Dialysis Technique Research Articles

Establishing a peritoneal dialysis technique survival core outcome measure: We look forward to the next possession.

Establishing a peritoneal dialysis technique survival core outcome measure: We look forward to the next possession.

A LIPOSOMAL CONTROLLED DELIVERY SYSTEM FOR PLANTAGO MAJOR L. EXTRACTS AND THEIR BIOLOGICAL ACTIVITY FOR WOUND HEALING

The objectives of this study are to determine the effective features of water and aqueous-ethanol extracts of Plantago major L. (Pm-dH2O and Pm-EtOH, respectively) in wound healing, such as antimicrobial, antioxidant potential, and fibroblast proliferation. Furthermore, it was targeted to obtain liposome structures loaded with Pm-extract for controlled release, characterize the obtained liposomes, and determine their release profiles. Antimicrobial activity (inhibition zone and minimum inhibition concentration), total antioxidant and oxidant (TAS, TOS, and OSI) potentials, total phenolic content (TPC), and total flavonoid content (TFC) of Pm extracts were tested. The radical scavenging activity of Pm extracts was quantified by the DPPH assay. Antioxidant capabilities of Pm extracts were determined with ABTS, CUPRAC, and FRAP. In vitro cytotoxicity tests of Pm extracts were examined on dermal fibroblast cells with MTT assay. Liposome structures loaded with Pm extracts were obtained using the ethanol injection method. Plant extract-loaded liposomes were characterized, and in vitro release kinetics were revealed by dialysis technique. Pm-EtOH extract inhibited the growth of microorganisms at lower concentrations than Pm-dH2O extract. According to TAS, TOS, and OSI values, it was concluded that there was a moderate antioxidant effect in Pm extracts in general. TPC and TFC of the Pm-EtOH extract are higher than the Pm-dH2O extract. Inhibition percentages of Pm-EtOH extract are higher than Pm-dH2O extracts against DPPH free radicals. The ABTS, CUPRAC, and FRAP antioxidant capacities of the Pm-EtOH extract are higher than that of the Pm-dH2O extract. Furthermore, according to dynamic light scattering and microscopy images, these plant extracts loaded liposomes had a high entrapment efficiency, a wide size range, and good stability. Pm extracts showed high cell viability and no cytotoxic effect on HDF cells. Liposome structures loaded with Pm extracts are fine alternatives for effective and controlled release to the wound site due to high entrapment efficiency, a wide size range, and good stability.

Poly(lactic-co-glycolic) acid nanoparticles with thermoresponsive shell for sustained release of dexamethasone

Polymeric nanocarriers based on poly(lactide-co-glycolide) (PLGA) enable drug encapsulation while achieving increased solubility of hydrophobic drugs, enhanced plasmatic half-life, and protecting the drug from early degradation/metabolization. Nevertheless, it is still difficult to effectively regulate the drug release from nanocarriers. Covering the surface of PLGA nanoparticles (NPs) with a thermoresponsive shell may be the key factor for building drug delivery systems with temporal and spatial control. In this respect, PLGA NPs with a mean size of 212 nm, containing dexamethasone (Dex) (Dex/PLGA NPs) have been produced by the dialysis technique without the use of a surfactant. Then, the nanoparticles were covered with poly(N-isopropylacrylamide-co-4-vinyl pyridine) (PVP) by ionic interactions between the amine groups of the PVP and carboxylic groups of PLGA. FT-IR and XPS spectroscopy were used to identify the new functional groups introduced on the PLGA nanoparticles' surface. The assembly of PVP on the PLGA NPs was analyzed by monitoring the particle size with temperature, zeta potential, AFM, and TEM analysis. The in vitro drug delivery investigation showed that temperature has significant control over the release rate of Dex from PVP-coated PLGA NPs. The thermosensitive polymer is hydrated at temperatures lower than LCST (20 °C) and forms a gel around the nanoparticles slowing down the release rate of Dex. Above the LCST, PVP becomes hydrophobic, collapses, inducing a substantially slower and sustained release of Dex, with 84 % released at 200 h.

Severe uterovaginal prolapse and start of peritoneal dialysis: Role of colpocleisis surgery. Report of two cases.

Utero-vaginal prolapse is a common condition in the female population. In addition to well-known predisposing risk factors malnutrition, autosomal dominant polycystic kidney disease (ADPKD) and dialysis technique may favour its occurrence or aggravation, especially in patients with end-stage kidney disease (ESKD). Depending on severity, a relative contraindication to peritoneal dialysis (PD) could be considered. We report the cases of two patients with a grade IV utero-vaginal prolapse who successfully started PD after obliterative surgery (partial colpocleisis by Le Fort).

Establishing a peritoneal dialysis technique survival core outcome measure: A standardised outcomes in nephrology-peritoneal dialysis consensus workshop report.

Technique survival, also reported with negative connotations as technique failure or transfer from peritoneal dialysis to haemodialysis, has been identified by patients, caregivers and health professionals as a critically important outcome to be reported in all trials. However, there is wide variation in how peritoneal dialysis technique survival is defined, measured and reported, leading to difficulty in comparing or consolidating results. We conducted an online international consensus workshop to establish a core outcome measure of technique survival. Discussions were analysed thematically. Fifty-five participants including 14 patients and caregivers from 13 countries took part in facilitated breakout discussions using video-conferencing. The following themes were identified: capturing important aspects of the outcome (requiring a core event to define the outcome, distinguishing temporary from permanent events, recognising heterogeneous experiences of transfers), adopting appropriate neutral nomenclature (conveying with clarity, avoiding negative connotations), and ensuring feasibility and applicability (capturing data relevant to clinical and research settings, ease of adoption). The suggested definitions for the core outcome measure were 'the event of a transfer to haemodialysis', or 'discontinuation of peritoneal dialysis'. Applying the principles described within the workshop, defining the outcome measure as a 'transfer to haemodialysis' was preferable. It is proposed that the core outcome of technique survival is redefined as 'transfer to haemodialysis' and that its components are standardised using simple, neutral terminology Components considered important by stakeholders included recording the reasons for transfer from peritoneal dialysis, and focussing on permanent events whilst ensuring the outcome remains easy to implement.

Association of Social Deprivation Index with Home Dialysis Technique Failure: A Single-Center Experience.

Despite offering several advantages to patients and healthcare systems, utilization of home dialysis modalities (HDM) remains low, particularly among racial and ethnic minorities, and those with increased sociodemographic stress. Providers' apprehension towards adverse outcomes and home dialysis failure remains a barrier to HDM referral. We investigated the relationship sociodemographic factors have on HDM use and technique failure. We performed a retrospective cohort study of adult incident ESRD patients over a six-year period at the University of Rochester to evaluate the association between demographic factors, social deprivation index (SDI), and co-morbidity burden on HDM utilization and technique failure. Person-time incidence rates were calculated to compare outcome variables, and rates were compared using a Poisson Rate Ratio Test. A univariate Cox regression was used to examine predictors impacting technique failure. Of the 873 patients, 102 started dialysis with HDM, 79 patients converted to HDM, and 692 remained on in-center hemodialysis (ICHD). Age, race, and SDI scores were significantly different between patients starting on ICHD, peritoneal dialysis (PD) and home hemodialysis (HHD) with no significant difference in comorbidity burden. Black patients represented 32% of the overall cohort, but only 16% of the initial home dialysis population. Compared to those that remained on ICHD, individuals converting from ICHD to HDM were younger and had significantly different SDI scores. SDI was not associated with HDM technique failure. Historically underrepresented racial populations are less represented in those starting home dialysis, however there was no racial difference in the group transitioning to HDM after initiating ICHD. Social deprivation scores were higher in those on ICHD compared to PD. Neither social deprivation nor race predicted success on home therapy. These findings demonstrate a disparity in initial modality, and a disconnect between sociodemographic factors associated with home dialysis use and those predicting HDM technique failure.

Optimisation of induction and purification protocols of recombinant 22.6kDa tegumental protein of Schistosoma spindale inprokaryotic vector

Schistosomosis is a prevalent zoonotic parasitic disease affecting both humans and animals on a global scale, with an estimated 165 million cattle and 200 million people impacted worldwide. Eventhough, serological methodologies designed for the identification of specific antibodies targeting parasitic antigens are esteemed for their high sensitivity, there are criticisms due to their incapacity to reliably indicate active infection, inability to correlate with the intensity of infection and lack of specificity. Enhancing the specificity of serological assays presents a significant challenge, primarily attributable to the identification and synthesis of specific antigens. In addressing these limitations, recombinant technology with specific immunogenic proteins as candidate antigens emerges as a viable alternative. In this study, induction of 22.6 kDa recombinant tegument protein of Schistosoma spindale was achieved using 0.6 mM concentration of IPTG at 37°C for four hours. Nickel chelating affinity chromatography was employed for protein purification, yielding maximum protein concentration at 75mM elution. Subsequently, the dialysis technique was employed to remove contaminants, while lyophilisation method was employed for protein concentration. The protein concentration post dialysis was measured at 0.220 mg/mL, while lyophilisation resulted in a concentration of 2mg/m Keywords: 22.6 kDa tegumental protein, Schistosoma spindale, dialysis, lyophilisation

8551 Comparability of Free Testosterone Measurements

Abstract Disclosure: H. Zhou: None. O. Sugahara: None. U. Danilenko: None. H.W. Vesper: None. Assessment of free testosterone (FT) has been recommended as a biomarker for diagnosis and management of hypogonadism and female hyperandrogenism. Reliable laboratory measurements are essential for properly diagnosing and treating these diseases. FT is currently measured using direct commercial immunoassays, assays using equilibrium dialysis (ED) or other separation techniques, or estimated by calculating free testosterone (cFT) using different formulas based on the levels of total testosterone and sex hormone binding globulin (SHBG). There are concerns about the accuracy and reliability of current methods that may negatively impact correct detection, treatment, and prevention in patient care. CDC’s Clinical Standardization Programs (CDC CSP) has developed an accurate, high throughput method using ED coupled with isotope dilution ultra-high-performance liquid chromatography tandem mass spectrometry (ED-UHPLC-MS/MS). The ED step uses an internationally recognized procedure and is performed in a custom designed dialyzer system that allows maintaining equal ratio of sample-to-buffer volume. The method uses certified pure primary reference material (National Measurement Institute-M914) as calibrator. The method has a limit of detection of 0.6 pg/mL, with an accuracy of ±5%, and precision less than 10% CV. The measurement range is 2 – 2000 pg/mL. The analytical performance of this method as well as other FT methods used in patient care was assessed using single-donor serum samples. The evaluated methods included two commercially available platforms utilizing Chemiluminescence Immunoassay or radioimmunoassay techniques, as well as six laboratory-developed assays using ED-LC-MS/MS. The results of the interlaboratory comparison study will help assessing the current level of agreement among FT assays, to identify potential factors causing differences among assays, and to assist with developing materials to improve the agreement among assays. Presentation: 6/1/2024

A-075 Comparability of Free Testosterone Measurements- Results of the Interlaboratory Study

Abstract Background Assessment of free testosterone (FT) has been recommended as a biomarker for diagnosis and management of hypogonadism and female hyperandrogenism. Reliable laboratory measurements are essential for correctly diagnosing and treating these diseases. FT is currently measured using direct commercial immunoassays, assays employing equilibrium dialysis (ED) or other separation techniques, or it is estimated by calculating free testosterone (cFT). There are concerns about the accuracy and reliability of current methods that may impact patient care. To obtain more information about variability of FT measurements used in patient care, CDC’s Clinical Standardization Programs (CDC CSP) conducted an interlaboratory comparison study. Methods CDC CSP developed an accurate, automated method using ED coupled with isotope dilution ultra-high-performance liquid chromatography tandem mass spectrometry (ED-UHPLC-MS/MS). The ED step follows an internationally recognized procedure. The method is calibrated with primary reference material (National Measurement Institute-M914) and was used to assign target values to sera used in the study. The FT concentrations ranged from 3 to 339 pg/mL. In the interlaboratory comparison study single-donor serum samples were provided to participants operating FT methods used in patient care. The participating methods included commercially available platforms utilizing Chemiluminescence Immunoassay or radioimmunoassay techniques, as well as laboratory-developed assays using ED-LC-MS/MS. Results Preliminary findings of the CSP interlaboratory comparison study found large variability among participating assays. The agreement among IA and among ED-LC-MS/MS assays was close. However, FT concentrations obtained by IAs were in average 6 times lower compared to the ED-LC-MS/MS methods. Results estimated using the Vermeulen equation overestimated FT in average by 15% compared to the ED-LC-MS/MS methods and by over 6 times compared to IAs. Conclusions Large variability is observed between FT laboratory developed tests (LDTs) and IAs. As both LDTs and IAs are used in patient care, standardization of FT measurements to assure better patient care is needed. CDC CSP is addressing the need by developing highly accurate and precise FT method and conducting an interlaboratory comparison studies that can aid with improvement of the agreement among assays and identifying potential factors causing differences among assays.

Rationale and design of ELIXIR, a randomized, controlled trial to evaluate efficacy and safety of XyloCore, a glucose-sparing solution for peritoneal dialysis.

Peritoneal dialysis adoption and technique survival is affected by limitations related to peritoneal membrane longevity and metabolic alterations. Indeed, almost all peritoneal dialysis fluids exploit glucose as an osmotic agent that rapidly diffuses across the peritoneal membrane, potentially resulting in metabolic abnormalities such as hyperglycemia, hyperinsulinemia, obesity, and hyperlipidemia. Moreover, glucose-degradation products generated during heat sterilization, other than glucose itself, induce significant morphological and functional changes in the peritoneum leading to ultrafiltration failure. The partial substitution of glucose with osmotic agents characterized by a better local and systemic biocompatibility has been suggested as a potential strategy to innovate peritoneal dialysis fluids. The approach aims to minimize glucose-associated toxicity, preserving the peritoneal membrane welfare and counteracting common comorbidities. In this work, we report the clinical trial design of ELIXIR, a phase III randomized, controlled, blinded outcome assessment study comparing Xylocore®, an innovative formulation based on Xylitol and l-carnitine, to standard glucose-based regimens, in end-stage kidney disease patients treated with continuous ambulatory peritoneal dialysis; 170 patients will be randomized (1:1) to receive XyloCore® or to continue their pre-randomization peritoneal dialysis (PD) therapy with glucose-only PD solutions, for 6 months. The primary study's objective is to demonstrate the noninferiority of XyloCore® in terms of Kt/V urea, for which a clinically acceptable noninferiority margin of -0.25 has been determined, assuming that all patients will be treated aiming to a minimum target of 1.7 and an optimal target of 2.0.

Separation and partial purification of lecithin: cholesterol acyltransferase from serum of obese women with a study of the effect of oily and nano-extract of Castanea fruit in activating the enzyme

Background: The Chestnut plant is one of the important plants for treating many diseases. Therefore, the oil extract of the Chestnut plant was taken to know its effect on activating an enzyme of lecithin: cholesterol acyltransferase that decreases in obese patients, by isolating it from the blood and using nanotechnology methods.Methods: The research included the isolation lecithin: acyltransferase cholesterol (LCAT) from the blood of 5 obese women, whose BMI was between 25-30 kg/m2, ages ranged from 40-45 years, and they were healthy without any diseases. The oil extract of Chestnut fruit was isolated. Fatty acids present in the oil extract were identified using capillary gas chromatography technique CGC, as the extract contained a percentage of unsaturated fatty acids and a lower percentage of saturated fatty acids. The enzyme was precipitated with ammonium sulfate, dialysis technique, and the gel filtration chromatography technique was used in purification. Finally, effect of the oil extract of the Chestnut fruit was studied at a concentration of (0-100) mg/ml and the nanoparticles-oil extract also on the activity of the LCAT (0-20) mg/ml. The nanoparticles of silver nitrate were prepared at a concentration of 1 mM with the oil extract of the Chestnut fruit and heated at a temperature of 60°C.Result: The highest peak was obtained from the gel filtration chromatography, which was highly effective. The number of purification times reached 91.72, and the recovery rate was 283.33%, and the effectiveness was qualitative 457.69 U/mg. Oil nanoparticles extraction was confirmed when the solution was transformed by changing its colors from colorless, yellow, orange, and finally coffee in color. The results showed an increase in the activity of the LCAT when treated with the two extracts, also the increase in the activity had a higher effect on the activity of the enzyme.Conclusion: We concluded during the study that the extract of the fruit of the oily nanoparticles was more effective in increasing the activity of an enzyme lecithin: cholesterol acyltransferase in healthy women with obesity. Keywords: Oil extract; Lecithin enzyme; Cholesterol acyltransferase; Chestnut

Absorbents therapy, as a conservative option, can improve kidney function in chronic kidney disease

Chronic Kidney Disease (CKD), also called chronic kidney failure, is increasingly recognized as a global public health problem in the entire world. It is characterized by slow, progressive and irreversible loss in kidney physiology. Todays, the prevalence of CKD is increasing dramatically. The CKD can affect almost every organ system including cardiovascular system. Many treatment have been attempted for CKD such as renal transplantation, hemodialysis (HD) and peritoneal dialysis (PD). At the end stage of CKD, HD is the most widely used therapy throughout the world. Although, these options can decrease volume expansion and uremic solute retention and also increase patient survival. However, there are certain complications associated with the use of these methods. Previous studies have been reported that the main side effects are headache, muscle cramp, abdominal pain, hypotension, hypertension, vomiting, and constipation. Therefore, the investigation for better and more convenient dialysis technique should continue, as well as the search for a better material to enhance clearance of nitrogenous waste products from the body. The intestine has significant effect in the clearance of nitrogenous waste products from the body. Therefore, it can be an appropriate site for CKD management. The potential mechanism of intestinal dialysis (ID) techniques is that it can absorb excess fluids, uremic toxins and electrolytes within the gastrointestinal (GI) tract, and exerts them in the feces before they can be absorbed into the blood. In the present review, we will focus on different absorbents, as a conservative treatment, to remove uremic waste metabolites from the GI tract for improvement of kidney function in chronic kidney disease.

Toward acid- and heparin-free dialysis: the regional anticoagulation approach.

In chronic intermittent hemodialysis, heparin is the standard anticoagulant as is the use of acid-containing dialysate. Regional anticoagulation (RA) with a calcium-free, citrate-containing dialysate has been developed. We compared RA using a calcium-free, citrate-free dialysate, routinely used in our center, versus systemic heparinization. In a retrospective, observational, single-center, crossover study, we examined 15 patients undergoing chronic hemodialysis who were at high risk of bleeding and temporarily unable to use heparin. These patients received temporary treatment with RA involving calcium-free and citrate-free dialysate. We compared the dialysis session success rates during two distinct periods: standard heparinization and RA procedure with a calcium-free and citrate-free dialysate. In our study of 15 patients on chronic hemodialysis which compared 30 RA sessions versus 28 heparin-based anticoagulation session, we observed a 100% success rate with a median session duration of 240 min in both RA and heparin groups. No early extracorporeal circulation (ECC) loss was reported. However, we noted significant differences in the post-dialysis ECC thrombosis scores, with higher Global Thrombosis Index (GTI) and higher membrane coagulation scores in the RA group (P<.007 and P<.02, respectively). No hypocalcaemia or hypercalcemia symptoms occurred. Median post-filter ionized calcium levels were 0.32 (0.29-0.39) mmol/L at 30 min and median patient ionized calcium levels was 1.19 (1.135-1.28) mmol/L at 60 min. No significant difference in per-dialysis arterial blood pressure was observed between groups. Our study evaluated the RA approach using a calcium-free, citrate-free acetate dialysate in a chronic hemodialysis center and found it effective. Although an acid-free dialysate was not used in this study, our findings suggest it could be the next frontier in the evolution of advanced dialysis techniques.

Serum alkaline phosphatase is a strong predictor of mortality in ESKD patients: analysis of the RISCAVID cohort

BackgroundMortality in hemodialysis (HD) patients remains unacceptably high compared with that of the general population and despite the continuous improvement of dialysis techniques. This study aimed to assess the role of alkaline phosphatase serum levels on cardiovascular and overall mortality in the RISCAVID study cohort through a long follow-up period, looking for associations with known risk factors for poor outcome.MethodsIn June 2004, a prospective observational study was started focusing on the cardiovascular risk in hemodialysis patients who lived in the north-west area of Tuscany (RISCAVID, “RISchio CArdiovascolare nei pazienti afferenti all’Area Vasta In Dialisi”). The RISCAVID cohort included 572 prevalent patients on maintenance HD for at least three months. Morbid or fatal events were prospectively recorded at 6-month intervals for a follow up time of 216 months.ResultsIn univariable Cox regression analysis, dialysis technique, Geriatric Nutritional Risk Index, peripheral vascular disease, and intact parathyroid hormone and total calcium serum levels were significantly associated with baseline alkaline phosphatase serum levels. Cox multivariable analysis showed that elevated serum alkaline phosphatase levels (the highest quartile), advanced age, dialysis vintage, type of vascular access, Geriatric Nutritional Risk Index, C-reactive protein and calcium serum levels, history of cardiovascular disease and peripheral vascular disease were independent predictors of overall mortality in maintenance HD patients. The fourth quartile of alkaline phosphatase was associated with all-cause 10-year mortality (HR: 1.47; 95% CI: 1.177–1.834) with a 47% increase with respect to the 1st, 2nd, and 3rd quartiles. This was also observed for 18-year all-cause mortality.ConclusionsAdjusted proportional analysis showed the alkaline phosphatase value to be an independent and powerful predictor of overall mortality in the hemodialysis population.Graphical

An Ethical Analysis of Therapy for Severe Congenital Kidney and Urinary Tract Anomalies.

Technological advancements before and after delivery have greatly altered the counseling of pregnant patients facing a fetal diagnosis of severe oligohydramnios or anhydramnios secondary to congenital anomalies of the kidneys and urinary tract. Once considered a nearly uniformly lethal abnormality, long-term survival may now be possible secondary to prenatal innovations aimed at restoring the amniotic fluid volume and the availability of more advanced neonatal dialysis techniques. However, these available therapies are far from perfect. The procedures are onerous for pregnant patients without a guarantee of success, and families must prepare themselves for the complex life-long medical care that will be necessary for surviving individuals. Multidisciplinary counseling is imperative to help pregnant individuals understand the complexity of these conditions and assist them in exercising their right to informed decision-making. Moreover, as with any developing field of medicine, providers must contend with ethical questions related to the treatment options, including questions regarding patient-hood, distributive justice, and the blurred lines between research, innovation, and standard care. These ethical questions are best addressed in a multidisciplinary fashion with consideration of multiple points of view from various subspecialties. Only by seeing the entirety of the picture can we hope to best counsel patients about these highly complex situations and help navigate the most appropriate care path.

#494 Analysis of technique failure and reasons for the end of follow-up in a peritoneal dialysis unit

Abstract Background and Aims Currently, there are various definitions for peritoneal dialysis technique failure, and several related factors are described. There is controversy regarding whether mortality should be considered a form of technique failure or not, as it involves an event of a different nature. Besides, the exit form peritoneal dialysis (PD) technique can occur due to the transition to hemodialysis (HD), kidney transplantation or the patient's death in general. The aim of this study was to investigate which factors are associated with survival in peritoneal dialysis technique. Method A retrospective study was conducted with 111 incident PD patients in the dialysis unit of Hospital Universitario Virgen de las Nieves, in Granada, Spain, between 2015 and 2020. A survival curve was obtained, evaluating the association of different variables with technique failure and the end of follow-up. By identifying mortality as a competitive risk for technique failure, a Fine and Gray competitive risks model was applied. Results A total of 111 patients were analyzed, with an annual technique survival of 90%, being it 83% at two years, and 74% at three years. Table 1 reflects the demographic and clinical characteristics of the patients. The main causes of technique failure were psychosocial causes (19%), peritoneal catheter mechanical issues (12%), ultrafiltration failure (9.52%), and peritonitis (9.52%). The main reasons for the end of follow-up were kidney transplantation (55%), transfer to HD (26%), and death (12.6%). Among the deceased, 64% were of cardiovascular origin, and 21% were infectious. Technique failure was more observed in patients over 65 years old, in those with a Charlson index higher than 4 points, with diabetes, a history of cardiovascular disease (CVD) and heart failure (HF), in former smokers, and in diabetic kidney disease. Conclusion Technique survival in our center was 90% at one year and 83% at two years, similar to previous Spanish records. The reasons for technique exit were: 55% due to kidney transplantation, 26% due to transfer to hemodialysis, and 19% due to for psychosocial causes. Risk factors related to technique failure were advanced age, Charlson index, diabetes, and a history of cardiovascular disease (CVD) and heart failure (HF).

#693 Reversed high-flux SUPRA HFR: a proof of concept pilot study to access the middle molecular weight uremic toxins

Abstract Background and Aims Supra HFR is an extracorporeal purification system in which convection, diffusion, and adsorption act separately. Thanks to a first hemofilter with a sieving coefficient for albumin of 0.02, the endogenous ultrafiltrate is purified by a neutral styrenic resin, then the reconstituted whole blood is led to a second low-flux filter. Recently, an evolution of Supra HFR, called Supra H, has been produced with the innovative second high-flux filter (Bellco, Mirandola, Italy, Kuf &amp;gt; 50 ml/h/mmHg). Aim of the study is a comparison between Supra HFR, Supra H and Supra H used in a reversed configuration, called “reversed Supra H”. The potential advantage of reversed Supra H is to achieve a fine tuning on the removal of medium molecular weight toxins through adsorption acting after the bulky tuning of these molecules with the new high-flux filter (Fig. 1). Method A pilot study was conducted on 4 patients in a cross-over manner. Each patient underwent one session of conventional Supra HFR, one session of Supra H, and one session of reversed Supra H. The median age of the patients was 61 (58-79) years, dialysis vintage was 113 (76-434) months, median blood flow from the vascular access was 300 (270-300) ml/min, dialysis time was 240 (225-240) minutes, and the amount of the endogenous ultrafiltrate (Qinf) produced was kept constant for each patient during the 3 different treatments and was 9.6 (9.2-12) liters. The medium molecular weight toxins studied were β2 microglobulin (β2M), myoglobin and free light chains κ and λ (FLC κ and λ). Albumin removal by all three methods was also studied. The removal of the studied substances was obtained by Reduction Rate per session (RRs) = [(dialysis start value-dialysis end value) / dialysis start value] *100. The dialysis end value was obtained by the stop dialysate flow method and corrected for hemoconcentration according to Schneditz D et al. ASAIO J 2012. Friedman's test was used to analyze the difference between the three groups. Dunn's post-hoc test was conducted to find differences between two groups at a time. Results Regarding the toxic substances studied, the dialysis start values were represented in Table 1. As to the β2M RRs the comparison of Supra HFR vs Supra H vs reversed Supra H was statistically significant in favor of using reversed Supra H (P=0.037), the same result was obtained for the RRs of FLCs κ (P=0.041). Dunn's test showed a significant increase in RRs of FLC κ with reversed Supra H compared with Supra HFR (P=0.040). No significant differences were found for the RRs of myoglobin and FLCs λ although reversed Supra H showed a better trend in the purification of these molecules (Fig. 2). RRs of albumin were similar with these three dialysis techniques. Conclusion The Supra H technique allows an increase in the RRs of tested uremic toxins compared to the RRs obtained by Supra HFR in the conventional version. The reversed Supra H configuration confirms the hypothesis of an even better depurative trend than the other two techniques. The significance of the results is certainly affected by the small number of patients enrolled.

#705 Survival of expanded hemodialysis and high-flux hemodialysis patients in Colombia: a cohort's study

Abstract Background and Aims Survival is a core outcome of hemodialysis (HD) therapy. Progressive improvement in the permeability and biocompatibility of membranes for HD, dialysis techniques and clinical processes around these therapies have been developed. Recently, expanded hemodialysis (HDx) enabled by the medium cut-off membrane Theranova® has demonstrated encouraging efficacy outcomes in terms of better clearance of medium molecules and better outcomes reported by patients when compared to high-flux hemodialysis membranes (HF HD). The objective of the present study is to compare survival in an HDx cohort versus an HF HD cohort at a 48-month follow-up. Method Cohort study, one group with expanded haemodialysis (HDx) enabled by Theranova® and the other with HF HD, adult prevalent HD patients (&amp;gt; 90 days) at Baxter Renal Care Services Colombia starting between September 1, 2017, and November 30, 2017, with follow-up for up to 48 months. The sociodemographic and clinical characteristics of all patients were summarized descriptively. A Fine-Gray regression model was performed to evaluate the factors associated with time to death from causes other than COVID-19, death attributable to COVID-19 cause is a competing risk. A sensitivity analysis was performed using different statistical methods, such as extended Cox regression and Cox regression, after adjusting for imbalance between the cohorts with the inverse probability of treatment weighting (IPTW) method. Results We evaluated 1092 patients, 533 in HF-HD vs 559 in HDx; the mean age 61 years; 42% had diabetes, and 19% had cardiovascular disease. All patients' sociodemographic and clinical characteristics are summarized descriptively by cohort arm (Table 1). A multivariate analysis was performed to evaluate the effect of demographic, clinical, and laboratory variables on the risk of death, adjusting for the competing risk of death from COVID-19 during four years of follow-up. Our results indicate that the Theranova dialyzer has a protective effect on mortality risk when controlling for confounding variables SHR = 0.75 [95% CI: 0.58 to 0.95, p-value = 0.019] (Table 2). The different sensitivity analyses report a statistically significant beneficial effect of Theranova versus HF dialyzer. See Table 3. Fig. 1 shows a difference in the survival functions according to the type of dialyzer. Conclusion HDx enabled by Theranova dialyzer was associated with an approximately 25% reduction in mortality risk compared to HF HD patients followed for up to 4 years; this effect was consistently observed using different survival analysis methods.

#1573 Effects of haemodialysis coupled with hemadsorption on uremic toxins removal, oxidative stress and cellular death.

Abstract Background and Aims The retention of middle-molecules and Protein Bound Uraemic Toxins (PBUT) in dialysis patients are directly linked to specific clinical complications such as anaemia, inflammation and cardiovascular disease leading to increased mortality. These toxins, not adequately cleared by current dialysis techniques, could be removed by adsorption as demonstrated in numerous studies on dialysis patients. Furthermore, in dialysis patients there's an increased inflammation and oxidative stress only partially attenuated by biocompatibility of newly developed membraned. This pathologic inflammatory response lead to tissue damage and cellular death. A particular form of programmed cellular death involving red blood cells is called Eryptosis and is detectable as changes in the morphology and in the shape of human erythrocytes. The aim of this study was to assess the safety of dialysis coupled with hemadsorption (HA+HD) in terms of biocompatibility and efficacy in terms of removal of middle-molecules and PBUTs. Method This was a preliminary analysis of a multicentre observational study that evaluated 4 dialysis session focusing on 7 chronic dialysis patients of our dialysis centre. Patients were treated with HA+HD with HA130 cartridge (Jafron) only in the early-week dialysis session and then returned to their usual prescription. Blood samples were taken before and after dialysis session in order to measure Eryptosis as a marker of biocompatibility and few uremic toxins to assess the efficacy of the treatment by using Removal Ratio. Eryptototic RBCs were identified by FS (cell volume dimension) and FITC_AnnexinV-binding (Beckman Coulter, Brea, CA, USA) using Navios Flow Cytometer (Beckman Coulter, Brea, CA, USA). A minimum 100.000 events were collected on each sample. Statistical analysis was performed using the SPSS Software package. A p-value of &amp;lt;0.05 was considered statistically significant. Results This study was carried out on 7 patients (4 women) with a mean age of 65.7 ± 11.5 years and a median dialysis vintage of 33 months (IQR 28-51). All patients had AVF with Qb of 330 ml/min. Dialysis length was 210 minutes. We didn't find any differences between Eryptosis values measured before and after dialysis (Table 1), and between different timepoints. We found significant reduction of PTH (pre: 391.5 ng/L, IQR 206.5-602.8 vs post: 162.0 ng/L, IQR 95.0-363.3; p=0.005) and β2-microglobulin (pre: 23.10 mg/L, IQR 22.1-24.1 vs post: 6.72 mg/L, IQR 6.2-8.3; p&amp;gt;0.005) throughout the dialysis session coupled with hemadsorption (Fig. 1). Conclusion In this preliminary analysis, we found that the association of Dialysis with Hemadsorption allows a great removal of middle molecular-weight uremic toxins without compromise biocompatibility and thus represent a better treatment option in patients with high retention of these toxins.

Impact of compliance with salt management guidelines before dialysis introduction on peritoneal dialysis technique survival: The importance of pre-dialysis care and education.

Peritoneal dialysis (PD) is a mode of therapy in which the patients themselves actively participate in the care of their own disease. We examined a possible association of salt reduction before starting dialysis with PD technique survival. This retrospective cohort study included 42 patients who started PD between April 2014 and March 2018. Participants were allocated to two groups based on their estimated daily salt intake before the initiation of dialysis: patients with an estimated daily salt intake <6 g/day were allocated to the appropriate salt intake group (AS group), while the rest were assigned to the high salt intake group (HS group). During a median follow-up of 47 months, PD technique survival, defined by death or transition to hemodialysis, was significantly lower in the HS group compared to the AS group. Successful salt reduction before dialysis introduction is associated with better PD technique survival.