Automated Peritoneal Dialysis Research Articles

The Carbon Footprint of Peritoneal Dialysis in Australia.

As climate change escalates with increasing health impacts, healthcare must address its carbon footprint. A critical first step is understanding the sources and extent of emissions from commonly utilised clinical care pathways. We used attributional process-based life cycle analysis to quantify CO2 equivalent emissions associated with the delivery of Baxter home automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) in Australia. Annual per patient carbon emissions attributable to the manufacture and disposal of PD fluids and consumables were 1,992 kg CO2equivalent emissions for APD and 1,245 kg CO2equivalent emissions for CAPD. Transport impacts varied depending on the distance between site of manufacture of PD fluids and consumables and the home state of the patient. As a result, the total impact of providing PD also differed by Australian state, ranging from 2,350-4,503 kg CO2 equivalent emissions for APD and from 1,455-2,716 kg CO2 equivalent emissions for CAPD. Recycling of polyvinyl chloride (PVC) could reduce emissions by up to 14 per cent for APD and 30 per cent for CAPD, depending on the distance between the site of PVC waste generation and the recycling centre. This study demonstrated higher per patient carbon emissions from APD compared to CAPD, due to both higher fluid and consumable requirements, and the consequent higher transport impacts. PVC recycling can partially mitigate PD associated carbon emissions.

Transition between peritoneal dialysis modalities: Impact on blood pressure levels and drug prescription in a national multicentric cohort.

Hypertension is a leading cause of kidney failure, affects most dialysis patients and associates with adverse outcomes. Hypertension can be difficult to control with dialysis modalities having differential effects on sodium and water removal. There are two main types of peritoneal dialysis (PD), automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). It is unknown whether one is superior to the other in controlling blood pressure (BP). Therefore, the aim of our study was to analyse the impact of switching between these two PD modalities on BP levels in a nationally representative cohort. This was a cohort study of patients on PD from 122 dialysis centres in Brazil (BRAZPD II study). Clinical and laboratory data were collected monthly throughout the study duration. We selected all patients who remained on PD at least 6 months and 3 months on each modality at minimum. We compared the changes in mean systolic/diastolic blood pressures (SBP/DBP) before and after modality transition using a multilevel mixed-model where patients were at first level and their clinics at the second level. We analysed data of 848 patients (814 starting on CAPD and 34 starting on APD). The SBP decreased by 4 (SD 22) mmHg when transitioning from CAPD to APD (p < 0.001) and increased by 4 (SD 21) mmHg when transitioning from APD to CAPD (p = 0.38); consistent findings were seen for DBP. There was no significant change in the number of antihypertensive drugs prescribed before and after transition. Transition between PD modalities seems to directly impact on BP levels. Further studies are needed to confirm if switching to APD could be an effective treatment for uncontrolled hypertension among CAPD patients.

The construction of a nomogram to predict the prognosis and recurrence risks of UPJO.

This study was conducted to explore the risk factors for the prognosis and recurrence of ureteropelvic junction obstruction (UPJO). The correlation of these variables with the prognosis and recurrence risks was analyzed by binary and multivariate logistic regression. Besides, a nomogram was constructed based on the multivariate logistic regression calculation. After the model was verified by the C-statistic, the ROC curve was plotted to evaluate the sensitivity of the model. Finally, the decision curve analysis (DCA) was conducted to estimate the clinical benefits and losses of intervention measures under a series of risk thresholds. Preoperative automated peritoneal dialysis (APD), preoperative urinary tract infection (UTI), preoperative renal parenchymal thickness (RPT), Mayo adhesive probability (MAP) score, and surgeon proficiency were the high-risk factors for the prognosis and recurrence of UPJO. In addition, a nomogram was constructed based on the above 5 variables. The area under the curve (AUC) was 0.8831 after self cross-validation, which validated that the specificity of the model was favorable. The column chart constructed by five factors has good predictive ability for the prognosis and recurrence of UPJO, which may provide more reasonable guidance for the clinical diagnosis and treatment of this disease.

Economic issues of treating patients with stage 5D chronic kidney disease by dialysis methods of renal replacement therapy in Ukraine: a single-center study

Background. The aim of the work was to determine the cost of treating patients with stage 5D chronic kidney disease (CKD) by dialysis methods of renal replacement therapy (RRT) in 2023 based on the analysis of the costs of using hemodialysis (HD) and peritoneal dialysis (PD) in one medical institution. Materials and methods. An open single-center study was conducted at the Кyiv City Center of Nephrology and Dialysis. During 2023, 779 patients with stage 5D chronic kidney disease received renal replacement therapy by dialysis methods in this institution. Among them, 718 participants were treated by hemodialysis and 61 patients by peritoneal dialysis (36 by continuous ambulatory peritoneal dialysis (CAPD) and 25 by automated peritoneal dialysis (APD)). Direct medical and non-medical costs were included in the calculation of the cost of treating chronic kidney disease patients using both dialysis methods. The estimate of the cost of treatment for one patient during the year was calculated according to the formula: when using hemodialysis/hemodiafiltration (HDF) method — the cost of 1 session × 156 sessions, in case of CAPD/APD — the cost of 1 treatment day × 365 days. Results. The analysis of the costs for the treatment of patients with stage 5D CKD allowed us to state that the average cost of one HD/HDF session in 2023 was 3,626.20 UAH, one day of CAPD and APD treatment was 1,539.78 and 1,829.12 UAH, respectively. The average cost of treatment of one patient by HD/HDF method during 2023 was 565,687.20 UAH, CAPD — 562,019.70 UAH, APD — 667,628.80 UAH. In the structure of the cost of treatment, regardless of the modality of RRT, the most expensive component is the cost of consumables. State reimbursement under the Program of Medical Guarantees in 2023 for the treatment of one patient with stage 5D CKD during the year was 385,788 UAH when using GD/GDF, 412,085 UAH for CAPD, 662,110 UAH for APD. That is, based on the data we received, the Program of Medical Guarantees covers only 68.2 % of the costs of medical institution for the treatment with HD/HDF, 73.3 % for the treatment with CAPD and almost 100 % for the treatment with APD. Conclusions. The real cost of treating patients with stage 5D CKD using dialysis methods of RRT is higher than the rate of state reimbursement. The Program of Medical Guarantees doesn’t fully cover the costs of medical institutions for the treatment of patients with stage 5D CKD using RRT methods. CAPD has indisputable advantages in terms of both medical and economic benefit. In addition, the advantage of using CAPD over other dialysis modalities during the war is the absence of dependence on water and electricity supply, the number and workload of medical personnel, the need for patients to constantly visit the dialysis center.

Analysis of a nurse-provided on-call peritoneal dialysis support in an outpatient reference care centre

BackgroundTo analyse the nature of medical or technical emergency issues of ambulatory peritoneal dialysis (PD) patients calling a nurse-provided emergency PD support service of a reference centre that is provided all year in the after-hours.MethodsWe retrospectively analysed patients’ chief complaint, urgency, resolution of and association to current PD treatment and modality directed to an on-call nurse-provided PD support service from 2015–2021 based on routinely collected health data. Calls were systematically categorized being technical/procedural-, medical-, material-related or type of correspondence. Call urgency was categorized to have “immediate consequence”, inquiry was eligible for “processing next working day” or whether there was “no need for further action”. Call outcomes were classified according to whether patients were able to initiate, resume or finalize their treatments or whether additional interventions were required. Unexpected adverse events such as patients’ acute hospitalization or need for nurses’ home visits were evaluated and quantified.ResultsIn total 753 calls were documented. Most calls were made around 7:30 a.m. (5:00–9:00; median, 25-75th CI) and 6:30 p.m. (5:00–8:15). 645 calls were assigned to continuous ambulatory- (CAPD) or automated PD (APD). Of those, 430 calls (66.7%) had an “immediate consequence”. Of those 77% (N = 331) were technical/procedural-, 12.8% (N = 55) medical- and 6.3% (N = 27) material related issues. 4% (N = 17) were categorized as other correspondence.Issues disrupting the course of PD were identified in 413 cases. In 77.5% (N = 320) patients were able to initiate, resume or finalize their treatment after phone consultation. Last-bag exchange was used in 6.1% enabling continued therapy in 83.6%.In 35 cases a nurse visit at patients’ home or patients' visit to the practice at the earliest possible date were required, while hospitalization was required in seven medical category cases (5.4% and 1.09% of total assessed calls, respectively).ConclusionThe on-call PD-nurse provides patient support for acute and imminent issues enabling them to successfully initiate, resume or finalize their prescribed treatment. Nurses triage of acute conditions facilitated rapid diagnostics and therapy. Maintaining quality PD homecare, the provision of trained personnel is indispensable. The information gathered in this study may therefore be used as a foundation to tailor educational programs for nephrology nurses and doctors to further develop their competencies in PD.

Trends in Automated Peritoneal Dialysis Prescriptions in a Large Dialysis Organization in the United States.

Changes in health care policies and recognition of patient benefit have contributed to increases in home-based dialysis, including peritoneal dialysis (PD). Frequent monitoring and early individualization of PD prescriptions are key prerequisites for the delivery of high-quality PD. The present analysis aimed to assess variations in PD prescriptions among incident automated PD (APD) patients who remain on PD for 120+ days. This retrospective analysis examined data from patients within a large dialysis organization that initiated PD with APD between 2015 and 2019. PD prescription data was described by calendar year, timing of PD, and residual renal function categories. Changes in prescriptions from PD initiation (day 1) to day 120 were assessed descriptively. The cohort included 11,659 patients. The mean age at PD initiation increased from 2015 (56 (15) years) through 2019 (58 (15) years), whereas most other variables demonstrated no clear temporal change. Most patients (86%) had nighttime PD prescribed, with an average of 4.9 (1.3) cycles per day, a mean total treatment volume of 9.3 (2.5) L, and a median daily total dwell time of 7 (6,9.5) hours. Relative to day 1 nighttime prescriptions, there were 1) small increases in the proportion of patients receiving 3 or fewer cycles per day and those receiving 6+ cycles per day, 2) a 100 ml mean increase in fill volume per exchange, and 3) a mean 0.5 L increase in total nighttime treatment volume at day 120. When changes in nighttime APD prescriptions were examined at the patient level, 49% of patients had day 120 prescriptions that were unchanged from their initial prescription. In the largest analysis of incident APD prescriptions conducted in the United States to date, the vast majority of patients were prescribed nocturnal PD only with limited variability across the first 4 months of therapy.

Peritoneal Dialysis (PD) Patient and Nurse Preferences around Novel and Standard Automated PD Device Features.

Despite offering greater lifestyle benefits to patients with end stage kidney disease (ESKD), adoption of peritoneal dialysis (PD) remains low globally, particularly among minorities and the socioeconomically disadvantaged. While automated PD (APD) affords a high potential for reducing the burden of kidney replacement therapy, understanding patient preferences is critical to guiding development of new and improved APD devices to better accommodate use in their daily lives. A quantitative cross-sectional survey study was performed using adaptive conjoint analysis (ACA) to quantify APD feature preferences among PD patients, PD nurses (RNs, and non-PD patients to ascertain the relative importance of eight specific cycler attributes including portability, noise, setup time, device size, setup directions, battery power, consumables, and PD RN control (PD RNs only), each with 2-3 descriptive feature levels. 42 PD patients, 24 non-PD patients, and 52 PD RNs were surveyed. Preference shares spanned nearly the entire range from 0% to 100%, indicating strong preference discrimination. For all groups, "Portability in the Home", "Noise Level", and "Setup time" were the most important features. PD patients gave highest priority to these features compared to other study participants, plausibly as features enabling improved lifestyle. A simulated "coat rack" style cycler with extended battery-power that was easy to move in the home, silent, required only 10-minute setup, and had a fully animated instruction screen was preferred by all groups > 90% compared to features present in existing cyclers. Addressing APD cycler technical and therapy-related issues to improve usability, comfort and convenience within the home may affect PD uptake and retention. Attention and priority must be given to patient centric APD cycler design directed at including features that improve quality of life for the device end-user.

Comparative simulation of intraperitoneal aminoglycoside regimens for patients with peritonitis on automated peritoneal dialysis.

Intraperitoneal (IP) aminoglycosides (AGs) continue to be the cornerstone of empiric management of peritonitis. AG dosing during automated peritoneal dialysis (APD), however, has not been well studied in patients with peritonitis. We sought to identify differences in AG exposure in the peritoneum and plasma for two different dosing regimens with little supporting evidence in patients on APD with peritonitis. A retrospective design that utilised the peritoneal and plasma concentration-time data from a prior study of 18 continuous ambulatory peritoneal dialysis (CAPD) patients with peritonitis to generate an in silico peritoneal and plasma PK model. This model was then used to compare via simulation using Phoenix© WinNonlin Software with IP AG dosing for a loading-dose regimen (1.5 mg/kg first dose) versus a fixed-dose regimen (0.6 mg/kg/d) in patients on APD with peritonitis. Outcome measures were (1) percentage of time where peritoneal peak concentrations/minimal inhibitory concentration (MIC) ratio >10, (2) AUC/MIC > 74 and (3) plasma Cmin concentrations. Both regimens resulted in > 90% optimal peak/MIC ratio and AUC/MIC ratios on days 1 and 5 of the dose protocol. The loading-dose regimen resulted in IP exposures that were 2.5 times greater in the peritoneal compartment on day 1. By day 5, both protocols resulted in similar accumulation of AG plasma Cmin concentrations of 2.5-3.4 mg/L versus 2.4-3.3 mg/L, respectively, for the loading-dose regimen versus fixed-dose regimen. The current international guidelines for the treatment of peritoneal dialysis-associated peritonitis can continue to recommend the fixed-dose regimen for those on APD with the addition of plasma Cmin monitoring after 3 days to assess for drug accumulation.

Experimental Lab Tests on Rabbits for the Optimization and Redesign of Low-Cost Equipment for Automated Peritoneal Dialysis.

This work shows the experiences acquired by the experimental test performed to validate an automated peritoneal dialysis machine using rabbits with kidney damage to find improvements that can be made for future advances. These are listed to understand the direction of the development of the machine. The article shows the device's background and previous tests using a testbed. The rabbit anatomy was prepared for nephrectomy surgery. The tests were practiced by checking all of the APD machine's subsystems. The data were analyzed to develop improvements in the process. The results indicate the importance of the DPA machine as an alternative by implementing peristaltic pumps to substitute disposable cassettes. The identified improvements are the main objectives for research to continue improving the technology.

Scheduling of Remote Monitoring for Peritoneal Dialysis Patients.

Peritoneal dialysis (PD) is performed as a home-based treatment and in this context, telemedicine has been proven helpful for improving clinicians' surveillance and maintaining PD patients in their home setting. The new e-health devices make remote patient monitoring (RPM) for automated peritoneal dialysis (APD) treatment possible, evaluating the data at the end of every treatment and adapting the prescription at distance if necessary. This paper aims to share a method for improving clinical surveillance and enabling PD patients to receive their treatment at home. In the present case series, we delineate the clinical protocol of the Vicenza PD Center regarding patient characteristics, timing, and the purpose of the APD-RPM. We present the Vicenza PD Center's experience, illustrating its application through three case reports as exemplars. Telemedicine helps to carefully allocate healthcare resources while removing the barriers to accessing care. However, there is a risk of data overload, as some data might not be analyzed because of an increased workload for healthcare professionals. A proactive physician's attitude towards the e-health system has to be supported by clinical instructions and legislative rules. International and national guidelines may suggest which patients should be candidates for RPM, which parameters should be monitored, and with what timing. According to our experience, we suggest that the care team should define a workflow that helps in formulating a correct approach to RPM, adequately utilizing resources. The workflow has to consider the different needs of patients, in order to assure frequent remote control for incident or unstable patients, while prevalent and stable patients can perform their home treatment more independently, helped by periodic and deferred clinical supervision.

In-Center Automated Peritoneal Dialysis: Clinical Features, Practice Patterns, and Patient Survival from a 6-Year Cohort Study in China.

In-center automated peritoneal dialysis (APD) has been more frequently adopted in clinical practice for maintenance PD patients in China. For a better understanding of its clinical uptake, this retrospective study reviewed incident PD patients for a period of 6 years, investigating the practice pattern of in-center APD, factors associated with the use of in-center APD, and report on the patient survival compared to the nonusers of APD among hospitalized PD patients. This was a cohort study of all incident PD patients who met the inclusion criteria from January 1, 2013 to September 30, 2018, and were followed until death, cessation of PD, loss to follow-up, or December 31, 2018. Clinical characteristics, patient outcomes, and detailed data on APD sessions were recorded. We used time-dependent Cox model to estimate the variables associated with the initiation of in-center APD, and marginal structural model through inverse probability weighting to adjust for time-varying APD use on the causal pathway to all-cause mortality. A total of 651 subjects over 17,501 patient-months were enrolled. Of these, 633 (97.2%) PD patients were hospitalized at least once during follow-up, and 369 (56.7%) received in-center APD at a certain point, and the timing of APD use during the first 3 months, first year, and first 2 years since PD inception were 14.8%, 45.4%, and 74.8%, respectively. A total of 12,553 in-center APD sessions were recorded, where 85.9% used 4 bags of 5L-exchanges per prescription. Time-dependent Cox model showed that diabetes (hazard ratio (HR), 1.39, 95% confidence interval (CI), 1.09-1.76), urine output (HR 0.80, 95% CI: 0.70-0.92), serum albumin (HR 0.84, 95% CI: 0.72-0.99), hemoglobin (HR 0.88, 95% CI: 0.77-0.99), and Ca × P (HR 1.19, 95% CI: 1.06-1.35) were significantly associated with in-center APD use. Among all hospitalized PD patients, the estimated HR corresponding to the marginal causal effect of in-center APD use on all-cause mortality was 0.13 (95% CI: 0.05-0.31, p &lt; 0.001). Starting APD after the first PD year was associated with a significantly lower risk of all-cause mortality (adjusted-HR 0.56, 95% CI: 0.33-0.95). In-center APD is used intensively during the first 2 years of PD and is associated with certain clinical features. Overall, in-center APD use was associated with a lower risk of all-cause death when compared with non-use.

Development of Dialysis and Leakage Detection on Different Technology

Dialysis is the treatment for chronic kidney disease (CKD) patients, including acute or end-stage renal disease (ESRD), by performing the filtration of toxic or waste substances from the patient’s body. Haemodialysis (HD) and peritoneal dialysis (PD) are common treatments for dialysis patients with the use of extracorporeal dialysis machines such as haemodialysis machines or automated peritoneal dialysis (APD) for HD and PD, respectively. For HD, is required a dialyser act as a single-use consumable during the treatment of the patient. However, the major concern on the haemodialysis machine might be the issue on false sense during the treatment. The leakage detector of the dialysis machine is important to detect and sense the parameters when that is a leakage event, such as blood leakage at the dialyser or arteriovenous fistula (AVF) dysfunction. Thus, this study provides a review of leakage detection that has been developed with different methodologies of the sensing unit on a haemodialysis machine.

Impact of Remote Monitoring on Standardized Outcomes in Nephrology-Peritoneal Dialysis

ObjectiveTo evaluate the association between the use of remote patient monitoring RPM in patients on automated peritoneal dialysis (APD) and the Standardized Outcomes in Nephrology in peritoneal dialysis (SONG-PD) clinical outcomes. MethodsProspective and multicenter cohort study conducted on patients with advanced chronic kidney disease on APD, recruited among 16 Spanish Hospitals, between June 1 and December 31, 2021. Patients were divided into two cohorts, namely patients on APD with RPM (APD-RPM) and patients on APD without RPM. The primary end-points were the standardized outcomes of the SONG-PD clinical outcomes: PD associated infection; CVD; mortality rate; technique survival; and life participation (assessed as health-related quality of life). Propensity score matching (PSM) was used to evaluate the association of RPM exposure with the clinical outcomes. ResultsA total of 232 patients were included, 176 (75.9%) in the APD-RPM group and 56 (24.1%) in the APD-without-RPM group. The mean patient follow-up was significantly longer in the APD-RPM group than in the APD-without-RPM one (10.4±2.8 versus 9.4±3.1 months, respectively, p=0.02). In the overall study sample, the APD-RPM group was associated with lower mortality rate (HR: 0.08; 95%CI: 0.01 to 0.69; p=0.020) and greater technique survival rate (HR: 0.25; 95%CI: 0.11 to 0.59; p=0.001). After PSM, APD-RPM continued to be associated with better technique survival (HR: 0.23; 95% CI: 0.06 to 0.83; p=0.024). ConclusionsThe use of RPM programs in patients on APD was associated with better survival of the technique and lower mortality rates. However, after PSM, only technique survival was significant.

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.

Level of Technological Maturity of Telemonitoring Systems Focused on Patients with Chronic Kidney Disease Undergoing Peritoneal Dialysis Treatment: A Systematic Literature Review

In the field of eHealth, several works have proposed telemonitoring systems focused on patients with chronic kidney disease (CKD) undergoing peritoneal dialysis (PD) treatment. Nevertheless, no secondary study presents a comparative analysis of these works regarding the technology readiness level (TRL) framework. The TRL scale goes from 1 to 9, with 1 being the lowest level of readiness and 9 being the highest. This paper analyzes works that propose telemonitoring systems focused on patients with CKD undergoing PD treatment to determine their TRL. We also analyzed the requirements and parameters that the systems of the selected works provide to the users to perform telemonitoring of the patient’s treatment undergoing PD. Fourteen works were relevant to the present study. Of these works, eight were classified within TRL 9, two were categorized within TRL 7, three were identified within TRL 6, and one within TRL 4. The works reported with the highest TRL partially cover the requirements for appropriate telemonitoring of patients based on the specialized literature; in addition, those works are focused on the treatment of patients in the automated peritoneal dialysis (APD) modality, which limits the care of patients undergoing the continuous ambulatory peritoneal dialysis (CAPD) modality.

Implementation of artificial intelligence Chatbot in peritoneal dialysis nursing care: Experience from a Taiwan medical center.

Coronavirus disease pandemic makes high requirements in delivering remote and efficient communication, and patient education. Because of the increases of digital and social media applications in Taiwan, we aim to apply Artificial Intelligence of LINE Chatbot to improve the self-care ability of patients undergoing peritoneal dialysis. We conducted the project since 1 May 2021 to 30 April 2022. We designed an automatically replied Chatbot system, and divided into six scopes of interaction interfaces, including peritoneal dialysis technique operation video, clinical reminder, home caring, hospital registration service, dietary guideline, and Automatic Peritoneal dialysis guidance. We surveyed patients' satisfaction with the LINE Chatbot 3 months later by the Likert 1-5 score-based questionnaire and the higher score indicated higher satisfaction. There were 440 patients who joined the PD AI Chatbot study and use the Chatbot, but the satisfaction questionnaire recovery rate was only 297 patients. We found that 91.7% of participants agreed 'Overall satisfaction with patient intelligent Chatbot application'. More than 4 points accounted for 86.6%. We traced every click in each section of the Chatbot and explored the potential scenario patients face. The Chatbot statistically significant reduced infection rate of exit site and tunnel infection before using (p = .049 and .024). Furthermore, peritonitis rate decreased from 0.93 to 0.8/100 patient month after using Artificial Intelligence technique. Peritoneal dialysis Artificial Intelligence Chatbot had similar effect with face-to-face education. The innovative Chatbot allowed delivering remote and digital information's to improve patients' self-care ability. Peritoneal dialysis patients were highly recognized and satisfied with the tools. It deserves to further explore the long-term impact of Artificial Intelligence Chatbot in peritoneal dialysis care.

Remote monitoring as a surveillance method in patients on automated peritoneal dialysis for preventing complications and COVID-19 contagion

BackgroundDue to the health emergency of COVID-19, telemedicine has become more relevant. Remote monitoring conspicuous as a valuable tool for the clinical follow-up of kidney patients, in this case, who are treated with automated peritoneal dialysis. This study aims to describe the use of remote monitoring as a surveillance method in a cohort of patients on automated peritoneal dialysis prevent complications and COVID-19 contagion. MethodsStudy of a cohort of patients who initially participated in a randomized block clinical trial in which the use of Automated Peritoneal Dialysis with Remote Monitoring (APD-RM) was compared with conventional treatment. A descriptive analysis was performed of the rates of infection by COVID-19, the time of incidence until this, mortality, and rates of transfer to hemodialysis. In addition, survival was measured by survival curves. ResultsOf the 509 patients, 19 were positive for COVID-19 (incidence rate of 7.0 episodes/100 patient-year), and only six patients recovered from the infection; the death rate was 2.6 % compared to all-cause death of 9.8 %. The most affected group of patients were those over 50 years old, with 71.4 % mortality, in contrast to younger patients infected, with a mortality of 60 %. During the follow-up period, 21 patients were transferred to HD: six due to peritonitis, five due to UF failure, seven due to catheter dysfunction, one due to uremic syndrome, one due to COVID-19, and one by surgical intervention. ConclusionAPD-RM patients have a significant advantage over other dialysis therapies because the use of telemedicine not only provides continuity in the patient's clinical treatment but also favors the prevention of COVID-19 infection, the management and prevention of complications inherent to therapy and the preservation of the life of Peritoneal Dialysis patients.

Comparative study on the burden of caregivers of patients with chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD)

Objective: To determine the differences in caregiver burden in patients with chronic renal failure undergoing renal replacement therapy in CAPD and APD. Material and methods: It is an analytical, non-experimental, comparative, cross-sectional, prospective study; with random selection and systematically assigned controls. People who perform the role of caregivers in patients with chronic renal failure on peritoneal dialysis, with renal replacement therapy in the modalities of CAPD and APD integrated into the peritoneal dialysis program in Campeche from January to July 2022, with a total of 60 primary caregivers. The Zarit test questionnaire and the caregiver effort index questionnaire were applied. Contribution: The following overload results were found for the CAPD caregiver of 12.9% and for APD 13.8%, in mild overload for CAPD 22.6% and for APD 10.3% and without overload CAPD 75.9% and APD 65.4%. The predominant gender of the caregiver was female for both modalities of peritoneal dialysis that correspond as follows CAPD 77.4% are women for APD women 75%. The average age found for CAPD was 46.87 and for DPA 45.55, with an average for CAPD and DPA respectively of 31 and 29 years.

A New Cycler for Automated Peritoneal Dialysis to Provide Efficient Dialysis and Improved Sleep Quality

Introduction: Automated peritoneal dialysis (APD) employs cyclers to control inflow and outflow of the dialysis fluid to the patient’s abdomen. To allow more patients to use this modality, cyclers should support the achievement of an adequate dialysis dose and be easy to use, cost-effective, and silent. The new SILENCIA cycler (Fresenius Medical Care, Bad Homburg, Germany), designed to improve these characteristics in comparison to its predecessor device, was evaluated in this respect in a prospective study. Methods: This cross-over study comprised two 2-week study periods, separated by a 3-week training phase. First, patients underwent APD with their current cycler (PD-NIGHT [Fresenius Medical Care, Bad Homburg, Germany] or HomeChoice Pro [Baxter, Deerfield, IL, USA] as control), followed by training on the SILENCIA cycler. Then, patients were switched to the SILENCIA cycler. During each treatment period, we collected data on total Kt/Vurea, ultrafiltration (UF) volume, patient-reported outcomes (sleep quality, among others), and device handling. Results: Sixteen patients were enrolled; 2 patients terminated the study prematurely before study intervention, 1 patient due to a protocol violation. In 13 patients, total Kt/Vurea and UF could be evaluated. Neither Kt/Vurea nor UF differed significantly between control and SILENCIA cyclers. Out of 10 patients answering the questionnaire on sleep quality after the 2-week phase with the SILENCIA cycler, sleep quality improved in 5 patients; in the other patients, sleep quality was rated unchanged compared to the previously used cycler. The average reported sleep time was 5.9 ± 1.8 h with the PD-NIGHT, 7.2 ± 2.1 h with HomeChoice Pro, and 8.0 ± 1.6 h with the SILENCIA cycler. All patients were much or very much satisfied with the new cycler. Conclusion: The SILENCIA cycler delivers adequate urea clearance and UF. Importantly, sleep quality improved, possibly related to less caution messages and alarms.

#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.