Renal Replacement Therapy Options Research Articles

Characteristics of Inherited Metabolic Disorders Following Kidney Transplantation: A 13-Year Observational Study

Background and Objectives: Inherited metabolic disorders (IMDs), primarily cystinosis, Fabry disease, and methylmalonic acidemia (MMA), are genetic conditions that typically result in multi-organ disease manifestations. Kidney function progressively deteriorates in many cases, with patients eventually reaching end-stage kidney disease (ESKD) and requiring renal replacement therapy. Kidney transplantation has been deemed the optimal renal replacement therapy option to achieve long-term survival in patients with IMD. Whilst improved long-term survival is expected, the patterns of clinical evolution for IMD after transplantation remain largely unknown. Methods: Our group conducted a retrospective observational study that included 37 adult patients with IMD (11 with cystinosis, 20 with Fabry disease, and 6 with MMA). The study evaluated the clinical status and progression of these patients following kidney transplantation between January 2010 and December 2023. Results: This generally resulted in good graft outcomes for patients with IMD. Standard immunosuppression regimes included tacrolimus, mycophenolate mofetil, and prednisolone. The mean graft survival duration was noted to be 12 years in patients with cystinosis, 11 years in patients with Fabry disease, and 7 years in patients with MMA. Suboptimal outcomes were noted with grafts of cadaveric origin and poor adherence to the prescribed post-transplant immunosuppression regime. A greater extra-renal morbidity burden was associated with a reduced duration of graft function and increased mortality in patients with IMD. Conclusions: Our findings emphasise the need for a multi-disciplinary approach in the care of IMD patients following kidney transplantation.

Urgent-Start Peritoneal Dialysis in Metformin-Associated Lactic Acidosis: A Critical Alternative When Immediate Hemodialysis is Unavailable.

Introduction Intermittent hemodialysis (IHD) is a preferable renal replacement therapy (RRT) option in metformin-associated lactic acidosis (MALA) due to rapid correct metabolic acidosis. However, IHD might not be started immediately. Immediate urgent-start peritoneal dialysis (iUSPD) is used as a life-saving dialysis option and then followed by IHD. The outcomes of iUSPD were compared with other extracorporeal dialysis in MALA. Methods In two tertiary hospitals in Thailand, the outcomes of patients with MALA who had received three different RRT modalities (iUSPD followed by IHD, IHD, and continuous renal replacement therapy [CRRT]) from January 2015 to December 2019 were compared. The primary outcome was 30-day mortality. The secondary outcomes were door-to-dialysis time and 90-day RRT dependence. Results 180 MALA cases that required dialysis were included (20 iUSPD, 120 IHD, and 40 CRRT). Their mean age was 64 years. Most of the patients had severe metabolic acidosis (mean pH 6.91, HCO3 6 mmol/L, and anion gap 40 mmol/L) and were critically ill. The 30-day mortality was 30% in iUSPD, 9.2% in IHD, and 32.5% in CRRT, p = 0.001). The mortality risk in the iUSPD group was not significantly different from those of the IHD and CRRT groups (adjusted HR 2.5, 95% CI 0.65-9.6 and adjusted HR 0.75, 95% CI 0.2-2.78, respectively). All dialysis modalities had comparable 90-day dialysis dependence. iUSPD exhibited the shortest door-to-dialysis time. Conclusion In MALA, iUSPD followed by IHD might be a viable RRT option to save patient lives if no other dialysis option are available.

Provision of transplant education for patients starting dialysis: Disparities persist

BackgroundAll patients starting dialysis should be informed of kidney transplant as a renal replacement therapy option. Prior research has shown disparities in provision of this information. In this study, we aimed to identify patient sociodemographic and dialysis facility characteristics associated with not receiving transplant information at the time of dialysis initiation. We additionally sought to determine the association of receiving transplant information with waitlist and transplant outcomes. MethodsWe retrospectively analyzed CMS-2728 forms filed from 2007 to 2019. The primary outcome was report of provision of information about transplant on the Centers for Medicare and Medicaid Services Form CMS-2728. For patients not informed at the time of dialysis, we collected the reported reason for not being informed (medically unfit, declined information, unsuitable due to age, psychologically unfit, not assessed, or other). Cox proportional-hazards model estimates were used to study determinants of addition to the waitlist and transplant (secondary outcomes). ResultsFifteen percent of patients did not receive information about transplant (N = 133,414). Non-informed patients were more likely to be older, female, white, and on Medicare. Patients informed about transplant had a shorter time between end-stage renal disease onset and addition to the waitlist; they also spent a shorter time on the waitlist before receiving a transplant. Patients at chain dialysis facilities were more likely to receive information, but this did not translate into higher waitlist or transplant rates. Patients at independent facilities acquired by chains were more likely to be informed but less likely to be added to the waitlist post acquisition. ConclusionsDisparities continue to persist in providing information about transplant at initiation of dialysis. Patients who are not informed have reduced access to the transplant waitlist and transplant. Maximizing the number of patients informed could increase the number of patients referred to transplant centers, and ultimately transplanted. However, policy actions should account for differences in protocols stemming from facility ownership.

Barriers to conservative kidney management for Japanese healthcare professionals involved in the treatment of end-stage renal disease.

Conservative kidney management (CKM) is a treatment alternative for patients with end-stage kidney disease (ESKD). Despite the increasing population of elderly dialysis patients in Japan, CKM is not as readily available compared with that in North America and Europe. Therefore, it is important to clarify the barriers to CKM in Japan. We interviewed 11 experts to explore their beliefs and issues regarding CKM. Based on the interviews, we categorized the CKM barriers into eight categories and created a 24-item questionnaire. A questionnaire survey was conducted among 112 medical professionals involved in ESKD management. To investigate the types of barriers, we conducted an exploratory factor analysis using the questionnaire results. Responses were obtained from 53 (47.3%) of 112 subjects (18 doctors, 29 nurses, 6 clinical engineers), with 94.3% considering CKM as a treatment option for ESKD. Factor analysis categorized the questions into the following: (1) Lack of palliative care experience, (2) Ethics and responsibility, (3) Patient's problem, (4) Dialog with patients and families, and (5) Lack of support system. Regarding barriers to CKM, "lack of experience in palliative care" and "lack of support system" scored the highest, and "ethics and responsibility" scored the lowest. Barriers to CKM may be classified into five factors, with "lack of experience in palliative care" and "lack of support system" being the important barriers to overcome. Additionally, most healthcare professionals consider CKM as the fourth option for renal replacement therapy.

#2603 Focus on a crucial moment in decision making: evaluate peritoneal dialysis as incident renal replacement therapy

Abstract Background and Aims Chronic kidney disease affects 10% of the world population (15.1% in Spain, ENRICA 2019 study), being a health problem with important physical, emotional, and socio-occupational repercussions. Deciding on the most appropriate renal replacement therapy (RRT) for each patient, according to their lifestyle and family environment, represents a considerable challenge. Peritoneal dialysis (PD) offers several benefits, including greater independence, preserved kidney function, less restrictive diet, and better adaptation to the patient's lifestyle. It also improves the capacity for self-training and learning. Although kidney transplantation is the best RRT option, PD has demonstrated better quality of life, patient autonomy, and higher survival rates. Despite these advantages, PD as a technique for starting RRT represents 16.4% among incident patients in Spain, reaching 25% in our community, similar data to that of other northern European countries (ERA EDTA Report 2021). Method We carried out a retrospective descriptive study of patients followed in Advanced Chronic Kidney Disease (ACKD) over a period of five years (2017-2021). The inclusion criteria considered the acceptance of the technique in optimal candidates, with integrity of the peritoneal membrane and/or functional abdominal cavity, as well as the ability to learn the technique and family support. The study aimed to assess the percentage of patients who, meeting optimal criteria for PD candidacy, successfully initiated the technique. Results The analyzed population consisted of 113 patients, 73.4% males, with a mean age of 77 years. 59% of ACKD patients were considered candidates, and of these, 73% (n 38) chose PD as the modality, successfully initiating the technique. The main causes of abandonment or failure of the technique were: Out of the 38 patients successfully initiating PD as RRT, 34% continued with this modality. Conclusion PD provides quality of life and autonomy to patients who choose this technique. Individualized and ongoing training through updated information is essential during this process, as it helps reduce most complications and reinforces patient autonomy.

The Role of Effluent Analysis and Culture in Diagnosis and Monitoring of Peritoneal Dialysis-Related Peritonitis

Peritoneal Dialysis (PD) is one of the available renal replacement therapy options for End-Stage Renal Disease (ESRD). One of the most common complications of PD is peritonitis. A 13-year-old boy was admitted to the hospital due to cloudy effluent and abdominal pain four days before admission. He was diagnosed with ESRD in 2015 and has undergone Continuous Ambulatory Peritoneal Dialysis (CAPD) since 2017. The physical examination findings were as follows: the temperature was 36.6 C, the conjunctiva was anemic, the abdomen was tender, and both of the lower extremities were edematous. Peritoneal dialysis effluent analysis showed yellow and turbid effluent with a leukocyte count of 13.346 cells/µL and polymorphonuclear (PMN) cells predominance (69.3%), effluent and serum urea of 221 and 243 mg/dL, effluent and serum creatinine of 16.7 and 18.26 mg/dL, respectively. Effluent Gram stain showed increased leukocytes without bacteria, while effluent culture showed the growth of Methicillin-sensitive Staphylococcus aureus. According to the International Society of Peritoneal Dialysis 2022 guidelines, all criteria for infective peritonitis in this patient were met: clinical features (turbid effluent and abdominal pain), increased cell count (>100 cells/µL) with PMN >50%, and positive effluent culture. The patient was administered intravenous Ampicillin-Sulbactam based on the effluent culture and antimicrobial susceptibility testing. Serial effluent analyses suggested a return-to-normal trend in leukocyte and PMN counts. After 18 days of hospitalization, the patient was allowed to discharge based on clinical and laboratory improvements.

Evaluation of efficacy, outcomes and safety of infant haemodialysis and ultrafiltration in clinical use: I-KID a stepped wedge cluster RCT

Abstract Background Critically unwell babies in intensive care units may develop acute renal failure. Options for renal replacement therapy are limited by their small size and available technology. Objectives To determine the clinical efficacy, outcomes and safety profile of the NIDUS® (a novel infant haemodialysis device) for babies under 8 kg, compared with current renal replacement therapy. Design A clinical investigation using a non-blinded cluster stepped wedge design with paediatric intensive care units randomised to sequences. Setting Paediatric intensive care units in six UK hospitals. Participants Children under 8 kg who required renal replacement therapy for fluid overload or biochemical disturbance. Interventions Continuous renal replacement therapy was provided by the usual methods: peritoneal dialysis and continuous haemofiltration (during control periods) and by the NIDUS (during intervention periods), a novel device designed for babies with a smaller circuit and filter and volumetric control of ultrafiltration. Main outcome measures Primary outcome was precision of ultrafiltration compared with prescription; secondary outcomes included biochemical clearances, accuracy of reported ultrafiltration and mortality. Data sources Bedside study data collected by weighing bags of fluid entering and leaving the device were entered into the study database along with case descriptors. Some secondary outcome data was collected via the Paediatric Intensive Care Audit Network. Results Ninety-seven participants were recruited by study closure, 62 to control and 35 to intervention. The primary outcome was obtained from 62 control but only 21 intervention patients, largely because of technical difficulties using NIDUS. The analysis comparing the available primary outcomes showed that ultrafiltration with NIDUS was closer to that prescribed than with control: standard deviations controls 18.75, intervention 2.95 (ml/hour), adjusted ratio 0.13, 95% confidence interval (0.03 to 0.71); p = 0.018. The mean clearances for creatinine, urea and phosphate were lower on peritoneal dialysis than NIDUS, which were in turn lower than continuous veno-venous haemofiltration. The variability in the clearances was in the same order. Of the 62 control patients, 10 died (2/62 on peritoneal dialysis; 7/13 on continuous haemofiltration) before discharge from paediatric intensive care unit (16%), compared with 12 out of 35 (34%) in the NIDUS group: p = 0.04, 95% confidence interval for difference (0 to 36%). Harms No important adverse events occurred and the NIDUS has an acceptable safety profile compared with other renal replacement therapies in this critically ill population with multi-organ failure. Mortality was lowest for Peritoneal Dialysis, highest for continuous haemofiltration, with the NIDUS in-between. Only one serious adverse device event which was reported to the Medicines and Healthcare products Regulatory Agency. Conclusions NIDUS works effectively, delivering appropriate blood clearances and accurate, controllable fluid removal (ultrafiltration), indicating that it has an important place alongside other dialysis modalities for infant renal replacement therapy. Future work Findings from this study indicate some modifications are required to NIDUS to improve usability. Further studies on use of the NIDUS device in other populations of babies for example those with chronic renal failure, and long-term outcomes are required. Trial registration This trial is registered as ISRCTN 13787486. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation Programme (NIHR award ref: 14/23/26) and is published in full in Efficacy and Mechanism Evaluation; Vol. 11, No. 1. See the NIHR Funding and Awards website for further award information.

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

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

Pulmonary Physiotherapy in Kidney Recipients: Evaluation of Effects on Functional Capacity


 Introduction: Renal replacement therapy (RRT), including dialysis and kidney transplantation (KT), is employed for treating patients with end-stage renal disease (ESRD). Among RRT options, KT offers the highest quality of life (QoL) and overall survival. However, pulmonary complications following KT remain significant contributors to morbidity, mortality, and potential graft failure. The primary objective of this study is to assess the impact of respiratory and strengthening exercises on respiration, body composition, physical performance, and QoL of the patients following KT. Materials and Methods: Preoperative assessments included forced expiratory volume in one second (FEV1), 6-minute walking test (6MWT) scores, body composition measurements, hand grip strength, and QoL scores using the Short Form 36 Scale (SF-36) for the patients undergoing their first KT at Antalya Medical Park Hospital. Participants were randomly assigned to two groups. The experimental group (EG) received respiratory exercises until discharge, followed by combined respiratory, upper, and lower extremity strengthening exercises three days a week for two weeks post-discharge, while the control group (CG) received standard care. Measurements were repeated at the end of the third postoperative week, and the changes from the initial measurements were statistically compared between the groups. Results: Demographic characteristics were comparable between the groups. The SF-36 physical function sub-parameter demonstrated a significant increase in the experimental group, while it decreased in the control group. Pain sub-parameter scores and grip strengths of the SF-36 QoL scale did not exhibit statistically significant changes in either group. Conclusion: Implementing early respiratory physiotherapy and strengthening program over three weeks following KT improved QoL and physical function significantly.

#5854 RENAL TRANSPLANTATION: THE BEST THERAPEUTIC OPTION FOR HEART TRANSPLANT RECIPIENTS WITH ADVANCED CKD

Abstract Background and Aims Chronic kidney disease is a frequent complication of heart transplant recipients (HT) and is associated with worse survival. Current literature shows that probably the best renal replacement therapy option for these patients is kidney transplantation (KT). The aim of our work is to assess the results of renal transplantation in HT recipients. Method Retrospective descriptive single-center study including all heart transplant recipients patients who received a kidney transplantation in our center between 1992 and 2022. Data on renal and overall vital survival as a well as the factors that could have influenced them and associated complications were analyzed. Results We included 14 patients, 64% men, with a mean age of 56 years at the time of the KT. A total of 30.8% received an anticipated KT. A total of 85.7% received a KT from a cadaveric donor. In 90% the induction immunosuppression consisted of thymoglobulin, prednisone, mycophenolate, and differed tacrolimus. The mean time between heart and kidney transplantation was 15 years. Six months after KT the mean GFR was 40 mil/min/1,73 m2, at 12 months 35 ml/min/1,73 m2 and at 5 years 30 ml/min/1,73 m2. Renal graft survival was 84% and patient survival was 93% at 10 years. Regarding complications, the most frequent were urological (38.5%) followed by infectious (30.8%). The incidence of acute rejection was 18%. Conclusion Our data confirms that kidney transplantation in heart transplant recipients has very positive results. It is necessary to promote collaboration between CT and RT units with the aim of identifying promptly those patients who are candidates for KT, being able to perform it in the best conditions (preemptive transplantation, possibility of living donor transplanation).

Anticoagulation options for continuous renal replacement therapy in critically ill patients: a systematic review and network meta-analysis of randomized controlled trials

BackgroundContinuous renal replacement therapy (CRRT) is a widely used standard therapy for critically ill patients with acute kidney injury (AKI). Despite its effectiveness, treatment is often interrupted due to clot formation in the extracorporeal circuits. Anticoagulation is a crucial strategy for preventing extracorporeal circuit clotting during CRRT. While various anticoagulation options are available, there were still no studies synthetically comparing the efficacy and safety of these anticoagulation options.MethodsElectronic databases (PubMed, Embase, Web of Science, and the Cochrane database) were searched from inception to October 31, 2022. All randomized controlled trials (RCTs) that examined the following outcomes were included: filter lifespan, all-cause mortality, length of stay, duration of CRRT, recovery of kidney function, adverse events and costs.ResultsThirty-seven RCTs from 38 articles, comprising 2648 participants with 14 comparisons, were included in this network meta-analysis (NMA). Unfractionated heparin (UFH) and regional citrate anticoagulation (RCA) are the most frequently used anticoagulants. Compared to UFH, RCA was found to be more effective in prolonging filter lifespan (MD 12.0, 95% CI 3.8 to 20.2) and reducing the risk of bleeding. Regional-UFH plus Prostaglandin I2 (Regional-UFH + PGI2) appeared to outperform RCA (MD 37.0, 95% CI 12.0 to 62.0), LMWH (MD 41.3, 95% CI 15.6 to 67.0), and other evaluated anticoagulation options in prolonging filter lifespan. However, only a single included RCT with 46 participants had evaluated Regional-UFH + PGI2. No statistically significant difference was observed in terms of length of ICU stay, all-cause mortality, duration of CRRT, recovery of kidney function, and adverse events among most evaluated anticoagulation options.ConclusionsCompared to UFH, RCA is the preferred anticoagulant for critically ill patients requiring CRRT. The SUCRA analysis and forest plot of Regional-UFH + PGI2 are limited, as only a single study was included. Additional high-quality studies are necessary before any recommendation of Regional-UFH + PGI2. Further larger high-quality RCTs are desirable to strengthen the evidence on the best choice of anticoagulation options to reduce all-cause mortality and adverse events and promote the recovery of kidney function.Trial registration The protocol of this network meta-analysis was registered on PROSPERO (CRD42022360263). Registered 26 September 2022.

Clinical outcome of intraoperative hemodialysis using a hemoconcentrator during cardiopulmonary bypass for dialysis-dependent patients.

The basic materials and structure of a hemoconcentrator incorporated into cardiopulmonary bypass (CPB) circuits are similar to those of hemodialyzers. Gravity drainage hemodiafiltration (GHDF) is an easy-to-use intraoperative renal replacement therapy (RRT) that utilizes a hemoconcentrator. This study aimed to verify whether GHDF can correct electrolyte imbalance and remove uremic toxins in dialysis-dependent patients and to evaluate the clinical outcomes of GHDF by comparing it with a conventional method of dilutional ultrafiltration (DUF). This study retrospectively compared perioperative clinical values of 41 dialysis-dependent patients (21 patients with GHDF and 20 patients with DUF) who underwent open-heart surgery. Changes in serum parameters before and after passing through the hemoconcentrator were also compared. Compared to DUF, GHDF significantly lowered potassium, blood urea nitrogen, and creatinine levels at the outflow of the hemoconcentrator. Less catecholamine was needed to wean CPB in GHDF than in DUF. The P/F ratio (arterial blood oxygen pressure/inhaled oxygen concentration) at the end of surgery was significantly higher in GHDF than in DUF (450.8 ± 149.7 vs. 279.3 ± 153.5; p < 0.001). Postoperative intubation time was shorter in GHDF than in DUF (8.3 ± 5.9 vs. 18.7 ± 16.1h; p = 0.006). The major morbidity and mortality rates were comparable in both groups. GHDF removed both potassium and uremic toxins more efficiently than DUF in dialysis-dependent patients. Less catecholamine was needed to wean CPB using GHDF. It improved the immediate postoperative respiratory function and enabled earlier extubation. GHDF is a novel and effective option for intraoperative RRT in dialysis-dependent patients undergoing open-heart surgery.

Diet Patterns, Nutrition Status and Physical Activity in Patients on Peritoneal Dialysis

Background: End-stage renal disease (ESRD) and renal replacement therapy options are associated with malnutrition, which occurs in 30-50% of patients. Suboptimal nutritional status and physical inactivity are common in peritoneal dialysis patients also and are consequences of the restrictive diet, appetite loss, and poor physical fitness. Materials and methods: This single-center observational study aimed to analyze the dietary intake, body composition, and physical activity of 19 peritoneal dialysis (PD) patients. Dietary assessment was performed with a three-day 24-hour dietary recall, while nutritional status was assessed with body composition measurements. Patients’ physical performance was assessed with a handgrip test and a sit-stand test. Each value was expressed as a percentage or mean ± SD. Continuous variables between normal values and of study values were compared using paired t-tests and Wilcoxon signed ranks test. A two-tailed P value &lt;0.05 was considered statistically significant. Results: The mean caloric intake of the 19 patients was 1545 ± 295 kcal/day (21.4 kcal/kg BW/day), and the mean protein intake was 0.8 g/kg BW/ day. The mean value of body mass index was 24.4 ± 2.9 kg/m2 , phase angle was 5.2 ± 0.9, lean tissue index was 14.5 ± 2.8 kg/m2 and adipose tissue index was 9.3 ± 3.6 kg/m2 . The results of the handgrip test and the sit-to-stand test showed muscular weakness associated with low caloric intake. Conclusion: In our PD patients, average energy and protein intakes were inadequate according to dietary recommendations, which are related to reduce muscle strength among observed patients and a poor physical activity profile. The overall approach of nutritional counseling is necessary to improve the nutritional status of patients.

First Kidney Transplantation in Child at National Children's Medical Center

Chronic kidney disease, regardless of etiology, have common mechanisms of progression and require certain therapeutic efforts aimed at delaying the onset of the end stage of chronic kidney disease. Once the estimated glomerular filtration rate (GFR) has decreased to less than 30ml/min per 1.73m2 and the child has stage 4 CKD, it is time to begin preparing the child and family for renal replacement therapy. For most patients with end-stage chronic kidney disease, kidney transplantation is the best renal replacement therapy (RRT) option, providing the maximum length and quality of life compared to other treatment options. Chronic kidney disease (CKD) is persistent impairment of kidney function, lasting for 3 months or more, defined as structural and/or changes in the body with varying degrees of decreased clearance function. NKF KDOQI recommendations. National Kidney Foundation; 2002. KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Assessment, Classification, and Stratification. Since the first successful kidney transplant in 1954, kidney transplantation has become the best treatment for adult patients with kidney failure. However, early pediatric kidney transplantation complicated by technical and immunological problems, resulting in worse patient and graft survival in children than in adults. Over the past 15 years, a number of advances have significantly improved patient and graft survival in pediatric kidney transplants. Kidney transplantation (KT) is the preferred renal replacement therapy for children with end-stage kidney disease (CKD) because survival and patient quality of life are better in children who receive a transplant compared to those who remain on dialysis. In addition, young children (under six years of age) are more likely to have improved growth after transplantation compared with those undergoing chronic hemodialysis or peritoneal dialysis.

Self-assessment of the health status and leisure activities of individuals on haemodialysis

Self-assessment of health status is an important marker of social and health aspects. Haemodialysis is an option for renal replacement therapy that alters daily life and impacts social participation and the performance of tasks that give the subject a socially accepted role. In this scenario, leisure activities have the potential to generate well-being and are associated with several aspects of daily life, but few studies have analysed their relationship with the self-assessment of health status. This is a cross-sectional, census study with 1024 individuals from haemodialysis units of a Southeast Brazilian region, with the application of a questionnaire in 2019. We calculated the difference between the proportions of self-assessment of health status (positive and negative) and the two logistic regression models. The chances of individuals on haemodialysis negatively evaluating their health increase when they do not perform artistic leisure activities (OR 2.15; 95% CI 1.35–3.43), physical and sports activities (OR 3.20; 95% CI 1.86–5.52), intellectual (OR 2.21; 95% CI 1.44–3.41), manuals (OR 1.82; 95% CI 1.22–2.72), social (OR 2.74; 95% CI 1.74–4.31), tourist (OR 2.08; 95% CI 1.37–3.17) and idleness and contemplative (OR 1.92; 95% CI 1.29–2.85). Negative health self-assessment is associated with not practicing artistic, manual, physical and sporting, social, intellectual, tourist, and contemplative leisure activities, which have the function of providing social participation and giving meaning to life.

Short- and long-term outcomes of early initiation of peritoneal dialysis following catheter insertion.

Early-start peritoneal dialysis (PD) (use of PD catheter within 48 hours of insertion) is an innovative approach for prompt initiation of PD. This study was conducted to analyze the outcomes of early-start PD. A total of 100 patients on PD were retrospectively analyzed. Patients were grouped according to the "break-in period": < 48 hours (PD1) and ≥ 14 days (PD2). PD was initiated with low dwell volumes (500 mL) in a recumbent position within 48 hours of surgery. PD prescription was gradually incremented over 10 days to minimize any complications. In our study, there were 48 patients in the PD1 group and 52 in the PD2 group. The most common cause of end-stage kidney disease (ESKD) was diabetes mellitus in both groups. Incidence of early mechanical complications (within 30 days of catheter insertion), such as catheter obstruction, early catheter leakage, catheter malposition, tip migration, and infectious complications, were not found to be higher in the PD1 group. 1- and 4-year catheter patency rates were 97.0% and 96.2% in the PD1 group, respectively. These rates were comparable with those in the PD2 group. Early-start PD was not associated with an increased incidence of catheter failure (HR = 1.0, 95% CI 0.28 - 3.47). An early break-in period of < 48 hours is a feasible option for ESKD patients without any significantly increased risk of mechanical or infectious complications. It offers a safe and efficacious option for renal replacement therapy.

Peritoneal dialysis in the era of COVID-19: experience of a Tunisian center.

The COVID-19 pandemic has transformed the health landscape by hampering the management of patients with chronic diseases. Providing optimal healthcare has become a critical issue, especially for patients with end-stage renal disease (ESRD) receiving in-center dialysis. Peritoneal Dialysis (PD) has the advantage of being a home-based therapy. Several papers about COVID-19 in the chronic kidney disease (CKD) population have been published, but few studies focused on the PD population, with limited case series. In this paper, we share our strategy for managing PD patients during the pandemic and describe the characteristics of 24 episodes of COVID-19 that occurred in our PD patients. Also, we report the impact of the pandemic on different outcomes and discuss the challenges of renal replacement therapy (RRT) in the time of COVID-19 and the advantages of PD. During the period from December 2019 to September 2021, 127 patients received PD in our center. Among them, we recorded 24 episodes of COVID-19 that occurred in 20 patients, corresponding to an incidence of 8.4 per 1000 patient-months. None of the 20 patients with COVID-19 were vaccinated and there was a significant male gender predominance in the COVID-19 group compared to the non-COVID-19 group. The prevalence of diabetic nephropathy and primary glomerulonephritis were also significantly higher in the COVID-19 group. The revealing symptoms were asthenia, dry cough, and the deterioration of general conditions in 100%, 75%, and 63% of the patients, respectively. A biological inflammatory syndrome was found in 30% of the patients. Chest computed tomography (CT) scan, performed in 5 patients, showed features of COVID pneumonia with an average extent of damage of 55%. The rate of patients starting PD during the study period was comparable to that before the pandemic. Furthermore, we did not find a significant difference between the infected and the non-infected groups regarding the incidence of peritonitis, PD technique failure, and mortality (6.1 [0–1.46] vs 3.9 [0.15–0.64] deaths per 1000 patient-months. COVID-19 does not seem to have influenced the outcomes of our patients treated with PD even before the launch of mass immunization in our country. Thus, PD can be a great option for RRT in the era of the COVID-19 pandemic since many issues could be managed remotely to avoid regular hospital visits and contribute to maintaining social distancing, which is the cornerstone of breaking the chain of transmission of the novel virus.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40620-022-01396-9.

Overview of peritoneal dialysis outcomes in Northern Cyprus: a nation based study

Aim: Peritoneal dialysis (PD) is the more preferred renal replacement therapy (RRT) option for most patients with end-stage renal disease (ESRD) who can not achieve a kidney transplantation. By an enhanced national PD program, more patients may have a chance to take the advantage of this treatment option. In this study, we aim to investigate whether PD is preferred as the first dialysis treatment modality in Northern Cyprus and reveal the outcomes in order to improve the further PD program. &#x0D; Material and Method: Peritoneal dialysis patients aged above 18 years who were followed between 2003-2021 in Northern Cyprus were investigated retrospectively. Demographic data, primary kidney diseases, comorbidities and previous RRT modalities were analysed. Episode(s) of peritonitis, total duration on PD therapy, switch to kidney transplantation or HD, and mortality rate were evaluated. Outcomes of elderly (≥ 65 years) and diabetic patients who were dropped out from PD were found out.&#x0D; Results: A total of 123 patients aged 18-83 years were included in the study. Forty percent of 123 PD patients initiated RRT with PD. The median time was found 1 month in the rest of the patients to transfer PD from other modalities. Renal transplantation was performed in 16.8% of patients during follow-up whereas 34.7% were transferred to HD after 41 months. Inadequate dialysis (40.7%), PD-related infections (29.6%), ultrafiltration insufficiency (18.5%), mechanical complications (11.1%) were the most common causes of switching from PD to HD. The duration of being under PD therapy was 36.5 months for 46 patients who died under PD therapy. Cardiovascular events (50%) and various infections (%35) were the leading causes of mortality. A total of 48 (43.2%) PD patients had at least one episode of peritonitis. Total duration on PD treatment, PD rate as initial RRT modality, the prevalence of hypertension and diabetes mellitus (DM), peritonitis rate, and use of automated PD were not significantly different between elderly (n=34) and adult individuals (18-65 years). The duration of being under PD therapy was longer for males than females (p=0.044) and the duration of PD therapy was similar in the dropped out patients with or without DM (p=0.205).&#x0D; Conclusion: A significant amount of patients received HD before initiation of PD (60%). Age is not be considered as a challenging barrier for PD initiation in Northern Cyprus. Precautions to prevent the development of peritonitis may contribute to extend the total duration of PD treatment.

MO1046: The Selection of Renal Replacement Therapy for End-Stage Kidney Disease Patients by the Shared Decision-Making Method

Abstract BACKGROUND AND AIMS In Japan, &amp;gt; 97% of patients with end-stage kidney disease (ESKD) select hemodialysis as a renal replacement therapy (RRT). Hemodialysis (HD) and peritoneal dialysis (PD) have been provided at our hospital for many years, and kidney transplantation (KT) has been available here since 2015. In January 2018, we introduced the option of RRT for outpatients based on the shared decision-making (SDM) method, which was recently shown to be useful for patients. METHOD Patients receive ∼1-h explanation of the SDM method by a nurse in the outpatient department. If patients desire additional outpatient visits, they receive as many as they want; a decision about RRT is not required after a single visit and patients can change their decision at any time. We conducted a prospective observational study to investigate patients’ selection of RRT and the influence of the SDM method on the selection of RRT. The data were examined by Fisher's exact test and significance was accepted at P &amp;lt; 0.05. RESULTS During the period from January 2018 to December 2021, 116 patients visited our outpatient department and 69 patients underwent RRT. Only 53% of the patients initially requested hemodialysis (Figure 1), but &amp;gt; 80% of the patients eventually underwent hemodialysis (Figure 2). From 2018 to 2021, 156 patients started RRT; 58 of them (37%) had visited the outpatient department before starting RRT. The number of patients who visited the outpatient department has increased year by year. The emergency initiation of dialysis decreased significantly after the outpatient use of the SDM method began [odds ratio (OR) 0.44, P = 0.024]. CONCLUSION There was a tendency for patients’ satisfaction regarding their own selection of RRT via the SDM method in the outpatient department. Patients can obtain the information they need and select a better treatment for themselves via an explanation of the SDM method. The SDM method is thus very effective for both patients and medical staff when considering RRT.

The Role of Peritoneal Dialysis in Different Phases of Kidney Transplantation.

The utilization of peritoneal dialysis (PD) has been increasing in the past decade owing to various government initiatives and recognition of benefits such as better preservation of residual renal function, quality of life, and lower cost. The Advancing American Kidney Health initiative aims to increase the utilization of home therapies such as PD and kidney transplantation to treat end stage kidney disease (ESKD). A natural consequence of this development is that more patients will receive PD, and many will eventually undergo kidney transplantation. Therefore, it is important to understand the effect of pretransplant PD on posttransplant outcomes such as delayed graft function (DGF), rejection, thrombosis, graft, and patient survival. Furthermore, some of these patients may develop DGF, which raises the question of the utility of PD during DGF and its risks. Although transplant is the best renal replacement therapy option, it is not everlasting, and many transplant recipients must go on dialysis after allograft failure. Can PD be a good option for these patients? This is another critical question. Furthermore, a significant proportion of nonrenal solid organ transplant recipients develop ESKD. Is PD feasible in this group? In this review, we try to address all of these questions in the light of available evidence.