). Without adjustments, the hazard ratio of MACE was 0.83 [95% CI 0.56–1.2] for CAPD, 0.49 [95% CI 0.31–0.77] for APD and 0.42 [95% CI 0.23–0.78] for home HD in comparison to in-center HD. After adjustment for possible confounders, the hazard ratio of MACE was 1.1 [95% CI 0.70–1.6] for CAPD, 0.88 [95% CI 0.53–1.5] for APD and 0.80 [95% CI 0.41–1.6] for home HD and not statistically significantly different in comparison to in-center HD. Conclusion We observed a lower risk of MACE among patients who entered APD or home hemodialysis compared to in-center hemodialysis, but after adjusting for potential confounding factors, the difference diminished and was no longer statistically significant.

Plasma and intraperitoneal pharmacokinetics of ceftazidime/avibactam in peritoneal dialysis patients

ObjectivesPeritonitis is a serious complication in patients undergoing automated peritoneal dialysis (APD) that increases morbidity and frequently disqualifies patients from the peritoneal dialysis programme. Ceftazidime/avibactam (CAZ/AVI) is a potential treatment option for APD patients with peritonitis caused by resistant Gram-negative bacteria, but limited data exist on systemic and target-site pharmacokinetics (PK) in patients undergoing APD. This study set out to investigate the PK of CAZ/AVI in plasma and peritoneal dialysate (PDS) of patients undergoing APD. MethodsA prospective, open-label PK study was conducted on eight patients undergoing APD. CAZ/AVI was administered as a single intravenous dose of 2 g/0.5 g over 120 minutes. APD cycles were initiated 15 hours after the study drug administration. Dense PDS and plasma sampling was performed for 24 hours after the start of administration. PK parameters were analysed with population PK modelling. Probability of target attainment (PTA) was simulated for different CAZ/AVI doses. ResultsPK profiles of both drugs in plasma and PDS were similar, indicating that the two drugs are well suited for a fixed-dose combination. A two-compartment model best described the PK of both drugs. A single dose of 2 g/0.5 g CAZ/AVI led to concentrations that far exceeded the PK/PD targets of both drugs. In the Monte Carlo simulations, even the lowest dose (750/190 mg CAZ/AVI) achieved a PTA of >90% for MICs up to 8 mg/L (The European Committee on Antimicrobial Susceptibility Testing epidemiological cut-off value for Pseudomonas aeruginosa) in plasma and PDS. DiscussionOn the basis of PTA simulations, a dose of 750/190 mg CAZ/AVI would be sufficient to treat plasma and peritoneal fluid infections in patients undergoing APD.

Life and Sleep Quality amongst Peritoneal Dialysis Patients: A Comparative Study

Introduction: Sleep disorders affect up to 70% of peritoneal dialysis (PD) patients and appear to have significant negative effects on their quality of life (QoL). We compared life and sleep quality between patients on automated PD (APD) and continuous ambulatory PD (CAPD). Material and Methods: Cross-sectional study in chronic PD patients followed in our Dialysis Unit in February 2022. We evaluated sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) and QoL with EUROHIS-QOL-8. Results: Fifty-two patients, mostly men (65.4%, n=32), with a mean age of 52.7±14.2 years and PD vintage of 24.3±17.1 months. Our sample had similar distribution between APD and CAPD; we found no difference between groups regarding demographic data, PD-related quality parameters or prevalence of previous sleep disturbances. Mean QoL index was 69.9%±9.3% and similar between APD and CAPD patients; EUROHIS-QOL-8 negatively correlated with the scores on ESS (p=0.004) and PSQI (p=0.011). Regarding sleep quality, the mean ESS was 8.8±4.2 and PSQI was 7.6±3.6. APD patients had similar scores on ESS, but higher prevalence of severe daytime sleepiness (ESS≥18) (p=0.04) and higher scores on PSQI (p=0.002). Within the PSQI, sleep’ latency (p=0.003), duration (p=0.002) and efficiency (p=0.013) were the most affected parameters. Higher PSQI scores also correlated with worse blood pressure control; a cut-off value for PSQI of 6 was found to increase the risk of uncontrolled hypertension. Conclusion: In our series, APD patients had worse global sleep quality (PSQI) when compared to ACPD patients. This difference was mainly due to worse sleep latency, duration and efficiency. The assessment of the quality of life showed no difference between groups, however there was a clear link between quality of life and sleep quality.

The problem of pulmonary arterial hypertension in end-stage renal disease: can peritoneal dialysis be the solution

BackgroundPulmonary arterial hypertension (PAH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PAH among patients with ESRD treated with automated peritoneal dialysis (APD), investigated the effect of different variables and compared pulmonary artery pressure and cardiac function at the beginning and end of the study.MethodsThis is a 5-year study in which 31 ESRD patients on APD were recruited after fulfilling inclusion criteria. Blood samples were collected from all patients for the biochemical and hematological data at the beginning of the study and every month and at the study termination. Total body water (TBW) and extracellular water (ECW) were calculated using Watson’s and Bird’s calculation methods. All patients were followed-up at 3-month interval for cardiac evaluation. Logistic regression analysis was used to assess the relation between different variables and PAH.ResultsThe mean age of the study population (n = 31) was 51.23 ± 15.24 years. PAH was found in 24.2% of the patients. Mean systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) were significantly higher in the APD patients at study initiation than at the end of the study (40.75 + 10.61 vs 23.55 + 9.20 and 29.66 + 11.35 vs 18.24 + 6.75 mmHg respectively, p = 0.001). The median ejection fraction was significantly lower in patients with PAH at zero point than at study termination [31% (27-34) vs 50% (46-52), p = 0.002]. Hypervolemia decreased significantly at the end of study (p <  0.001) and correlated positively with the PAP (r = 0.371 and r = 0.369), p = 0.002). sPAP correlated with left ventricular mass index, hemoglobin level, and duration on APD.ConclusionsLong term APD (> 1 years) seemed to decrease pulmonary arterial pressure, right atrial pressure and improve left ventricular ejection fraction (LVEF). Risk factors for PAH in ESRD were hypervolemia, abnormal ECHO findings and low hemoglobin levels. Clinical and echocardiographic abnormalities and complications are not uncommon among ESRD patients with PAH. Identification of those patients on transthoracic echocardiography may warrant further attention to treatment with APD.

Peritoneal dialysis in the modern era.

The practice and clinical outcomes of peritoneal dialysis (PD) have demonstrated significant improvement over the past 20 years. The aim of this review is to increase awareness and update healthcare professionals on current PD practice, especially with respect to patient and technique survival, patient modality selection, pathways onto PD, understanding patient experience of care and use prior to kidney transplantation. These improvements have been impacted, at least in part, by greater emphasis on shared decision-making in dialysis modality selection, the use of advanced laparoscopic techniques for PD catheter implantation, developments in PD connecting systems, glucose-sparing strategies, and modernising technology in managing automated PD patients remotely. Evidence-based clinical guidelines such as those prepared by national and international societies such as the International Society of PD have contributed to improved PD practice underpinned by a recognition of the place of continuous quality improvement processes.

Automated peritoneal dialysis as a cost-effective urgent-start dialysis option for ESRD patients: A prospective cohort study.

Several studies have reported the feasibility of urgent-start peritoneal dialysis (PD) as an alternative to hemodialysis (HD) using a central venous catheter (CVC). However, the cost-effectiveness of automated peritoneal dialysis (APD) as an urgent-start dialysis modality has not been directly evaluated, especially in China. We prospectively enrolled patients with end-stage renal disease (ESRD) who required urgent-start dialysis at a single center from March 2019 to November 2020. Patients were grouped according to their urgent-start dialysis modality (APD and HD). Urgent-start dialysis conducted until 14 days after PD catheter insertion. Then, PD was maintained. Each patient was followed until July 2021 or death or loss to follow-up. The primary outcome was the incidence of short-term dialysis-related complications. The secondary outcome was the cost and duration of the initial hospitalization. Technique survival, peritonitis-free or bacteriamia-free survival and patient survival were also compared. Sixty-eight patients were included in the study, of whom 36 (52.9%) patients were in APD group. Mean follow-up duration was 20.1 months. Compared with the HD group, the APD group had significantly fewer short-term dialysis-related complications. The cost of initial hospitalization was also significantly lower in APD patients. There was no significant difference between APD and HD patients with respect to duration of the initial hospitalization, technique survival rate, peritonitis-free or bacteriemia-free survival rate, and patient survival rate. Among ESRD patients with an urgent need for dialysis, APD as urgent-start dialysis modality, compared with HD using a CVC, resulted in fewer short-term dialysis-related complications and lower cost.

MO874: Incidence of Severe Infections in Home Haemodialysis and Peritoneal Dialysis Patients

Abstract BACKGROUND Dialysis patients have a more than ten-fold risk of dying from infections compared with general population. In earlier studies, the risk of infections was similar in peritoneal dialysis (PD) and haemodialysis (HD), but comparison to home HD has not been performed. Our aim was to study the incidence of severe infections after start of home HD as compared with continuous ambulatory PD (CAPD) and automated PD (APD). METHODS We included all 536 adult patients, who were on home dialysis at day 90 from start of kidney replacement therapy (KRT) between 2004 and 2017 in Helsinki healthcare district. Severe infections were identified from patients’ laboratory data as a plasma C-reactive protein over 100 mg/L and confirmed from the patient data system. The cumulative incidence of the first severe infection was estimated considering death as a competing risk event. Hazard ratios of first severe infection were assessed using Cox regression with propensity score adjustment. Incidence rate (IR) and ratios (IRR) of all severe infection episodes were calculated. RESULTS The probability of getting a severe infection during the first year of dialysis was 35% for CAPD, 25% for APD and 11% for home HD patients. During a 5-year follow-up, the hazard ratio of severe infection was 2.8 [95% confidence interval (95% CI) 1.6–4.8] for CAPD and 2.2 (95% CI 1.4–3.5) for APD in comparison to home HD with adjustment for propensity scores. IR of infections/100 patient-years was 54 for CAPD, 37 for APD and 20 for home HD patients. The IR of peritonitis was 37 for CAPD and 25 for APD patients. When infection episodes caused by peritonitis were excluded, the IR of severe infections was not higher among PD than home HD patients. CONCLUSION The risk of severe infection was considerably lower among home HD than PD patients. This difference was mainly explained by the peritonitis episodes among the PD patients.

MO679: Peritonitis May Disrupt Cyclic Periodicity of Ultrafiltration in Peritoneal Dialysis

Abstract BACKGROUND AND AIMS Due to chronic damage of the peritoneal membrane on long-term treatment, peritoneal dialysis (PD) is a time-limited therapy. Effective PD is achieved by adequate peritoneal ultrafiltration (UF) and small solute clearance while maintaining an appropriate fluid and salt homeostasis. Availability of remote patient monitoring on automated PD (APD) allows clinicians to remotely retrieve data for treatment analysis, proposed to improve clinical outcomes. However, machine-derived data are vastly different from traditionally observed data (e.g. quantity, noise, missing normative values). Recently correlation of daily UF changes on APD with changing peritoneal membrane function in association with clinical risk factors and outcomes has been observed. High intra- and interpatient variability of UF remains not fully explained. We aim at a better understanding of UF variability by submitting APD machine readouts to spectral analysis in association with clinical risk factors of membrane dysfunction. METHOD This was a secondary analysis of the Medical University of Vienna APD cycler treatment data from patients using Homechoice Pro cyclers (Baxter, IL, USA), extracted from the cycler management software (PD link, Baxter). Analysis was conducted using R software (R Core Team 2020). Daily UF was processed using the Lomb-Scargle periodogram (LSP), a method commonly used in astrophysics and neurophysiology to detect rhythms in (unevenly sampled) time series. Peaks of power spectrum, frequencies, and periodicities were compared between patients with and without peritonitis episodes during their PD treatment utilizing a Mann–Whitney U-test and associated with the total number of peritonitis episodes using Kendall rank correlation. A P-value &amp;lt; 0.05 was considered significant; all tests were two-sided. RESULTS LSP analysis was performed on daily UF data from n = 129 APD patients with a mean observation time of 598 days (SD ± 517), male: female 61:39% (n = 79:50), incident: prevalent patients 77:23% (n = 99:30), and diabetic: non-diabetic patients 25:75% (n = 32:97). Observation time extended from the introduction of APD until kidney transplantation (43%, n = 55), transfer to hemodialysis (23%, n = 29), death (27%, n = 35), kidney function recovery (8%, n = 1), or loss to follow-up (7%, n = 9). After inspection of LSPs n = 9 patients were excluded from further analysis as their periodicity matched the time of their clinical endpoint. A total of 45 of the remaining 120 patients (38%) never experienced a peritonitis episode, and a total of 0.3 (SD ± 0.7) peritonitis episodes/patient-year were observed. LSP computation revealed cyclic periodicity in UF in all patients with an overall median peak period length of 329 days (IQR 62–882 days), median peak power of 21 (IQR 7–91), and median peak frequency of 0.42 (IQR 0.36–0.46). Differences between patients with and without peritonitis episodes during PD treatment are displayed in Table 1. Correlation analysis revealed significant association between the number of peritonitis episodes and peak periodicity of UF (tau=0.14, P = 0.04), and peak power (tau = 0.21, P = 0.003). Peak frequency of UF was not significantly correlated. CONCLUSION Patients on APD cycler treatment seem to display cyclic periodicity of UF, being significantly associated with the number of peritonitis episodes and significantly different between patients with and without peritonitis episodes. Smaller-scale periodicity (median 216 days) in patients without peritonitis seems to be disrupted by peritonitis resulting in significantly higher periodicity (median 670 days). The causes and implications of these results remain unclear and need further investigation. However, as peritonitis is a known risk factor for peritoneal membrane dysfunction, prolongation of UF periodicity might reflect disruption of peritoneal membrane function.

MO669: Predictive Parameters of Automated PD Cycler Software for Diagnosis of Catheter Dysfunction

Abstract BACKGROUND AND AIMS An adequately functioning catheter is of vital importance for successful long-term treatment and technique survival to peritoneal dialysis (PD) patients. According to the 2021 International Society of Peritoneal Dialysis guidelines on membrane function, catheter drainage problems should be suspected first in patients with low ultrafiltration (UF) capacity. Catheter dysfunction and the consequent decrease in UF are frequent complications in PD patients associated with significant negative clinical outcomes. METHOD We introduce the use of a combination of parameters obtained from daily measurements of the cycler software PD Link (Baxter) for predicting catheter dysfunction in automated peritoneal dialysis (APD) patients. Out of 117 APD patients treated at the Medical University of Vienna from 2015 to 2021, we identified all patients with verified catheter malposition and dysfunction (n = 14, cases) and compared them to controls without clinical evidence of mechanical problems and a recent X-ray confirming position of the PD catheter tip in the recto-vesical/recto-uterine space (n = 19). We retrieved cycler data for 7 days each and tested parameters predictive capability of catheter dysfunction. RESULTS Total number of alarms/week &amp;gt;7 as single predictive parameter of catheter dislocation identified 85.7% (sensitivity) of patients with dislocated catheter and 31.6% (1—specificity) of control patients. A combination of two out of three parameters (number of alarms/week &amp;gt;7,  drain time &amp;gt;22 min,  UF of last fill &amp;lt;150 mL) identified the same proportion of patients with catheter dislocation, but was more accurate in identifying controls (21% false positive). CONCLUSION We confirmed our clinical impression that number of alarms, total drain time at the end of cycler session and UF of last fill are good predictors for mechanical drainage problems. In contrast to yearly peritoneal equilibration test measurements, these data provide valuable information for clinical management of PD patients on a daily base and will be easily available in new APD cyclers with devices connected to remote monitoring platforms.

24-h Glycaemic profiles in peritoneal dialysis patients and non-dialysis controls with advanced kidney disease

For patients on peritoneal dialysis (PD), the deleterious effects of high concentrations of dialysate glucose on the peritoneal membrane are well-documented. Systemic effects of peritoneally absorbed glucose are more poorly defined. Using continuous glucose monitoring (CGM), we aimed to describe 24-h glycaemic profiles of PD patients without diabetes and compare with non-dialysis controls with stage 5 chronic kidney disease (CKD-5). In this cross-sectional, case-control study, 15 patients on PD (9 automated PD (APD) and 6 continuous ambulatory PD (CAPD)) and 16 CKD-5 controls underwent 72 h of CGM and metabolic profiling. CGM was used to derive average glucose concentrations and within-participant standard deviation (SD) of glucose. Data were analysed for the whole 72-h monitoring period and as daytime (09.00 to 21.00) and night-time (21.00 to 09.00). Average glucose concentrations and within-participant SD of glucose for the whole monitoring period were not different between the three groups (p ≥ 0.5). Daytime average glucose concentrations were also similar across the three groups (p = 0.729). APD was associated with a significantly higher nocturnal glucose than CAPD (5.25 mmol/L ± 0.65 vs. 4.28 ± 0.5, p = 0.026). A significant drop in nocturnal glucose compared with daytime average seen in both CAPD patients and controls was absent in APD patients. Systematically different glycaemic patterns were observed in non-diabetic APD and CAPD patients, including an absence of physiological nocturnal glucose dipping in patients on APD. Comprehensive CGM data sets highlight subtleties not appreciated by traditional metabolic biomarkers; this has implications when choosing the most appropriate outcome measures in future research addressing the metabolic impact of PD.

Prevalence of mild cognitive impairment in automated peritoneal dialysis patients.

Cognitive deterioration decreases quality of life, self-care and adherence to treatment, increasing mortality risk. There is scarce information of cognitive impairment in peritoneal dialysis (PD) and data are controversial. Our aim was to determine the frequency and associated factors of cognitive impairment in patients on automated PD (APD). In this cross-sectional study, 71 patients on APD underwent clinical, biochemical and cognitive function evaluation by means of the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Cognitive function was also evaluated in healthy controls. Participants mean age was 42 ± 16 years, 79% were men and dialysis vintage was 17 months ( interquartile range 7-32). In APD patients, cognitive impairment was present in 7% (mild deterioration) and 68% according to the MMSE and MoCA, respectively, and 4 and 37% in the healthy controls. Patients with cognitive impairment (according to MoCA) were older, with less education, had diabetes more frequently and higher serum glucose as well as lower serum creatinine, phosphorus and sodium concentrations than patients with normal cognitive function. In multiple linear regression analysis, predictors for the MoCA score (R2 = 0.63, P = 0.002) were education {B = 0.54 [95% confidence interval (CI) 0.20-0.89]; P = 0.003}, age [B = -0.11 (95% CI -0.21 to -0.01); P = 0.04], serum sodium [B = 0.58 (95% CI 0.05-1.11); P = 0.03] and creatinine concentration [B = 3.9 (95% CI 0.03-0.83); P = 0.03]. In this sample of APD patients, the prevalence of cognitive impairment by the MoCA was 65% and was associated with older age, lower education level and lower serum concentrations of sodium and creatinine.

Similar survival on home haemodialysis and automated peritoneal dialysis: an inception cohort study.

ABSTRACTBackgroundSeveral studies have shown superior survival of patients on home haemodialysis (HD) compared with peritoneal dialysis (PD), but patients on automated PD (APD) and continuous ambulatory PD (CAPD) have not been considered separately. As APD allows larger fluid volumes and may be more efficient than CAPD, we primarily compared patient survival between APD and home HD.MethodsAll adult patients who started kidney replacement therapy (KRT) between 2004 and 2017 in the district of Helsinki-Uusimaa in Finland and who were on one of the home dialysis modalities at 90 days from starting KRT were included. We used intention-to-treat analysis. Survival of home HD, APD and CAPD patients was studied using Kaplan–Meier curves and Cox regression with adjustment for propensity scores that were based on extensive data on possible confounding factors.ResultsThe probability of surviving 5 years was 90% for home HD, 88% for APD and 56% for CAPD patients. After adjustment for propensity scores, the hazard ratio of death was 1.1 [95% confidence interval (CI) 0.52–2.4] for APD and 1.6 (95% CI 0.74–3.6) for CAPD compared with home HD. Censoring at the time of kidney transplantation (KTx) or at transfer to in-centre HD did not change the results. Characteristics of home HD and APD patients at the start of dialysis were similar, whereas patients on CAPD had higher median age and more comorbidities and received KTx less frequently.ConclusionsHome HD and APD patients had comparable characteristics and their survival appeared similar.

POS-656 CORRELATION OF BIO-IMPEDANCE ANALYSIS REPORTS WITH IN-HOME BLOOD PRESSURE MEASUREMENTS IN AUTOMATED PERITONEAL DIALYSIS PATIENTS

A key objective of peritoneal dialysis (PD) is to achieve euvolemia. Patients undergoing automated PD (APD) are frequently fluid overloaded, while anuric APD patients with low fluid removal can have uncontrolled hypertension, left ventricular hypertrophy and worse survival. In this report, we aim to explore the correlation of fluid status in APD patients with in-home blood pressure (HBP) measurements and number of antihypertensives used.

Technique failure in remote patient monitoring program in patients undergoing automated peritoneal dialysis: A retrospective cohort study.

Remote patient monitoring (RPM) programs in automated peritoneal dialysis (APD) allow clinical teams to be aware of many aspects and events of the therapy that occur in the home. The present study evaluated the association between RPM use and APD technique failure. A retrospective, multicentre, observational cohort study of 558 prevalent adult APD patients included between 1 October 2016 and 30 June 2017 with follow-up until 30 June 2018 at Renal Therapy Services network in Colombia. Patients were divided into two cohorts based on the RPM use: APD-RPM (n = 148) and APD-without RPM (n = 410). Sociodemographic and clinical characteristics of all patients were summarized descriptively. A propensity score was used to create a pseudo-population in which the baseline covariates were well balanced. The association of RPM with technique failure was estimated adjusting for the competing events death and kidney transplant. Five hundred fifty-eight patients were analyzed. 26.5% had APD-RPM. In the matched sample comprising 148 APD-RPM and 148 APD-without RPM patients, we observed a lower technique failure rate of 0.08 [0.05-0.15] episodes per patient-year in APD-RPM versus 0.18 [0.12-0.26] in APD-without RPM cohort; incidence rate ratio = 0.45 95% confidence interval: [0.22-0.91], p-value = 0.03. The use of an RPM program in APD patients may be associated with a lower technique failure rate. More extensive and interventional studies are needed to confirm its potential benefits and to measure other patient-centered outcomes.

Day and night changes in energy expenditure of patients on automated peritoneal dialysis

Automated peritoneal dialysis (APD) treatment for end-stage kidney disease affords patients a degree of autonomy in everyday life. Clinical investigations of their energy expenditure (EE) are usually based on resting EE, which could mask day and night variations in EE. The aim of this study, therefore, was to compare the components of EE in APD patients and healthy control (C) subjects. Patients treated with APD for more than 3 months were compared with C volunteers matched for age and lean body mass (LBM). Biochemical analyses were performed and body composition was determined by DEXA to adjust EE to LBM. Total EE, its different components and respiratory quotients (RQ) were measured by a gas exchange method in calorimetric chambers. Spontaneous total and activity-related EE (AEE) were also measured in free-living conditions over 4 days by a calibrated accelerometer and a heart rate monitor. APD (n=7) and C (n=7) patients did not differ in age and body composition. REE did not differ between the two groups. However, prandial increase in EE adjusted for dietary energy intake was higher in APD patients (+57.5±12.71kcal/h) than in C subjects (+33.8±10.5kcal/h, p=0.003) and nocturnal decrease in EE tended to be lower in APD patients undergoing dialysis sessions (- 4.53±8.37kcal/h) than in subjects (- 11.8±7.69kcal/h, p=0.059). Resting RQ (0.91±0.09 vs 0.81±0.04, p=0.032) and nocturnal RQ (0.91±0.09 vs 0.81±0.04, p=0.032) were significantly higher in APD patients, indicating a preferential use of glucose substrate potentially absorbed across the peritoneum. AEE was lower in APD patients (595.9±383.2kcal/d) than in C subjects (1205.2±370.5kcal/d, p=0.011). In contrast, energy intakes were not significantly different (1986±465 vs 2083±377kcal/d, p=0.677). Although the two groups had identical resting EE, APD patients had a higher prandial increase in EE, a lower activity-related EE and higher resting and nocturnal RQ than healthy subjects.

Relationship between initial peritoneal dialysis modality and risk of peritonitis

Peritonitis is a critical complication of peritoneal dialysis (PD). Investigators have reported the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) versus automated peritoneal dialysis (APD), but the available evidence is predominantly based on observational studies which failed to report on the connection type. Our understanding of the relationship between peritonitis risk and PD modality thus remained insufficient. We studied 285 participants who began PD treatment between 1997 and 2014 at three hospitals in Nara Prefecture in Japan. We matched 106 APD patients with 106 CAPD patients based on their propensity scores. The primary outcome was time to first episode of peritonitis within 3 years after PD commencement. In total, PD peritonitis occurred in 64 patients during the study period. Patients initiated on APD had a lower risk of peritonitis than did those initiated on CAPD in both the unadjusted and adjusted models. The hazard ratio (HR) and 95% confidence interval (CI) for the primary endpoint were 0.30 (0.17–0.53) in the fully adjusted model including connection type. In the matched cohort, APD patients had a significantly lower risk of peritonitis than did CAPD patients (log-rank: p < 0.001, HR 0.32, 95% CI 0.16–0.59). The weighting-adjusted analysis of the inverse probability of treatment yielded a similar result (HR 0.35, 95% CI 0.18–0.67). In conclusion, patients initiated on APD at PD commencement had a reduced risk of peritonitis compared with those initiated on CAPD, suggesting APD may be preferable for prevention of peritonitis among PD patients.

Influence of bowel habits on gut-derived toxins in peritoneal dialysis patients.

Gut-derived uremic toxins have been associated with adverse outcomes in chronic kidney disease (CKD). Alterations in bowel habits, including constipation, seem to play an additional role in uremic toxicity. The aim of this study is to investigate the association of bowel habits with gut-derived uremic toxins and intestinal permeability in patients on automated peritoneal dialysis(APD). This cross-sectional study enrolled 58 APD patients (age 52.5 ± 15.1years; dialysis vintage 14.1 (6.0-36.5)months). Constipation was defined according to the Rome IV criteria. Bowel habits were assessed by the Bristol Stool Scale (BSS < 3 characterized by hard consistency of stools and/or low frequency of evacuation, a surrogate of slow intestinal transit time, and BSS ≥ 3, defining regular bowel habit). The total and free serum concentration of p-cresyl sulfate (PCS), indoxyl sulfate (IS) and indole-3-acetic acid (IAA) were dosed by high-performance liquid chromatography. Lipopolysaccharide (LPS) and zonulin were assessed by ELISA and D(-)-lactate by colorimetric method. Dietary intake was assessed by the 3-day food records. No differences were observed in clinical, demographic, and dietary characteristics between constipated (n = 30) and non-constipated (n = 28) groups. A trend for higher total PCS (p = 0.07) and free PCS (p = 0.06) was found in constipated patients. Patients with BSS < 3 (n = 11) exhibited significantly higher levels of total and free PCS (p < 0.01) and total IAA (p = 0.04). Conversely, No difference was found in IS levels. Except for a lower serum level of D(-)-lactate in patients with BSS < 3 (p = 0.01), zonulin and LPS levels were not different. Disturbed bowel habits, mainly characterized by slow transit time, may play a role in the accumulation of uremic toxins, particularly PCS, in patients on automatized peritoneal dialysis.

Comparison of patient survival and technique survival between continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

This retrospective cohort study compared patient survival and technique survival between patients on continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) using recent data at a single tertiary medical center in Taiwan. From medical records, we identified incident 459 CAPD patients and 266 APD patients on dialysis for at least 90 days and aged more than 18 years to estimate mortality and technique failure rates, and related hazard ratio (HR) and 95% confidence interval (CI) from 2007 to 2018. There were more women (52.3%) in the CAPD group, whereas patients in the APD group were younger. Compared to CAPD patients, APD patients had a lower mortality rate (2.83 vs. 5.79 per 100 person-years) with an adjusted HR of 0.69 (95% CI = 0.47-1.02), and a lower technique failure rate (9.70 vs. 17.52 per 100 person-years) with an adjusted HR of 0.65 (95% CI = 0.51-0.83). Further subgroup analyses revealed that, compared to CAPD, APD was associated with a significant lower risk of technique failure in male patients, patients aged 50-65 years, diabetic patients, patients without cardiovascular disease (CVD), patients with higher peritoneal permeability, or patients initiating PD in an earlier era. The mortality risk was not significant between CAPD and APD patients. APD is associated with a lower risk of technique failure than CAPD, particularly for male patients, and patients aged 50-65 years, with diabetes, without CVD, with high or high average peritoneal permeability, or initiating PD in an earlier era.