Peritoneal Dialysis Technique Research Articles

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

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

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.

Unusual and complicated peritonitis: Your questions answered.

Effective treatment of infections is a growing challenge owing to antimicrobial resistance. Peritoneal dialysis (PD) patients experience more frequent hospitalisations than the general population and have greater exposure to antibiotics, making them particularly vulnerable to this threat. Over the last decade, we have noted a surge in cases of complicated peritoneal dialysis-associated peritonitis (PD peritonitis) caused by antimicrobial-resistant organisms, including extended-spectrum beta-lactamase (ESBL), AmpC beta-lactamase-producing Enterobacterales, Pseudomonas aeruginosa and fungi. Practitioners must be alert to these organisms, seek early recognition of these resistance patterns and make timely adjustments in order to avoid delay in treatment that may increase risk of PD catheter removal and technique failure. We present a case of successful treatment of ESBL peritonitis, highlight its challenges, while providing guidance on management of other unusual and complicated PD peritonitis.

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.

Educational interventions and identification of risk factors to prevent and reduce peritonitis in peritoneal dialysis: A scoping review.

Peritonitis is a common and serious complication of peritoneal dialysis and is one of the main causes of peritoneal dialysis technique failure and long-term hemodialysis conversion. The aim of the review was to identify and clarify peritonitis risk factors and learn about strategies employed at international level to prevent and reduce the occurrence of peritoneal dialysis associated infections and their complications. A scoping review. Adults in pertitoneal dialysis. The methodology framework of Arksey and O'Malley and PRISMA for Scoping Reviews guidelines were applied. A search was conducted of PubMed, Scopus and CINAHL using terms to identify peritoneal dialysis -associated risk factors and interventions carried out for the prevention and reduction of peritonitis in adult persons living at home. The 17 studies selected were based on work carried out in nine different countries. Eleven articles analysed modifiable risk factors (low educational level, being a foreigner and low adherence to aseptic technique) and non-modifiable risk factors (age and comorbidities) that predispose to peritonitis in peritoneal dialysis. The other six studies applied an intervention to improve the prevalence of peritonitis considering educational practices adapted to patient characteristics and the application of retraining. Personalised patient training and the identification of risk factors for peritonitis are key to reducing complications and enhancing the survival of peritoneal dialysis patients and the effectiveness of the technique.

The Peritoneal Dialysis Surprise Question and Technique Survival: Are you surprised?

The Peritoneal Dialysis Surprise Question and Technique Survival: Are you surprised?

Medication Management with Antihypertensive Agents and Associations with Peritoneal Dialysis Technique Failure in a Large, Retrospective Incident Cohort

Medication Management with Antihypertensive Agents and Associations with Peritoneal Dialysis Technique Failure in a Large, Retrospective Incident Cohort

Surgical aspects of peritoneal dialysis

Modern replacement kidney therapy belongs to a life-saving type of medical aid and includes dialysis and kidney transplantation. In the worlds nephrological practice integrated approach is preferable: the treatment starts with peritoneal dialysis as the most physiological method and later kidney transplantation or hemodialysis. Well-functioning peritoneal access is a key factor of successful peritoneal dialysis. Studies have shown that peritoneal dialysis, compared with hemodialysis, especially when performed in a dialysis center (not at home), has some clinical advantages. In particular, this treatment better preserves residual kidney function, better corrects anemia, avoids the need for vascular access, which in turn reduces the risk of access-related infectious complications, which in turn are the main cause of hospitalization and mortality among patients with end-stage renal disease. This review is focused on catheters for peritoneal dialysis access and methods of their placement. Malpractice of implantation technique can lead to unwanted consequences ranging from cuff extrusion and catheter migration to total loss of the latter. Following implantation technique by surgeons helps to avoid malpractice and improve the results. Implantation of a peritoneal catheter is an important component of peritoneal dialysis, which determines the quality of treatment, the development of non-infectious and infectious complications of peritoneal dialysis, and the duration of peritoneal dialysis therapy. A number of methods for implanting peritoneal catheters have been proposed in the world. All of them have the right to exist, each has its own advantages and disadvantages. When choosing a method, the surgeon is guided by the objective data of the patient, the patients ability to endure more invasive interventions (duration, anesthesia, volume of surgery), the capabilities of the surgical department, experience and qualifications. Expansion of indications for the use of the peritoneal dialysis technique, its complications, as well as concomitant diseases should determine the optimal method for implanting a peritoneal dialysis catheter for a given patient. It should be noted that to date, sufficient data have not been obtained on the effect of the method of peritoneal catheter implantation on the expansion of indications for peritoneal dialysis, the incidence of complications, and the need for additional surgical interventions.

Implementation of artificial intelligence Chatbot in peritoneal dialysis nursing care: Experience from a Taiwan medical center.

Coronavirus disease pandemic makes high requirements in delivering remote and efficient communication, and patient education. Because of the increases of digital and social media applications in Taiwan, we aim to apply Artificial Intelligence of LINE Chatbot to improve the self-care ability of patients undergoing peritoneal dialysis. We conducted the project since 1 May 2021 to 30 April 2022. We designed an automatically replied Chatbot system, and divided into six scopes of interaction interfaces, including peritoneal dialysis technique operation video, clinical reminder, home caring, hospital registration service, dietary guideline, and Automatic Peritoneal dialysis guidance. We surveyed patients' satisfaction with the LINE Chatbot 3 months later by the Likert 1-5 score-based questionnaire and the higher score indicated higher satisfaction. There were 440 patients who joined the PD AI Chatbot study and use the Chatbot, but the satisfaction questionnaire recovery rate was only 297 patients. We found that 91.7% of participants agreed 'Overall satisfaction with patient intelligent Chatbot application'. More than 4 points accounted for 86.6%. We traced every click in each section of the Chatbot and explored the potential scenario patients face. The Chatbot statistically significant reduced infection rate of exit site and tunnel infection before using (p = .049 and .024). Furthermore, peritonitis rate decreased from 0.93 to 0.8/100 patient month after using Artificial Intelligence technique. Peritoneal dialysis Artificial Intelligence Chatbot had similar effect with face-to-face education. The innovative Chatbot allowed delivering remote and digital information's to improve patients' self-care ability. Peritoneal dialysis patients were highly recognized and satisfied with the tools. It deserves to further explore the long-term impact of Artificial Intelligence Chatbot in peritoneal dialysis care.

The influence of different peritoneal dialysis techniques on wound infection in patients with peritoneal dialysis tube.

More and more research has started to investigate the effect of peritoneal dialysis treatment on the incidence of pericatheter wound complications in chronic kidney disease (CKD). This meta-study evaluated the effect of emergency peritoneal dialysis (EPD) with conventional peritoneal dialysis (CPD) in patients with catheter-related complications. We looked up 4 databases: PubMed, EMBASE, Cochrane, and Web of Science, and analysed the data with RevMan 5. There were a total of 15 studies with 3034 participants. While the quality of the research included was fairly good, the evidence was mediocre. In the meta-analyses, the risk of leak in the conduit with PD was very high (OR, 2.48; 95% CI, 1.72, 3.59, p < 0.00001). However, for those treated with urgent medical method prior to initiation of PD, the risk for peritonitis, catheter dysfunction and bleeding was similar compared with CPD. Based on limited information, immediate initiation of PDs is advised in order to increase the quality of life for people in urgent need, except if there is no consideration for loss of fluid. The low quality of the evidence is holding up the evidence. This research, however, is also informative because of the large number of available data. Consequently, additional high quality, large, randomized controlled studies are required to establish.

Impact of peritoneal dialysis strategy on technique and patient survival.

The aim of this study was to evaluate the impact of peritoneal dialysis (PD) strategy on technique and patient survival. This was a retrospective, single-center study conducted on consecutive patients with chronic kidney disease who underwent PD between January 2009 and December 2019. The study sample was stratified into four different groups according to PD technique [automated (APD) or manual (CAPD)] and icodextrin use (yes versus no). The primary endpoints were survival of both technique and patient. A total of 531 patients were included in the analysis. Mean±standard deviation age was 60.6±14.6 years, 68.4% (363) were men and 34.8% (185) had diabetes. The median technique survival time was 19 (15) months. A total of 185 (34.8%), 96 (18.1%), 99 (18.7%) and 151 (28.4%) patients were included in the CAPD/No-Icodextrin, CAPD/Icodextrin, APD/No-Icodextrin and APD/Icodextrin study groups, respectively. Throughout the study, 180 (33.9%) patients underwent renal transplant, 71 (13.4%) were changed to hemodialysis and 151 (28.4%) died. Age [hazard ratio (HR) 0.975, 95% confidence interval (CI) 0.960-0.990, P=.001] and incidence of early peritoneal infection (HR 2.440, 95% CI 1.453-4.098, P=.001) were associated with technique survival, while age (HR 1.029, 95% CI 1.013-1.045, P<.001), Charlson Index (HR 1.192, 95% CI 1.097-1.295, P<0.001), use of icodextrin (HR 0.421, 95% CI 0.247-0.710, P<.001) and APD/Icodextrin (HR 0.499, 95% CI 0.322-0.803, P=.005) were associated with patient survival. Icodextrin use and APD/Icodextrin had a positive impact on patient survival, while older age and higher Charlson Index had a negative one. Age and incidence of early peritoneal infection significantly impacted on technique survival.

#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.

#4202 FLUID OVERLOAD AT THE BEGINNING OF PERITONEAL DIALYSIS: A CROSS-SECTIONAL STUDY TO DETERMINE ITS ASSOCIATION WITH SERUM BIOMARKERS

Abstract Background and Aims Volume management in peritoneal dialysis (PD) patients is of major importance as fluid overload has been associated with cardiovascular and non-cardiovascular morbidity and mortality. Clinical examination itself has a poor diagnostic accuracy for minor deviations from normohydration, highlighting the need of additional tools. The aim of this study was to evaluate the association between serum biomarkers (CA-125 and NT-proBNP) and volume status, evaluated by clinical and bioimpedance analysis, at the initiation of PD technique. Method Single-center cross-sectional study including PD patients that started technique between 2017 and 2022. Demographic and clinical data were collected from the electronic records. Parameters evaluated were clinical examination, serum biomarkers, bioimpedance and dialysis adequacy. Results A total of 79 patients (51 male) were included with a mean age of 57±15 years. All of them started with CAPD and 52% were under icodextrin. Hypertension, cardiovascular disease and diabetes were present in 94%, 51% and 34%, respectively. The great majority were under renin-angiotensin-aldosterone system inhibitors (91%), beta-blockers (48%) and diuretic therapy (94%). Baseline PET showed that 77% were high or high-average transporters. Mean weekly Kt/V was 2.4±15. The mean residual renal function (RRF) and residual diuresis were 6.7±15 mL/min/1.73 m2 and 1.6±0.8 L (4% anuric), respectively, and 11% had ultrafiltration failure. Median nPCR was 0.9 g/Kg/day (IQR 0.3). Median NT-proBNP and CA-125 were 1337 pg/mL (IQR 3401) and 14.6 U/mL (IQR 17.6), respectively. NT-proBNP was positively associated with overhydration (OH &amp;gt;2 L) (r = 0.31; p = 0.009), CA-125 (r = 0.28; p = 0.01) and icodextrin use (p = 0.002). It was negatively associated with weekly Kt/V (r = -0.35; p = 0.003), RRF (r = -0.36; p = 0.002), ultrafiltration test (UFT) (r = -0.35; p = 0.003) and nPCR (r = -0.28; p = 0.001). CA-125 was positively associated with higher overhydration (OH &amp;gt; 3.6 L), D/P creatinine (r = 0.3; p = 0.004) and icodextrin use (p = 0.001). It was negatively associated with weekly Kt/V (r = -0.3; p = 0.01), UFT (r = -0.25; p = 0.03) and nPCR (r = -0.23; p = 0.04). NT-proBNP was still associated with overhydration in a multivariable analysis, adjusted to diabetes, icodextrin use, RRF and CA-125 (p = 0.024). Conclusion Serum NT-proBNP and CA-125 seem to be good markers of overhydration at PD baseline. They were also associated with worse dialytic efficacy and ultrafiltration, lower residual renal function and an early need of icodextrin use. Malnourished patients were associated with higher NT-proBNP and CA-125. Early and effective management of hydration may improve clinical outcomes, allowing personalized dialysis prescription and nutritional support.

#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.

Laparoscopic peritoneal dialysis catheter insertion: an oasis harnessed-experience and results at a tertiary care centre in India.

Peritoneal dialysis is a life sustaining renal replacement therapy for patients with end stage renal disease. In comparison to hemodialysis it offers better mobility and independence to patients. A number of techniques including open, laparoscopic and fluoroscopy guided, and their modifications, have been described for intraperitoneal catheter insertion. We describe our technique and results of laparoscopic peritoneal dialysis (PD) catheter insertion at a tertiary care centre in India. 48 patients were referred from the department of nephrology at our centre for laparoscopic PD catheter insertion. A two port technique was used in 37 patients and three port technique was implemented in the rest for simultaneous adhesiolysis and/or omentectomy. A straight tip catheter was tunneled through the rectus muscle in all patients. Two patients had incisional hernia from a previous abdominal surgery which was repaired concomitantly with onlay meshplasty. The operative time ranged between 20 and 35min under general anaesthesia. Three patients were subjected to urgent start dialysis of which one patient developed peridrain leak as an early complication which was managed conservatively. All other patients were commenced on peritoneal dialysis two weeks after surgery. There was no other surgical site occurrence or episodes of peritonitis reported in a 6month follow up period with the department of nephrology. In the era of minimal access surgery, the laparoscopic approach is feasible for widespread and safe use for PD catheter insertion. The benefits of PD can thus be made available to patients at civil hospitals even with a basic laparoscopy setup.

Association between gut microbial diversity and technique failure in peritoneal dialysis patients

Background Gut dysbiosis in peritoneal dialysis (PD) patients causes chronic inflammation and metabolic disorders which result in a series of complications, probably playing an important role in PD technique failure. The reduction in gut microbial diversity was a common feature of gut dysbiosis. The objective was to explore the relationship between gut microbial diversity and technique failure in PD patients. Methods The gut microbiota was analyzed by 16s ribosomal RNA gene amplicon sequencing. Cox proportional hazards models were used to identify association between gut microbial diversity and technique failure in PD patients. Results In this study, a total of 101 PD patients were enrolled. During a median follow-up of 38 months, we found that lower diversity was independently associated with a higher risk of technique failure (hazard ratio [HR], 2.682; 95% confidence interval [CI], 1.319–5.456; p = 0.006). In addition, older age (HR, 1.034; 95% CI, 1.005–1.063; p = 0.020) and the history of diabetes (HR, 5.547; 95% CI, 2.218–13.876; p < 0.001) were also independent predictors for technique failure of PD patients. The prediction model constructed on the basis of three independent risk factors above performed well in predicting technique failure at 36 and 48 months (36 months: area under the curve [AUC] = 0.861; 95% CI, 0.836–0.886; 48 months: AUC = 0.815; 95% CI, 0.774–0.857). Conclusion Gut microbial diversity was independently correlated with technique failure in PD patients, and some specific microbial taxa may serve as a potential therapeutic target for decreasing PD technique failure.

Gravity-assisted continuous flow peritoneal dialysis technique use in acute kidney injury in children: a randomized, crossover clinical trial.

Our previously demonstrated continuous flow peritoneal dialysis (CFPD) technique in children with acute kidney injury (AKI), although effective, was manpower heavy and expensive due to the high-volume pumps required. The aim of this study was to develop and test a novel gravity-driven CFPD technique in children using readily available, inexpensive equipment and to compare this technique to conventional PD. After development and initial in vitro testing, a randomised crossover clinical trial was conducted in 15 children with AKI requiring dialysis. Patients received both conventional PD and CFPD sequentially, in random order. Primary outcomes were measures of feasibility, clearance and ultrafiltration (UF). Secondary outcomes were complications and mass transfer coefficients (MTC). Paired t-tests were used to compare PD and CFPD outcomes. Median (range) age and weight of participants were 6.0 (0.2-14) months and 5.8 (2.3-14.0) kg, respectively. The CFPD system was easily and rapidly assembled. There were no serious adverse events attributed to CFPD. Mean ± SD UF was significantly higher on CFPD compared to conventional PD (4.3 ± 3.15 ml/kg/h vs. 1.04 ± 1.72 ml/kg/h; p < 0.001). Clearances for urea, creatinine and phosphate for children on CFPD were 9.9 ± 3.10 ml/min/1.73m2, 7.9 ± 3.3 ml/min/1.73m2 and 5.5 ± 1.5 ml/min/1.73m2 compared to conventional PD with values of 4.3 ± 1.68 ml/min/1.73m2, 3.57 ± 1.3 ml/min/1.73m2 and 2.53 ± 0.85 ml/min/1.73m2, respectively (all p < 0.001). Gravity-assisted CFPD appears to be a feasible and effective way to augment ultrafiltration and clearances in children with AKI. It can be assembled from readily available non-expensive equipment. A higher resolution version of the Graphical abstract is available as Supplementary information.

Value of an Integrated Home Dialysis Model in the United Kingdom: A Cost-Effectiveness Analysis

ObjectivesThis study aimed to determine the lifetime cost-effectiveness of increasing home hemodialysis as a treatment option for patients experiencing peritoneal dialysis technique failure compared with the current standard of care. MethodsA Markov model was developed to assess the lifetime costs, quality-adjusted life-years, and cost-effectiveness of increasing the usage an integrated home dialysis model compared with the current patient pathways in the United Kingdom. A secondary analysis was conducted including only the cost difference in treatments, minimizing the impact of the high cost of dialysis during life-years gained. Sensitivity and scenario analyses were performed, including analyses from a societal rather than a National Health Service perspective. ResultsThe base-case probabilistic analysis was associated with incremental costs of £3413 and a quality-adjusted life-year of 0.09, resulting in an incremental cost-effectiveness ratio of £36 341. The secondary analysis found the integrated home dialysis model to be dominant. Conclusions on cost-effectiveness did not change under the societal perspective in either analysis. ConclusionsThe base-case analysis found that an integrated home dialysis model compared with current patient pathways is likely not cost-effective. These results were primarily driven by the high baseline costs of dialysis during life-years gained by patients receiving home hemodialysis. When excluding baseline dialysis-related treatment costs, the integrated home dialysis model was dominant. New strategies in kidney care patient pathway management should be explored because, under the assumption that dialysis should be funded, the results provide cost-effectiveness evidence for an integrated home dialysis model.