Peritoneal Dialysis Duration Research Articles

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

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

Effluent decoy receptor 2 as a novel biomarker of peritoneal fibrosis in peritoneal dialysis patients.

Peritoneal fibrosis (PF) is a common complication of peritoneal dialysis (PD), but a specific and sensitive biomarker for PF is lacking. The present study aimed to determine the use of effluent decoy receptor 2 (eDcR2) as a biomarker for PF in PD patients. PD patients (n = 248) were recruited, and peritoneal specimens were collected at PD initiation (n = 30) and cessation (n = 33). Enzyme-linked immunoassay was used to measure eDcR2 and the eDcR2 appearance rate (eDcR2-AR) was calculated. The levels of DcR2 mRNA and protein were determined. The correlation of eDcR2 level with peritoneal function, histological parameters and DcR2 expression were analysed. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic performance of eDcR2 for PF, which was defined as a submesothelial thickness 150 µm or more. Co-localisation of DcR2 with a mesothelial marker, fibroblast markers and fibrotic markers were determined. The eDcR2-AR level correlated with PD duration, D/P Cr values, peritoneal Kt/V and peritoneal injury scores, especially submesothelial thickness (r = 0.638, p < 0.001). DcR2 was primarily expressed in peritoneal fibroblasts, and co-localised with α-SMA, vimentin, collagen I and fibronectin, but not with E-cadherin. Peritoneal DcR2 expression had a positive correlation with eDcR2-AR. ROC analysis indicated eDcR2 had an area under the curve of 0.907 for detection of PF (sensitivity: 78.6%, specificity: 100%) and the best cut-off value was 392.5 pg/min. The eDcR2-AR level is a potential biomarker for assessing PF in PD patients. Effluent DcR2 was mainly derived from peritoneal fibroblasts and DcR2-positive cells may accelerate PF, suggesting that it may be a potential therapeutic target.

Reduction in peritonitis rates: 18-year results from the most active pediatric peritoneal dialysis center in China.

Most of the available epidemiological data on peritonitis have been derived from developed countries. Limited data from China have been reported. An 18-year (2001-2018) peritoneal dialysis (PD) program at the Children's Hospital of Fudan University was described, and data on peritonitis were retrospectively analyzed. Since 2001, a program with a comprehensive PD care bundle has been developed, and 283 patients (53.7% male, median age 9.3years) were enrolled between 2001 and 2018. Among these patients, 117 peritonitis episodes occurred in 68 (24.0%) patients over 4896 patient-months. The peritonitis rate decreased 20-fold from 2.2 episodes per patient-year in 2003 to 0.11 episodes in 2018. The culture-negative rate decreased from 68.7% during 2001-2006 to 18.5% during 2013-2018, and the proportion of gram-negative and fungal infections increased significantly from 6.6 to 33.8% and 0 to 9.2%, respectively (p < 0.001). Short stature as height ≤ - 2 SD (OR 2.35, 95% CI 1.30-4.24, p = 0.005) and PD duration ≥ 1year (OR 3.38, 95% CI 1.76-6.49, p < 0.001) were independently associated with a higher risk of developing peritonitis. Of the 117 peritonitis episodes, 9.4% required permanent removal of the catheter, among which half were fungal infections. Patients with peritonitis had a higher risk for PD technique failure (p = 0.006), but there was no difference in estimated patient survival rates and no patient death due to peritonitis. With the successful development of the PD program and care bundles per the International Society of Pediatric Dialysis (ISPD) guidelines, peritonitis rates have been tremendously reduced in the most active pediatric PD center in China. Growth deficits and a long PD duration were risk factors for developing peritonitis, requiring further close monitoring for a better outcome. A higher resolution version of the Graphical abstract is available as Supplementary information.

POS-675 DECORIN DEFICIENCY EXACERBATES PERITONEAL INFLAMMATION AND FIBROSIS IN A MURINE MODEL OF PERITONEAL DIALYSIS

Peritoneal dialysis (PD) is an important mode of renal replacement therapy, but its success depends on preservation of the structural and functional integrity of the peritoneal membrane. Despite being a common complication in patients on long-term PD, there is no effective treatment for peritoneal fibrosis. Decorin is a soluble dermatan sulphate proteoglycan, with anti-fibrotic properties, synthesized by peritoneal mesothelial cells. We previously demonstrated that decorin level in effluent dialysate decreased with increasing PD duration.

Effluent N-terminal expressed in renal cell carcinoma/mesothelin predicts increased peritoneal permeability in patients undergoing peritoneal dialysis.

We investigated whether N-terminal and C-terminal products of expressed in renal cell carcinoma/mesothelin (N-ERC and C-ERC) in peritoneal effluent can predict peritoneal permeability in patients undergoing peritoneal dialysis (PD). Thirty-seven peritoneal effluent samples were obtained from 26 PD patients. High transport status was determined by the peritoneal equilibration test as a dialysate/plasma ratio of creatinine (D/P Cr) ≥ 0.81. Effluent cancer antigen 125 (CA125) was used as a reference. Effluent N-ERC concentration was better correlated with D/P Cr than effluent C-ERC or CA125 concentration. In multivariate analyses, effluent N-ERC and C-ERC, but not CA125, were significant predictors of high transport status after adjusting for age, PD duration, and residual renal Kt/V. ROC analysis showed that effluent N-ERC was the best predictor of high transport status among those three biomarkers. Effluent N-ERC predicts increased peritoneal permeability in patients undergoing PD.

Recommendations and techniques of peritoneal dialysis in chronic kidney disease in cats

Dialysis represents the process of separating a substance with colloidal dispersion from particles with molecular dispersion, based on the property of some membranes to retain only colloidal particles. The peritoneal dialysis procedure involves the existence of several stages. Loading is the step in which the dialysis fluid is introduced into the peritoneal cavity. The waiting, or inactive phase, takes place while the fluid is in the peritoneal cavity and the products of metabolism are transported across the peritoneal membrane into the dialysis fluid. Drainage is done after a few hours and consists of extracting the dialysis fluid and replacing it with a new fluid. The method of placement of peritoneal dialysis catheters is dependent on the catheter itself, the patient and the expected duration of peritoneal dialysis.

Relation of Serum Hepcidin Levels and Restless Legs Syndrome in Patients Undergoing Peritoneal Dialysis.

Introduction: Restless legs syndrome is a common and severe complication in patients undergoing peritoneal dialysis (PD), which seriously affects the life quality and prognosis of patients undergoing PD. Unfortunately, there are still no effective prevention and treatment measures. Serum hepcidin was demonstrated to be related to primary restless legs syndrome (RLS), whereas there are no studies on the relationship between serum hepcidin and RLS in patients undergoing PD. We aimed to evaluate the role and function of serum hepcidin in patients undergoing PD with RLS.Methods: A total of 51 patients undergoing PD with RLS and 102 age-and gender-matched patients undergoing PD without RLS were included. We collected the clinical data including serum hepcidin of those patients undergoing PD. We scored the severity of RLS according to the International restless leg Syndrome Research Group rating scale (IRLS). We compared the clinical characteristics of the two groups and evaluated the determinant factors of RLS by Logistic regression analysis. In addition, we evaluated the diagnostic value of serum hepcidin in patients undergoing PD with RLS by receiver operating characteristic (ROC) curve. We also analyzed the influencing factors of IRLS by multivariate linear regression analysis.Results: The duration of PD, serum hepcidin, and calcium were found to be significantly higher in patients undergoing PD with RLS than those patients undergoing PD without RLS (P < 0.001, P < 0.001, and P = 0.002, respectively). The level of hemoglobin, albumin, and RKF were significantly lower in patients undergoing PD with RLS (P = 0.002, P = 0.042, and P < 0.001, respectively). The duration of PD [odds ratio (OR) 1.038, 95% CI: 1.017, 1.060, P < 0.001], hemoglobulin level (OR 0.969, 95% CI: 0.944, 0.995, P = 0.019), calcium level (OR 9.224, 95% CI: 1.261, 67.450, P = 0.029), albumin level (OR 0.835, 95% CI: 0.757, 0.921, P < 0.001), hepcidin level (OR 1.023, 95% CI: 1.009, 1.038, P = 0.001), and RKF (OR 0.65, 95% CI: 0.495, 0.856, P = 0.002) are independent determinant factors of RLS in patients undergoing PD. Multivariate linear regression analysis revealed that, in addition to albumin, they were also independently associated with the severity of RLS.Conclusion: A significant relation was detected between serum hepcidin level and RLS in patients undergoing PD.

Peritoneal Expression of SGLT-2, GLUT1, and GLUT3 in Peritoneal Dialysis Patients

Introduction: In peritoneal dialysis (PD) patients, the peritoneal membrane is affected by glucose-based solutions used as peritoneal dialysate fluids. This exposure leads to changes of the membrane which may eventually culminate in fibrosis and method failure. In vitro or animal studies demonstrated that glucose transporters are upregulated upon exposure to these solutions. Expression studies of glucose transporters in human peritoneum have not been reported yet. Methods: Expression of SGLT-2, GLUT1, and GLUT3 in human peritoneal biopsies was analyzed by real-time polymerase chain reaction and Western blot analysis. The localization of these glucose transporters in the peritoneum was evaluated by immunohistochemistry using a Histo-Score. Results: Peritoneal biopsies of patients (healthy controls, uremic, PD, and encapsulating peritoneal sclerosis [EPS]) were analyzed. We found evidence of SGLT-2, GLUT1, and GLUT3 expression in the peritoneal membrane. Protein expression of SGLT-2 increases with PD duration and is significantly enhanced in EPS patients. All transporters were predominantly, but not exclusively, located adjacent to the vessel walls of the peritoneal membrane. Conclusion: Our study showed that SGLT-2, GLUT1, and GLUT3 were regularly expressed in the human peritoneum. SGLT-2 was particularly upregulated in PD patients with EPS, suggesting that this upregulation may be associated with pathological changes in the peritoneal membrane in this syndrome. Since preclinical studies in mice show that SGLT-2 inhibitors or downregulation of SGLT-2 ameliorated pathological changes in the peritoneum, SGLT-2 inhibitors may be potentially promising agents for therapy in PD patients that could reduce glucose absorption and delay functional deterioration of the peritoneal membrane in the long term.

Analysis of risk factors of postoperative mortality in peritoneal dialysis patients with developed peritonitis

Abstract. Peritoneal dialysis (PD)-associated peritonitis can lead to dysfunction in PD delivery as a result of thickening of the peritoneal membrane, usually due to recurrent peritonitis, and result in peritonitis with ileus or intestinal perforation. This study sought to investigate the risk factors that lead to mortality in patients receiving PD who underwent surgery for peritonitis.&#x0D; Methods. The study was designed as a retrospective observational study and included 36 patients who received PD and underwent surgical treatment for peritonitis between 2011 and 2020. Data on patient demographics, comorbid diseases, duration of PD application, number of peritonitis episodes due to PD, surgical procedures performed due to peritonitis, and postsurgical morbidity and mortality rates were collected.&#x0D; Results. It was found that mortality increased with advancing age in patients with coronary artery disease (CAD) compared to those without CAD, and this increase was statistically significant (p = 0.002). In addition, it was determined that the accompanying cirrhosis significantly increased mortality in elderly patients (p = 0.043). In considering the surgical procedures performed, it was found that segmental small-bowel resection (n = 16) was mostly performed due to ileus or intestinal perforation, and no additional pathological findings other than peritonitis were encountered in 12 patients. Mortality occurred in eight patients in the advanced-age group and one patient in the other group among patients operated on for peritonitis. No difference in mortality rate was found according to the surgical procedure (p = 0.512). Binary logistic regression analysis was applied and age, coroner artery diseases (CAD), and dialysis time for risk of mortality. Respectively, age (odds ratio [OR]= 1.09; 95% Cl [1.013-1.193]; p=0.024), CAD [OR] = 43.7; 95% Cl [5.191-368.755]; p &lt;.001 and dialysis time [OR] = 1.786; 95% [1.060-3.010]; p=0.029 was calculated.&#x0D; Conclusions. Mortality increased by 1.09 times for each one-year increase in age after 52.5 years of age and also CAD increased the mortality rate by 43.7 times. Prolonged PD duration increased the mortality rate especially after 11.5 months, increased the peritonitis-related mortality rate by 1.7 times. We propose that since surgical interventions may be performed in peritonitis due to PD; and do not increase peritonitis-related mortality, an appropriate surgical procedure can be performed safely in experienced centers before it is too late.&#x0D;

Gut microbial metabolite TMAO increases peritoneal inflammation and peritonitis risk in peritoneal dialysis patients

Trimethylamine-N-oxide (TMAO), a gut microbiota-produced metabolite, is accumulated in chronic kidney disease (CKD) patients. It is well known to contribute to CKD-related cardiovascular complications. However, the effect of TMAO on peritoneal dialysis (PD)-related peritonitis remains largely unknown. Here, we demonstrate that serum concentrations of TMAO were positively correlated with C-reactive protein levels, and the appearance rate of dialysate IL-6 and PAI-1, in PD patients. During the follow-up period of 28.3 ± 8.0 months, patients with higher TMAO levels (≥50 μM) had a higher risk of new-onset peritonitis (HR, 3.60; 95%CI, 1.18-10.99; P=0.025)afteradjustingfor sex, age, diabetes, PD duration, BUN,rGFR,C-reactive protein, BMI and β2-M. In CKD rat models, TMAO significantly promoted peritoneal dialysate-induced inflammatory cell infiltration, inflammatory cytokines production in the peritoneum. In vitro study revealed that TMAO directly induced primary peritoneal mesothelial cell necrosis, together with increased production of pro-inflammatory cytokines including CCL2, TNF-α, IL-6, and IL-1β. In addition, TMAO significantly increased TNF-α-induced P-selectin production in mesothelial cells, as well as high glucose-induced TNF-α and CCL2 expression in endothelial cells. In conclusion, our data demonstrate that higher levels of TMAO exacerbate peritoneal inflammation and might be a risk factor of incidence of peritonitis in PD patients.

Assessment of peritoneal thickness using CT in relation to dialysis adequacy in peritoneal dialysis patients

AbstractStudies assessing peritoneal thickness by CT in peritoneal dialysis (PD) patients are lacking. In this study, we aimed to investigate the association between peritoneal thickness as measured by CT and dialysis adequacy with peritoneal membrane characteristics in PD patients. Ninety‐four PD patients were enrolled. Peritoneal thickness was measured by CT. Patients with and without a decrease in Kt/V of at least 0.3 over time were classified as Group 1 and Group 2, respectively. An increase of 0.1 unit of dialysate/plasma (D/P) creatinine over time were considered significant. The relationship between peritoneal membrane thickness, change in Kt/V, and peritoneal membrane characteristics were investigated. There were 31 (33.0%) patients in Group 1. The duration of PD (86.0 ± 64.1 vs. 59.6 ± 45.2 months, p: 0.023), peritoneal thickness (1.02 ± 0.37 vs. 0.87 ± 0.21 mm, p: 0.015), peritoneal calcification (7 [22.6%] vs. 3 [4.8%] patients, p: 0.013], increased D/P creatinine ratio (14 [45.2%] vs. 14 [22.2%] patients, p: 0.031) and CRP (13.9 ± 11.2 vs. 7.1 ± 4.8 mg/L, p: 0.045) were significantly higher in Group 1, whereas albumin (3.6 ± 0.5 vs. 3.8 ± 0.6 g/dL, p: 0.047) and parathyroid hormone (355.2 ± 260.2 vs. 532.1 ± 332.9 ng/L, p: 0.015) levels were significantly lower. Peritoneal thickness was significantly correlated with duration of PD (r: 0.775, p &lt; 0.001) and CRP (r: 0.282, p: 0.006). Regression analysis showed that peritoneal thickness (Exp (B) [95% CI]: 0.029 [0.003–0.253], p: 0.001) was independent predictor of decreased Kt/V in PD patients. In conclusion, prolonged PD duration and increased peritoneal thickness are associated with a decrease in Kt/V over time. CT may be an alternative and noninvasive method instead of peritoneal biopsy for determining the structural changes of the peritoneal membrane .

Risk factors and clinical outcomes of encapsulating peritoneal sclerosis: A case-control study from China.

Encapsulating peritoneal sclerosis (EPS) is an uncommon, but serious complication in patients with continuous ambulatory peritoneal dialysis (PD) who have a considerable mortality rate. This study aimed to identify risk factors and outcomes of EPS in Chinese patients on PD. Sixteen patients on PD who met the International Society for Peritoneal Dialysis criteria for diagnosis of EPS in the First Affiliated Hospital of Sun Yat-Sen University from 1997 to 2018 were included. Patients without EPS were matched for age, sex and the duration of PD and selected at a 1:3 ratio for the controls. A case-control study was conducted to analyse the clinical profile and risk factors associated with EPS in patients. The prevalence of EPS in patients on PD in our centre was 0.55%. The percentage of EPS significantly increased with the duration of PD. In univariate regression analysis, a history of peritonitis (odds ratios (OR): 2.83; 95% confidence interval (CI): 0.82-9.68; p = 0.08), peritoneal glucose exposure (OR: 1.12; 95% CI: 1.03-1.22; p < 0.01) and a high peritoneal transport status (OR: 14.70; 95% CI: 1.85-117.02; p < 0.01) were associated with EPS in patients on PD. However in the multivariate model, only a high peritoneal transport status (adjusted odds ratios (aOR): 13.65; 95% CI: 1.69-109.96; p = 0.01) was independently associated with EPS. The rate of EPS significantly increases with the duration of PD. Progressive peritoneal dysfunction, especially a high peritoneal transport status, is associated with a higher risk of EPS in this population.

Overhydration May Be the Missing Link between Peritoneal Protein Clearance and Mortality

Introduction: Peritoneal protein loss (PPL) has been associated with mortality. Inflammation was assumed a putative cause with malnutrition as a consequence. Hydrostatic convection is a major drive for microvascular protein transport, but most studies in peritoneal dialysis (PD) patients overlooked this mechanism. An association between peritoneal protein clearance (PPCl) and venous congestion has been reported recently. The aim of this study was to explore the importance of fluid overload in PPCl in PD. Methods: Sixty-seven prevalent PD patients were assessed with peritoneal equilibration test and multifrequency bioelectrical impedance assessment (BIA). PPL and PPCl were calculated from simultaneously obtained 24-h peritoneal effluent. Results: PPL averaged 5.2 g/24 h. It was higher in patients on continuous treatment than in those without a long dwell. Significant associations between PPCl and BIA parameters of overhydration were found in both univariable and multivariable analyses. Lean mass index, partly dependent on hydration status, was associated with PPCl in univariable but not in multivariable analysis. A multiple linear model identified extracellular water excess and higher D/P creatinine as predictors of higher PPCl, independent of PD duration, type of PD, age, gender, albumin, cardiovascular disease, C-reactive protein, or lean mass index. Conclusions: The uni- and multivariable strong associations between fluid overload and PPCl support the importance of hydrostatic pressure-induced convection for PPCl. Also, peritoneal small solute transport was associated with PPCl. Both are amenable by adjusted dialysis prescription, especially focused on fluid status and avoidance of overhydration. The assumption of an association with inflammation and malnutrition was not confirmed.

Effects of bicarbonate/lactate-buffered neutral peritoneal dialysis fluids on angiogenesis-related proteins in patients undergoing peritoneal dialysis

BackgroundIn order to facilitate the safe and long-term delivery of peritoneal dialysis (PD), it is necessary to improve the biocompatibility of peritoneal dialysis fluids (PDFs). The novel bicarbonate/lactate-buffered neutral PDFs (B/L-PDFs) are expected to be improved biocompatible. This study evaluated the biocompatibility of B/L-PDFs by analysis on the profile of angiogenesis-related proteins in drained dialysate of patients undergoing PD.MethodsConcentrations of 20 angiogenesis-related proteins in the dialysate were semi-quantitatively determined using a RayBio® Human Angiogenesis Antibody Array and were compared between B/L-PDFs and conventional lactate-buffered neutral PDFs (L-PDFs).ResultsThe expression of growth-related oncogene (GRO α/β/γ), which belongs to the CXC chemokine family, decreased significantly after use of the B/L-PDFs compared to the L-PDFs (P = 0.03). The number of the proteins with lower level in the B/L-PDFs compared with L-PDFs was significantly negatively correlated with the PD duration (Spearman ρ = − 0.81, P = 0.004).ConclusionThis study suggested that B/L-PDFs are more biocompatible than conventional PDFs.

C1 inhibitor mitigates peritoneal injury in zymosan-induced peritonitis.

Peritonitis, due to a fungal or bacterial infection, leads to injury of the peritoneal lining and thereby forms a hazard for the long-term success of peritoneal dialysis (PD) and remains a lethal complication in patients with PD. This study investigated whether C1 inhibitor (C1-INH) could protect against the progression of peritoneal injuries with five daily administrations of zymosan after mechanical scraping of the rat peritoneum to mimic fungal peritonitis. Severe peritoneal injuries were seen in this model, accompanied by fibrinogen/fibrin exudation and peritoneal deposition of complement activation products such as activated C3 and C5b-9. However, intraperitoneal injection of C1-INH decreased peritoneal depositions of activated C3 and C5b-9, ameliorated peritoneal thickening, reduced the influx of inflammatory cells, and prevented the production of peritoneal fibrous layers with both one and two doses of C1-INH each day. Our results suggest that C1-INH might be useful to protect against peritoneal injuries after causes of peritonitis such as fungal infection. This clinically available agent may thus help extend the duration of PD.NEW & NOTEWORTHY Peritoneal injuries associated with peritonitis comprise an important issue to prevent long-term peritoneal dialysis (PD) therapy. Here, we showed that C1 inhibitor (C1-INH), as an anticomplement agent, protected against peritoneal injuries in a peritonitis animal model related to fungal infection. Therefore, C1-INH might be useful to protect against peritoneal injuries after peritonitis due to fungal infection. This clinically available agent may thus help extend the duration of PD.

Clinical factors affecting cerebral oxygenation in patients undergoing peritoneal dialysis.

Although cerebral regional oxygen saturation (rSO2) is significantly lower in hemodialysis (HD) patients than that in healthy controls, investigations on cerebral oxygenation in peritoneal dialysis (PD) patients are limited. We aimed to confirm the cerebral oxygenation status and identify the factors affecting cerebral rSO2 in PD patients. Thirty-six PD patients (21 men and 15 women; mean age, 62.8 ± 12.7 years) were recruited. In addition, 27 healthy volunteers (17 men and 10 women; mean age, 43.5 ± 18.8 years) were recruited as a control group. Cerebral rSO2 was monitored at the forehead using an INVOS 5100c oxygen saturation monitor. Cerebral rSO2 was significantly lower in PD patients than that in healthy controls (57.0 ± 7.3% vs 68.9 ± 8.6%, p < 0.001); moreover, cerebral rSO2 was significantly correlated with natural logarithm (Ln)-PD duration (r = -0.389, p = 0.019) and serum albumin concentration (r = 0.370, p = 0.026) in a simple linear regression analysis. Multivariable linear regression analysis was performed using variables that showed a significant correlation and p < 0.20 (serum creatinine, serum sodium, Ln-C-reactive protein, and dosage of erythropoiesis-stimulating agent) with the cerebral rSO2. Cerebral rSO2 was independently associated with Ln-PD duration (standardized coefficient: -0.339) and serum albumin concentration (standardized coefficient: 0.316). Cerebral rSO2 was significantly affected by the PD duration and serum albumin concentration. Further prospective studies are needed to clarify whether preventing a decrease in serum albumin concentration leads to the maintenance of cerebral oxygenation in patients undergoing PD.

MO1011IDENTIFICATION OF EARLY BIOMARKERS OF PERITONEAL MEMBRANE DYSFUNCTION IN CHILDREN ON PERITONEAL DIALYSIS USING METABOLOMICS ANALYSIS -PRELIMINARY RESULTS OF AN ONGOING PROSPECTIVE STUDY

Abstract Background and Aims Peritoneal dialysis (PD) are the main renal replacement treatment for children and adolescents with end stage kidney disease (ESRD). Peritoneal fibrosis is a major complication in long-term PD patients. Aim of the present study is to record the metabolic "fingerprint" of children on PD and to investigate its correlation with PD history and dialysis adequacy as well as the emergence of potential biomarkers that could detect early or predict peritoneal dysfunction. Method Samples of serum, urine and peritoneal effluent collected from 15 children with ESRD on PD. At the same time and 6 months later was performed PET-test as well as assessment of KT/V and creatinine clearance. Samples were subjected to targeted metabolomic analysis of amino acids and derivatives. Regarding metabolic technologies used, all samples (peritoneal fluid, urine, blood) were analyzed by a hydrophilic interaction liquid chromatography coupled to mass spectrometry (HILIC-MS / MS) method previously developed and validated in our laboratory for the simultaneous determination of amino acids and their derivatives in biological fluids. Αalso, high flow analysis was carried out (LC-q-tof analysis – HPLC /MS ). Results Using (HILIC-MS / MS) method, we found out that peritoneal dialysis duration, presence or absence of diuresis and PD creatinine clearance values are associated with significant differences in the levels of several metabolites, including glycine, creatinine, proline and 4-hydroxyproline, leucine, valine, glutamine and glutamic acid. Using (LC-q-tof analysis – HPLC /MS) approximately 200 metabolites were analyzed in the aforementioned samples. Figure 1 illustrates the number of metabolites detected in each matrix, as well as the common metabolites between the three matrices. These metabolites were associated with peritoneal dialysis duration, creatine clearance and presence or absence of diuresis. Several metabolites showed statistical difference between the examined groups. In detail, regarding serum analysis, five metabolites, including hydroxy phenyl acetic acid, glutathione ox, glucosamine-6-P, indole acetic acid and riboflavin showed statistical difference between the examined groups based on PD vintage. Based on urine excretion four metabolites named histidine, shikimic acid, thiamine and methionine were statistically different. Concerning urine analysis, two metabolites namely uridine and itaconic acid showed statistical difference when patients sub grouped based on PD vintage. Peritoneal fluid analysis highlighted one metabolite, uridine, that levels are significantly lower in patients on PD therapy for more than 4 years while based on creatinine clearance levels subgroups, two metabolites, lactate and pantothenic acid present statistically significant difference. Conclusion Metabolomics may be a tool in the evaluation of patients with ESRD on PD as it appears to reflect the clinical phenotype of the patient and the functional phenotype of the peritoneal membrane. Our results are the preliminary results of an ongoing prospective study. Limitation of the study is the small sample of patients, which does not allow safe clinical interpretation.

MO720SARS-COV2 INFECTION IN THE POPULATION ON PERITONEAL DIALYSIS

Background and AimsThe novel coronavirus disease 2019 (COVID-19) has now spread to the entire world as a highly contagious pandemic. The disease has proved to be more serious in populations with underlying diseases like kidney diseases, diabetes, or cardiovascular diseases. People with end-stage renal disease are known for their weakened immune systems and vulnerability to different types of infections. Recent studies have shown high prevalence and poor prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in hemodialysis patients, but its effect on peritoneal dialysis (PD) patients is still unknown.The aim of this study was to investigate the clinical, biological, and scannographic particularities and the prognosis of SARS-CoV-2 infection in patients on PD.MethodWe conducted a monocentric descriptive study including all the confirmed cases of SARS-CoV-2 infection in the PD unit of the Nephrology department in Charles Nicolle Hospital. The first confirmed case was in March 2019 and our study period ended in January 2021. We used Real-Time Reverse Transcriptase polymerase chain reaction (RT- PCR) to confirm SARS-CoV-2 infection after nasopharyngeal swabbing.ResultsEight patients were included: 7 men and 1 woman. The mean age was 40.25 years-old [22-60]. All the patients were hypertensive, 2 of them were diabetics and 3 of them had cardiac pathologies: coronary heart disease in 2 patients and atrial fibrillation in the other patient. One patient had history deep vein thrombosis. All the patients were on automated PD with an average duration of PD of 40.56 months [1-84]. Two of them had history of peritonitis. Regarding the revealing symptoms of COVID-19, all the patients suffered from asthenia, a deterioration of general condition was observed in 7 patients, dry cough was also present in 7 patients, 4 patients described muscle and body aches, 3 patients reported diarrhea and vomiting, dyspnea was observed in 2 patients, only one patient reported loss of taste and smell, and fever was present in only one case.Two patients had low peripheral oxygen saturation (70% and 88%). All the patients had lymphopenia with an average of 557 [900-280]. C-reactive protein was high in 6 patients with an average of 84.7 mg/l. Chest computed tomography (CT) scan was practiced in 3 patients, it was positive in all of them with average extent of damage of 60%. Four patients were admitted in hospital and one of them in the intensive care unit (ICU) for high oxygen needs. All the patients received azithromycin, and vitamin C and D and zinc supplementation. A preventive dose of heparin was prescribed in 5 patients. No patient required intubation. No patient had thromboembolic complications. Six patients fully recovered since more than one month. Regarding the other two patients we have a follow-up of only one week since the beginning of symptoms, one of them is pauci-symptomatic and the other one is still admitted in the ICU.ConclusionAccording to our findings, patients on PD are not at increased risk for severe illness from COVID-19 or other adverse outcomes.

MO542MOLIDUSTAT FOR ANAEMIA IN JAPANESE PATIENTS UNDERGOING PERITONEAL DIALYSIS: A SINGLE ARM, OPEN-LABEL, PHASE 3 STUDY

Abstract Background and Aims Erythropoiesis-stimulating agents (ESA) are the standard of care for anaemia due to chronic kidney disease (renal anaemia). Molidustat, a novel hypoxia-inducible factor prolyl hydroxylase (HIF–PH) inhibitor for the treatment of renal anaemia, could offer an alternative to ESAs. Molidustat was evaluated in the “molidustat once daily improves renal anaemia by inducing erythropoietin (MIYABI) program”, comprising five phase 3 studies. The present study investigated the safety and efficacy of molidustat in Japanese patients with renal anaemia undergoing peritoneal dialysis (PD) and previously treated with ESAs or not. Method This was a 36-week, open-label, single-arm, phase 3 study in Japanese patients ≥20 years with renal anaemia undergoing PD and not expected to start maintenance haemodialysis. Molidustat was administered once daily at a starting dose of 75 mg. Doses were titrated every 4 weeks based on the patient’s haemoglobin (Hb) response to the previous dose during visits to maintain the Hb level within the target range of ≥ 11.0 g/dL to &amp;lt; 13.0 g/dL (Japanese guidelines). The primary efficacy outcome was the responder rate, defined as the proportion of patients who meet all of the following criteria: (1) mean Hb level during the evaluation period in the target range from week 30 to week 36; (2) ≥50% of Hb values within the target range during the evaluation period; (3) no rescue treatment before the end of the evaluation period. Other outcomes included mean Hb level during the evaluation period and its change from baseline, Hb level at each visit and the number of treatment-emergent adverse events (TEAEs). Results Overall, 51 patients received molidustat (49 ESA-treated; 2 ESA-untreated) and 36 (70.6%) completed treatment. Mean age was 63.3 years, mean body weight was 62.4 kg and 62.7% were male. Mean baseline Hb level was 11.19 g/dL and mean duration of peritoneal dialysis was 2.8 years. Over the study period, mean treatment duration was 200.8 days with a mean dosage of 93.8 mg/day. The responder rate (95% confidence interval [CI]) during the evaluation period was 54.9% (40.3, 68.9). The proportions of patients meeting criterion (1), (2) or (3) were 54.9%, 58.8% and 92.2%, respectively. The mean (95% CI) for mean Hb level during the evaluation period was 11.18 (10.83, 11.54) g/dL and the mean (95% CI) for the change in mean Hb level during the evaluation period from baseline was 0.00 (–0.41, 0.41) g/dL. Mean Hb level stayed in the target range from week 12–36. Of the 15 patients who did not complete treatment, 9 discontinued because of a TEAE, 4 initiated rescue treatment and 2 progressed to maintenance haemodialysis. Overall, 98.0% of patients experienced ≥1 TEAE during the study; most TEAEs were mild (49.0%) or moderate (37.3%) in intensity. The most common TEAEs were nasopharyngitis (35.3%), constipation and medical device site infection (11.8% each). No deaths were reported, and major adverse cardiovascular events occurred in 2.0% of patients. Conclusion In this phase 3, single-arm, open-label study, over 70% of patients completed the study and more than half of the patients met the responder criteria. Molidustat maintained Hb in the prespecified range (≥ 11.0 g/dL to &amp;lt; 13.0 g/dL) and was well-tolerated over the 36 weeks of treatment. Molidustat offers a potential alternative to ESAs in patients with renal anaemia undergoing PD.

MO701COMBINED PROCEDURE OF PRE- EXISTING ABDOMINAL WALL HERNIA REPAIR AND PERITONEAL CATHETER INSERTION. LONG TERM FOLLOW- UP IN PERITONEAL DIALYSIS TREATMENT

Abstract Background and Aims Successful peritoneal dialysis (PD) program requires a combination of optimal peritoneal access and low incidence of complications. Between pitfalls of this modality are early mechanical complications such as leak, malfunction, and new abdominal wall hernia formation in the long term of PD treatment. Pre-existing abdominal wall hernia is a relative contraindication for PD. Hernias are also a known and not uncommon complication over the course of PD and one of the causes of technique failure. In our center, a physical examination and an ultrasound for hernias detection are routine procedures before the start of PD. If a hernia is discovered, combined hernia repair and catheter implantation are performed. The aim of this study was to assess to long- term results of this approach. Method The current study presents the retrospective analysis of 10 years' experience of our PD program (1.01.2009 – 31.12. 2018) including all incident PD patients who underwent their first peritoneal catheter placement procedure during the study period. The primary endpoints of the study were the rate of hernia formation in the course of PD treatment, type of hernias, identification risk factors for hernia formation and rate of hernia recurrence after previous repair. The secondary endpoint was the rate of procedure-related complications: infectious, leaks and primary catheter malfunction in patients who underwent surgical catheter insertion compared to percutaneous technique. Patients were followed until the end of PD treatment or until 31.10.2019. Results A total of 211 patients were included in the analysis. Of these, 24.5% underwent surgical procedures and 75.5% percutaneous insertion. Mean follow-up was 23.3 ± 25 months (2 to 96 months). About half (53.1%) of the patients were diabetic, aged 64.2±13 years. In 32 patients (15%) a preventive hernia repair with a simultaneous catheter implantation were performed. Patients who underwent a preventive hernia repair were significantly older than other patients (69.4±11.1 years versus 63.2±13.1 years, P=0.013). During the study period, 203 of 211 patients were treated by PD. Thirty three (16.1%) have developed 38 new hernias. Patients suffering from a new hernia during PD were predominantly male, with longer dialysis vintage than patients without new hernia formation (35.3±22.8 months versus 23±22.9, respectively. P=0.001). Five of 33 patients suffered multiple hernias, including recurrent hernias at the same site. Most common types were inguinal and umbilical (44.7% each other), while only few were incisional or ventral. None of our patients suffered from a pericatheter one. The overall rate of new hernias development was 0.09/patient/years. Neither age, comorbidities, obesity nor polycystic kidney disease did not increase the rate of hernia formation during the course of PD treatment. There was no significant association between type of catheter insertion procedure (surgical/percutaneous) and infections, leakages or catheter function. Leak incidence in diabetic patients was significantly higher in comparison with nondiabetic patients (8% versus 1%, P=0.021). Infectious complications were not different between diabetic and not diabetics patients (5.4% among diabetic patients versus 2% nondiabetic, P=0.29). Conclusion Our findings show that male gender and prolonged peritoneal dialysis duration are the main risk factors for the appearance of hernias in the course of PD therapy. Our data also confirm previous observations that the placement of PD catheter using a paramedian incision approach significantly reduces the incidences of exit site and incision hernias. We suggest that early diagnosis of latent asymptomatic hernias and hernia repair prior to starting PD can improve technique survival.