Number Of Peritonitis Episodes Research Articles

#4850 20 YEARS' EXPERIENCE OF PERITONEAL DIALYSIS IN SARAWAK, MALAYSIA

Abstract Background and Aims Peritoneal dialysis is a modality of renal replacement therapy first introduced in the 1960s. In the event of the recent COVID 19 pandemic, peritoneal dialysis is gaining popularity due to the increased preference of home dialysis. Sarawak is the largest state in Malaysia with a population of more than 2 million. Unfortunately, 13% of households in the state are living in poverty. We present our experience with continuous ambulatory peritoneal dialysis (CAPD) for the past years in a geographically and socioeconomically challenging region. Method Sarawak General Hospital is the centre of referral for Tenckhoff catheter insertion from other districts in Sarawak. This is a retrospective record review of all CAPD patients who were under our clinic follow up from 2001 to 2022. Data examined included patient's demographic data, incidence of peritoneal dialysis related peritonitis and their outcome. Results All of the patients on CAPD were recorded by December of each year since we started our service in 2001 which shows a rising trend of patients on CAPD, with the highest in December 2022 at 399 patients. The number of patients with dialysis related peritonitis was also collected. Despite having more patients on CAPD, the number of peritonitis episodes per patient-year were in a decreasing trend. This was the result of the implementation of empirical first line intra-peritoneal antibiotics as part of the CAPD Peritonitis Management Protocol in 2015 and Decontamination Protocol in 2016. Conclusion Despite the headwinds of geographic and socioeconomic challenges, the number of patients on CAPD is on the rise. Over the years, peritonitis rate declined approaching to 0.2 episodes per patient-year. This was made possible with the introduction of local decontamination protocol and CAPD peritonitis management protocol, which helped improve the life expectancy and health of renal patients in the region.

#5462 METABOLIC PROFILING IN CHILDREN WITH END STAGE RENAL DISEASE ON PERITONEAL DIALYSIS: PRELIMINARY RESULTS OF AN ONGOING PRESPECTIVE STUDY

Abstract Background and Aims Peritoneal dialysis (PD) is 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 Serum samples from 15 patients undergoing peritoneal dialysis were analyzed. Two targeted LC-MS methodologies were used for the determination of 107 metabolites in total. The obtained results were compared based on demographic and clinical parameters, both before and after the dialysis procedure. Serum samples were further divided into subgroups, based on PD duration, creatine clearance, sex, anuria. Reragding metabolic techologies used, all samples 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. Αlso, high flow analysis was carried out (LC-qTOF analysis – HPLC /MS). Results 8-OH-2-deoxyguanosine (8-hydroxy-2' -deoxyguanosine (8-OHdG) was the only metabolite found to differentiate between serum samples collected before and after PD (p<0.05). Grouping the samples by age groups (child, teen and late teen-young adult) we found out that succinate like lactate, N-acetyl-β-d-glucosaminidase (NAG), are potential markers for the quality of PD. Grouping the patients by number of peritonitis episodes (3 groups: no episodes, 1-2 episodes and >3 episodes) cytosine, riboflavin, glutamic acid, methylxantine and malate found to differentiate between the three groups (p <0.05). Regrading the creatinine cleranace, xylose, dCDP, HIAA, pyroglutamic, A CoA and methylxantine seems to be significan biomarkers. Grouping the patients based on the presence or absence of diuresis,HIAA, kynurenic,glucuronic and pantothenic acid found to differentiate between the two groups (p<0.05) Conclusion Based on the literatute the majority of the metabolites showed a statistically significant difference are involved in the inflammation process. 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. In any case, metabolomics seems to be a useful tool for the study and identification of biomarkers in patients with ESRD on PD.

MO679: Peritonitis May Disrupt Cyclic Periodicity of Ultrafiltration in Peritoneal Dialysis

Abstract BACKGROUND AND AIMS Due to chronic damage of the peritoneal membrane on long-term treatment, peritoneal dialysis (PD) is a time-limited therapy. Effective PD is achieved by adequate peritoneal ultrafiltration (UF) and small solute clearance while maintaining an appropriate fluid and salt homeostasis. Availability of remote patient monitoring on automated PD (APD) allows clinicians to remotely retrieve data for treatment analysis, proposed to improve clinical outcomes. However, machine-derived data are vastly different from traditionally observed data (e.g. quantity, noise, missing normative values). Recently correlation of daily UF changes on APD with changing peritoneal membrane function in association with clinical risk factors and outcomes has been observed. High intra- and interpatient variability of UF remains not fully explained. We aim at a better understanding of UF variability by submitting APD machine readouts to spectral analysis in association with clinical risk factors of membrane dysfunction. METHOD This was a secondary analysis of the Medical University of Vienna APD cycler treatment data from patients using Homechoice Pro cyclers (Baxter, IL, USA), extracted from the cycler management software (PD link, Baxter). Analysis was conducted using R software (R Core Team 2020). Daily UF was processed using the Lomb-Scargle periodogram (LSP), a method commonly used in astrophysics and neurophysiology to detect rhythms in (unevenly sampled) time series. Peaks of power spectrum, frequencies, and periodicities were compared between patients with and without peritonitis episodes during their PD treatment utilizing a Mann–Whitney U-test and associated with the total number of peritonitis episodes using Kendall rank correlation. A P-value < 0.05 was considered significant; all tests were two-sided. RESULTS LSP analysis was performed on daily UF data from n = 129 APD patients with a mean observation time of 598 days (SD ± 517), male: female 61:39% (n = 79:50), incident: prevalent patients 77:23% (n = 99:30), and diabetic: non-diabetic patients 25:75% (n = 32:97). Observation time extended from the introduction of APD until kidney transplantation (43%, n = 55), transfer to hemodialysis (23%, n = 29), death (27%, n = 35), kidney function recovery (8%, n = 1), or loss to follow-up (7%, n = 9). After inspection of LSPs n = 9 patients were excluded from further analysis as their periodicity matched the time of their clinical endpoint. A total of 45 of the remaining 120 patients (38%) never experienced a peritonitis episode, and a total of 0.3 (SD ± 0.7) peritonitis episodes/patient-year were observed. LSP computation revealed cyclic periodicity in UF in all patients with an overall median peak period length of 329 days (IQR 62–882 days), median peak power of 21 (IQR 7–91), and median peak frequency of 0.42 (IQR 0.36–0.46). Differences between patients with and without peritonitis episodes during PD treatment are displayed in Table 1. Correlation analysis revealed significant association between the number of peritonitis episodes and peak periodicity of UF (tau=0.14, P = 0.04), and peak power (tau = 0.21, P = 0.003). Peak frequency of UF was not significantly correlated. CONCLUSION Patients on APD cycler treatment seem to display cyclic periodicity of UF, being significantly associated with the number of peritonitis episodes and significantly different between patients with and without peritonitis episodes. Smaller-scale periodicity (median 216 days) in patients without peritonitis seems to be disrupted by peritonitis resulting in significantly higher periodicity (median 670 days). The causes and implications of these results remain unclear and need further investigation. However, as peritonitis is a known risk factor for peritoneal membrane dysfunction, prolongation of UF periodicity might reflect disruption of peritoneal membrane function.

Risk factors for Encapsulating Peritoneal Sclerosis in patients undergoing peritoneal dialysis: A meta-analysis.

Encapsulating Peritoneal Sclerosis (EPS) is the most serious complication of long-term peritoneal dialysis (PD), which considerably reduces the patient's quality of life, leading to patients discontinuing PD. Considering these negative effects, it is necessary to systematically review and determine the risk factors of EPS. The PubMed, Embase, Web of Science, Cochrane Library, and China Biology Medicine (CBM) were searched from their inception to January 1st, 2022, and the bibliographies from the citations of relevant articles were manually searched. The ROBINS-I (Risk of Bias in Non-randomized studies of Interventions) tool was used to evaluate the risk of bias of included studies. Ten studies involving 12595 participants were included in this meta-analysis. The results revealed that a younger age at PD onset (MD = -7.70, 95% CI, -11.53~-3.86), a higher transporter (MD = 0.13, 95% CI, 0.09~0.18), a longer PD duration (SMD = 1.15, 95% CI, 0.68~1.61), a longer peritonitis duration (MD = 12.66, 95% CI, 3.85~21.47), and history of glomerulonephritis (OR = 1.42, 95% CI, 1.02~1.97) were significant risk factors for EPS. However, sex, use of icodextrin, the number of peritonitis episodes, and history of multicystic kidney disease did not affect the risk of EPS. This review provides a scientific basis for further understanding the etiology of PD-related EPS and improving prevention strategies. More high-quality studies are necessary to validate this paper's findings.

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.
 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.
 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 <.001 and dialysis time [OR] = 1.786; 95% [1.060-3.010]; p=0.029 was calculated.
 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.

MO688CALCIUM PHOSPHATE PRODUCT IN PERITONEAL DIALYSIS: A RISK FACTOR FOR TYPE I MEMBRANE FAILURE?

Abstract Background and Aims Type I membrane failure (T1MF), increased transport status with ultrafiltration, and solute removal inadequacy are among the most challenging issues in peritoneal dialysis (PD) continuity. Although quite common, the causes of T1MF are not fully understood. This study aims to identify risk factors associated with T1MF. Method This is a retrospective, single site, cohort study of incident adult peritoneal dialysis patients sampled between January 2000 and January 2020. Patients were classified as “increased transporters” who had two or more categories of a rise in peritoneal equilibration test (PET), and “stable transporters” who had had a rise of 1 or no categories from their baseline during follow-up. The four-hour dialysate/plasma creatinine ratio was used to classify PET categories. The study endpoint was five years for stable transporters, and at the time of two category rise in the PET test for increased transporters. Results Baseline demographics, diabetes frequency, residual renal function (RRF), non-phosphate baseline laboratory, parathormone levels, and PD modalities were similar between the increased transporters (n=48) and the stable transporters (n=93). Significantly more patients were using renin-angiotensin-aldosterone system (RAAS) blockers in stable transporters and high-glucose dialysates in increased transporters (p=0.03 and p<0.01). Icodextrin, calcitriol, calcium-based phosphate binder use, and the number of peritonitis episodes were similar between the groups. Increased transporters reached the endpoint in 3.9(±0.7) years. Increased transporters had a higher baseline phosphate than stable transporters (p=0.02). The frequency of patients with an RRF and groups’ mean RRF in ml were similar at the endpoint (p=0.37, p=0.13). Increased transporters had a significantly higher baseline and endpoint CaXP than stable transporters (p<0.01 and p=0.02). Baseline weekly peritoneal Kt/V and peritoneal creatinine clearance (PCrCl) were similar at baseline. Increased transporters had significantly lower endpoint peritoneal Kt/V and insignificantly lower endpoint PCrCl than stable transporters (p<0.01 and p=0.05). ΔUF was negative for increased transporters and positive for stable transporters. Age, diabetes, peritonitis episodes, RAAS blocker use, and PD modality were insignificant in Cox regression analysis. A CaXP of >55 was related to 2.51-fold, and high-glucose dialysates were associated with a 2.93-fold increased risk for a rise in transport status (p=0.01 and p<0.01). Mean follow-up was 7.0 (±3.9) years for stable transporters and 5.6 (±2.0) years for increased transporters. Technical survival was significantly higher in stable transporters (p=0.03). Conclusion Our study revealed a CaXP of >55 is a risk factor for a significant increase in transport status, presumably due to peritoneal calcification. The peritoneal Kt/V, PCrCl, and UF rates declined accordingly. The high-glucose dialysates are associated with a high risk in analyses. However, it is not possible to determine whether these solutions are the cause or the result of Type I membrane failure.

MO686THE EFFECT OF A CONTINUOUS TRAINING PROGRAM ON PERITONEAL DIALYSIS PATIENTS' SURVIVAL

Abstract Background and Aims Peritoneal Dialysis (PD) is a well-established method for dialysis of end stage kidney disease patients. Peritoneal membrane alters with time from several causes such as bioincompatible PD solutions, uremia, and the cumulative effect of peritonitis episodes. Each center follows a specific training program to prevent the appearance of peritonitis episodes. The aim of this study was to retrospectively evaluate the influence of proper and continuous training on the mortality of peritoneal dialysis patients. Method This is a single center retrospective study of 133 PD patients conducted for the time period 2009 – 2019 (10 years). The training course was taught one-on-one, nurse-to-patient at the initiation of dialysis and then once every 6 months at their regular visit or sooner if there was a peritonitis episode. The program included a rated questioner based on the Canadian Association of Nephrology Nurses for Nursing Standards and Practice Recommendations published on August 2008. The patients were divided into two groups according to the mean value (34) of their questioner sum (QS). Group A included 69 patients with mean age of 66 ± 15 years (36 M, 33 F) with mean PD duration of 45 ± 30 months and they achieved a score less than 34. Group B included 64 patients with mean age of 61 ± 18 years (42 M, 22 F) with mean PD duration of 62± 32 months and they achieved a score greater than 34. The cumulative all-cause survival of the PD patients was calculated by Kaplan Meier, was compared using Long Rang analysis and was also adjusted for their age, gender, the modality of PD applied, the presence of Diabetes and their level of education. Using Cox Regression, we tried to find independent risk factors such as the score they achieved in the questioner. The two groups were compared also for their overhydration and their frequency appearance of peritonitis or exit site infection. Results The cumulative survival using Kaplan-Meier analysis revealed statistically significant deference between the two groups (Log Rank p<0.001) with Group B (QS>34) achieving better survival. When the survival was adjusted for age, sex, Diabetes, PD modality the result remains the same. Trying to find among the total of our patients the possible risk factors for mortality, using Cox Regression analysis, their QS score (representing their training level for PD) was statistically significant (HR 0,931 {0.892, 0.971}, p=0.001) independent risk factor, as well as age and PD modality, for our patient survival. Additionally, Group B (QS>34) had statistically significant a smaller number of peritonitis episodes (p<0.001) and presence of peripheral edema (p<0.001). Conclusion In our study we concluded that continuous and monitored training of peritoneal dialysis patients has a significant effect on their survival and the frequency of peritonitis appearance.

Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis

BackgroundPeritoneal dialysis has become commonly used for renal replacement therapy; however, some patients withdraw from peritoneal dialysis due to complications, including peritoneal dialysis-related peritonitis, resulting in the low number of patients on peritoneal dialysis. Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis are less certain. This retrospective study aimed to investigate these risk factors. MethodsWe retrospectively analyzed clinical characteristics, laboratory data, and causative microorganisms of 204 episodes of peritoneal dialysis-related peritonitis between 2007 and 2018 at our institution. ResultsOf the 204 episodes, 38 resulted in withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis. The number of peritonitis episodes per patient-year and the incidence of cardiovascular disease were significantly higher in the withdrawal group. Similarly, this group had low levels of serum creatinine, urea nitrogen, serum albumin, alanine aminotransferase, cholinesterase and high C-reactive protein, and second dialysate cell counts after antibiotic administration. Multivariate logistic regression analysis revealed that serum albumin (odds ratio: 0.465; 95% confidence interval: 0.249–0.868; P=0.016) and cardiovascular disease (odds ratio: 2.508; 95% confidence interval: 1.184–5.315; P=0.016) exhibited significant differences. ConclusionsThe results of this study suggest that hypoalbuminemia and the presence of cardiovascular disease were independent risk factors for withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis.

Peritonitis related to chronic peritoneal dialysis in Slovenian pediatric patients.

Peritonitis is the most significant complication of chronic peritoneal dialysis (PD). We aimed to define the frequency and country-specific characteristics of peritonitis in Slovenian pediatric patients. All 23 children and adolescents treated with PD at our center between November 1995 and December 2019 were included in the study. There were 15 boys (65.2%) and 8 girls (34.8%). The median age at PD start was 4.8 years (range: 0 - 16.8 years). Patient demographic data, PD modality, treatment duration, and PD-related infections were collected retrospectively by reviewing the patients' medical records and the microbiology database. Data on the number of peritonitis episodes, microbiology results, and treatment outcomes were of prime interest. 30 peritonitis episodes were registered. The incidence rate was 1/33 patient-months (0.35/year). Twelve patients never experienced peritonitis (52.2%). Gram-positive organisms were isolated in 52.9% (Staphylococcus aureus (4/18), Staphylococcus epidermidis (4/18)). Gram-negative isolates were present in 32.4% (Escherichia coli (4/11), Pseudomonas species (2/11)). Fungal peritonitis occurred in 2.9% and negative culture peritonitis in 11.8%. Initial empirical treatment with vancomycin and ceftazidime was successful in 89.5%. PD was discontinued in 2 patients (8.7%) because of fungal peritonitis and refractory peritonitis. Our results compare favorably with the published literature. Awareness of local patient and microbial characteristics is crucial for the successful treatment and prevention of PD-associated infections.

Encapsulating Peritoneal Sclerosis in Long-Termed Peritoneal Dialysis Patients.

Background Encapsulating peritoneal sclerosis (EPS) is a rare but serious clinical complication of long-term peritoneal dialysis (PD) patients with high mortality. The purpose of this study was to assess the clinical characteristics of patients with EPS and to search for possible factors useful for EPS prevention and early diagnosis. Method This retrospective study was performed in a single dialysis center in Taiwan between August 1990 and April 2014. Overall, a total of 565 patients were included and the medical records of those patients who had developed EPS (EPS group) and those who had not developed EPS (control group) were collected. We compared several factors between these two groups. Result In the univariate analysis, EPS was significantly associated with a change of transport state (Delta 2) (p = 0.007), duration of PD (p < 0.001), duration of peritonitis treatment (p = 0.001), number of peritonitis episodes (p = 0.002), and fungus related peritonitis (p = 0.031). After multivariate logistic model analysis, we found that only the duration of PD was independently significantly associated with EPS (p = 0.034). In addition, we used the ROC curve and found that a duration of peritoneal dialysis of about 8.4 years is the best cut-off point to predict EPS occurrence. Conclusion In this study, long-termed PD duration is the only strong independent risk factor for EPS development. Total peritonitis times, total peritonitis treatment duration, and marked increased peritoneal D/Pcr ratio were also significantly associated with the duration of PD.

Intraperitoneal Vancomycin Plus Either Oral Moxifloxacin or Intraperitoneal Ceftazidime for the Treatment of Peritoneal Dialysis−Related Peritonitis: A Randomized Controlled Pilot Study

Intraperitoneal administration of antibiotics is recommended as a first treatment for managing peritoneal dialysis (PD)-related peritonitis. However, the efficacy of oral administration of quinolones has not been well studied. Randomized controlled pilot study. 80 eligible patients with PD-related peritonitis from Peking University First Hospital (40 in each arm). Intraperitoneal vancomycin, 1g, every 5 days plus oral moxifloxacin, 400mg, every day (treatment group) versus intraperitoneal vancomycin, 1g, every 5 days plus intraperitoneal ceftazidime, 1g, every day (control group). The primary end point was complete resolution of peritonitis, and secondary end points were primary or secondary treatment failure. PD effluent white blood cell count. Baseline demographic and clinical characteristics of the 2 groups were comparable. There were 24 and 22 Gram-positive organisms, 6 and 7 Gram-negative organisms, 9 and 10 culture-negative samples, and 1 and 1 fungal sample in the treatment and control groups, respectively. Complete resolution of peritonitis was achieved in 78% and 80% of cases in the treatment and control groups, respectively (OR, 0.86; 95% CI, 0.30-2.52; P=0.8). There were 3 and 1 cases of relapse in the treatment and control groups, respectively. Primary and secondary treatment failure rates were not significantly different (33% vs 20% and 10% vs 13%, respectively). In each group, there was 1 peritonitis-related death and 6 transfers to hemodialysis therapy. During the 3-month follow-up period, 7 and 3 successive episodes of peritonitis occurred in the treatment and control groups, respectively. Only 2 adverse drug reactions (mild nausea and mild rash, respectively) were observed in the 2 groups. Sample size was relatively small and the eligibility ratio was low. Also, the number of peritonitis episodes was low, limiting the power to detect a difference between groups. This pilot study suggests that intraperitoneal vancomycin with oral moxifloxacin is a safe, well-tolerated, practical, and effective first-line treatment for PD-related peritonitis. Larger adequately powered clinical trials are warranted.

Peritoneal dialysis effluent miR-21 and miR-589 levels correlate with longitudinal change in peritoneal transport characteristics

BackgroundThe role of microRNA (miRNA) in peritoneal fibrosis and longitudinal change in transport is uncertain. MethodsWe studied 80 new peritoneal dialysis (PD) patients. Peritoneal transport was determined by standard peritoneal equilibration test (PET) of creatinine at baseline. Based on published literature, PD effluent levels of 10 miRNA targets were quantified. PET and miRNA quantification were repeated one year later in 46 patients. ResultsBaseline PD effluent levels of all targets tested had modest but significant correlation with peritoneal transport parameters. PD effluent miR-21 and miR-589 levels correlated with dialysate-to-plasma creatinine concentration at 4h (D/P4) at baseline (r=0.377, p=0.001 and r=0.237, p=0.037, respectively) and after one year of PD (r=0.362, p=0.014 and r=0.402, p=0.007). The change in PD effluent −21 and miR-589 levels over one year correlated with the corresponding change in D/P4 (r=0.470, p=0.001 and r=0.479, p=0.002). The number of peritonitis episodes during follow up significantly correlated with the change in PD effluent miR-21 (r=0.387, p=0.009) and miR-589 (r=0.336, p=0.027) levels. There was no significant correlation between PD effluent miRNA level and ultrafiltration volume. ConclusionAmongst the 10 miRNA targets tested, miR-21 and miR-589 showed consistently significant relation with peritoneal transport. Further studies are needed to delineate their mechanisms of regulating peritoneal transport.

Predictors of Residual Renal Function Decline in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Residual renal function (RRF) is an important prognostic indicator in continuous ambulatory peritoneal dialysis (CAPD) patients. We determined the predictors of RRF loss in a cohort of incident CAPD patients. We reviewed the record of 645 incident CAPD patients. RRF loss is represented by the slope of decline of residual glomerular filtration rate (GFR) as well as the time to anuria. The average rate of residual GFR decline was -0.083 ± 0.094 mL/min/month. The rate of residual GFR decline was faster with a higher proteinuria (r = -0.506, p < 0.0001) and baseline residual GFR (r = -0.560, p < 0.0001). Multivariate analysis showed that proteinuria, baseline residual GFR, and the use of diuretics were independent predictors of residual GFR decline. Cox proportional hazard model showed that proteinuria, glucose exposure, and the number of peritonitis episodes were independent predictors of progression to anuria, while a higher baseline GFR was protective. Each 1 g/day of proteinuria is associated with a 13.2% increase in the risk of progressing to anuria, each 10 g/day higher glucose exposure is associated with a 2.5% increase in risk, while each peritonitis episode confers a 3.8% increase in risk. Our study shows that factors predicting the loss of residual solute clearance and urine output are different. Proteinuria, baseline residual GFR, and the use of diuretics are independently related to the rate of RRF decline in CAPD patients, while proteinuria, glucose exposure, and the number of peritonitis episodes are independent predictors for the development of anuria. The role of anti-proteinuric therapy and measures to prevent peritonitis episodes in the preservation of RRF should be tested in future studies.

Peritoneal dialysis outcomes in a modern cohort of overweight patients

The incidence of obesity is increasing both in the general population and in incident dialysis patients. While there is evidence that being overweight is associated with good outcomes in hemodialysis, the evidence in peritoneal dialysis (PD) patients is not very clear. We studied a modern cohort of PD patients to examine outcomes in large patients. Forty-three patients who started PD, who weighed more than 90 kg at dialysis initiation, between January/2000 and June/2010 were matched with 43 control patients who weighed less than 90 kg. Detailed review of the charts was undertaken. The mean weight and body mass index of the wt < 90 kg group were 69.3 ± 11.3 kg and 25.0 ± 3.9 kg/m(2). The number of peritonitis episodes per year was 0.33 ± 0.6 (wt < 90 kg) and 0.82 ± 1.7 (wt ≥ 90 kg) (p = 0.26). The median time to first peritonitis showed a trend toward earlier peritonitis in larger patients [9.5 (4.3, 27) months in wt ≥ 90 kg, 19.1(7.9, 30.8) months in wt < 90 kg] but did not reach statistical significance (p = 0.12). Surprisingly, hernias and leaks were more common in the weight <90 kg group (44 vs. 18.6 % p = 0.02). There was no difference in total number of hospitalizations or the number of days hospitalized. Kaplan-Meier analysis of survival on PD showed no differences between the two groups (logrank p = 0.99). Cox regression analysis using age, race, cause of ESRD due to diabetes and Charlson comorbidity index as the covariates did not show weight to be associated with survival on PD. Large patients tend to do just as well on PD, with survival on PD being no different compared to individuals with lower weight and body mass index.

Risk Factors for Encapsulating Peritoneal Sclerosis in Long‐Term Peritoneal Dialysis: A Retrospective Observational Study

Encapsulating peritoneal sclerosis (EPS) is a serious complication that occurs in patients with long-term peritoneal dialysis (PD). Investigation of risk factors that contribute to EPS in patients on long-term PD therapy is needed. In a retrospective, observational study, data were collected for 107 patients treated with PD therapy for more than 5 years. Fifty cases of EPS were compared with 57 cases of non-EPS. To evaluate the impact of PD-associated peritonitis in EPS, univariate and multivariate logistic regression models were applied. Episodes of peritonitis, number of peritonitis episodes and the duration of peritonitis were included as explanatory variables in addition to previously reported risk factors. D/P Cr and serum β2MG levels in the EPS and non-EPS groups were: 0.82 ± 0.10 and 0.67 ± 0.12 (P < 0.01), and 33.8 ± 8.54 and 29.2 ± 8.18 mg/L (P < 0.01), respectively. Episodes of peritonitis, number of peritonitis episodes and the duration of peritonitis was 68% and 42% (P < 0.01), 1.80 ± 2.19 and 0.75 ± 1.07 times (P < 0.01), and 18.1 ± 15.3 and 10.2 ± 4.90 days (P < 0.01), in the EPS and non-EPS groups, respectively. Furthermore, multivariate logistic regression models demonstrated that both D/P Cr and the duration of peritonitis were independently associated with EPS (P < 0.01 and P < 0.05, respectively). In patients on long-term PD therapy, D/P Cr and the duration of peritonitis are independently associated with EPS. Earlier treatment to promote an early recovery from PD-associated peritonitis could be critical in preventing EPS.

A 2-year follow-up study of patients on automated peritoneal dialysis

Automated peritoneal dialysis (APD) is increasingly being used for the treatment of end stage renal disease. We present our experience of APD at a government run tertiary care institute. APD was initiated for 22 patients between 2002 and 2010. On comparing APD and continuous ambulatory peritoneal dialysis (CAPD) patients, no difference in patient survival and technique survival was observed. CAPD patients had higher number of peritonitis episodes, greater decline in the serum albumin and a greater number of patients failed to achieve adequacy targets compared to APD.

The Impact of Social Support on the Survival of Chinese Peritoneal Dialysis Patients

Social support is an independent risk factor for mortality among new hemodialysis patients. We evaluated the effect of social support on the outcome of Chinese peritoneal dialysis (PD) patients. We studied 167 prevalent PD patients. They completed the Medical Outcomes Study Social Support Survey, Chinese Version (MOS-SSS-C) questionnaire. Patients were followed for 1 year. Outcome measures included change in nutritional status, hospitalization, and technique and actuarial patient survival. Actuarial survival was 57.1%, 72.7%, 85.3%, and 88.6% for MOS-SSS-C total score quartiles I, II, III, and IV, respectively (log rank test, p = 0.037). Technique survival was 57.1%, 81.9%, 91.9%, and 91.4% (log rank test, p = 0.0044). By multivariate analysis with the Cox proportional hazard model to adjust for confounders, every 1 point increase in MOS-SSS-C total score was associated with a 0.6% [95% confidence interval (CI) 0.2%-0.9%, p = 0.003] reduction in the risk of death and a 0.5% (95%CI 0.1%-1.0%, p = 0.037) reduction in the risk of technique failure. The MOS-SSS-C score had no significant effect on change in nutritional or dialysis adequacy indices, hospitalization, or number of peritonitis episodes in 1 year. The degree of social support is an important predictor of actuarial and technique survival in Chinese PD patients. Measures to enhance social support may represent an easily achievable means of improving the clinical outcome of PD patients.

Does a history of peritoneal dialysis result in an impaired gastrointestinal life quality?

Peritoneal dialysis (PD) invariably induces sclerotic changes in the peritoneal membrane. The impact of these changes on the well-being of PD patients has not been studied sufficiently. In a matched-pair analysis, the gastrointestinal life quality of patients with a history of PD was compared with end-stage renal disease patients who never performed PD, using a standardized questionnaire (gastrointestinal life-quality index [GLQI]). We identified all patients in our dialysis unit who underwent PD between 1989 and 2001 and who were alive in October 2001 (PD patients; n=53). Patients who were treated by hemodialysis (HD patients) were recruited as pairs. Hemodialysis and PD patients did not differ in gastrointestinal life quality (GLQI: HD 106.0+/-16.4 points; PD 104.0+/-16.7 points; p=0.70). Gastrointestinal life quality was neither correlated with the number of peritonitis episodes, nor with the duration of PD treatment. Peritoneal dialysis treatment is not associated with a long-term impairment of gastrointestinal life quality.

Predictors of Hospitalization in Patients on Peritoneal Dialysis: The Missouri Experience

Background: We analyzed a large number of demographic and biochemical variables to identify predictors of hospitalization in subjects on peritoneal dialysis (PD). Methods: All patients initiated on PD at our center from January 1990 through December 1999 were included. The following variables at the initiation of PD were included: demographics, clinical data, nutritional and adequacy parameters, transport characteristics, and various co-morbidities. Co-morbidities were graded for severity using a modified version of the Index of Coexistent Disease. Variables included during the course of PD consisted of weighted time average of a number of laboratory, adequacy, and nutritional parameters along with the number of peritonitis episodes per year. Stepwise linear regression was used following a univariate screening procedure to identify independent predictors of the outcome of hospitalization days per month on PD. Results: The subject population consisted of 191 subjects (105 men, 86 women; 180 Caucasians, 10 African-American, 1 Asian). The mean age was 61 ± 13 (SD) years and mean duration of follow-up was 21 ± 18 months. The baseline variable analysis revealed that the presence of partner to perform PD predicted increased hospitalization (p < 0.0001). Additionally, the presence and severity of peripheral vascular disease and residual renal Kt/V at baseline (negative association) predicted increased hospitalization. In the analyses of ongoing variables, stepwise linear regression solely identified weighted time average albumin as a strong negative predictor of hospitalization (p < 0.0001). Conclusion: A comprehensive analysis of a large number of variables revealed that serum albumin during the course of PD (negative association) and the need for partner to perform PD strongly predicted increased hospitalization in PD subjects.

Impact of Nutritional Status on Peritonitis in CAPD Patients

To determine the impact of nutritional status on peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in a developing country. 56 patients with end-stage renal disease on CAPD were randomly selected for this study. These patients were assessed for nutritional status and peritonitis episodes. Nutritional parameters were assessed by anthropometry, diet, body mass index (BMI), Nutritional Risk Index (NRI), serum albumin level, and Subjective Global Assessment (SGA). Based on SGA, patients were categorized into either group 1 (malnutrition, n = 31) or group 2 (normal nutritional status, n = 25). Peritonitis was considered the primary outcome and was compared between the two groups. Demographic profiles, Kt/V, creatinine clearance, and mean follow-up of the two groups were similar. Number of peritonitis episodes was significantly higher in patients with malnutrition (25/31) compared to patients with normal nutritional status (4/25) (p = 0.001). Mean peritonitis rate per patient per year was also significantly higher in patients with malnutrition (0.99 +/- 1.07) compared to patients with normal nutritional status (0.18 +/- 0.42) (p = 0.007). On univariate analysis, malnutrition based on SGA (p = 0.009), NRI (p = 0.02), serum albumin level (p = 0.005), and calorie intake (p = 0.006) was a significant predictor of peritonitis. On multivariate Cox regression analysis, only SGA (p = 0.001, odds ratio 0.08, 95% confidence interval 0.02-0.36) was found to be a significant predictor of peritonitis. On general linear model, the observed power of prediction of peritonitis was 0.96 based on SGA. On Kaplan-Meier survival analysis, peritonitis-free survival in patients with normal nutrition (42 months) was significantly higher compared to patients with malnutrition (21 months) based on SGA (log rank p = 0.003). We conclude that peritonitis rate is high in patients with malnutrition and that malnutrition indices, especially SGA, can predict the peritonitis rate in CAPD patients.