Continuous Peritoneal Dialysis Research Articles

Peritoneal dialysis in Herzegovina, Federation of Bosnia and Herzegovina: 18 years of experience from our center.

Due to treatment of end-stage-renal-disease (ESRD), continuous peritoneal dialysis (CAPD) is used in 11% of cases and is associated with several PD-associated infections. Clinical data on 71 patients with CAPD were evaluated in addition to exit site infections and episodes of acute peritonitis (AP). There were 39 men and 32 women. Average age was 61 years when we began CAPD and average time spent on CAPD program was 3.35 years. Illness that dominantly caused ESRD was diabetes (23 patients). Exit site infection was mostly caused by S epidermidis-MRSE and AP was most commonly caused by Staphylococcus sp. group. Most common cause of death was cardiovascular disease. At the end of this study, 9 patients were alive and still on CAPD, 10 were transplanted, 15 switched to HD and 36 died. Optimal prevention measures and treatment of infectious complications in CAPD is necessary for better treatment possibilities.

Continuous peritoneal dialysis in pediatric patients with chronic kidney diseases: a case series and literature review

Background: Continuous ambulatory peritoneal dialysis (CAPD) is still a viable option for pediatric renal replacement therapy in both acute and chronic conditions. In a country with limited resources, CAPD is still the treatment of choice for pediatric patients with end stage chronic kidney disease (CKD). Case presentation: We present a case series of six children with chronic kidney diseases on continuous ambulatory peritoneal dialysis (CAPD (age range: 10–16 years old). All patients were diagnosed with CKD stage 5. Of the six patients, four were diagnosed with nephrotic syndrome, one with systemic lupus erythematosus with kidney involvement, 1 with primary glomerulopathy, and one was diagnosed with congenital anomaly of a kidney. In this study, most patients experienced infection as the side effect of CAPD (n = 4; 66.67%), while the remainings experienced adhesion (n = 2; 33.33%). CAPD was effective in 4 of 6 patients who received the device. Discussion: Due to the emergence of complications, the lack of long-term efficacy of CAPD is the most significant factor limiting its application. Conclusion: The authors report a case series of successful experience with CAPD in children with CKD in Indonesia. Although CAPD is effective, the majority of patients in this series do not survive.

Research hotspots and development trends in volume management of peritoneal dialysis patients: a bibliometrics and visual analysis up to 2022

ObjectivesAmong different renal replacement therapies (RRTs), peritoneal dialysis (PD) is a family based treatment method with multiple advantages, which allowing patients to maintain autonomy, avoiding frequent hospital visits, and preventing the spread of the disease virus. To visually analyze the literatures related to volume management of PD patients through bibliometric methods, to explore research hotspots and development trends in this field.MethodsThe relevant literatures of PD patient volume management in the Web of Science core collection database were retrieved with the terms of peritoneal dialysis, volume management, capacity management, fluid status, and volume overload. The retrieval time was from the establishment of the database to October 2022. CiteSpace 6.1.R3 software was used to visually analyze Country, Institution, Author, Keyword, and draw keyword clusters and keyword emergence maps.ResultsA total of 788 articles were included in the analysis, and the annual number of papers was on the rise, with the American, China, and Brirain in the top three, and Peking University and University College London in the top. Keywords cluster analysis showed 11 clusters. In the keyword emergence analysis, the keywords with higher emergence intensity rank are continuous cyclic peritoneal dialysis, ambulatory peritoneal dialysis, and icodextrin. The current research hotspots and trends are in the evaluation of peritoneal dialysis patients’ volume status, the selection and adjustment of dialysis prescriptions, and adverse health outcomes.ConclusionThe research on peritoneal dialysis volume management in China started late, but it has developed rapidly, and has a firm grasp of current research hotspots. However, there is less cooperation with other countries, so international exchanges and cooperation should be strengthened. At present, the volume assessment methods and dialysis modes are still the research hotspots, paying more attention to the adverse health outcomes of patients.

Wunderlich Syndrome in a Peritoneal Dialysis Patient with Warfarin Iatrogenic Coagulopathy: Should We Really be so Aggressive on Cardioembolic Events Prevention?

Wunderlich syndrome is a rare condition characterized by atraumatic spontaneous renal hemorrhage that can have serious associated complications, especially in chronic kidney disease and end-stage kidney disease patients due to their complexity. Diagnosis requires a high index of suspicion, since its classical presentation with Lenk’s triad is only seen in less than a quarter of patients. Early detection is of outmost importance because of this syndrome potential for causing hemodynamic instability and shock. Spontaneous renal hemorrhage has been reported much less frequently in peritoneal dialysis as compared to hemodialysis. To our knowledge, only 3 single-cases involving peritoneal dialysis patients were published since the year 2000. We describe an uncommon case report of a 68-year-old male undergoing continuous ambulatory peritoneal dialysis for 5 years and taking warfarin for permanent atrial fibrillation who developed Wunderlich syndrome presenting with Lenk’s triad. The patient was managed with percutaneous drainage of the renal hemorrhage and was able to continue peritoneal dialysis in the acute phase of disease. Unfortunately, he subsequently developed peritoneal membrane failure having to transition to hemodialysis 2.5 months after the WS episode. The authors will review literature on Wunderlich syndrome on end-stage kidney disease patients, discuss oral anticoagulation on peritoneal dialysis patients, maintenance of the technique, and finally, address the consequences of Wunderlich syndrome on peritoneal membrane diffusion capacity.

History of Pediatric Nephrology in Türkiye.

This article analyzes the foundation, institutiona-lization, and development of pediatric nephrology in Türkiye. Erich Frank is the pioneer and inspiration for Turkish nephrologists. He pioneered the training of a new generation of modern physicians, the first generation of Turkish nephrologists, and the establishment of the discipline of nephrology. Turkish pediatricians closely followed these developments and tried to improve their knowledge, making an effort to study abroad. These physicians established pediatric nephrology departments in their universities, trained young pediatric nephrologists, initiated pediatric hemodialysis-peritoneal dialysis units, and realized renal transplantation in children. Another pioneer of pediatric nephrology is Prof. İhsan Doğramacı, who established the first pediatric nephrology department at the Ankara-Hacettepe Medical Center in the 1960s. He directed many physicians to pediatric nephrology and provided them education and research opportunities abroad. Pediatric nephrology became a subspecialty in pediatrics in 1983 in Türkiye. Over the years, the number of Turkish pediatric nephrologists has increased; in 1990, they established the Pediatric Nephrology Association. This gave momentum to the standardization of education, better patient care, and scientific studies. Renal biopsies were initiated in 1964, the first pediatric hemodialysis application was conducted in 1974, the first renal transplantation from the living donor was in 1975, and the first continuous peritoneal dialysis was in 1989. With regard to international collaborations, since 2000, a council member from Türkiye has continuously been elected to the executive board of the European Society for Pediatric Nephrology; currently, the European Society for Pediatric Nephrology is led by President Rezan Topaloğlu. Several Turkish pediatric nephrologists have worked in international associations. Today, Türkiye has 107 pediatric nephrology centers, 265 well-trained specialists, 28 hemodialysis units, 39 peritoneal dialysis units, and 26 pediatric transplant centers.

Shift from severe hypotension to salt-dependent hypertension in a child with autosomal recessive polycystic kidney disease after bilateral nephrectomies: a case report

BackgroundAutosomal recessive polycystic kidney disease (ARPKD) is a significant cause of morbidity and mortality in infants and children. In severe cases bilateral nephrectomies are considered but may be associated with significant neurological complications and life-threatening hypotension.Case presentationWe describe a case of a 17 months old boy with genetically confirmed ARPKD who underwent sequential bilateral nephrectomies at the age of 4 and 10 months. Following the second nephrectomy the boy was started on continuous cycling peritoneal dialysis with blood pressure on the lower range. At the age of 12 months after a few days of poor feeding at home the boy experienced a severe episode of hypotension and coma of Glasgow Come Scale of three. Brain magnetic-resonance imaging (MRI) showed signs of hemorrhage, cytotoxic cerebral edema and diffuse cerebral atrophy. During the subsequent 72 h he developed seizures requiring anti-epileptic drug therapy, gradually regained consciousness but remained significantly hypotensive after discontinuation of vasopressors. Thus, he received high doses of sodium chloride orally and intraperitoneally as well as midodrine hydrochloride. His ultrafiltration (UF) was targeted to keep him in mild-to-moderate fluid overload. After two months of stable condition the patient started to develop hypertension requiring four antihypertensive medications. After optimizing peritoneal dialysis to avoid fluid overload and discontinuation of sodium chloride the antihypertensives were discontinued, but hyponatremia with hypotensive episodes reoccurred. Sodium chloride was reintroduced resulting in recurrent salt-dependent hypertension.ConclusionsOur case report illustrates an unusual course of blood pressure changes following bilateral nephrectomies in an infant with ARPKD and the particular importance of tight regulation of sodium chloride supplementation. The case adds to the scarce literature about clinical sequences of bilateral nephrectomies in infants, and as well highlights the challenge of managing blood pressure in these patients. Further research on the mechanisms and management of blood pressure control is clearly needed.

Gravity-assisted continuous flow peritoneal dialysis technique use in acute kidney injury in children: a randomized, crossover clinical trial.

Our previously demonstrated continuous flow peritoneal dialysis (CFPD) technique in children with acute kidney injury (AKI), although effective, was manpower heavy and expensive due to the high-volume pumps required. The aim of this study was to develop and test a novel gravity-driven CFPD technique in children using readily available, inexpensive equipment and to compare this technique to conventional PD. After development and initial in vitro testing, a randomised crossover clinical trial was conducted in 15 children with AKI requiring dialysis. Patients received both conventional PD and CFPD sequentially, in random order. Primary outcomes were measures of feasibility, clearance and ultrafiltration (UF). Secondary outcomes were complications and mass transfer coefficients (MTC). Paired t-tests were used to compare PD and CFPD outcomes. Median (range) age and weight of participants were 6.0 (0.2-14) months and 5.8 (2.3-14.0) kg, respectively. The CFPD system was easily and rapidly assembled. There were no serious adverse events attributed to CFPD. Mean ± SD UF was significantly higher on CFPD compared to conventional PD (4.3 ± 3.15 ml/kg/h vs. 1.04 ± 1.72 ml/kg/h; p < 0.001). Clearances for urea, creatinine and phosphate for children on CFPD were 9.9 ± 3.10 ml/min/1.73m2, 7.9 ± 3.3 ml/min/1.73m2 and 5.5 ± 1.5 ml/min/1.73m2 compared to conventional PD with values of 4.3 ± 1.68 ml/min/1.73m2, 3.57 ± 1.3 ml/min/1.73m2 and 2.53 ± 0.85 ml/min/1.73m2, respectively (all p < 0.001). Gravity-assisted CFPD appears to be a feasible and effective way to augment ultrafiltration and clearances in children with AKI. It can be assembled from readily available non-expensive equipment. A higher resolution version of the Graphical abstract is available as Supplementary information.

Peritoneal Dialysis Care in Mainland China: Nationwide Survey.

Peritoneal dialysis (PD) care in mainland China has been progressing in the past 10 years. To complement information from the dialysis registry, a large-scale nationwide survey was conducted to investigate the current infrastructure and management of PD care at hospitals of different tiers. A web-based multiple-choice questionnaire was distributed through the National Center for Nephrology Medical Quality Management and Control to PD centers of secondary and tertiary hospitals in October 2020. The 2-part survey collected the information of PD centers and the clinical management of patients on PD. A total of 788 effective surveys from 746 hospitals were voluntarily returned, and data were extracted and analyzed. The effective survey data covered 101,537 patients on PD, with 95% (96,460/101,537) in the tertiary hospitals. The median number of patients per PD center was 60 (IQR 21-152); this number was 32 (IQR 8-65) and 70 (IQR 27-192) for secondary and tertiary hospitals, respectively. There was a discrepancy in the availability of designated physical areas for different functions of PD care between the secondary and tertiary hospitals. The proportion of tertiary hospitals with PD training (P=.01), storage (P=.09), and procedure area (P<.001) was higher compared to secondary hospitals. PD catheter placement was performed in 96% (608/631) of the PD centers in tertiary hospitals, which was significantly higher compared to 86% (99/115) in secondary hospitals (P<.001). Automated PD was available in 55% (347/631) of the tertiary hospitals, which was significantly higher than that in secondary hospitals (37/115, 32%) according to the survey (P<.001). The most commonly performed PD module was continuous ambulatory peritoneal dialysis (772/788, 98%), followed by intermittent peritoneal dialysis (543/788, 69%). The overall reported nocturnal intermittent peritoneal dialysis was 31% (244/788); it was 28% (220/788) for continuous cycling peritoneal dialysis and 15% (118/788) for tidal peritoneal dialysis. Comparisons between the secondary and tertiary hospitals revealed no significant differences in prophylactic antibiotic use for PD catheter placement and therapeutic use for peritonitis. The first peritoneal equilibrium test was conducted in 58% (454/788) of patients at 4-6 weeks after initiation of PD, and 91% (718/788) reported at least one peritoneal equilibrium test per year. Overall, 79% (570/722) and 65% (469/722) of PD centers performed assessment for dialysis adequacy and residual kidney function, respectively; and 87% (685/788) of patients on PD were followed every 1 to 3 months for laboratory and auxiliary examinations. This national survey reflects the current status and disparities of PD center management in mainland China. The study results suggest that the PD care needs to be more conveniently accessible in secondary hospitals, and quality management and staff training in secondary hospitals are still in high demand.

Tidal continuous cycling peritoneal dialysis in children

About 10% of all home peritoneal dialysis regimens in children with chronic kidney disease stage 5 are reported to involve some form of a tidal peritoneal dialysis (TPD) prescription. Despite this, there remain several gaps in how pediatric nephrologists approach the use of TPD. This stems from a combination of factors such as the confusing technical terminology pertaining to TPD, seemingly conflicting data on the risks, benefits, and indications for TPD, and lastly, limited published guidelines on the practical aspects of how to write a TPD prescription, based on the indication, in children. Our educational review, using evidence-based data, attempts to bridge this gap and provide an easy-to-use guide on the key practical aspects of TPD in children.

A Review on Major Pathways Leading to Peritoneal Fibrosis in Patients Receiving Continuous Peritoneal Dialysis.

Peritoneal fibrosis (PF) is the most important complication of peritoneal dialysis (PD) that may arise among patients receiving continuous ambulatory peritoneal dialysis (CAPD). PF is a complex process, and many factors contribute to the formation of fibrosis.PD solutions with high glucose content, chronic inflammation, inflammatory cytokines, angiogenesis, and mesothelial to mesenchymal transition (MMT) are factors contributing to the fibrosis of the peritoneum.These factors, as well as stress-induced fibrosis, are going to be discussed further in this article. Although mostexperimental models are promising in preventing or delaying PD-related fibrosis, most of these recommended treatment options require further research.The lack of sufficient data from real PD patients and many inconclusive data makeclinicians depend on conservative treatment.New therapeutics are indeed required for the management of patients undergoing PD to prevent the dreaded complication that may arise from continuous PD. Newer PD solutions are needed to improve survival and minimize the complication associated with PD.Recently, newer PD solutions have been shown to improve patient survival and peritoneal viability and reduce this complication that may arise as a result of continuous PD.

The expression of matrix metalloproteinase-12 in the peritoneum of rats with continuous peritoneal dialysis.

Peritoneal dialysis (PD) is an important alternative treatment for end-stage renal disease. Continuous exposure to non-physiological fluids during PD is associated with pathological responses, such as sustained microinflammation, leading to tissue fibrosis and angiogenesis. However, the effect of PD fluid on submesothelial cells has not yet been investigated in detail. We investigated the association between macrophages and the expression of matrix metalloproteinase-12 (MMP-12), an elastin proteinase secreted by macrophages, in the peritoneal tissue of rats undergoing continuous PD. Morphological data revealed that the submesothelial layer of the peritoneum in PD model rats was markedly thickened, with fibrosis and angiogenesis. In the fibrillization area, elastin was disorganized and fragmented, and macrophages accumulated, which tended to have M2 characteristics. The expression of MMP-12 was enhanced by continuous exposure to PD fluid, suggesting that MMP-12 expression may be involved in PD fluid-induced peritoneal damage. The results of this study may lead to a better understanding of the mechanisms underlying fibrosis in PD.

Quality of Life Assessment in Patients of Stage V Chronic Kidney Disease

Introduction: Despite ongoing advances in the treatment of chronic kidney disease (CKD), the mortality rate, and level of health-related quality of life (HRQOL) for the CKD population remain significantly higher than for the general population. The importance of measuring end-stage renal failure (ESRF) patients' quality of life in relation to healthcare lies in not only providing absolute survival but also the quality of that survival. Due to cost constraints, the profile of chronic kidney disease patients and their treatment in Bangladesh is almost identical to that of India, with patients frequently requesting a reduction in the frequency of dialysis sessions, the use of less expensive dialyzers, dialyzer reuse, and the absence of erythropoietin therapy. Hence, augmenting the QOL may perhaps be a challenge and an observable fact of specific interest for renal healthcare teams. This study is intended to assess KDQOL among patients receiving hemodialysis for 8 hours, and 12 hours per week, patients receiving CAPD, and patients of CKD stage V who decline any form of renal replacement therapy, and remained on conservative treatment. The aim of the study was to assess the quality of life among patients of CKD Stage V. Methods: This cross-sectional study was carried out at the Department of Nephrology, Dhaka Medical College Hospital and BIRDEM general hospital. The patients who received consultation at the Outdoor Department of selected hospital from November 2010 to October 2011. The study assess the of Quality of Life, and Cost Effectiveness on different modalities of treatment among the patients of chronic kidney disease stage V, and also to find out the best modality of dialysis. A total number of 134 consecutive patients were enrolled in this study, out of which 42 patients who were advised to commence renal replacement therapy, and after counseling opted to remain in conservative treatment were considered as GROUP I, 39 patients who received hemodialysis 8 hours per week were considered as GROUP II, 30 patients who received hemodialysis 12 hours per week in one or more centers were considered as GROUP III, and 23 patients who received Continuous Peritoneal Dialysis at least 3 exchanges per day were considered as GROUP IV. Result: Mean age was almost similar in all four groups, and most of the patients were 5th decade, and above. Male was predominant in all four groups, and the male-female ratio was almost 2:1 in the whole study patients. Diabetic nephropathy and glomerulonephritis were more common etiology of CKD in all four groups. Monthly expenditure was significantly (p&lt;0.05) higher in group IV, followed by group III, group II, and group I in all three follow-ups, however, monthly expenditure was almost similar between group III, and group IV (p&gt;0.05) but the mean monthly expenditure was higher in group IV patients. Mean serum Creatinine was lowest in group IV followed by group III, group II, and group I in descending order. Serum albumin was low in all the groups but almost parallel in all follow-ups in group II, groups I, and group IV, whereas the lowest was in group II followed by group I and group IV, but declined in group III during the 2nd, and 3rd follow-up from 1st follow-up. Hemoglobin level consistently remained within the target range in group IV in all follow-ups but below the target range in group I followed by group II, and group III in ascending order. The physical component score increased significantly in Group III, and Group IV at consecutive follow-ups, however, it was higher in Group IV. Similarly, the mental component score was recorded highest in Group IV, followed by group III, group II, and group I. Regarding mortality, it was observed that more than half of the patients were expired in group I, one-third in group II, and 16.7% in group III, and only 8.7% in group IV during final follow-up. Conclusion: Patients receiving continuous ambulatory peritoneal dialysis achieved the best clinical parameters in terms of control of blood pressure, and volume overload. On the other hand, parameters were a lot away from the desired target in patients receiving hemodialysis for 8 hours per week, and they did not have significantly better parameters in comparison to those who were only on conservative treatment. The scenario of serum albumin, and serum creatinine, though complicated by the existence of malnutrition, were in best approximation to the desired level in these patients. According to the age-sex-matched risk categorization of the patients, it was found that the majority of patients on conservative treatment were in more than the average risk category.

POS-102 INCIDENCE, MICROBIOLOGICAL SPECTRUM AND OUTCOME OF ACUTE PERITONITIS IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

Peritonitis is still the leading cause of morbidity and technique failure in continuous ambulatory peritoneal dialysis (CAPD) patients.Data on factors affecting outcome of continuous peritoneal dialysis related peritonitis and microbiology is limited.

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.

Continuous Renal Replacement Therapy versus Peritoneal Dialysis in reversing Cefepime-Induced Non-Convulsive Status Epilepticus: A Case Report (P9-8.005)

Continuous Renal Replacement Therapy versus Peritoneal Dialysis in reversing Cefepime-Induced Non-Convulsive Status Epilepticus: A Case Report (P9-8.005)

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.

MO720: Elevated Dialysate IL-6 Concentrations are Prospectively Associated with Impaired TLR-Stimulated Cytokine Release from Peritoneal Cells—a Longitudinal Cohort Study

Abstract BACKGROUND AND AIMS Infectious complications and peritoneal inflammation occurring in a significant proportion of PD patients lead to progressive peritoneal membrane injury and account for most peritoneal dialysis (PD) technique failures. Reduced peritoneal immune-competence, caused by the continuous exposure to PD fluids, has been described as a therapy-related pathomechanism. We therefore hypothesized a relationship between dialysate interleukin 6 (IL-6) concentrations and peritoneal host defense. We established an ex vivo stimulation assay to test host defense mechanisms in only 9 mL of PD effluent. The aim of this study was to analyse basal inflammation and immune-competence in the 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 We prospectively analysed 195 serial routine peritoneal equilibration tests (PETs) of 123 stable PD patients treated exclusively with low-GDP, multi-chamber PD fluids during the glucose dwells and compared the data to routine follow-up clinical data. The cohort represents 76% of all eligible PD patients treated between April 2013 and September 2020 at the local Department of Nephrology. The study was approved by the local ethics committee and was conducted in accordance with the Declaration of Helsinki. All participants underwent a standardized 4-h PET with 3.86% glucose PDF as routine follow-up to test peritoneal membrane transport function, with an additional ex vivo cell stimulation protocol. PD effluent samples were obtained at the 1- and 4-h PET timepoints and immediately processed. 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 24 h. Unstimulated samples kept in parallel were used as controls. IL-6 concentrations were measured with ELISA in the supernatants. RESULTS Patients were stratified into two cohorts (incident and prevalent) at 120 days of continuous PD therapy. The cohorts were statistically indistinguishable except for stratification-specific variables. During a total follow-up period of 2499 patient-months, 55 patients underwent repeated PETs. Ex vivo stimulation of peritoneal cells significantly increased the IL-6 release 20-fold compared to unstimulated controls and resulted in a dwell-time dependent increase, with a significant lower cytokine released at the 1 h PET timepoint. To assess local inflammation, IL-6 concentrations in PD effluent of the 4 h PET were analysed. PD effluent IL-6 concentrations from the entire study cohort or from incident and prevalent patient subcohorts correlated neither with patient characteristics, RRF, disease background (including prior peritonitis) nor with time on PD. Effluent IL-6 concentrations correlated significantly with markers of systemic inflammation, serum CRP and albumin, with PSTR and with peritoneal protein loss. Interestingly, effluent IL-6 concentrations also had predictive value for risk of a subsequent peritonitis episode during follow-up. Effluent IL-6 levels were, in contrast, negatively correlated with ex vivo–stimulated IL-6 release from PD effluent cells, most remarkably in PD patients with history of prior peritonitis. CONCLUSION This longitudinal study provides the first direct evidence in PD patients of a correlation between peritoneal inflammation and impaired peritoneal immune cell function, likely driving infectious complications. Our study results suggest a mechanistic link between peritoneal inflammation and host defense that may foster innovative therapeutic approaches to improve clinical outcomes of chronic PD.

Effectiveness of Automated Peritoneal Dialysis Compared to Outpatient Procedure: A Systematic Review and Meta-analysis Study

Introduction: The growing trend of renal failure has focused clinical therapy on the cost-effective alternatives such as peritoneal dialysis. Therefore, the present study has investigated the effectiveness of two methods of continuous and automatic peritoneal dialysis in the patients with end stage renal disease.&#x0D; Methods: This study was conducted in the form of a systematic review. Advanced search was done in PubMed, Cochrane Library, Scopus databases, and in title, abstract, and keyword fields without any restrictions. The inclusion criteria included clinical trial research focused on two methods of peritoneal dialysis. The process of data extraction was performed, using a standard checklist. The quality of the studies was evaluated by the Cochrane quality assessment checklist and the results of the indicators were analyzed in the form of meta-analysis.&#x0D; Results: A total of 5 clinical trials, including 311 patients, were included in the study. All studies had high quality. Automated method has the advantage of continuous procedure in terms of complications such as mortality (RR 1.42, 95% CI 0.48 to 4.21), peritonitis (RR: 0.80, 95% CI 0.50 to 1.29), exit-site (RR:1.07,95% CI 0.52 to 2.15) and tunnel (RR 1.01,95%CI 0.18 to 5.67). The kt/v index was better in the automatic method than the continuous method (SMD 0.37, 95%CI 0.01 to 0.73), on the other hand, creatinine clearance in the continuous method was better than the automatic method (SMD -0.40, 95%CI 0.78 to 0.02).&#x0D; Conclusion: The side effects of the two treatment methods did not differ, but considering the indicators of dialysis adequacy, creatinine clearance was performed better in the continuous outpatient method, while the results of the kt/v index in the automatic method were better. In terms of cost items, along with clinical indicators, it seems that final decision-making for macro-health policies has helped.

Continuous veno-venous hemodiafiltration in neonates with maple syrup urine disease.

Herein, we aimed to discuss our experience in 16 newborn patients with Maple syrup urine disease (MSUD) who were treated with urgent renal replacement therapy (RRT). The patients underwent continuous veno-venous hemodiafiltration (CVVHDF) or peritoneal dialysis (PD) as renal replacement therapy. Eleven (68.75%) patients underwent CVVHDF and five (31.25%) underwent peritoneal dialysis. The median leucine reduction rate per hour was 2.56% (1.75-7.6) in the CVVHDF group, 0.78% (0.54-1.83) in the PD group, and was significantly higher in the CVVHDF group (p=0.001). Posttreatment plasma leucine levels were found to be 198 (20-721) μmol/L in the CVVHDF group and 600 (250-967) μmol/L in the PD group, and CVVHDF was found to be significantly lower (p=0.08). Complications such as hypotension, electrolyte imbalance, and filter obstruction occurred in the CVVHDF group. This study showed that CVVHDF is more effective than PD for rapidly eliminating elevated leucine levels caused by MSUD in the newborn and it is not associated with increased complication rates.

The Role of Continuing Nursing Method on Iimproving the Quality of Nursing for Patients with Continuous Peritoneal Dialysis

The Role of Continuing Nursing Method on Iimproving the Quality of Nursing for Patients with Continuous Peritoneal Dialysis