Peritoneal Dialysis Technique Survival Research Articles

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

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

#2771 Peritoneal dialysis after kidney graft loss … and now, what?

Abstract Background and Aims The evolution of peritoneal dialysis (PD) as renal replacement therapy (RRT) after graft loss is not well defined. Method Retrospective analysis of the Andalusian Renal Registry of patients who received their first kidney transplant (KT) in Andalusia (Spain) and returned to dialysis between 1978-2023. Patients who lost follow-up and those who underwent preemptive re-KT were excluded of the study. We compared clinical characteristics and evolution between those who started hemodialysis (HD) and peritoneal dialysis (PD) after graft loss. Secondly, we analyzed technique and patient survival in those who started PD post-KT versus patients on PD as their first renal replacement therapy (RRT) We performed multivariate analysis for PD technique and patient survival risk factors using Cox regression. Results During this period, we followed 11868 KT recipients in Andalusia. Of these, 3148 (26.52%) lost the graft: 2768 started HD and 298 PD. 82 patients underwent preemptive re-KT. Patients who returned to DP were younger (p &amp;lt; 0.001) and glomerulonephritis as cause of chronic kidney disease (CKD) was more frequent (p = 0.019). The pre-KT RRT was HD in 96.3% of patients starting HD post-KT and PD in 48.3% of patients who returned to PD after KT (p &amp;lt; 0.001). Survival of patients in the HD group was lower than those who started PD (p = 0.026). In the multivariate analysis, older age when dialysis restarted, male sex and diabetes were risk factors for patient death and not the type of dialysis. When comparing only the post-KT PD group (n = 298) versus patients on PD as their first RRT (n = 5312), patients on the first group were younger (57.1 vs. 41.9; p &amp;lt; 0.001) and time on PD was longer (24.4 vs. 19 months; p &amp;lt; 0.001). The causes of PD drop-out also varied between groups (p &amp;lt; 0.001). During this period, 269 post-KT PD patients left the technique mainly due to re-KT (34.3%) and in the PD group as the first RRT, there were 4919 technique drop-outs, mainly due to transfer to HD (35.3%) and death (30%). The percentage of peritonitis was higher in the post-KT PD group, although without significant differences (post-KT PD 27.9% vs. PD as first RRT 23.25%; p = 0.061). Survival of the DP technique in post-KT PD group was 78.2% at 1 year and 38.5% at 5 years, and 77.7% and 42.1% respectively in the DP group as the first DP RRT (p = 0.059). In the multivariate analysis, patient age and diabetes as a cause of CKD, behaved as risk factors for patient survival. Conclusion Almost half of the patients starting PD after KT had been on PD prior to transplantation. They tend to have more peritonitis although survival of the technique and complications were very similar to those observed in patients on PD as first RRT.

Peritoneal Dialysis Technique Survival: A Cohort Study

Rationale & ObjectiveReasons for transfer from peritoneal dialysis (PD) to hemodialysis (HD) remain incompletely understood. Among incident and prevalent patients receiving PD, we evaluated the association between prior treatment with HD and PD technique survival. Study DesignRetrospective cohort study. Setting & ParticipantsAdults who initiated PD at a Dialysis Clinic, Inc. (DCI) outpatient facility between January 1, 2010 and September 30, 2019. ExposuresThe primary exposure of interest was timing of PD start, categorized as PD-first, PD-early, or PD-late. Other covariates included demographics, clinical characteristics, and routine laboratory results. OutcomesModality switch from PD to HD sustained for more than 90 days. Analytical ApproachMultivariable Fine-Gray models with competing risks and time-varying covariates, stratified at 9 months to account for lack of proportionality. ResultsAmong 5224 patients who initiated PD at a DCI facility, 3174 initiated dialysis with PD (“PD-first”), 942 transitioned from HD to PD within 90 days (“PD-early”), and 1108 transitioned beyond 90 days (“PD-late”); 1472 (28%) subsequently transferred from PD to HD. PD-early and PD-late patients had higher risk of transfer to HD as compared to PD-first patients [adjusted hazard ratio (aHR) 1.51 (95% CI: 1.17-1.96) and 2.41 (1.94-3.00), respectively, in the first 9 months and aHR 1.16 (0.99-1.35) and 1.43 (1.24-1.65), respectively, after 9 months]. More peritonitis episodes, fewer home visits, lower serum albumin, lower residual kidney function, and lower peritoneal clearance calculated with weekly Kt/V were additional risk factors for PD-to-HD transfer. LimitationsMissing data on dialysis adequacy and residual kidney function, confounded by short PD technique survival. ConclusionsInitiating dialysis with PD is associated with greater PD technique survival, though many of those who initiate PD late in their dialysis course still experience substantial time on PD. Peritonitis, lower serum albumin, and lower Kt/V are risk factors for PD-to-HD transfer that may be amenable to intervention.

Effect of proactive combination therapy with peritoneal dialysis and hemodialysis on technique survival and mortality.

Clinically relevant evidence for the timing of starting combination therapy with peritoneal dialysis and hemodialysis remains scarce. We retrospectively examined whether combination therapy during the induction phase of dialysis prolongs peritoneal dialysis duration. This retrospective study includes 160 patients who underwent combination therapy from 20 dialysis facilities. Four groups were categorized: combination at peritoneal dialysis induction (n = 12, Proactive combination group), and combination following peritoneal dialysis durations of < 2years (n = 65), 2-5years (n = 70), or > 5years (n = 13). Differences in technique survival of dialysis, mortality, and hospitalization due to cardiovascular events in the groups were observed. The Proactive combination group had the longer mean duration of combination therapy (3.18years) comparing to that of combination therapy following peritoneal dialysis (1.45years), but total peritoneal dialysis duration was shorter than in control groups (4.02years). Of the 160 cases in the entire cohort, there were 8 deaths, 18 ischemic heart disease hospitalizations, and 18 stroke hospitalizations. The Proactive group had lower crude mortality rate (0/12 cases, 0.0%) and crude hospitalization rate for ischemic heart disease (1/11, 8.3%) than the other groups. However, this cohort study did not have enough statistical power to adjust for patients' background, and we were unable to fully examine the differences in such clinical outcomes by the timing of initiation of combination therapy. Use of combination therapy in the induction phase might prolong the duration of combination therapy, but is not necessarily effective for prolonging peritoneal dialysis technique survival.

Nephrologists’ perspectives on communication and decision-making regarding technique survival in peritoneal dialysis: an international qualitative interview study

ObjectivesPeritoneal dialysis (PD) allows patients increased autonomy and flexibility; however, both infectious and non-infectious complications may lead to technique failure, which shortens treatment longevity. Maintaining patients on PD remains a...

#4793 DOES PRIOR ABDOMINAL SURGERY INFLUENCE TECHNIQUE SURVIVAL OF PERITONEAL DIALYSIS PATIENTS?

Abstract Background and Aims Prior abdominal surgery may result in peritoneal membrane adhesions and fibrosis, compromising the success of peritoneal dialysis (PD). The impact of this factor on peritoneal membrane function and PD technique survival has not been adequately investigated. The aim of our study was to disclosure the effect of prior abdominal surgical procedures on PD technique survival (main outcome), efficacy rates and also evaluate the risk of infectious complications (secondaries outcomes). Method We performed a retrospective, longitudinal study, that included 155 PD patients followed at our unit, since September 2018 to September 2022. Two groups were created: G1 (without previous abdominal surgery) and G2 (with previous abdominal surgery). Demographic and clinical characteristics, such as age, gender, chronic kidney disease (CKD) etiology, time on PD program, dialytic efficacy (Kt/V), peritoneal equilibration test results and episodes of peritonitis were registered from our unit database. Statistical analyses were performed using SPSS statistics version 23,0. The statistical hypothesis tests with p-value &amp;lt;0,05 were considered significant. Results One-hundred and fifty-five patients (female: 50,9%) with a mean age of 55,4 ± 7 years were selected. The main CKD cause was glomerular diseases (n = 43, 27,7%), followed by uncertain etiology (n = 32, 20,6%) and autosomal dominant polycystic kidney disease (n = 21, 13,5%). G1 (n = 87; 56,1%) and G2 (n = 68; 43,9%) had similar distributions of gender (female: 50,6% vs 47,1%, p = 0,061), age (50,4± 9 vs 55,4 ±10 years, p = 0,076) and dialysis vintage (27,9 vs 28,2 months, p = 0,081). In G1, 62,1% of patients were on continuous ambulatory peritoneal dialysis (vs 55,9% in G2). The majority of patients were high-average transporters in both groups (58,6% vs 54,4%, p = 0,066). Previous comorbidities were (G1 vs G2): arterial hypertension (95,4% vs. 98,5%, p = 0,87), diabetes (27,6% vs. 26,5%, p = 0,83), heart failure (25,3% vs. 26,5%, p = 0,64), peripheral arterial disease (28,7% vs 35,3%, p = 0,082), body mass index &amp;gt;30 kg/m2 (20,7% vs 29,4%, p = 0,072) and dyslipidemia (64,4% vs. 64,7%, p = 0,91). In G1, Kt/V was inferior a 1,7 in 36,8% of patients (vs 66,2% in G2, p&amp;lt;0,001). Seven patients (8,1%) have reported more than one peritonitis during time in PD in group 1 (vs 32,4% in G2, p&amp;lt;0,001). We found no differences in PD technique survival between both groups. Transition to hemodialysis happened in 26,4% of patients in G1 (vs 26,5% in G2, p = 0,092). Mortality rate was similar in both groups (6,9% vs 10,3%, p = 0,063). Conclusion According to our results, prior abdominal surgical procedures do not appear to compromise technique survival in patients on PD. Although, abdominal surgical events places PD patients in a higher risk of infectious complications and lower efficacy rates. Thus, this group of patients deserve a more detailed evaluation before starting PD, in order to understand if they are good candidates for the technique, as this may not be the most advantageous for them in the long term.

#5564 OUTCOMES OF PERITONEAL DIALYSIS AFTER KIDNEY TRANSPLANT FAILURE: A SINGLE-CENTER EXPERIENCE

Abstract Background and Aims There is a hesitation in returning peritoneal dialysis (PD) after kidney transplant (KTx) failure. Studies in larger multicentre matched cohorts are missing. Method We conducted a retrospective study about 19 patients who started PD after KTx failure (PDpostTx group) between January 2010 and August 2022 in Ankara University School of Medicine who were compared with 70 never-transplanted patients having started PD during the same period (PDnoTx group). Patients’ clinical data and PD technique survival as well as peritonitis episodes were analysed. Results Mean age was 51 years and continuous ambulatory PD was the treatment of choice (59.6%) (Table 1). Even the mean time on PD was similar between groups (45.4 months in PDpostTx vs 51.7 months in PDnoTx, p = 0.525), transfer to HD was more common in PDpostTx patients (36.8% vs 10.0%, p = 0.015). The main cause of transfer to HD was ultrafiltration failure, which was significantly higher in PDpostTx group (p = 0.002). Diuresis at baseline was similar between groups, but decreased significantly in PDpostTx group at first year and final follow-up (p &amp;lt; 0.001, and p = 0.001, respectively). Peritonitis was more common in PDpostTx group (68.4% vs 30.0%, p = 0.002). Diabetes mellitus was a risk factor for peritonitis episode (p = 0.012), but we didn’t observe any effect of immunosuppressive therapy on peritonitis and reduction of the diuresis. In multivariate analysis, KTx failure (p = 0.014), peritonitis episodes (p = 0.011) and ultrafiltration failure (p &amp;lt; 0.001) were associated with a higher risk of transfer to HD. Over the study period, patients’ survival was similar between groups (p = 0.766). Conclusion We reported similar patient survival, but higher peritonitis rates and PD technique failure in the PDpostTx group, when compared to patients who started PD for other reasons. Considering these findings, taking precautions against peritonitis is more important for patients who started PD after KTx failure.

Catheter insertion techniques for improving catheter function and clinical outcomes in peritoneal dialysis patients.

Catheter insertion techniques for improving catheter function and clinical outcomes in peritoneal dialysis patients.

Prevalence and outcome of abdominal wall hernia in patients with end-stage renal disease on peritoneal dialysis.

We aimed to study the prevalence, risk factors, management, and outcome of hernias in end-stage renal disease (ESRD) patients on peritoneal dialysis (PD) from India. This was a retrospective study of ESRD-PD patients who developed hernias over 11 years. Of 470 PD patients, 21 developed hernias (4.2%). Mean age of patients was 49.9 ± 15.36 years; 15 (66.66%) were males; 18 (85.71%) patients had umbilical hernia, 3 (14.28%) had inguinal hernia. Continuous ambulatory PD (CAPD) versus automated PD (APD) (OR: 11.623, 95% CI: 2.060-65.581, p=0.005) was the independent risk factor identified. Incarcerated umbilical/inguinal hernia was managed surgically (6 [28.57%]); uncomplicated umbilical hernia (15 [71.42%]) managed conservatively (shift to (APD) [33.33%]; switch to low-volume APD [20%], switch to low-volume CAPD [46.66%]). None had postoperative hernia recurrences; 4 (19%) had PD technique failure; median PD survival was 36 (IQR 17-55) months. Although complicated hernias in PD require surgical repair, uncomplicated umbilical hernias can be managed conservatively by switching to APD/low-volume CAPD, with good long-term PD technique survival.

Pleiotropic effects of atorvastatin in peritoneal dialysis patients: A retrospective-prospective observational cohort study

Abstract. Recent studies demonstrate a large number of non-lipid modifiable effects of statins in various diseases. However, although atherogenic dyslipidemia is a common feature in peritoneal dialysis (PD) patients, statins use is supported by limited data and there is a general lack of research on their pleiotropic effects in this patients’ cohort. The present study aimed to evaluate the possible pleiotropic effects of atorvastatin in PD patients.&#x0D; Methods. A total of 114 PD patients with an average age of 55 (48-65) years and a dialysis vintage of 31 (14-50) months were included in this combined retrospective and prospective multicentre cohort study. PD patients (n = 54) who had started receiving atorvastatin before or after dialysis initiation and been treated with atorvastatin no less than 12 months were included in the Atorvastatin Group. PD patients (n = 60) who have never taken statins consisted of Atorvastatin-free Group.&#x0D; In addition to routine clinical and PD adequacy tests, concentrations of interleukins -6, -10, tumor necrosis factor-alpha, and monocyte chemoattractant protein-1 in PD effluent (PDE) were evaluated in all study participants at the start of the follow-up period. The primary outcomes were the 3-year PD technique survival and the all-cause mortality of PD patients during the follow-up period.&#x0D; Results. Atorvastatin users had lower serum phosphate and parathyroid hormone concentrations, higher weekly creatinine clearance, peritoneal weekly Kt/V urea, and, accordingly, total weekly Kt/V compared to the Atorvastatin-free Group. PDE cytokines assessment demonstrated significantly lower concentrations of all studied cytokines in the Atorvastatin Group compared with the Atorvastatin-free Group. In the Cox regression models, atorvastatin use was significantly associated with better PD technique survival (HR = 0.28 (95% CI 0.15; 0.54), p = 0.003) and mortality reduction in the PD patients regardless of their age, diabetes, anuric status, albumin and C-reactive protein levels, and history of PD peritonitis (HR = 0.24 (95% CI 0.15; 0.44), p &lt; 0.0001).&#x0D; Conclusions. Atorvastatin treatment was associated with the normalization of phosphate-calcium metabolism, low intraperitoneal inflammation and incidence of PD-associated peritonitis, and better dialysis adequacy in our cohort of PD patients. These pleiotropic effects of atorvastatin may be one of the reasons for the lower all‐cause mortality in PD patients. Further studies are needed to determine the necessity of statins prescribing in PD patients.

Representativeness of the PDOPPS cohort compared to the Australian PD population.

The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) is an international, prospective study following persons treated by peritoneal dialysis (PD) to identify modifiable practices associated with improvements in PD technique and person survival. The aim of this study was to assess the representativeness of the Australian cohort included in PDOPPS compared to the complete Australian PD population, as reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Adults with at least one PD treatment reported to ANZDATA Registry during the census period of PDOPPS Phase I (November 2014 to April 2018) were compared to the Australian PDOPPS cohort. The primary outcomes were the representativeness of centres and persons. Secondary outcomes explored the association of person characteristics with consent to study participation. After data linkage, 511 PDOPPS participants were compared to 5616 Australians treated with PD. Within centres eligible for PDOPPS, selected centres were similar to other Australian centres. The PDOPPS participants' cohort tended to include older persons, more males, a higher proportion of Caucasians and more persons with higher socioeconomic advantage compared to the Australian PD population. Differences in distribution across sex and ethnicities between the PDOPPS cohort and the overall PD population were in part due to the selection and consent processes, during which females and non-Caucasians were more likely to not consent to PDOPPS participation. Sampling methods used in PDOPPS allowed for good national representativeness of the included centres. However, representativeness of the unweighted PDOPPS sample was suboptimal in regard to some participant characteristics.

Incremental peritoneal dialysis is a safe and feasible prescription in incident patients with preserved residual kidney function.

Incremental peritoneal dialysis (PD) is recommended as a component of high-quality care by the international society for PD; however, its feasibility and clinical outcomes have not been widely reported. The aim of this study is to describe our experience with incremental PD. This was a retrospective cohort study of incident PD patients at Eastern Health between 2015 and 2019. Patients who stopped PD within 30 days were excluded. Incremental PD was defined in CAPD as using <8L/day of exchange volume and in automated PD as dialysing without a last fill. Dialysis modality accorded with patient and physician preferences. The 96 patients were included in this study; 54 with incremental PD. Compared to full-dose PD, incremental PD patients were more likely to be female, had less comorbid diabetes (28% vs. 52%) and higher residual kidney function (RKF) (Kt/V 2.0 ± 0.7 vs. 1.4 ± 0.7). Age, BMI and starting eGFR did not differ between groups. Incremental PD exposed patients to lower exchange volumes (4.4 ± 2.1 vs. 8.5 ± 1.1L/day), glucose load (46 ± 41 g/day vs. 119 ± 46) and was associated with a longer peritonitis-free survival. PD technique survival, rates of peritonitis or hospitalization were comparable between groups. Predictors for longer incremental PD use included older age and higher starting eGFR. Incremental PD is a feasible, goal-directed initial prescription in patients with RKF with comparable peritonitis rates and technique survival. Validation of this prescription in prospective studies is warranted.

MO687FREE WATER TRANSPORT AND ABSOLUTE DIP OF DIALYSATE SODIUM CONCENTRATION: EARLY CLINICAL PARAMETERS FOR PERITONEAL FIBROSIS IN PD PATIENTS?

Abstract Background and Aims Reduction of peritoneal salt and water removal is an important cause of shortened patient and technique survival in peritoneal dialysis (PD). The aim of this study was to longitudinally analyze changes in fluid and solute transport parameters in PD patients during the first year of treatment, using peritoneal equilibration test (PET). Method Retrospective observational study of incident PD patients who underwent 4-hour 3.86% glucose PET with additional measurement of ultrafiltration at 1 hour, 1 month after PD initiation and 12 months later. Parameters of peritoneal transport such as dialysate-to-plasma ratio of creatinine (D/Pcreat), ultrafiltration at 1 and 4 hours, small-pore ultrafiltration (SPUF), free water transport (FWT), sodium removal and absolute dip of dialysate sodium concentration (ΔDNa) at 1 hour (as an expression of sodium sieving), were calculated. Serum cancer antigen 125 (CA-125) was also assessed. Clinical, analytical and demographic data were analyzed. Statistical analysis was performed using SPSS (Version 23 for Mac OSX). Results The average age of 16 incident PD patients was 58.69 ± 8.51 years, 10 (62.5%) were male and 5 (31.8%) were diabetic. Ten patients (62.5%) were on automated peritoneal dialysis (APD). One month after PD initiation, membrane characteristics were: D/P = 0.684 ± 0.589, total UF at 4h = 0.696 ± 0.283L, UF at 1h = 0.487 ± 0.162L, SPUF = 0.303 ± 0.359L, FWT = 0.207 ± 0.738L, %FWT = 51.855 ± 11.828%, sodium removal = 38.048 ± 16.087mmol/L and ΔDNa = 11.125 ± 3.34mmol/L. Average serum CA-125 was 51.206 ± 22.6U/mL. A paired sample t-test was performed to compare these parameters 1 and 12 months after PD initiation and revealed a statistically significant increase of 0.11± 0.196L (p=0.042) on SPUF and 18.607 ± 7.1mmol/L (p=0.019) on sodium removal. ΔDNa showed a decrease of 2.5 ± 0.743mmol/L (p=0.005) and % FWT of 11.782 ± 12.831% (p=0.002). FWT also showed a decrease of 0.168 ± 0.019L, total UF at 4h of 0.206 ± 0.142L and UF at 1h of 0.114 ± 0.243L, however did not reach statistical significance. D/Pcreat remained stable. CA-125 showed a mild decrease of 3.644 ± 22.364U/mL although not statistically significant. Pearson correlation revealed a positive correlation between the variation of total UF at 4h and the variation of FWT (r=0.553, p=0.026) and ΔDNa (r=0.503, p=0.047), but not with SPUF, sodium removal, D/Pcreat or CA-125, during the study follow-up period. Conclusion The reduction of FWT through aquaporins and, particularly, the reduction of ΔDNa as a sodium sieving measure, appear to be the first functional changes in peritoneal membrane, suggesting that fibrosis may begin soon after PD initiation. Our results indicate that FWT and ΔDNa can be used to access fibrotic peritoneal alterations earlier than other conventional parameters such as D/Pcreat.

Trends in Peritoneal Dialysis Technique Survival, Death, and Transfer to Hemodialysis: A Decade of Data from the RDPLF

Introduction: There is limited information on the trends of peritoneal dialysis (PD) technique survival over time. This study aimed to estimate the effect of calendar time on technique survival, transfer to hemodialysis (HD) (and the individual causes of transfer), and patient survival. Methods: This retrospective, multicenter study, based on data from the French Language Peritoneal Dialysis Registry, analyzed 14,673 patients who initiated PD in France between January 1, 2005, and December 31, 2016. Adjusted Cox regressions with robust variance were used to examine the probability of a composite end point of either death or transfer to HD, death, and transfer to HD, accounting for the nonlinear impact of PD start time. Results: There were 10,201 (69.5%) cases of PD cessation over the study period: 5,495 (37.4%) deaths and 4,706 (32.1%) transfers to HD. The rate of PD cessation due to death or transfer to HD decreased over time (PR 0.96, 95% CI: 0.95–0.97). Compared to 2009–2010, starting PD between 2005 and 2008 or 2011 and 2016 was strongly associated with a lower rate of transfer to HD (PR 0.88, 95% CI: 0.81–0.96, and PR 0.91, 95% CI: 0.84–0.99, respectively), mostly due to a decline in the rate of infection-related transfers to HD (PR 0.96, 95% CI: 0.94–0.98). Conclusions: Rates of the composite end point of either death or transfer to HD, death, and transfer to HD have decreased in recent decades. The decline in transfers to HD rates, observed since 2011, is mainly the result of a significant decline in infection-related transfers.

Outcome measures for technique survival reported in peritoneal dialysis: A systematic review

Peritoneal dialysis (PD) technique survival is an important outcome for patients, caregivers and health professionals, however, the definition and measures used for technique survival vary. We aimed to assess the scope and consistency of definitions and measures used for technique survival in studies of patients receiving PD. MEDLINE, EMBASE and CENTRAL databases were searched for randomised controlled studies (RCTs) conducted in patients receiving PD reporting technique survival as an outcome between database inception and December 2019. The definition and measures used were extracted and independently assessed by two reviewers. We included 25 RCTs with a total of 3645 participants (41-371 per trial) and follow up ranging from 6 weeks to 4 years. Terminology used included 'technique survival' (10 studies), 'transfer to haemodialysis (HD)' (8 studies) and 'technique failure' (7 studies) with 17 different definitions. In seven studies, it was unclear whether the definition included transfer to HD, death or transplantation and eight studies reported 'transfer to HD' without further definition regarding duration or other events. Of those remaining, five studies included death in their definition of a technique event, whereas death was censored in the other five. The duration of HD necessary to qualify as an event was reported in only four (16%) studies. Of the 14 studies reporting causes of an event, all used a different list of causes. There is substantial heterogeneity in how PD technique survival is defined and measured, likely contributing to considerable variability in reported rates. Standardised measures for reporting technique survival in PD studies are required to improve comparability.

POS-645 THE INCIDENCE AND RISK FACTORS OF PERITONEAL DIALYSIS TREATMENT FAILURE: A RETROSPECTIVE ANALYSIS AT NATIONAL KIDNEY AND TRANSPLANT INSTITUTE (NKTI)

End stage renal disease (ESRD) is a global health burden worldwide. In the Philippines, based on the Philippine Renal Disease Registry (PDRD), the number of ESRD cases from a population of 10,000 last 2013, had increased to 14,000 in 2016. NKTI, being the tertiary referral hospital for patients who are suffering from ESRD, has the largest Peritoneal Dialysis (PD) center and most number of patients on PD. It is the goal of this study to be able to share the clinical expertise and resources of the hospital on PD by being able to provide recommendations that can be translated into protocols and guidelines that will aid in improving PD technique survival.

POS-661 PERITONEAL DIALYSIS TECHNIQUE FAILURE : INCIDENCE AND PREDICTORS

Peritoneal dialysis (PD) offers similar clinical outcomes to hemodialysis (HD) at a proportion of the cost. To improve PD technique survival, we need to identify the patients at risk of this complication. The aim of this study is to estimate the incidence of technique failure (TF) in PD, and to determine its predictors in our population.

Urgent-start peritoneal dialysis versus conventional-start peritoneal dialysis for people with chronic kidney disease.

Urgent-start peritoneal dialysis (PD), defined as initiation of PD within two weeks of catheter insertion, has been emerging as an alternative mode of dialysis initiation for patients with chronic kidney disease (CKD) requiring urgent dialysis without established permanent dialysis access. Recently, several small studies have reported comparable patient outcomes between urgent-start and conventional-start PD. To examine the benefits and harms of urgent-start PD compared with conventional-start PD in adults and children with CKD requiring long-term kidney replacement therapy. We searched the Cochrane Kidney and Transplant Register of Studies up to 25 May 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. For non-randomised controlled trials, MEDLINE (OVID) (1946 to 27 June 2019), EMBASE (OVID) (1980 to 27 June 2019), Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov (up to 27 June 2019) were searched. All randomised controlled trials (RCTs) and non-RCTs comparing the outcomes of urgent-start PD (within 2 weeks of catheter insertion) and conventional-start PD ( ≥ 2 weeks of catheter insertion) treatment in children and adults CKD patients requiring long-term dialysis were included. Studies without a control group were excluded. Data were extracted and quality of studies were examined by two independent authors. The authors contacted investigators for additional information. Summary estimates of effect were examined using random-effects model and results were presented as risk ratios (RR) with 95% confidence intervals (CI) as appropriate for the data. The certainty of evidence for individual outcome was assessed using the GRADE approach. A total of 16 studies (2953 participants) were included in this review, which included one multicentre RCT (122 participants) and 15 non-RCTs (2831 participants): 13 cohort studies (2671 participants) and 2 case-control studies (160 participants). The review included unadjusted data for analyses due to paucity of studies reporting adjusted data. In low certainty evidence, urgent-start PD may increase dialysate leak (1 RCT, 122 participants: RR 3.90, 95% CI 1.56 to 9.78) compared with conventional-start PD which translated into an absolute number of 210 more leaks per 1000 (95% CI 40 to 635). In very low certainty evidence, it is uncertain whether urgent-start PD increases catheter blockage (4 cohort studies, 1214 participants: RR 1.33, 95% CI 0.40 to 4.43; 2 case-control studies, 160 participants: RR 1.89, 95% CI 0.58 to 6.13), catheter malposition (6 cohort studies, 1353 participants: RR 1.63, 95% CI 0.80 to 3.32; 1 case-control study, 104 participants: RR 3.00, 95% CI 0.64 to 13.96), and PD dialysate flow problems (3 cohort studies, 937 participants: RR 1.44, 95% CI 0.34 to 6.14) compared to conventional-start PD. In very low certainty evidence, it is uncertain whether urgent-start PD increases exit-site infection (2 cohort studies, 337 participants: RR 1.43, 95% CI 0.24 to 8.61; 1 case-control study, 104 participants RR 1.20, 95% CI 0.41 to 3.50), exit-site bleeding (1 RCT, 122 participants: RR 0.70, 95% CI 0.03 to 16.81; 1 cohort study, 27 participants: RR 1.58, 95% CI 0.07 to 35.32), peritonitis (7 cohort studies, 1497 participants: RR 1.00, 95% CI 0.68 to 1.46; 2 case-control studies, participants: RR 1.09, 95% CI 0.12 to 9.51), catheter readjustment (2 cohort studies, 739 participants: RR 1.27, 95% CI 0.40 to 4.02), or reduces technique survival (1 RCT, 122 participants: RR 1.09, 95% CI 1.00 to 1.20; 8 cohort studies, 1668 participants: RR 0.90, 95% CI 0.76 to 1.07; 2 case-control studies, 160 participants: RR 0.92, 95% CI 0.79 to 1.06). In very low certainty evidence, it is uncertain whether urgent-start PD compared with conventional-start PD increased death (any cause) (1 RCT, 122 participants: RR 1.49, 95% CI 0.87 to 2.53; 7 cohort studies, 1509 participants: RR 1.89, 95% CI 1.07 to 3.3; 1 case-control study, 104 participants: RR 0.90, 95% CI 0.27 to 3.02; very low certainty evidence). None of the included studies reported on tunnel tract infection. In patients with CKD who require dialysis urgently without ready-to-use dialysis access in place, urgent-start PD may increase the risk of dialysate leak and has uncertain effects on catheter blockage, malposition or readjustment, PD dialysate flow problems, infectious complications, exit-site bleeding, technique survival, and patient survival compared with conventional-start PD.

Does Prior Abdominal Surgery Influence Peritoneal Transport Characteristics or Technique Survival of Peritoneal Dialysis Patients?

Introduction: Prior abdominal surgery may result in peritoneal membrane adhesions and fibrosis, compromising the success of peritoneal dialysis (PD). The impact of this factor on peritoneal membrane function and PD technique survival has not been adequately investigated. Methods: Following an observational, retrospective design, we studied 171 incident PD patients, with the main objective of analyzing the influence of prior abdominal surgical procedures (main study variable) on baseline and evolutionary peritoneal transport characteristics (main outcome) and PD patient and technique survival (secondary outcomes). Abdominal surgeries were categorized according to the degree of presumed injury to the peritoneal membrane. We also considered the additive effect of aggressions to the membrane during the first year on PD therapy. Results: All patients had a baseline peritoneal equilibration test with complete drainage at 60′, and 113 patients had a second study at the end of the first year. Sixty-one patients (35.7%) had a record of prior abdominal surgery, including 29 patients with at least one major intraperitoneal surgery, 22 having undergone minor intraperitoneal procedures, and 21 with a background of major abdominopelvic extraperitoneal surgery. We did not observe differences, at baseline or after 1 year, among patients with or without previous abdominal procedures regarding small solute transport, overall capacity of ultrafiltration, free water transport, small pore ultrafiltration, or peritoneal protein excretion. Stratified analysis, considering prior and first-year-on-PD peritoneal aggressions, did not reveal any differences, although in this case our analysis was hampered by a limited statistical power. Abdominal surgical events did not influence patient or PD technique survival. Conclusion: Prior abdominal surgical procedures do not appear to compromise peritoneal membrane function or technique survival in patients successfully started on PD.

The negative impact of depressive symptoms on patient and technique survival in peritoneal dialysis: a prospective cohort study.

The relationship between depression and long-term clinical outcomes in peritoneal dialysis is unclear. This study was to explore the effect of depressive symptoms on patient survival and technique survival in continuous ambulatory peritoneal dialysis (CAPD) patients. Patients who had received CAPD therapy for ≥ 3months were recruited from January to June, 2009, with follow-up until June, 2019. The Beck Depression Inventory-II (BDI-II) was used to evaluate depressive symptoms (BDI scores ≥ 14) at baseline. The primary outcome was all-cause mortality, and the secondary outcome was technique failure. Participants were 275 CAPD patients (mean age 49.6 ± 15.9years, male 54.2%). Of these, 86 (31.3%) experienced depressive symptoms. The depressive group had fewer males, longer PD duration at enrollment, higher calcium levels, and lower residual glomerular filtration rates (all P < 0.05) than the non-depressive group. Long-term patient survival (P = 0.037) and technique survival (P = 0.003) were significantly poorer in depressive group than in non-depressive group. After adjustment for confounders in multivariate Cox proportional hazard regression models, depressive symptoms remained independent predictors of mortality risk [hazard ratio (HR) 1.60, 95% confidence interval (CI) 1.03-2.48; P = 0.035] and technique failure (HR 1.92, 95% CI 1.07-3.47; P = 0.029). The prevalence of patients with depressive symptoms was 31.3% in this cohort. The patient survival rate and technique survival rate in depressive group were lower than in non-depressive group. Depressive symptoms were independent risk factors for long-term mortality and technique failure in CAPD patients.