CAPD Patients Research Articles

#593 Prevalence and outcomes of tuberculous peritonitis among CAPD patients in National Kidney and Transplant Institute from January 2016 to January 2023

Abstract Background Continuous ambulatory peritoneal dialysis is a cost effective and efficient modality of renal replacement therapy. However, infectious processes such as peritonitis may lead to peritoneal membrane failure necessitating shift to hemodialysis. Tuberculous peritonitis is an unusual cause of peritonitis, which may lead to risk of hospitalization and significant morbidity and mortality. Aims To determine the prevalence and outcomes of tuberculous peritonitis among patients on continuous ambulatory peritoneal dialysis Method A retrospective, descriptive study of patients on continuous ambulatory peritoneal dialysis with tuberculous peritonitis from January 2016 to January 2023 in National Kidney and Transplant Institute. Demographic, clinical and laboratory data of patients with TB peritonitis were collected via chart review. Results Among 1182 patients on continuous ambulatory peritoneal dialysis, 2.03% had tuberculous peritonitis. Average length of time from development of symptoms to diagnosis is 24.5 days. Majority of presenting symptoms were hazy drain and abdominal pain. 66.7% retained their peritoneal dialysis catheter. PD catheter was removed in 33% of TB peritonitis due to peritoneal dialysis failure and unresolving peritonitis. Mortality was 37.5% after diagnosis of tuberculous peritonitis. Only significant factor associated with mortality was length of time on continuous ambulatory peritoneal dialysis to development of TB peritonitis (p = 0.0332). Conclusion Relative high prevalence of tuberculous peritonitis could be related to high background occurrence of tuberculosis in the country. Majority of cases had resolution of symptoms and effective dialysis during course of anti-tuberculous treatment and did not warrant peritoneal dialysis catheter removal.

Specific gut microbiome and metabolome changes in patients with continuous ambulatory peritoneal dialysis and comparison between patients with different dialysis vintages.

In recent years, the role of gut microbiota and derived metabolites in renal disease has attracted more attention. It has been established that the gut microbiota is a potential target for medical interventions in renal disease including chronic kidney disease (CKD), acute kidney injury (AKI) and renal calculus. Emerging evidence has related dialysis treatment to the microbial composition and function of the intestines, and there are many reports related to HD, but few studies have been related to PD. Previous studies have found that PD patients have intestinal flora disturbances, so we speculate that intestinal flora and its metabolites may be the regulatory factors in long-term therapy of PD. And as far as we know, there have been no studies characterized the gut microbiota in PD patients of different dialysis vintages. It is a cross-sectional study based on clinical data and biological samples of 72 patients with CAPD, 13 patients with ESRD and 13 healthy volunteers. The intestinal microecological characteristics of CAPD patients were comprehensively evaluated by combining the intestinal microflora structure, enterotoxin and receptor (serum LPS and LBP), intestinal barrier function index (serum D-Lactate), intestinal uremic toxin (serum IS, PCS, TMAO), fecal SCFAs and other multi-dimensional and multi-omics studies. Furthermore, the changes of intestinal microecology in CAPD patients of different dialysis vintages (≥ 3 and < 12 months, ≥ 12 and < 24 months, ≥ 24 and < 60 months, ≥ 60 months) were further explored, and the correlations between intestinal microecology indicators and some clinical indicators were analyzed. Fecal and serum samples were collected from PD patients (PD group, n = 72), ESRD patients (ESRD group, n = 13) and healthy volunteers (Normal group, n = 13). Fecal samples were subjected to microbiome (16S rDNA) and SCFA (GC-MS) analyses. Serum samples were subjected to LPS, LBP, D-lactate, IS, PCS, and TMAO (ELISA) analyses. The diversity and richness of intestinal flora in CAPD patients were lower than those in healthy people and ESRD patients, and the microflora structure was different. Anaerobes of Blautia and facultative anaerobes and aerobic bacteria with Bacilli and Lactobacillales those in Firmicutes are the main intestinal flora in CAPD patients. The abundance of Bacteroidaceae, Bacteroides, Faecalibacterium and other dominant bacteria in the intestinal tract of CAPD patients decreased. Proteobacteria, Enterobacteriaceae and Escherichia-Shigella increased their colonization (LDA > 4). In CAPD patients of different dialysis vintages, there was no significant change in the diversity and richness of microflora, and the microflora structure of PDC group was significantly different from that of PDD, which the abnormal expansion of enterobacter group was more prominent in PDC and the abundance of Bacteroides group was relatively higher in PDD. Intestinal barrier damage, intestinal uremic toxin accumulation and short-chain fatty acid reduction were observed in CAPD patients, such as the serum level of D-Lactate, PCS and TMAO were significantly higher than that in the Normal group (P < 0.05),and the fecal levels of BA and CA were significantly lower (P < 0.05). The intestinal microecological disorder of PDC group, while that of PDD group showed a better trend. Such as the PDC group had a significantly higher serum level of LPS, D-Lactate and TMAO (P < 0.01), and significantly lower serum level of LBP (P < 0.01), and lower fecal levels of AA and BA (P > 0.05) than the PDD group. The intestinal microecology and metabolic system of CAPD patients had changes compared with healthy people and ESRD non-dialysis patients, and there were differences in CAPD patients with different dialysis vintages. PD patients on dialysis for more than 60 months showed a better trend in the intestinal microecology than patients with 24∼36 months, which suggested that the intestinal microecology of PD patients had a certain ability of self-regulation and remodeling under the management of standardized system and it is necessary to strengthen the monitoring of the intestinal status and the occurrence of related complications in PD patients on dialysis of 24∼36 months of dialysis vintage. It is initially considered that the mechanism of intestinal microecology is a potential target for intervention in the diagnosis and treatment of CAPD and incorporating intestinal microecosystem monitoring into the long-term management of CAPD patients is a new strategy.

#2530 “HOME-MADE” REMOTE MANAGEMENT IN CAPD

Abstract Background and Aims Remote control of dialysis parameters has become an essential routine in the Centers that perform Peritoneal Dialysis. For patients in APD there are Cloud-based platforms or with VPN connection that allow daily monitoring and which have proved to be very useful for reducing hospital visits and treatment complications, especially during the recent pandemic. The same cannot be said of CAPD patients for whom the procedures are carried out manually, without electromedical devices, with a paper report of the parameters. Furthermore, to date, there are no dedicated applications able to communicate these important measurements to the Centres. Method In March 2021 we created a calculation table file, with limited data entry, divided by days, daily exchanges and monthly sheets. Patients and/or caregivers can insert loading and drainage volumes, type of bags used, blood pressure values, weight and diuresis at an agreed time. The system automatically calculates and graphically displays the total daily and monthly average ultrafiltration for each exchange, the daily balance as well as the average of all the aforementioned parameters for the entered period (Figure 1). There is also a graphic sheet with an annual summary of the average values (Figure 2). The file is uploaded online, subject to the patient's consent, via a free file hosting service that allows modification and reading shared and protected by password between patients and Center operators. Results To date, 9 CAPD patients in our Center have been included in the program with good acceptance by patients and caregivers, who enter data based on their availability of time and regularly in anticipation of the monthly outpatient visit. The staff of the Centre, both Doctors and Nursing, access the file periodically, in case of need and in preparation for the visit. In this way, regular checks and evaluations of prescription compliance, ultrafiltration efficacy, maintenance within the expected ranges of weight, blood pressure and fluid balance of patients in CAPD are obtained, as is the case for patients in APD. Conclusion The creation of a shared file for monitoring the dialysis parameters of CAPD patients could be able to reduce the existing gap with those in APD, at least as regards the vital and dialysis parameters, since the functioning of the catheter in individual exchanges cannot be evaluated. A more extensive experience is needed, and is being studied, to confirm the usefulness of this approach which currently already guarantees a reduction in hospital admissions and integrates and structures the clinical information that can be obtained in the traditional way.

#5367 CLINICAL SIGNIFICANCE OF NORMO-HYDRATION STATE IN PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims The assessment of fluid status in dialysis patients is of paramount importance. Managing persistent volume overload and instability during dialysis is a significant challenge, with concomitant symptomatic and asymptomatic intradialytic hypotension (IDH) that results in dialysis-induced myocardial ischemia (cardiac stunning) and long patient recovery times.Our aim was to estimate the status of hydration in our peritoneal dialysis population by body composition monitoring (BCM) device to modify our pharmacological and dialysis policy and to evaluate echocardiographic parameters of the RV functions in patients with end-stage renal disease (ESRD) undergoing PD. Method We used a Fresenius Body Composition Monitor (BCM), a whole-body bioimpedance spectroscopy (50 frequencies, 5–1,000 kHz), to assess the body composition of 35 patients on peritoneal dialysis in our centre..We measured body weight, 24 h diuresis and performed a BCM session. Analysed results of echocardiography focused on RV (tricuspid annular plane systolic excursion (TAPSE). As per statistics, comparisons between 2 groups done by students t test, Mann Whitney U test or Wilcoxon test. Correlation between data was done by Pearson or spearman correlation. And lastly categorical variables were assessed by fisher's exact, and Chi squared test. Results Average age was 47 years old (SD 9,45 t-test p = 0,1154:). Gender distribution was 54,3% of our patients were female. 8,6% of our patients were anuric, 91,4% had residual urine (more than 1 litre). TAPSE value were average 23,17 mm (±4,5).We measured over-hydration in 8 cases by BCM that followed dialysis policy modification. In 8 PD patients we measured more than 2 L volume overload (VO) with BCM followed by dialysis policy modification (fluid intake restriction, diuretic dose increasing, frequent solution exchange). Conclusion Our data raised the importance of regular echocardiography to identify it. More attention should be focused on improving BP and volume control and identifying treatment strategies that effectively lower further deterioration in PD patients. One way of doing this is monitoring with BCM. With this clinician can manage persistent overload in CAPD patients, to better modify the dialysis regime, restrict fluid intake and use diuretics, to all in all preserve LV and RV function, and to prevent deterioration of the peritoneal membrane, and most importantly improve their survival.

340.4: Accessibility to the Kidney Transplantation Beyond Immunology

Background: Kidney transplantation (KT) has proven to be the preferable kidney replacement therapy (KRT) as it provides a better survival and quality of life. Well-known patient-related factors influencing patients’ access to KT are blood type, age, comorbidities, and pre-sensitization to HLA antigens. Research on home dialysis modalities´ effect on this matter is scarce. Methods: We included all adult patients who started kidney replacement therapy (KRT) between 2004 and 2017 in the Helsinki University Hospital treated with home dialysis modalities (N=536), including home hemodialysis (HHD) and peritoneal dialysis; both CAPD and APD. A control group of in-center HD (ICHD) patients was randomly selected (N=200). The patients were followed-up until kidney transplantation, death, or end of follow-up in December 2020. We retrieved from registries variables with a potential effect on access to transplantation, of special interest we considered dialysis modality at 90 days after initiating KRT. Results: In all, 481 out of 736 patients were waitlisted for kidney transplantation, of whom 423 were transplanted (88%), 23 patients (5%) died on the waitlist (WL), 24 were permanently removed from the WL (5%) and 11 were still on the WL at the end of FU. The probability of waitlisting was 2.1 as high in CAPD patients (p=0.004), and 7.9 times as high in both APD and HHD patients (p<0.001) compared to ICHD. Cardiovascular morbidity did not affect waitlisting. Of those who were waitlisted, both ICHD (N=74) and CAPD (N=80) patients were older than APD (N=199) and HHD (N=128) patients (mean age 54; 56; 48 and 49 YO respectively). Mean (95% CI) time elapsed from KRT initiation to WL inclusion was 307 days (251-362), time from WL to KT was 458 days (542-636) and time off the WL due to an intercurrence was 96 days (80-112). There were no differences between dialysis modalities in terms of time from WL to KT (p=0.176), but time to WL was significantly longer in ICHD patients (p=0.014) (Figure 1) The time off the WL equally delayed KT irrespective of the dialysis mode. (p=0.141) Dialysis modalities had an impact on the time elapsed from WL to KT (log rank p=0.028). (Figure 2) By Cox regression analysis the variables that were significantly related with the outcome were panel reactive antibodies type 1 (p=0.033), and time off the WL (p<0.001), while cardiovascular comorbidity (p=0.246), dialysis modality (p=0.208), malignancy (p=0.675), panel reactive antibodies type 2 (p=0.679) and age (p=0.054) did not reach the level of significance. Altogether 732 episodes resulted in the patients being temporarily removed from the WL, and the most common reasons were PD-peritonitis (20%), other infections (26%), and surgery/dental treatment (10%). On the other hand, both vascular access complications (1%) and cardiovascular intercurrences (4.9%) were uncommon. Conclusions: Dialysis modality significantly influences patients’ access to transplantation. APD and HHD modalities provided a benefit in terms of accessing the WL. In patients wait listed, intercurrent complications during dialysis, mainly infections, significantly prolonged the waiting time for KT in all patients beyond immunological reasons.

Assessment of microbiological profile in peritoneal dialysis in patients with chronic kidney disease

Peritonitis is a serious complication of peritoneal dialysis (PD). It is the primary reason for hospitalization and switching over to hemodialysis. In the present study, we aimed to determine the microbiological profile of peritoneal dialysis fluid in patients with acute and chronic renal failure and identify these organisms' susceptibility patterns. This cross-sectional study was conducted in the Institute of Microbiology and Institute of Nephrology in the Rajiv Gandhi Government General Hospital from April 2016 to March 2017. A total of 100 patients who were &amp;#62;18 years of age, acute and chronic renal failure patients who underwent Peritoneal Dialysis and patients on Continuous and Intermittent Peritoneal Dialysis were included. The study population included 100 patients who satisfied the inclusion criteria. 63% were males, and 37% were females. The patients had a mean age of 44.15±13.89. 28 samples were culture positive, out of which 13 (46.4%) were Gram-negative, 10 (35.7%) were Gram-positive and 5 (17.9%) were Fungal isolates. Among them, the majority were Acinetobacter baumannii (20%) and Candida non-albicans (20%), followed by Staphylococcus aureus (16%), Coagulase-negative Staphylococcus (16%), Klebsiella oxytoca (8%), Klebsiella pneumoniae (4%), Enterococcus faecalis (4%).Peritoneal infections were more common in patients with longer duration of dialysis and diabetes mellitus. CAPD patients were having a higher risk of infections compared to IPD. As the number of infections associated with peritoneal dialysis rises, routine PD fluid microbiological analysis after the procedure will help improve patient care by using appropriate antibiotics as soon as possible before any major clinical problem arises.

Evaluation of the Reasons for Emergency Department Application in Patients with Peritoneal Dialysis

ABSTRACT Background: Severe acute problems, which are related to different systems, could be reasons for applying to the emergency department in patients with peritoneal dialysis. In this study, the aim was to evaluate the reasons and treatment of applications to the emergency department in these patients after office hours. Methods: This study included followed up CAPD patients, who applied to the Emergency Department between January 2017 and May 2020 at our University. Demographical, biochemical, and clinical data, such as, renal, peritoneal, and weekly Kt/V, normalized protein catabolic rate (nPCR), peritoneal UF, and GFR were recorded from the outpatient’s department data. In addition, reasons for application to emergency services and hospitalization were evaluated. Results: 38 peritoneal dialysis patients applied 88 times to the emergency department and were hospitalized between 2017 and 2020. Patients, who applied after office hours were included in the study. Around 130 patients were regularly followed-up in our CAPD outpatient clinic during this period. While the most important peritoneal reasons for admission were exit site infection and catheter dysfunction, extra peritoneal complications were various. Patients were hospitalized in the Cardiology and General Surgery departments with a high rate of acute cardiovascular events and acute abdominal pathologies. Conclusion: Although the first approach to these patients in the emergency department is usually performed by a consulted nephrologist, effective and priority treatment could only be given by an emergency doctor, who has knowledge about the special problems of dialysis patients.

MO715: The Role of Duration and Modality Choice on Sodium and Water Removal for Peritoneal Dialysis Patients

Abstract BACKGROUND AND AIMS Hypervolemia is common in peritoneal dialysis (PD) and contributes to hypertension and left ventricular hypertrophy, thus increasing the cardiovascular risk of these patients. The achievement of adequate water and sodium balance is considered a major determinant of dialysis adequacy and seems to have a greater effect on PD outcome than Kt/V and small solute clearances. However, the contribution of different PD modalities to dialytic sodium removal remains not well defined. The aim of this study was to explore the effect of different PD modalities on sodium and water removal. METHOD This is a single-center cohort study of 21 patients (m = 12, f = 9). They were examined according to their modality of PD: CAPD (continuous ambulatory PD n = 9) and APD (continuous cycler PD n = 12). CAPD patients’ median age was 74 years (66–79), median time on PD was 37 months (24–59), median Kt/V 2.4 (1.9–3.1) and median eGFR 9.9 mL/min (3.5–12.4). APD patients’ median age was 47 years (32–75), median time on PD 65 months (52–87), median Kt/V 2.439 (2.12–2.8) and median eGFR 2.3 mL/min (0–5). We used the modified peritoneal equilibration test (PET with DW 4.25%) and double mini-PET to calculate the small solute transport rate (D/P of creatinine), water removal (FWT—free water transport, ΔNa—sodium dip, OCG—osmotic conductance of glucose) and mesothelial cell integrity (CA125 appearance rate in dialysis effluent). We also calculate the total amount of sodium excretion from the 24 h PD effluent collection and urine collection. Using bioimpedance spectroscopy we calculate the patients’ total body water, the overhydration and the intracellular and extracellular volume (ECV). RESULTS We did not find between the two groups any statistically significant difference for water movement through the membrane (ΔNa P = 0.427; FWT P = 0.384; OCG P = 0.27), for the marker of mesothelial cell mass (CA125AR P &amp;gt; 0.05) or for hydration status (OH, ECV). There was a statistically significant difference between the two groups for the small solute transport rate (Cr d/p, P = 0.025), for the total daily amount of sodium excretion through the membrane (P &amp;lt; 0.001), i.e. patients on APD having faster solute movement and excrete more sodium during the day compared to CAPD patients. Additionally, from the regression analysis there was statistically significant correlation between the daily dialysis sodium excretion and solute movement (P = 0.007, r = 0.58) and total time on PD (P = 0.004, r = 0.612). CONCLUSION These results indicate that there is no inferiority of APD compared to CAPD for sodium excretion due to the smaller time duration of the cycles (sodium sieving). Additionally, we notice that even though the patients on APD remained longer on PD and received larger daily volumes of PD effluent there was not any difference in mesothelial cell marker or water transport indicators. Inevitable time probably through neo angiogenesis results in faster solute transport.

Patient-reported gastrointestinal symptoms in patients with peritoneal dialysis: the prevalence, influence factors and association with quality of life

BackgroundThe aims of this study were to investigate the prevalence and the influence factors of gastrointestinal symptoms, and its association with the quality of life (QOL) in peritoneal dialysis (PD) patients.MethodsContinuous ambulatory PD patients (CAPD) who followed up in our PD center between March 2016 and December 2017 were enrolled in this cross-sectional study. Gastrointestinal symptom rating scale (GSRS) was used to evaluate gastrointestinal symptoms. The related clinical data were also collected. Multiple linear regression analysis was test for the influence factors associated with score of GSRS and QOL.ResultsThis study included 471 CAPD patients. The mean age was 48.5±13.9 years, 53.9% were male and 15.1% with diabetic nephropathy. The median duration of PD was 37.3 (17.5~66.5) months. The median score of GSRS was 1.2(1.1~1.3) scores. Totally 82.2% (n=387) CAPD patients had at least one gastrointestinal symptom. Higher glycosylated hemoglobin, higher score of depression, lower diastolic blood pressure, urine output, score of instrumental activities of daily living scale and more amount of pills per day were independently associated with higher score of GSRS (all P<0.05). Score of dyspepsia and eating dysfunction were independently associated with worse score of QOL and physical health (all P<0.05).ConclusionsGastrointestinal symptoms were common but not serious in CAPD patients. Glycemic control, depression, blood pressure, urine output, activity of daily life and amount of pills were all associated with gastrointestinal symptoms. Moreover, gastrointestinal symptoms were correlated with QOL of PD patients.

COVID-19 Infection in CAPD Patients: A Single-Center Indian Experience.

COVID-19 Infection in CAPD Patients: A Single-Center Indian Experience.

Albumin Description of Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients in Sardjito Hospital Yogyakarta

Albumin profile is an important sign of nutritional status as a quality-of life parameter, whereas hypoalbuminemia has been shown to be associated with a high mortality rate for patients with End Stage Renal Disease (ESRD) undergoing dialysis including CAPD. The study was conducted to determine serum albumin levels in patients with ESRD undergoing CAPD therapy. The study was conducted in a cross-sectional manner on ESRD patients who were still actively undergoing CAPD in the outpatient Installation of Dr. Sardjito Hospital Yogyakarta until November 2018. Subjects were examined for serum albumin levels. There were 57 research subjects with the category of albumin levels &lt;3.5 g / dL as many as 19 (33.3%), between 3.5-4.0 g / dL as many as 27 (47.3%) and albumin levels&gt; 4.0 g / dL of 11 (19.3%). There were no significant differences in all age groups, BMI and duration of CAPD. Albumin profile can be an independent parameter of quality of life and even a predictor of mortality in CAPD patients because it does not depend on age group, BMI and length of CAPD

Understand the difference between clinical measured ultrafiltrationand real ultrafiltration in peritoneal dialysis

BackgroundIt has been noticed for years that ultrafiltration (UF) is important for survival in peritoneal dialysis. On the other hand, precise and convenient UF measurement suitable for patient daily practice is not as straight forward as it is to measure UF in the lab. Both overfill and flush before fill used to be source of measurement error for clinical practice. However, controversy finding around UF in peritoneal dialysis still exists in some situation. The current study was to understand the difference between clinical measured UF and real UF. The effect of evaporation and specific gravity in clinical UF measurement were tested in the study.MethodsFour different brands of dialysate were purchased from the market. The freshest dialysate available in the market were intentionally picked. The bags were all 2 L, 2.5% dextrose and traditional lactate buffered PD solution. They were stored in four different conditions with controlled temperature and humidity. The bags were weighted at baseline, 6 months and 12 months of storage. Specific gravity was measured in mixed 24 h drainage dialysate from 261 CAPD patients when they come for their routine solute clearance test.ResultsThere was significant difference in dialysate bag weight at baseline between brands. The weight declined significantly after 12 month’s storage. The weight loss was greater in higher temperature and lower humidity. The dialysate in non-PVC package lose less weight than PVC package. The specific gravity of dialysate drainage was significantly higher than pure water and it was related to dialysate protein concentration.ConclusionStorage condition and duration, as well as the type of dialysate package have significant impact in dialysate bag weight before use. Evaporation is likely to be the reason behind. The fact that specific gravity of dialysate drainage is higher than 1 g/ml overestimates UF in manual exchanges, which contributes to systemic measurement error of ultrafiltration in CAPD.Trial registrationClinicalTrials.gov ID: NCT03864120 (March 8, 2019) (Understand the Difference Between Clinical Measured Ultrafiltration and Real Ultrafiltration).

Status and factors related to post-traumatic growth in continuous ambulatory peritoneal dialysis: A multi-centre study.

AimTo investigate the extent of post‐traumatic growth, and the correlation between post‐traumatic growth and self‐perceived stress, post‐traumatic growth and self‐perceived burden among CAPD patients.DesignA cross‐sectional study.MethodsThis was a multi‐centre study including 752 patients from 44 hospitals. Self‐perceived stress, self‐perceived burden and post‐traumatic growth were measured using the post‐traumatic growth inventory (PTGI), the Chinese version of the perceived stress questionnaire (CPSQ) and the self‐perceived burden scale (SPBS). A multiple stepwise regression analysis was fit with the total PTGI score as the outcome of interest.ResultsPatients concurrently experienced post‐traumatic growth and stress following peritoneal dialysis. The initiation of patients’ education level, employment status and self‐perceived stress were all found to relate to growth among Chinese CAPD patients. There was not sufficient evidence to suggest that self‐perceived burden was related to experiencing growth.

A STUDY OF EVALUATION OF THYROID FUNCTION STATUS IN CONTINOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

Background/Aim: End-stage-renal-disease (ESRD) patients/CAPD have a high rate of abnormal thyroid hormone (include subclinical hypothyroidism and non-thyroidal illness syndrome) compared with those without kidney disease. These thyroid dysfunctions are associated with higher death risk due to cardiovascular disease in the general population, little is known about the effect of thyroid disease in patients received peritoneal dialysis. Methods: Cross-sectional research, 118 participants (59 healthy people, 57 CAPD patients) were enrolled. We examined the association of thyroid status, assessed by serum TSH, free T3, free T4 levels which were measured by immunoassay method. Results: Mean serum TSH level of patients were higher than those of control group, p&lt;0.05 (3.15±2.28 μUI/mL versus 1.65±0.82 μUI/mL); mean FT3 level of patients were lower than those of control group, p&lt;0.05 (2.42±0.46 pg/mL versus 3.01±0.41 pg/mL); mean FT4 level of patients were lower than those of control group, p&gt;0.05(1.26±0.24 ng/dL vs 1.18±0.18 ng/dL). Among 57 CAPD patients, 35.1% abnormal thyroid function; 19.3% subclinical hypothyroidism; 15.8% low FT3; 1 patient has low FT4. Mean serum TSH level of patients were higher than those of control group, p&lt;0.05 (3.15±2.28 μUI/mL versus 1.65±0.82 μUI/mL); mean FT3 level of patients were lower than those of control group, p&lt;0.05 (2.42±0.46 pg/mL versus 3.01±0.41 pg/mL); mean FT4 level of patients were lower than those of control group, (p&gt;0.05, 1.26±0.24 ng/dL vs 1.18±0.18 ng/dL). Conclusion: Subclinical hypothyroidism and low FT3syndrome are high in CAPD patients. Additionally, FT4 serum concentration is associated with PD duration and serum creatinine; FT3 is dependent risk factor of rate Kt/V Urea weekly, also cardiovascular disease. Key words: ambulatory peritoneal dialysis, continous ambulatory peritoneal dialysis patients (CAPD), abnormal thyroid function, subclinical hypothyroidism

The prognosis and risk factors of baseline high peritoneal transporters on patients with peritoneal dialysis.

The relationship between baseline high peritoneal solute transport rate (PSTR) and the prognosis of peritoneal dialysis (PD) patients remains unclear. The present study combined clinical data and basic experiments to investigate the impact of baseline PSTR and the underlying molecular mechanisms. A total of 204 incident CAPD patients from four PD centres in Shanghai between 1 January 2014 and 30 September 2020 were grouped based on a peritoneal equilibration test after the first month of dialysis. Analysed with multivariate Cox and logistic regression models, baseline high PSTR was a significant risk factor for technique failure (AHR 5.70; 95% CI 1.581 to 20.548 p = 0.008). Baseline hyperuricemia was an independent predictor of mortality (AHR 1.006 95%CI 1.003 to 1.008, p < 0.001) and baseline high PSTR (AOR 1.007; 95%CI 1.003 to 1.012; p = 0.020). Since uric acid was closely related to high PSTR and adverse prognosis, the in vitro experiments were performed to explore the underlying mechanisms of which uric acid affected peritoneum. We found hyperuricemia induced epithelial‐to‐mesenchymal transition (EMT) of cultured human peritoneal mesothelial cells by activating TGF‐β1/Smad3 signalling pathway and nuclear transcription factors. Conclusively, high baseline PSTR induced by hyperuricaemia through EMT was an important reason of poor outcomes in CAPD patients.

Frequency of Pulmonary Hypertension in Patients with Chronic Kidney Disease Stage 5 (CKD Stage 5) and Correlation of PASP with Biochemical Parameters of CKD

Background: Pulmonary hypertension is an independent predictor of mortality. It is a recognized condition in patients with chronic kidney disease. Objective: To find out the frequency of pulmonary hypertension in CKD stage 5 patients and relation of PASP with biochemical parameters of CKD. Methods: This cross-sectional study was conducted in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2014 to June 2016 over a period of 2(two) years. One hundred twenty patients with CKD stage 5 on dialysis (HD and CAPD) and pre dialysis for more than 3 months were selected for this study. Result: Pulmonary hypertension was found in 56.6% maintenance HD patients, in 13.3% CAPD patients and in 20.6% pre dialysis patients. A significant correlation of pulmonary arterial systolic pressure with age, duration of dialysis, serum phosphate, and serum iPTH levels was found. Conclusion: Frequency of pulmonary hypertension was highest in hemodialysis group (56.6%). Routine screening and early detection is important in order to avoid the serious consequences of the disease.

The Ratio of Dialysate NGAL to Plasm NGAL (NGAL D/P) Can Reflect Peritoneal Transport in CAPD Patients

Methods: 20 CAPD anuria patients without peritonitis in our peritoneal dialysis center were recruited from July 2016 to July 2018. These patients were divided into high-transport peritoneum group and non-high transport peritoneum group according to peritoneal transport type. Patients from both groups received the same dialysis solutions and dialysis modality. Peritoneal transport type, serum C-reactive protein, peritoneal equilibrium test results, dialysate NGAL, plasm NGAL, the ratio of dialysate NGAL to plasm NGAL (D/P NGAL) from both groups were recorded. Spearman’s correlation coefficient was employed to examine the relations between variables. Receiver operating characteristic (ROC) curve analysis was used to calculate the area under the curve (AUC) for ratio of dialysate NGAL to plasm NGAL (D/P NGAL) and peritoneal creatinine to serum creatinine (D/P creatinine).

MO690HIGHER EXPRESSION OF TOLL LIKE RECEPTOR AND CELL ADHESION MOLECULES ARE ASSOCIATED WITH RECURRENT/RELAPSE PERITONITIS AND MORTALITY IN PATIENT ON CAPD

Abstract Background and Aims CAPD is an established modality of treatment for patients with end stage renal disease (ESRD). Peritonitis is a leading cause of technique failure and death in patients on CAPD. Studies on expressions of host genetic factors like TLRs, CAMs, Pro and Anti-inflammatory cytokines and their link to peritonitis and other co-morbidity and functional status are lacking throughout the world. Hence the present study was done to determine the expressions of TLR2 and TLR4, CAMs and inflammatory cytokines in patients on CAPD. Method A total of 110 ESRD patients categorized into 3 groups: 1- CAPD patients (n=45), group 2- CAPD with peritonitis patients (n=35), and group 3- CAPD patients with recurrent/relapsing peritonitis. (n=30) from department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow were included in the study. Blood sample was collected for analysis of cytokines and Cell adhesion molecules level and RNA extraction. Dialysate (only from patients undergoing PD with or without peritonitis)- whole drained bag; 50-100 ml for microscopy and culture for bacterial and fungal pathogens using automated BACTEC culture system in patients with peritonitis and supernatant was collected for cytokine ELISA. Statistical analysis: One-way ANOVA (Two tailed) and non-parametric student t-test used for statistical analysis of differences between the group. Results mRNA expression of TLR 2 and TLR 4 expression was higher in peritonitis and recurrent/relapsing peritonitis group as compared to CAPD patient without peritonitis group. mRNA expression of TNF-alpha, IL-1B and IFN-gamma was higher in peritonitis group of patients compared to all other group of patients. mRNA expression of IL-10 and IL-4 was also highest in Peritonitis group. Level of IL-1β and TNF-alpha was observed to be elevated in peritonitis and recurrent/relapse peritonitis patients compared to CAPD in sera and dialysate. IL-12 level in Sera was also elevated in peritonitis patients but its level in dialysate was highest in CAPD without peritonitis as compared to peritonitis and recurrent/relapse. IL-10 and IL-4 was observed to be elevated in peritonitis group followed by CAPD with recurrent/relapse peritonitis in sera whereas in dialysate level of IL-4 was higher in both peritonitis group and Recurrent groups of patients but IL-10 level was highest in peritonitis group but less in recurrent/relapse. mRNA Expression levels of adhesion molecule ICAM-1 and LFA-1 were observed to be higher in Peritonitis and Recurrent groups as compared to the CAPD without peritonitis; whereas, in sera the level of ICAM-1 was higher in peritonitis patients. However, in dialysate its level was observed to be almost similar. Level of LFA-1 was observed to be higher in peritonitis group in dialysate but in sera its level was higher in Recurrent group with peritonitis. Conclusion It is likely that CAMs are also involved in the pathogenesis of CAPD peritonitis, its morbidity and mortality. TLRs activation by bacterial molecules leads to the induction of chemokines and cytokines through the activation of NF-ķB pathway and may be responsible for atherosclerosis, morbidity, and mortality in ESRD patients. Elevated level of ICAM-1, IL-1beta, TNF-a and IFN-G may be responsible for chronic inflammation in PD patients.

MO699PERITONITIS RISK OF PD MODALITIES AND TECHNICAL SURVIVAL ACCORDING TO BASELINE PERITONEAL TRANSPORT STATUS

Abstract Background and Aims The PD modality is usually modulated according to the PET and dialysis adequacy during follow-up but, initial modality choice generally depends on patient preferences and lifestyle regardless of patients’ baseline transport status. However, the relationship between baseline transport status, the PD modality chosen, and technical survival is not well established. Peritonitis is one of the leading causes of technical failure, hospitalization, and death in PD. While obesity, low albumin levels, exit-site infections, and nasal staphylococcus carriage are well-defined risk factors for peritonitis, some suggest CAPD could be another risk factor due to increased daily connection to PD. Many studies indicated that CAPD and APD have similar technical survival rates. In this study, we aimed to identify the impact of the baseline transport status on technical survival of CAPD and APD. We also investigated peritonitis risk of modalities considering all defined risk factors. Method This is a retrospective, single-center, cohort study of incident adult PD patients followed-up between January 2010 and January 2020. One hundred and thirty-six patients, followed-up for at least three years, were included. Patients with malignancy and who had less than 1.7 Kt/V per week were excluded. Peritonitis is defined according to the "International Society Peritoneal Dialysis" guideline. According to the baseline PET, patients were divided into two groups as follows; 1) high or high average transporters and 2) low or low average transporters. Risk factors for peritonitis, five years, and overall technical survival of both modalities according to baseline transport status were determined. Results The mean age was 35.5±12 years, and the median follow-up time was 47 (36-178) months. Sixty-six (48%) of the patients were female. Patients' first-year Kt/V per week was 2.18±0.4, and the mean ultrafiltration was 0.9±0.4 liters. 26 (19%) of the patients had diabetes mellitus, 57(42%) patients had hypertension, and 27 (20%) of the patients had a history of hemodialysis of more than three months. 89 (65%) of the patients were performing CAPD, 59 (66%) of whom were low or low-average transporters. 47(35%) of patients were performing APD and 28(60%) of whom were high or high-average transporters. During the follow-up, a total of 71 peritonitis episodes were observed, and the incidence of peritonitis was 0.13 episodes/year. Univariate logistic regression analysis showed that CAPD, low education level (being primary school graduate or illiterate), HD treatment before PD, and bathing less than once per week were associated with peritonitis risk. However, multivariate analysis of associated factors demonstrated that only CAPD was a significant risk factor for peritonitis [odds ratio:2.360 (95% confidence interval:1.075-5.180), p=0.03]. Kaplan-Meier survival analysis showed that low or low-average transporters and high or high-average transporters had similar technical survival rates in both CAPD or APD at the end of three years (figure 1). Similar rates were found in overall survival. Conclusion In our study, APD and CAPD patients had similar technical survival regardless of the peritoneal transport characteristics. However, CAPD was found to be a factor for peritonitis. Thus, it may be appropriate to initiate the PD treatment with APD modality and evaluate patients to switch modalities with PET only in case of peritoneal dialysis inadequacy.

FC 099DECLINING PERITONEAL HOST DEFENCES REVEALED BY EX-VIVO CYTOKINE RELEASE ASSAY OF PERITONEAL DIALYSIS EFFLUENT CELLS

Abstract Background and Aims Infectious complications occur in a significant proportion of PD patients, limiting long-term applicability. Reduced peritoneal immune-competence, caused by the continuous exposure to PD-fluids, has been described as a therapy-related pathomechanisms, prompting the need for a tool to assess the functional peritoneal immune status. We established an ex-vivo stimulation assay to test host defence mechanisms in only 9ml of PD-effluent. The aim of this study was to analyse basal inflammation and immune-competence in the general PD population at routine conditions to evaluate the assay as surrogate parameter of immune competence and linking it to PD vintage and clinical outcome parameters. Method 147 of 284 (51.8%) adult and paediatric PD patients treated between April 2013 and September 2020 at the local Department of Nephrology were included in the analysis. The study was approved by the local ethics committee and was conducted in accordance with the Declaration of Helsinki. Patients were exclusively treated with neutral pH/multi-chamber PD fluids during the glucose dwells. The majority of the 558 included PD-effluent samples were obtained during standard 4-hours peritoneal equilibration tests (PET) with 3.86% glucose containing PDF. Samples from the pre-PET dwell and at PET time points 1-hour and 4-hours were collected and immediately processed. Additional effluent samples were obtained during unscheduled hospitalization and in the event of an acute peritonitis. Effluent samples were collected directly from the drainage bags into standard 9 ml additive-free sample tubes. For ex-vivo stimulation, 100 ng/ml toll-like receptor (TLR) 4 agonist LPS and TLR2 agonist Pam3Cys were added to the effluent in the 9 ml collection tubes in duplicates and incubated at 37°C for 24h. Unstimulated samples kept in parallel were used as controls. IL-6 and TNF-α concentrations were measured with ELISA in the supernatants. Results Ex-vivo stimulation of peritoneal cells significantly increased the IL-6 and TNF-α release compared to unstimulated controls and resulted in a dwell-time dependent increase, with a significant lower cytokine released at the 1h PET time point. To assess local inflammation IL-6 levels of crude effluent were determined. IL-6 concentrations remained stable over time on PD. Interestingly, we were able to show higher IL-6 levels in CAPD patients in comparison to APD. As chronic exposure to PD-fluids has been shown to dampen the peritoneal immune competence, consecutive peritoneal effluent bags, obtained from patients were analysed. In this subcohort of 183 4h-PET effluents we found a decline in cytokine secretion with time on PD (IL-6 r=-0.27, p=0.00015, TNFa r=-0.25, p=0.00071). In a subgroup the ex-vivo cytokine release of effluent samples from patients with an acute peritonitis was assessed. IL-6 levels of acute peritonitis effluent samples did not differ from the stimulated IL-6 levels of effluent samples without acute peritonitis (2.45 pg/mL vs 2.31 pg/mL, p=0.85, t-test) suggesting that the assay seemingly represents the in-vivo host-defence cytokine release accurately. Conclusion The study provides evidence of a correlation of declining local host defence and duration of PD-therapy. It supports the hypothesis of PD duration-dependent progressive impairment of the ability of the peritoneal immune cells to secrete cytokines in response to a pathogenic stimulus and thereby dampening the global peritoneal immuno-competence. This suggests the utility of this clinically feasible ex-vivo induced cytokine-release assay in peritoneal effluent as a surrogate of the functional peritoneal immune competence. Future analyses need to evaluate the assay as a tool to predict common clinical outcomes and define reference values to facilitate stratification of patient populations, clinical staging and to guide novel therapeutic interventions.