Complication Of Dialysis Research Articles

Allicin Ameliorated High-glucose Peritoneal Dialysis Solution-induced Peritoneal Fibrosis in Rats via the JAK2/STAT3 Signaling Pathway.

Peritoneal fibrosis (PF) is one of the most serious complications of peritoneal dialysis (PD) and is the greatest obstacle to the clinical application of PD. Chinese herbal monomers have been effective in the prevention and treatment of PF. The aim of this study was to observe the effect of allicin on PF in rats induced by high glucose and to investigate its molecular mechanism of action. A rat model of PF was established by using a 4.25% glucose-based standard peritoneal dialysis solution. The degree of peritoneal pathological damage was assessed by Hematoxylin and eosin (H&E) staining. Peritoneal collagen deposition was detected by Masson's trichrome staining. The levels of Interleukin-6 (IL-6), Tumor necrosis factor-α (TNF-α), Interleukin-1β (IL-1β) and monocyte chemoattractant protein-1 (MCP-1) in the serum were measured by Enzyme Linked Immunosorbent Assay (ELISA). The expression levels of TGF-β, α-smooth muscle actin (α-SMA) and collagen I were examined by western blotting and immunohistochemistry. The protein expression levels and mRNA levels of E-cadherin, N-cadherin, vimentin, janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3) in peritoneal tissue were determined by western blotting and qRT-PCR. TGF-β1 stimulated human peritoneal mesothelial cells (HPMCs), and the cells were treated with allicin and the JAK2/STAT3 pathway activator colivelin alone or in combination. A cell counting kit-8 (CCK-8) assay was used to measure cell viability. The role of JAK2/STAT3 in the effects of allicin was confirmed via in vitro mechanistic research by western blotting, wound healing assays and Transwell assays. Allicin relieves the inflammatory response by downregulating the levels of IL-1β, IL-6, MCP-1 and TNF-α. Furthermore, allicin decreased the expression of TGF-β, α-SMA and collagen I. Allicin also alleviated epithelial-to-mesenchymal transition (EMT), as specifically manifested by increased E-cadherin and reduced N-cadherin and vimentin. Further studies revealed that allicin reduced the protein levels of JAK2, STAT3, p-JAK2, and p-STAT3. The results of the cellular experiments verified the above results. The ability of allicin to inhibit fibrosis and the EMT process was significantly attenuated after HPMCs were treated with colivelin. Taken together, these findings suggest that allicin inhibits inflammation and EMT, thereby improving PF, and this protective effect may be achieved by inhibiting the JAK2/STAT3 signaling pathway.

Addressing cognitive impairment in peritoneal dialysis: a systematic review and meta-analysis of prevalence, risk factors, and outcomes

Abstract Background Cognitive impairment (CI) is a critical complication in peritoneal dialysis (PD) patients, associated with decreased quality of life and increased hospitalization. Despite its significant impact, the prevalence, risk factors, and consequences of CI in PD patients are not well understood. We aimed to determine the prevalence, risk factors, and outcomes of CI in PD patients. Methods We performed systematic reviews in OVID Medline, Embase, and Cochrane databases until February 2024 to identify cross-sectional and cohort studies on prevalence of CI (identified by cognitive assessment scales) in PD patients. Newcastle-Ottawa Scale was used to assess risk of bias. A pooled meta-analysis of CI prevalence in PD and a subgroup analysis comparing the risk of CI between PD and non-PD settings were performed using a random-effects model. Results A total of 19 studies were identified, involving 2,882 PD patients. The pooled prevalence of CI in PD patients was 47.7% (95%CI: 35.8-59.9%). CI in patients undergoing PD appears to be associated with older age, female gender, lower levels of education, and is linked to higher rates of hospitalization and peritonitis, compared to those without CI. However, it is not associated with increased mortality. Compared to hemodialysis, PD showed a trend toward a lower risk of CI (OR 0.64, 95%CI 0.39–1.03; p=0.068). Conclusion CI is highly prevalent and associated with several adverse clinical outcomes in PD patients. These findings could contribute to facilitate the development of screening and early intervention strategies to reduce the burden of disease in this population.

Clinical outcomes in peritoneal dialysis with refractory peritonitis: significance of the day 5 cell count.

Peritoneal dialysis-associated peritonitis is a common and severe complication of peritoneal dialysis, associated with high morbidity and mortality. However, there's a lack of research on refractory peritonitis, which is difficult to manage and has a poor prognosis. Our study aimed to investigate factors affecting clinical outcomes in peritoneal dialysis patients with refractory peritonitis over a 12-year period at a medical faculty hospital in Turkey. We conducted a retrospective study at a single center from January 2009 to December 2020, involving 135 patients with 236 episodes of refractory peritonitis. The average age of the patient cohort was 53.0 ± 15.9years, and 72 (53.4%) of the patients were male. The leading identified causes of end-stage kidney disease were glomerulonephritis, hypertensive glomerulosclerosis, and diabetic nephropathy. Data on microbiological etiology, dialysate white blood cell counts, and patient demographics were analyzed to identify catheter removal risk factors. Statistical significance was set at p ≤ 0.05. Comparative analysis between patients with and without catheter loss revealed no significant differences in gender, age, presence of diabetes, prior hemodialysis, or duration of peritoneal dialysis. However, multivariate logistic regression analysis showed thata dialysate white blood cell count exceeding 1000/mm3 on day 5and hospitalization had a positive associationwith catheter loss, while the presence of gram-positive bacterial growth had an inverse correlation. Our study shows that fifth-day dialysate white blood cell count predicts refractory peritonitis outcomes. Future research should focus on developing tools to manage catheter removal proactively and enhance patient prognosis.

CT data analysis of catheter morphology and displacement in peritoneal dialysis: an exploratory study.

Catheter displacement is a common complication of peritoneal dialysis. The aim of this study was to explore the correlation between catheter morphology and displacement by analyzing CT data, providing a scientific basis for optimizing catheter morphology within abdominal wall layers. We retrospectively analyzed the clinical data of 94 patients. The parameters for analyzing catheter morphology were defined based on six key points identified from CT images. The covariates considered in the analysis included demographics, primary disease, body size, peritoneal dialysis method, and total weekly urea clearance index. During a mean follow-up period of 1056 ± 480 days, only the angle of the intramuscular part (IM angle) of the catheter significantly correlated with the time to first catheter displacement according to the multivariate analysis (hazard ratio [HR]: 1.039, 95% confidence interval [CI] 1.02-1.058, 0.01). When the cut-off value of IM angle was 39.4 , the area under receiver-operating characteristic (ROC) curve for predicting catheter displacement was 0.791 (95% CI 0.701-0.881, 0.01), with a sensitivity and specificity of 82.9% and 66.0%, respectively. Kaplan-Meier survival curves showed that the catheter survival rate was significantly higher in the group with an IM angle < 39.4 than in the group with an IM angle > 39.4 (log-rank =19.479, 0.01). None of the catheter morphology parameters were significantly correlated with technique survival in the multivariate analysis. There is a correlation between catheter morphology and catheter displacement. An IM angle > 39.4 is an independent risk factor for catheter displacement, while the position and angle of the subcutaneous part are not correlated with catheter displacement.

Pleuroperitoneal Communication: A Rare Complication of Peritoneal Dialysis Observed in an Ecuadorian Hospital

Pleuroperitoneal Communication: A Rare Complication of Peritoneal Dialysis Observed in an Ecuadorian Hospital

The Surprise Question in Hemodialysis, Frailty, Nutrition, Patient-reported Quality of Life, and All-Cause Mortality: The Osaka Dialysis Complication Study (ODCS)

Rationale & ObjectiveA response “no” (SQ-No) to the surprise question (SQ) of whether a clinician would be surprised if a dialysis patient died in the next 6 months is associated with a higher risk of all-cause death. It is uncertain what domains are intuitively assessed with SQ. We hypothesized that SQ would be assessing the patient’s frailty, malnutrition, or patient-perceived health-related quality of life in a cohort of patients on maintenance hemodialysis. Study DesignCohort study Setting & ParticipantsA multi-center study including 994 patients on maintenance hemodialysis in Japan Predictors1) SQ answered by nurses, 2) frailty by modified Cardiovascular Health Study criteria, 3) malnutrition as evaluated by Geriatric Nutritional Risk Index (GNRI), and 4) patient-perceived health-related quality of life examined by the 36 Item Short-Form Health Survey (SF-36) physical component summary (PCS). OutcomesAll-cause mortality Analytical ApproachCox proportional hazard models ResultsMedian age and dialysis vintage were 66 and 5.9 years, respectively, and 35.8% were female, and 39.6% had diabetic kidney disease. The prevalence of SQ-No and frailty was 19.7% and 45.9%. Medians GNRI and SF-36 PCS were 96.3 and 36.9, respectively. During follow-up for 5 years, 247 patients died. Each of SQ-No, being frail, a low GNRI, and a low SF-36 PCS was a significant predictor of a higher risk for mortality independent of potential confounders. SQ-No remained a significant predictor after further adjustment for frailty or GNRI, but SQ-No was no longer significant when adjusted for SF-36 PCS. LimitationsWe did not assess the agreement of responses to SQ between different raters. ConclusionsPredictive ability of SQ was closely related to SF-36 PCS in hemodialysis patients. SQ by nurses appears to assess the physical domain of patient-perceived health-related quality of life rather than objectively assessed frailty or malnutrition.

Association between Serum Zinc and All-Cause Mortality in Patients Undergoing Maintenance Hemodialysis: The Osaka Dialysis Complication Study (ODCS).

Zinc is an essential microelement, and its deficiency is common in patients undergoing hemodialysis. However, the association between serum zinc and mortality in these patients remains unclear. The aim of this study was to explore the possible association between serum zinc levels and all-cause mortality in prevalent patients with kidney failure on maintenance hemodialysis. This was a prospective cohort study of maintenance hemodialysis patients followed up for 5 years. The key exposure was serum zinc level measured at baseline, and the outcome was all-cause mortality. Their association was analyzed using Cox proportional hazard models. Among 1662 eligible patients selected for this analysis, 468 (28%) died. Lower serum zinc levels were associated with a higher risk for mortality, independent of the major demographic factors and factors including mineral and bone disorder and renal anemia. However, this association was no longer significant when adjusted for serum albumin. Because there was a close correlation between serum zinc and albumin levels, we performed further analyses in which participants were categorized into four groups by median serum zinc (68 µg/dL) and albumin (3.7 g/dL) levels. In the lower serum albumin groups, risk of death was significantly higher in those with lower zinc than those with higher zinc levels, whereas such a difference was not significant in the high serum albumin groups. In patients undergoing maintenance hemodialysis with lower serum albumin levels, a lower serum zinc level was associated with a higher risk of mortality.

An investigation into the correlation between intraperitoneal teicoplanin concentrations and treatment outcomes in peritoneal dialysis-associated peritonitis.

Peritoneal dialysis-associated peritonitis (PDAP) is a frequent complication of peritoneal dialysis. The guidelines from the International Society for Peritoneal Dialysis (ISPD) suggest administering teicoplanin through the peritoneal route to treat PDAP, but do not specify the ideal concentration for peritoneal dialysis effluent (PDE). Patients meeting the trial criteria for PDAP in our hospital between July 2022 and December 2023 were enrolled. Data on PDE white blood cell count, PDE neutrophil percentage, clinical symptoms, CRP, and PCT were gathered pre- and post-treatment. Incidences of adverse drug reaction (ADR) and case numbers during treatment were recorded. Subsequently, patients were categorized into cured and uncured groups for evaluating the relationship between PDE teicoplanin concentration and treatment effectiveness. The self-control study results on teicoplanin efficacy indicated intraperitoneal teicoplanin administration achieved an efficacy rate of 88.9% and an ADR incidence of 5.5% in treating PDAP patients. There was no observed correlation between teicoplanin blood concentration and PDE concentration. PDE teicoplanin concentrations on days 1, 3, 5, and 7 post-dosing were higher inthe cured group, with a significant contrast in PDE concentration on day 5 between the 18.98 ± 2.43mg/L of the cured group and the 12.07 ± 2.68mg/L of the uncured group. ROC curve revealed a higher likelihood of cure in patients when PDE teicoplanin concentration exceeded 15.138mg/L on day 5 post-dosing. Univariate and multifactorial studies identified 24-h urine volume and the number of daily abdominal dialysis sessions as influential factors in PDE teicoplanin concentration on day 5. A positive correlation was found between 24-h urine volume and PDE teicoplanin concentration, with PDAP patients having urine volume over 537mL showing significantly higher drug concentrations. Conversely, the number of daily PDAP sessions was negatively correlated with PDE teicoplanin concentrations, indicating that patients with 1∼3 daily PDAP sessions had notably higher PDE teicoplanin concentrations compared to those with 4∼6 sessions. Therefore, PDAP patients who use intraperitoneal teicoplanin could effectively control infection by monitoring the PDE teicoplanin concentration (>15.138mg/L) on day 5 after dosing.

Pathogenic microorganism DNA high-throughput genetic sequencing to diagnose peritoneal dialysis-associated peritonitis due to Mycobacterium tuberculosis infection

Peritoneal dialysis-associated peritonitis is a serious complication of peritoneal dialysis, and the prevention and treatment of this condition are important for improving the long-term survival and quality of life of patients. However, peritoneal dialysis-associated peritonitis due to Mycobacterium tuberculosis infection is relatively rare and not easily diagnosed. Here, we present a case of peritoneal dialysis-associated peritonitis caused by Mycobacterium tuberculosis identified by pathogenic microbial DNA high-throughput genetic sequencing. This case demonstrates that pathogenic microbial DNA high-throughput genetic sequencing could be used to improve the detection rate of pathogenic microorganisms in patients with complex conditions, thereby allowing for earlier initiation of treatment.

Peritoneal-dialysis-associated peritonitis due to Staphylococcus sciuri: a case report and literature review

BackgroundPeritoneal-dialysis-associated peritonitis is a serious complication of peritoneal dialysis; prevention and treatment are crucial to reduce patient morbidity and mortality. Staphylococcus sciuri is an organism that, although present in several animal species, rarely causes disease in humans, particularly in patients undergoing peritoneal dialysis.Case presentationA 54-year-old man with end-stage kidney disease on continuous ambulatory peritoneal dialysis was admitted to the emergency department with nausea, vomiting, slight abdominal distention, and cloudy peritoneal dialysis effluent. Relevant medical history included occupational exposure to different animal species. The white blood cell count in the peritoneal dialysis fluid sample was 11,200 cells/mm3 with 90% polymorphonuclear cells. Peritoneal-dialysis-associated peritonitis was diagnosed. Empirical antibiotic treatment was started according to the International Society for Peritoneal Dialysis guidelines. Staphylococcus sciuri was identified in the peritoneal dialysis effluent culture by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The treatment was modified on the basis of the sensitivity results. Medical cure was established on the basis of the negative result of the dialysate culture and absence of alterations in the cell count with differential after the end of treatment. The patient was instructed to be careful when administering peritoneal dialysis, especially in the care involved in being in contact with animals.ConclusionsThis article highlights the importance of Staphylococcus sciuri as a significant pathogen due to its virulence and antibiotic resistance, especially in patients undergoing peritoneal dialysis. Prevention strategies as well as timely diagnosis and treatment compliance according to the International Society for Peritoneal Dialysis are essential for successful outcomes.

Scrotal edema due to bilateral metachronous tears in the spigelian fascia in a peritoneal dialysis patient: A case report.

Scrotal and penile edema is a noninfectious complication of peritoneal dialysis (PD). A tear in the Spigelian fascia is occasionally recognized as a Spigelian hernia. However, there is no documented evidence that this is a contributing factor for scrotal edema in individuals undergoing PD. We encountered a case of scrotal edema in a patient undergoing PD due to bilateral metachronous tears in the Spigelian fascia, which was successfully treated through surgical repair. A 20-year-old man with end-stage kidney disease due to Alport syndrome underwent PD. Eight months after induction of PD, he heard a rupture sound in the left inguinal region after coughing and developed genital edema. A computed tomography scan showed a tear in the left Spigelian fascia. Surgical repair was successful and there was no recurrence after PD was resumed. Seven months after surgery, he heard a rupture sound in the right inguinal region after coughing and developed genital edema. A computed tomography scan showed a tear in the right Spigelian fascia. Surgical repair was successful and there has been no recurrence since. It is important to recognize that the development of scrotal edema in a patient undergoing PD may be indicative of a tear in the Spigelian fascia.

Decreased incidence of peritoneal dialysis-associated peritonitis in young children.

Peritonitis is the most common complication of peritoneal dialysis (PD). This study aimed to investigate changes in the incidence, risk factors, microbiology, and clinical outcomes of PD-associated peritonitis in the past decades. This was a retrospective study that included children who initiated chronic PD at our institution between 2000 and 2017. The patients were divided into two groups according to the year of initiation: those who initiated PD between 2000 and 2008 and those who initiated PD between 2009 and 2017. The incidence and characteristics of peritonitis were compared between the groups. A total of 184 patients with a median age of 10.2 years were included in this study. Of the patients, 92 experienced 210 episodes of peritonitis. The incidence rate of peritonitis decreased from 0.35 to 0.21 episodes/patient year during the study period (P = 0.001). During the 2000-2008 period, the 2-year peritonitis-free survival rate was significantly lower for patients under 2 years of age than for the other age groups (P = 0.004), whereas this was not observed during the 2009-2017 period. The multivariable Cox proportional hazard model showed that the <2 years age group had a significantly higher risk of developing peritonitis in the 2000-2008 period. However, this was not evident in the 2009-2017 period. The incidence of PD-associated peritonitis decreased, particularly in children under 2 years of age. Thus, younger age may not be a risk factor for PD-associated peritonitis.

Machine learning-based prediction of vancomycin concentration after abdominal administration in patients with peritoneal dialysis-related peritonitis.

Peritonitis is a serious complication of peritoneal dialysis (PD), in which insufficient control of antibacterial drug concentrations poses a significant risk for poor outcomes. Predicting antibacterial drug concentrations is crucial in clinical practice. The limitations imposed by compartment models have presented a considerable challenge. In this study, we employed machine learning as model-free methods to circumvent the constraints of compartment models. We collected data from 68 observations from 38 patients with peritoneal dialysis-related peritonitis who were treated with vancomycin from the EHR system. This data included information about drug administration, demographic details, and experimental indicators as predictors. We constructed models using Genetic Adaptive Supporting Vector Regression (GA-SVR), KNN-regression, GBM, XGBoost, and a stacking ensemble model. Additionally, we used RMSE loss and partial-dependence profiles to elucidate the effects of these predictors. GA-SVAR outperformed other large-scale models. In 10-fold cross-validation, the RMSE ratio and R-squared values for direct concentration prediction were 23.5% and 0.633, respectively. The ROC AUC for predicting concentrations below 15 and exceeding 20 μg/mL were 0.890 and 0.948, respectively. Notably, the most influential predictors included times of drug administration and weight. These predictors were also influenced by residual kidney function. To assist in controlling vancomycin concentrations for patients with PD-related peritonitis in clinical practice, we developed GA-SVR and a corresponding explainer model. Our study improves the controlling of vancomycin in clinical settings by enhancing our understanding of vancomycin concentration in patients with PD-related peritonitis.

A case of recurrent peritoneal dialysis-related peritonitis caused by Stenotrophomonas maltophilia during ongoing antibiotic treatment for Enterococcus faecalis-induced peritonitis.

Recurrent peritonitis is a serious complication of peritoneal dialysis (PD), which could result in PD withdrawal and mortality. However, cases of recurrent peritonitis occurring during ongoing antimicrobial therapy are rarely reported. Herein, we present a 71-year-old man who experienced initial peritonitis due to Enterococcus faecalis. Despite effective antimicrobial therapy, he developed recurrent peritonitis while on antimicrobial therapy. PD fluid culture analysis yielded Stenotrophomonas maltophilia (S. maltophilia). He was treated with multiple antimicrobials, and the peritoneal catheter was removed. To the best of our knowledge, this is the first case of recurrent peritonitis caused by S. maltophilia, which was developed during antimicrobial treatment. Our report findings suggest the importance of considering S. maltophilia infection in an atypical case of very early recurrent peritonitis.

A comprehensive exploration of chronic kidney disease and dialysis in Canada's Indigenous population: from epidemiology to genetic influences.

This study aims to review the escalating prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) among Canada's Indigenous population, focusing on risk factors, hospitalization and mortality rates, and disparities in kidney transplantation. The study explores how these factors contribute to the health outcomes of this population and examines the influence of genetic variations on CKD progression. The review synthesizes data on prevalence rates, hospitalization and mortality statistics, and transplantation disparities among Indigenous individuals. It also delves into the complexities of healthcare access, including geographical, socioeconomic, and psychological barriers. Additionally, the manuscript investigates the impact of racial factors on blood characteristics relevant to dialysis treatment and the genetic predispositions influencing disease progression in Indigenous populations. Indigenous individuals exhibit a higher prevalence of CKD and ESRD risk factors such as diabetes and obesity, particularly in regions like Saskatchewan. These patients face a 77% higher risk of death compared to their non-Indigenous counterparts and are less likely to receive kidney transplants. Genetic analyses reveal significant associations between CKD and specific genomic variations. Through analyses, we found that healthy Indigenous individuals may have higher levels of circulating inflammatory markers, which could become further elevated for those with CKD. In particular, they may have higher levels of C-reactive protein (CRP) fibrinogen, as well as genomic variations that affect IL-6 production and the function of von Willebrand Factor (vWF) which has critical potential influence on the compatibility with dialysis membranes contributing to complications in dialysis. Indigenous people in Canada are disproportionately burdened by CKD and ESRD due to socioeconomic factors and potential genetic predispositions. While significant efforts have been made to assess the socioeconomic conditions of the Indigenous population, the genetic factors and their potential critical influence on compatibility with dialysis membranes, contributing to treatment complications, remain understudied. Further investigation into these genetic predispositions is essential.

Diagnostic Accuracy of MMP-8 and IL-6-Based Point-of-Care Testing to Detect Peritoneal Dialysis-Related Peritonitis: A Single-Center Experience.

Peritoneal dialysis-related peritonitis (PDRP) is the most common complication of peritoneal dialysis (PD), which can lead to poor outcomes if not diagnosed and treated early. We aimed to investigate the diagnostic accuracy of MMP-8 and IL-6-based point-of-care tests (POCTs) in diagnosing PDRP in PD patients. This retrospective chart review study was conducted at a comprehensive kidney center in Qatar. It involved all adult PD patients who underwent PDRP from July 2018 to October 2019 and for whom MMP-8 and IL-6-based POCTs were used to diagnose presumptive peritonitis. Measures of diagnostic accuracy were computed. Peritoneal fluid effluent analysis was the reference standard. We included 120 patients (68 [56.7%] females, ages 55.6 ± 15.6 years, treatment duration 39.5 ± 30.4 months [range: 5-142 months]). In this population, MMP-8 and IL-6-based POCTs yielded 100% in all dimensions of diagnostic accuracy (sensitivity, specificity, positive and negative predictive values). MMP-8 and IL-6-based POCTs might be helpful in the early detection of PDRP. This monocentric observation requires further confirmation in a prospective multicentric setting.

#2355 Eradication of Staphylococcus aureus carriage in patients undergoing peritoneal dialysis

Abstract Background and Aims Peritonitis is a common and serious complication of peritoneal dialysis (PD). A single episode of severe peritonitis or multiple peritonitis episodes frequently leads to diminished peritoneal ultrafiltration capacity, hospitalization, and a switch to hemodialysis. Prevention of infection is the mainstay for the reduction of peritonitis rate. According to the current guidelines, we use nasal antibiotic prophylaxis if patients are identified as nasal Staphylococcus aureus carriers on screening prior to PD beginning. Eradication of S. aureus Regular with nasal mupirocin reduces the rate of exit-site infections but has uncertain effects on the risk of peritonitis. The aim of this study was to evaluate the rate of S. aureus peritonitis in our cohort of patients receiving PD. Method A retrospective single-center study was conducted in a large Italian PD center. We reviewed all cases of bacterial peritonitis from 1999 to 2023. Demographic and clinical characteristics of the patients and microbiological features of the bacteria identified in cultures were extracted from electronic health record. From 2011, all patients were screened before surgery for Methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) with nares swabs. All patients with positive nasal colonization for MSSA and MRSA were treated with nasal mupirocin (nasal ointment twice daily for 5 consecutive days every 4 weeks) until eradication was confirmed by a nasal swab. According to our protocol, from 2011, screening for S. aureus carriage along peritoneal fluid culture was performed in all patients on PD with an episode of peritonitis to verify nasal colonization with S. aureus. The study was approved by the regional ethical committee of Emilia Romagna (507/2021/OSS/AOUMO SIRER ID 2845). Results Overall, 345 cases of peritonitis were reviewed in 214 patients who received peritoneal dialysis. In our center, the rate of peritonitis was 0.23 episodes/patient-year. After the introduction of nasal screening for S. aureus carriage, the episodes of S. aureus peritonitis decreased in frequency (0.0093 episodes/patient-year vs. 0.034 episodes/patient-year) and as absolute number (17.8% vs 3.6%; p = 0.001). No differences were observed in the rate of catheter removal in the two populations (p = 0.99). The age of 109 patients screened for S. aureus carriage was 64.1 ± 17 years. Males accounted for 58.9% and automated PD (APD) was chosen by 66% of the subjects. After an average period of 1.6 years from the start of PD, 7 patients experienced S. aureus peritonitis in the absence of exit-site or tunnel catheter infection. Nasal screening at the time of peritonitis showed that half of them were carriers of S. aureus and half were negative (one patient was not screened). Colonization from S. aureus was found in another 9 patients whose peritonitis was caused by a different type of bacteria (44% S. epidermidis, 33.3% Enterobacteriaceae, 11.1% Acinetobacter, and 11.1% culture-negative peritonitis). Conclusion Our data document that screening for S. aureus, along with other preventive measures, contributes to significantly reducing the rate of S. aureus peritonitis in patients screened and treated for S. aureus carriage at the time of PD start. Routine screening and the use of a mask during connection are required because recolonization occurs frequently in this population.

#988 Peritoneal dialysis related peritonitis: insights from a long-term analysis of an Italian center

Abstract Background and Aims Peritonitis is a common and severe complication of peritoneal dialysis (PD). For comparative analysis standardized definitions are crucial, but most studies have been used heterogenous methods to measure outcomes. The ISPD 2022 guidelines have revised and clarified numerous definitions and proposed new peritonitis categories. Thus, deeper comprehension concerning the incidence, prevalence, and outcome of cause- and time specific peritonitis in contemporary cohorts is required. Method Between 1st January 2009 and 31st May 2023, 267 patients who started PD at our institution were included in the study (Tab. 1). All PD-related peritonitis episodes that occurred in our unit during the study period were collected. The new definitions and outcomes of ISPD 2022 recommendations were employed. Results During the study period 113 patients (42.3%) experienced 219 peritonitis (Tab. 2). The overall peritonitis rate was 0.25 episode/patient year. During the study period, 230 patients (88.5%) discontinued the dialytic technique; among them 122 were transferred to HD. Peritonitis represented the main cause of hemodialysis (HD) transfer (35.2%). Patient cumulative probability of remaining peritonitis-free at one year was 84.2%. The initial antibiotic regimen (cefazolin in association with tobramycin ip) was effective in 131 episodes (141/219, 64.3%), while the medical cure and refractory peritonitis rates were equal to 70.3 and 22.4%, respectively. The rates of peritonitis associated death, HD transfer, catheter removal and hospitalization were 6.8%, 18.3%, 18.7% and 64.4%, respectively. Relapsing, repeat, recurrent and enteric peritonitis accounted for 7.8%, 6.8%, 4.1% and 2.7% of all episodes, respectively. Catheter insertion, catheter related and pre-PD peritonitis were 4.2, 2.1 and 0.5%. Gram-positive and Gram-negative bacteria accounted for 74.1% and 21.3% of peritonitis, respectively. Initial antibiotic regimen was more effective in Gram-positive (76.4%) than Gram-negative (35.1%) microorganisms (p &amp;lt; 0.0001). Culture-negative peritonitis accounted for 25.6% of all specimens. In comparison with positive-culture peritonitis, culture-negative episodes showed a higher medical cure rate (88.4%, 46/52 vs 68.9%, 104/151; p &amp;lt; 0.01) and were significantly less likely to be complicated by hospitalization (48.1%, 25/52 vs 72.2%, 109/151; p &amp;lt; 0.05), catheter removal (9.6%, 5/52 vs 22.5%, 34/151; p &amp;lt; 0.05), HD transfer (9.6%, 5/52 vs 21.9%, 33/152; p &amp;lt; 0.05) and death (0%, 0/52 vs 8.6%, 13/151, p &amp;lt; 0.05). However, initial antibiotic regimen response was similar between culture-negative and culture-positive episodes (71.2%, 37/52 vs 62.3%, 94/151, p = ns). Rates of relapsing, repeat and recurrent peritonitis were 0.023, 0.018 and 0.011 episode/patient-year, respectively accounting for 7.8, 6.8 and 4.1% of all episodes The composite outcome of either catheter removal or death due to peritonitis was higher in relapsing (42.1%, 8/19, p &amp;lt; 0.05) and recurrent (44.4%, 4/9, p &amp;lt; 0.05) episodes than generic peritonitis (19.1%, 34/178) but similar to repeat peritonitis (3/15, 20%, p = ns). Although peritonitis from enteric causes represented only 2.7% of all episodes, they needed catheter removal in one-third of events (33.3%) and caused patient death (66.6%) in the remaining cases. Conclusion Although representing the leading cause of HD transfer cause, more than 50% of incident PD patients never experienced peritonitis. Carrying a worse outcome than generic peritonitis, entities such as relapsing, recurrent and enteric peritonitis should be aggressively treated. Conversely, culture-negative peritonitis showed a better prognosis as compared to positive-culture episodes. However, aiming at the prevention of microbial resistances, the reduction of culture-negative cases is necessary to minimize patient exposure to empiric therapy with multiple antibiotics. In our experience first-line empirical antibiotic therapy was effective in almost 65% of the cases. Nevertheless, the efficacy of this regimen was unsatisfactory in Gram-negative microorganisms requiring further microbiological and pharmacokinetic evaluation.

#267 “Surprise question”, malnutrition, frailty, and health-related quality of life in predicting mortality in a cohort of haemodialysis patients

Abstract Background and Aims “Would I be surprised if this patient died in the next year (or six months)?” This question by a medical staff is called “surprise question” (SQ) and the answer “no” (SQ-No) was shown to predict a higher risk of mortality. However, it is unknown what is intuitively assessed by this question. We examined whether SQ is assessing the patient's malnutrition, frailty, or self-perceived health-related quality of life in haemodialysis patients. Method We analysed data from 994 patients on maintenance haemodialysis who participated in the Osaka Dialysis Complication Study (ODCS). Attending nurses answered to SQ. Malnutrition was evaluated by Geriatric Nutritional Risk Index (GNRI). Frailty was assessed by a modified CHS criteria. Patient-perceived health-related quality of life was examined by SF36 physical component summary (PCS). The associations of these exposures with 5-year all-cause mortality (ACM) were analysed by Cox proportional hazards model. Results Median of age and dialysis vintage was 66 and 5.9 years, 35.8% were female, and 39.6% had diabetic kidney disease. The prevalence of SQ-No and frailty was 19.7% and 46.2%. Medians of GNRI and SF36 PCS were 96.3 and 46.2, respectively. During follow-up, 250 patients died. Each of SQ-No, a low GNRI, being frail, and a low SF36 PCS was a significant predictor of a higher risk for ACM independent of potential confounders. SQ-No remained a significant predictor after further adjustment for GNRI or frailty, but SQ-No was no longer significant when adjusted for SF36 PCS. Conclusion Predictive ability of SQ was closely related to SF36 PCS in haemodialysis patients. SQ by nurses appears to assess patient-perceived health-related quality of life rather than objectively assessed malnutrition or frailty.

#831 Associations of quality of life with hospitalization for infection and subsequent death in hemodialysis patients: Osaka Dialysis Complication Study

Abstract Background and Aims Health-related quality of life (HRQOL) as self-reported health status is known to predict mortality in hemodialysis (HD) patients. Infection is one of the major causes for death in those patients, although limited studies have examined possible associations of HRQOL with infection-related outcomes. In the present study, we examined the associations of HRQOL scores with all-cause mortality, hospitalization for infection, and subsequent death in HD patients. Method Patients for this study were selected from the Osaka Dialysis Complication Study (ODCS) which is a prospective cohort study from 2012 to 2017 including a total of 1696 HD patients. HRQOL was assessed by Medical Outcomes Study short form 36 (SF-36) questionnaire to determine scores of the physical component summary (PCS) and the mental component summary (MCS) at baseline, and patients were divided into tertiles of them. The key outcomes were all-cause mortality, hospitalization for infection, and subsequent death after infection. Association was analyzed with Cox proportional hazards models or Fine-Gray models to estimate hazard ratios (HRs) with the highest tertile of PCS or MCS (T3) as referent. Models were unadjusted and adjusted for potential confounders including major demographic factors, traditional cardiovascular risk factors, and the factors related to chronic kidney disease-mineral and bone disorder (CKD-MBD), protein energy wasting and inflammation, and renal anemia. Results We analyzed data from 1464 patients, and we identified 384 all-cause deaths, 321 hospitalizations for infections, and 143 subsequent deaths following infection. Risk of all-cause death was the highest in the lowest PCS tertile in unadjusted model, and this association remained significant in multivariable-adjusted models. In addition, a lower PCS was significantly predictive of a higher risk of both hospitalization for infection in models unadjusted and adjusted for demographic variables, but not significant in a model adjusted for all confounders. However, risk of death after hospitalization for infection was significantly higher in the lowest PCS tertile in unadjusted and in multivariable-adjusted models, compared with the highest PCS tertile. In contrast, MCS was not associated with all-cause mortality, hospitalization for infection, or death following hospitalization for infection. Conclusion A low PCS was associated with both hospitalization for infection and subsequent death after infection in HD patients, but it was more closely associated with the latter. This study revealed that HRQOL, particularly its physical component, is an independent predictor of infection-related outcomes in this population.