Peritoneal Dialysis Treatment Research Articles

Dynamics of peritoneal transport and cardiovascular outcomes of peritoneal dialysis treatment

BACKGROUND: Solute and water transport by peritoneal membrane has significant variation between patients; the function changes significantly over time. This affects treatment outcomes and requires individual approaches. AIM: To evaluate the influence of the baseline peritoneal transport state, its dynamics during peritoneal dialysis and the possibility of long-term outcomes modification. MATERIALS AND METHODS: The dynamics of peritoneal transport of solutes (in peritoneal equilibrium test, PET) and water (in mini-PET) was evaluated in a prospective interventional open-label study with historical control among 96 unselected consecutive patients admitted in three dialysis centers with unified program of peritoneal membrane monitoring and protection. RESULTS: Compared to the matched standard arm, the increase in peritoneal solute transport was significantly slower (by 9.5%) in the observation group. Ultrafiltration in classical PET decreased more slowly (by 28%). At baseline ultrafiltration was satisfactory (the proportion of the patients with ultrafiltration less 400 ml was 7.6%); water transport by small pores did not decrease (−1.1 ± 5.9 ml/year), and the decrease in total ultrafiltration (by 32.1 ± 8.2 ml/year) was due to a decrease in free water transport (by 29.9 ± 7.6 ml/year). Negative dynamics of free water transport was associated with total glucose load and with monthly glucose load greater than 2.68 kg/month. More than one case of peritonitis was associated with a more rapid decline in free water transport. The comorbidity increased in 34 of 96 patients, with median first/last scores of 5 (4–6) and 6 (4–7) points; (Wilcoxon Z = −5.423; p 0.001). When analyzed separately by peritoneal transport category, a significant worsening of the comorbidity index was observed only for high average and high transporters (Z = −2.754, p = 0.006 and Z = −3.357, p = 0.001, respectively). CONCLUSIONS: The interaction between peritoneal transport, primarily free water transport, and cardiovascular disease is certainly two-way: deterioration of water balance due to loss of effective ultrafiltration leads to volume overload and progression of cardiovascular disease. On the other hand, cardiovascular disease contributes to peritoneal membrane damage. The most sensitive monitoring of interventions effectiveness in membrane protection and preventing cardiovascular disease progression is the separate measuring of water transport through small pores and ultrapores, which simultaneously reveals a feature of progressive peritoneal fibrosis, a potential precursor of encapsulating peritoneal sclerosis.

Medication Regimen Complexity and Patient-Centred Outcomes in Patients Undergoing Peritoneal Dialysis.

Although patients undergoing peritoneal dialysis (PD) typically have complex treatment needs, the effect of medication regimen complexity on patient outcomes has not been thoroughly evaluated. This study aims to quantify medication regimen complexity and evaluate patient-centred outcomes including medication adherence and its determinants in patients undergoing PD. This study combined a retrospective audit of baseline data with a prospective evaluation of patient-related outcomes among patients undergoing PD at a large metropolitan dialysis centre in Australia. Medication regimen complexity was assessed using the 65-item Medication Regimen Complexity Index (MRCI), while patient outcomes were evaluated with validated self-reported questionnaires, including the 4-item Morisky-Green-Levine Scale (MGLS), EQ-5D-5L and EQ VAS. A total of 131 patients participated [median age 67 (IQR 57-74) years]. Patients on PD were found to have complex medication regimens with an average MRCI score of 28.6 ± 11.4. Over half of the participants were deemed to be adherent to their prescribed medications as measured by the MGLS (n = 79; 60.3%). Male participants were more likely to be non-adherent to medications compared to female participants (OR 2.465; 95% CI 1.055-5.759). Participants with higher serum phosphate levels were 2.5 times more likely to report non-adherence to their medications (OR 2.523; 95% CI 1.247-5.104), while a higher health-related quality of life (HRQoL) was associated with medication adherence (OR 0.151, 95% CI 0.031-0.732). Patients on PD are prescribed complex medication regimens in addition to PD treatments that they perform at home. Patients on PD who were adherent to their medications had significantly better outcomes in terms of HRQoL and serum phosphate levels compared to non-adherent patients.

Associations with Peritoneal Dialysis Treatment Failure in Young Adults: A Mixed-Methods Study

Associations with Peritoneal Dialysis Treatment Failure in Young Adults: A Mixed-Methods Study

Body Image and Sexual Life in Patients Receiving Peritoneal Dialysis Treatment: A Descriptive Study from Turkey

Body Image and Sexual Life in Patients Receiving Peritoneal Dialysis Treatment: A Descriptive Study from Turkey

SGLT-2 inhibitors in chronic peritoneal dialysis patients: a follow-up study

BackgroundSodium-glucose transporter-2 inhibitors (SGLT-2i) are recommended for use in patients with type 2 diabetes comorbid atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease. Limited reports are currently available for their use in dialysis patients. In an observational, retrospective follow-up study, we reported the clinical characteristics of chronic peritoneal dialysis (PD) patients on SGLT-2i.MethodsWe enrolled 50 diabetic chronic PD patients, and 11 continued SGLT-2i after PD treatment. We reported the patients’ ultrafiltration, HbA1c, urinary tract infection episodes, and venous CO2 during follow-up and compared the differences in these factors between patients with and without SGLT-2i.ResultsThe mean age of the patients was 65 ± 15 years, and 16 (32%) patients were female. The age, gender, heart failure, and primary kidney disease were not different between patients with and without SGLT-2i at enrollment. In an average of 31 months follow-up, patients with SGLT-2i had higher ultrafiltration (1322 ± 200 ml/day vs. 985 ± 415 ml/day, p = 0.013), hemoglobin (11.2 ± 1.7 vs. 10.2 ± 1.7 g/dl), white blood cell count (9.2 ± 3.7 vs. 7.4 ± 2.1 109/L), and a lower venous CO2 (p = 0.036). The urine amount, the overall survival, the technical survival, and the chance of UTI were not different between patients with and without SGLT2i.ConclusionSGLT-2i may increase ultrafiltration volume and hemoglobin levels in chronic PD patients. SGLT-2i did not increase urinary tract infection but was linked to subclinical metabolic acidosis.What was knownThe effect of SGLT-2i in chronic PD patients is not clear?This study addsSGLT-2i is associated with increased ultrafiltration, hemoglobin, white blood cell counts, and a decreased CO2 in PD patient.Potential impactSGLT-2i may increase ultrafiltration in PD patients.

Who decides on peritoneal dialysis treatment? A decision analysis for patients with kidney failure.

Peritoneal dialysis, a home-based treatment, enhances patient well-being but is less preferred in Taiwan. This study uses in-depth interviews and ranking surveys to examine the decision-making process of 25 patients (13 male, 12 female, aged 31-80) who initiated peritoneal dialysis. Findings reveal that physicians significantly influence dialysis choices, with their expertise and leadership being core factors. Patients' participation in decision-making is categorized as "active" or "passive" based on their knowledge and acceptance of treatments. Family members also play a crucial role in decisions for patients relying on familial care. Trust in physicians' recommendations is crucial, emphasizing the importance of a strong doctor-patient relationship and ongoing support to boost patient confidence in peritoneal dialysis.

The efficacy of sacubitril/valsartan in patients receiving peritoneal dialysis with diabetes and heart failure with preserved ejection fraction.

To investigate the efficacy of sacubitril/valsartan in the treatment of peritoneal dialysis (PD) in patients with diabetes and heart failure with preserved ejection fraction (HFpEF). Patients with diabetes who underwent PD and had HFpEF (n = 64) were divided into two groups: the experimental group (n = 31), which was administered sacubitril/valsartan, and the control group (n = 33), administered valsartan alone. Data were collected before and after treatment to compare the inter-group changes in cardiac function indexes, residual renal function (RRF), and PD adequacy indexes. Compared with the control group, the N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were lower in the experimental group after treatment (Wilcoxon test, p < 0.05). The descent ranges of NT-proBNP, left ventricular end-systolic dimension, and left ventricular fraction shortening, as well as increases in the amplitude of left ventricular ejection fraction after treatment were better in the experimental group than in the control group (t-test, p < 0.05). The descent ranges of residual renal glomerular filtration rate, residual renal Kt/Vurea, and residual renal creatinine clearance, as well as increases in the amplitude of β2-microglobulin, were lower in the experimental group than in the control group (Wilcoxon test, p < 0.05). However, there were no significant differences between the two groups in the descent ranges of the PD adequacy indexes (Wilcoxon test, p > 0.05). Hyperkalemia occurred in 8 cases (25.81%) in the experimental group and 13 cases (39.39%) in the control group, while hypotension occurred in 2 cases (6.45%) and 1 case (3.03%), respectively. No other adverse effects were observed in either group. The findings suggest that sacubitril/valsartan can safely and effectively improve RRF and cardiac function in patients with diabetes combined with HFpEF receiving PD, but it has little effect on PD adequacy.

Management of Chronic Heart Failure in Dialysis Patients: A Challenging but Rewarding Path.

Chronic heart failure (CHF) is a common complication and cause of death in dialysis patients. Although several clinical guidelines and expert consensus on heart failure (HF) in the general population have been issued in China and abroad, due to abnormal renal function or even no residual renal function (RRF) in dialysis patients, the high number of chronic complications, as well as the specificity, variability, and limitations of hemodialysis (HD) and peritoneal dialysis (PD) treatments, there are significant differences between dialysis patients and the general population in terms of the treatment and management of HF. The current studies are not relevant to all dialysis-combined HF populations, and there is an urgent need for high-quality studies on managing HF in dialysis patients to guide and standardize treatment. After reviewing the existing guidelines and literature, we focused on the staging and diagnosis of HF, management of risk factors, pharmacotherapy, and dialysis treatment in patients on dialysis. Based on evidence-based medicine and clinical trial data, this report reflects new perspectives and future trends in the diagnosis and treatment of HF in dialysis patients, which will further enhance the clinicians' understanding of HF in dialysis patients.

Assessment of the perceptions of health-related quality of life in Greek patients undergoing automated peritoneal dialysis with remote monitoring: A qualitative study.

This study aimed to explore in depth the lived experience and quality of life outcomes in patients receiving automated peritoneal dialysis (APD) treatment. The study adhered to the standards of the Consolidated Criteria for Reporting Qualitative Research. A total of 19 APD patients were recruited and assessed using in-depth semi-structured interviews on various aspects of life with respect to APD modality. The interviews were transcribed verbatim and analyzed using Interpretive Phenomenological Analysis. Study findings generated five superordinate themes: (a) treatment-free daily routine, (b) sleep disturbances, (c) remote care, (d) limitations of peritoneal dialysis, and (e) the dimension of chronic disease. Further analysis of the material revealed the relationship of these themes with individual patient characteristics. Overall, our findings suggest that APD characteristics contribute to the perceptions of quality of life in patients under dialysis considerably.

Description and outcomes of a staff-assisted peritoneal dialysis program in the United States.

Staff-assisted peritoneal dialysis (PD) can help overcome barriers to self-care but is not yet available in the United States (US). We developed and implemented a staff-assisted PD program that fits within current regulatory and cost restraints in the US healthcare environment. Patient care technicians (PCTs) were trained on PD procedures and troubleshooting common problems. The program expanded from two centers in August 2020 to sixteen by October 2022. We described the logistic elements of program delivery, and patient and treatment outcomes for patients discharged by end of April 2023, with a cohort follow up until October 2023. A total of 121 patients were referred to the program. The most common indications for referral were physical function limitations, cognitive impairment, and psychosocial challenges. Staff assistance was provided for 73 patients. Mean age was 72 (standard deviation 14) years. A total of 604 visits were delivered, with a median 5 (interquartile range [IQR] 3-10, range: 1-49) visits per patient. Median duration of assistance was 8 (IQR: 2-21, range: 1-84) days. Assistance was most frequently needed for PD treatment setup and for observing and directing the technique. No peritonitis events or exit-site infections were reported. Sixty-eight patients (93%) were discharged on PD without staff assistance. The 6- and 12-month survival of PD without assistance was 71% and 57%, respectively. Staff-assisted PD for limited time periods is operationally feasible with PCTs in the US and can support transitioning and maintaining patients on PD.ClinicalTrials.gov Identifier: NCT04319185.

#2241 Validation of a new formula for total body water in peritoneal dialysis patients

Abstract Background and Aims Peritoneal dialysis (PD) adequacy, assessed primarily by Kt/V, is crucial in routine clinical practice for detecting issues with PD treatment. This metric relies on urea levels and its volume (V) distribution, classically equivalent to total body water (TBW). TBW estimation, commonly achieved through the Watson and Watson (WW) formula, lacks dialysis patients in its original study, it also excluded patients with water metabolism disturbances, raising concerns about its generalizability to this population. Responding to this need, a new formula (NF) for calculating TBW in PD patients was developed in our center, with the aim of improving the correlation between administered Kt/V and clinical outcomes. Consequently, this study seeks to validate the proposed formula by applying it to a population. Method A prospective study conducted at a single center within PD program involved the collection of data on adequacy and Body Composition Monitoring (BCM) spanning from May 2023 to January 2024. TBW was calculated using the WW formula and the proposed new formula (TBW BI=0.36*Height+0.241*weight−9.675*BSA−26.234 for man and TBW BI=0.36*Height+0.241*weight−9.675*BSA−28.926 for woman). Categorical variables are presented as frequencies and percentages, continuous variables as means and standard deviations, or medians and interquartile ranges for variables with skewed distributions. A p-value &amp;lt; 0.05 was considered significant. Both formulas were subjected to correlation analysis with BCM TBW to assess mean differences using a paired-samples T test. Additionally, the resulting Kt/V values were compared, along with an examination of concordance in the detection of Kt/V values below 1.7. Results 66 measurements were collected from 36 PD patients. 29.2% (n = 10) were female, and the mean age was 59.7 years. Both formulas exhibited strong correlations with BCM TBW (WW: ρ = 0.949 and NF: ρ = 0.953, p &amp;lt; 0.001). BCM TBW showed a significant difference from WW TBW (34.8 vs. 38.1 liters, p &amp;lt; 0.001), but not when compared to the new formula (34.8 vs. 33.9, p = 0.06). The resulting BCM-derived Kt/V significantly differed from both formulas, with a larger mean difference compared to the WW formula (BCM: 2.71 vs. WW: 2.42, p &amp;lt; 0.001, and vs. the new formula: 2.77, p = 0.04). There was a perfect association between the use of NF and identification of BCM derived KtV measurements under the 1.7 target (Phi = 1, p &amp;lt; 0.001), an association that was strong for WW (Phi = 0.69, p &amp;lt; 0.001). Conclusion Errors in quantifying PD adequacy can lead to delayed detection of technical issues or inappropriate adjustments to already adequate prescriptions. We present a novel formula, specific for the PD population, reducing errors in PD quantification, particularly in settings where BCM is not available.

#546 Decline of kidney function before and after start of peritoneal dialysis (PD)

Abstract Background and Aims Residual kidney function (RKF) is a key component for PD adequacy and associated with improved volume status, nutrition and quality of life as well as with increased survival. The aim of the present study was to compare decline of kidney function before and after start of PD. Method We studied patients starting PD (during 2000-2019) in an ongoing prospective study of patients starting dialysis. Study inclusion in almost all PD patients coincided with PD catheter insertion. Patients were included in the present analysis if they had at least one urinary collection before, and one after PD initiation (a), PD initiation less than six months after study inclusion (b) and &amp;gt; 6 months PD treatment (c). P-creatinine to calculate eGFR was retrospectively collected for 12 months before start of PD. During a large part of the study period, it was a clinical routine to collect 24-hour urine collections regularly in CKD5 patients, and these data were retrieved when available. After start of PD, regular 24-hour urine collections were part of the clinical routine to follow up and were retrieved for up to 12 months after PD start. eGFR was measured using the CKD-epi 2021 equation and GFR was calculated as the average of urinary creatinine and urea clearance corrected for BSA. The decline of eGFR before start of PD, the decline of GFR from 24-hour urine collections and the decline of GFR after start of PD were compared to each other. Results We studied 138 patients starting PD. The mean age was 55 ± SD13 years, and there were 80 males and 58 females. The mean blood pressure was 153 ± SD21/89 ± SD11 mmHg and BMI was 25 ± SD4 kg/m2. The etiologies of end stage kidney disease were nephrosclerosis 17%, diabetic nephropathy 22%, glomerulonephritis 25%, polycystic kidney disease 14% and other 22%. The GFR at PD start was 8.5 ± SD 2.3 mL/min/1,73 m² and eGFR was 5.8 ± SD 1.9 mL/min/1,73 m². The results show a significantly slower kidney function decline rate after start of PD, with an average of −0.59 mL/min/1,73 m²/month before PD initiation compared to −0.34 mL/min/1,73 m²/month after. Conclusion Decline of GFR was slower after start of PD suggesting that earlier initiation of dialysis may be beneficial for the preservation of RKF. Notably, there was a marked attenuation after 3 months of dialysis. Furthermore, the decline rate of GFR before PD start was similar using eGFR or GFR from 24-h urine collection, though for eGFR at somewhat lower levels. However, there were pronounced differences between those two methods in individual patients demonstrating that eGFR is unreliable with very low GFR. Further study will be performed to analyze what factors that are associated with better preservation of RKF.

#2234 A new formula for total body water in peritoneal dialysis patients

Abstract Background and Aims Peritoneal dialysis (PD) adequacy, assessed primarily by Kt/V, is crucial in routine clinical practice for detecting issues with PD treatment. This metric relies on urea levels and its volume (V) distribution, classically equivalent to total body water (TBW). TBW estimation, commonly achieved through the Watson and Watson (WW) formula, lacks dialysis patients in its original study, it also excluded patients with water metabolism disturbances, raising concerns about its generalizability to this population. Despite limitations, WW has been widely used in trials assessing optimal dialysis dosage in the PD population. Body composition monitoring (BCM) with bioimpedance (BI) offers a more reliable method for TBW determination, commonly used in dialysis programs for quantifying overhydration. However, its higher cost and limited availability compared to estimate formulas pose challenges. Thereby, this study aims to compare TBW values derived from the WW formula and BCM analysis with BI. Additionally, intends to create a new, patient-specific TBW formula based on biometric measurements for PD. Method We retrospectively analyzed adequacy measurements and BCM data from a Portuguese PD center. Patient information included age, sex, height, weight, and BCM-TBW and Percentage Body Fat (PBF). Derived parameters encompassed WW-derived TBW, Body Surface Area (BSA) via the DuBois formula and Body Mass Index (BMI). Statistical analysis, using Microsoft Excel 2017 and IBM SPSS version 25, with a p-value&amp;lt;0.05 considered significant, followed by a step-wise approach: Results 400 measurements were collected from 90 chronic PD patients. 25.1% (n = 23) were female (101 measurements), with a mean age of 56.2 ± 11.9 years. Mean weight was 74.0 ± 12.5 kg, BMI 26.4 ± 4.1 and BSA 1.80 ± 0.80. BCM TBW obtained was significantly lower compared to WW-TBW (33.7 and 38.4 litters respectively, mean difference −4.65 ± 4.17, P &amp;lt; .001). This difference correlated positively with increased PBF (ρ = 0.73, P &amp;lt; .001). BCM TBW correlated positively with weight, height, BMI and BSA (ρ = 0.62, ρ = 0.68, ρ = 0.28 and ρ = 0.62, respectively, with P &amp;lt; .001 overall), without correlation with age (ρ = 0.0, P = .99). For linear regression analysis, the first step was to exclude outlier values for BCM TBW using median ± 1.5 x interquartile range resulting in 383 measurements comprised between 22.15 and 44.95 L. A multiple linear regression using BSA, height, weight and sex to predict BCM TBW. The overall regression model was statistically significant (R2 = 0.59, F (4 378) = 138.17, P &amp;lt; .001). All the variables significantly contributed to the model at predicting BCM TBW (BSA: β = −0.283, P &amp;lt; .001; Height: β = 0.495, P &amp;lt; .001; Weight: β = 0.56, P &amp;lt; .001; Sex: β = 0.237, P &amp;lt; .001). Two formulas were extrapolated from this regression: Conclusion We present a pivotal formula for TBW calculation in PD patients, aiming to improve the correlation between provided Kt/V and clinical outcomes. This addresses the exclusion of diverse patient characteristics in previous studies. However, given the new evidence challenging the association between Kt/V and clinical outcomes in PD, it becomes imperative to appropriate measures for PD adequacy and subject them to examination in novel randomized clinical trials.

#2573 Effect of pre-transplant dialysis modalities on delayed graft function

Abstract Background and Aims Kidney transplantation represents the optimal treatment for end-stage renal disease patients. Benefits and disadvantages of different pre-transplant dialysis modalities and the effects on post-transplant outcomes remain unclear, but many authors identify peritoneal dialysis (PD) such a “bridge” versus renal transplantation. Method We analyze a consecutive series of 249 renal transplanted patients (mean age 48 ± 11 years, 67% males) between June 1998 and February 2016 with a low prevalence of comorbidities (diabetes 2%, hypertension 31%, previous cardiovascular events 2%). The median follow-up was 136 months [interquartile range (IR) 91-197 months]. The pre-transplant treatment was hemodialysis (HD) in 215 patients (86%) and peritoneal dialysis (PD) in the remaining 34 patients (14%). The majority of patients received a cadaveric donor organ (219 patients, 88%). Results Delayed Graft Function (DGF) was registered in 151 patients (61%). Analyzing pre-transplant dialysis treatment, 15 patients about 34 (44%) on pre-transplant PD had DGF vs 136/215 (63%) on pre-transplant HD treatment (P = 0.03). Remarkable PD patients were older (48 ± 12 years) than HD patients (44 ± 11 years), but this difference did not rise statistical significance (P = 0.09); similarly the prevalence of living donors were higher (13%) in the group of HD patients respect the group of PD patients (9%, P = 0.53). In a longitudinal analysis the last estimated Glomerular Filtration Rate (eGFR) was lower in patients with DGF (44, IR 19-66 ml/min/1,73 m2) vs patients without DGF (48, IR 35-73 ml/min/1,73 m2, P = 0.04), but no substantial differences was noted at the end of observation in eGFR between the two groups of patients (HD, eGFR 45, IR 25-68 ml/min/1,73 m2 vs PD eGFR 46, IR 24-67 ml/min/1,73 m2). Conclusion Results of this study confirm that PD treatment can be considered an optimal “bridge” for renal transplantation probably because peculiar characteristic of this dialysis modality (such us long term preserved diuresis and residual renal function respect HD patients) impacts positively on recovery of renal function. Further study need to clarify these controversial points.

#1454 Usefulness of the clinical frailty scale in Dutch patients with end-stage kidney disease

Abstract Background and Aims Frailty is common in end-stage kidney disease (ESKD) patients which may benefit from advance care planning. Currently there are multiple frailty screening instruments available, of which the Frailty Index is commonly used to estimate frailty in ESKD patients. The Clinical Frailty Scale is a less time consuming alternative to estimate frailty. We aimed to investigate the performance of the Clinical Frailty Scale as a screening tool for frailty in an ESKD population. Method A cross-sectional observational study was performed at Kidney Centre Apeldoorn. Included patients received haemodialysis, peritoneal dialysis, pre-dialysis care, or conservative treatment. Frailty was assessed with both the Frailty Index and the Clinical Frailty Scale. The Frailty Index consisted of 38 components considering activities of daily living, physical aspects, psychosocial factors, comorbidities, and functional tests. The functional tests included grip strength, walking speed, and cognitive functioning measured by the Mini Mental State Examination. The Frailty Index was calculated by dividing the number of deficits by the total number of components measured. A patient with a Frailty Index ≥0.25 was considered frail. The Clinical Frailty Scale consisted of nine classes varying from very fit to terminally ill. Patients who scored 4 on the Clinical Frailty Scale were considered vulnerable. Patients with a score ≥5 were considered frail. Nephrologists not familiar with the Clinical Frailty Scale were asked to complete the Clinical Frailty Scale after medical consultation. The sensitivity, specificity and area under the curve (AUC) of the Clinical Frailty Scale were determined. The Frailty Index was used as the golden standard. Results In total, 144 patients were included of whom 60 (41.7%) were frail according to the Frailty Index. The mean age was 67.4 years (SD±13.5) and 56 (38.9%) were female. Overall, 72 patients (50.0%) were treated by haemodialysis, 13 (9.0%) by peritoneal dialysis, 6 (4.2%) received conservative treatment, and 53 (36.8%) were pre-dialysis patients. According to the Frailty Index, 55.6% of the haemodialysis patients were frail compared to 20.8% of the pre-dialysis patients. The Clinical Frailty Scale identified 37 (25.7%) patients as frail and 17 (11.8%) patients as vulnerable. The cut-off point of the Clinical Frailty Scale for vulnerable (≥4) had a sensitivity of 63.3%, a specificity of 81.0%, and AUC of 0.72. The cut-off point of the Clinical Frailty Scale for frail (≥5) had a sensitivity of 50.0%, a specificity of 91.7%, and AUC of 0.71. Conclusion Prevalence of frailty was high in patients with ESKD. Although the Clinical Frailty Scale is a quick and easy tool for the identification of frailty in ESKD patients, the sensitivity of the Clinical Frailty Scale was too low to implement it in daily clinical practice. Sensitivity might be increased by training of nephrologists in using the Clinical Frailty Scale.

#2784 Deep learning algorithm predicts individual ultrafiltration trajectories for patients on automated peritoneal dialysis 12 weeks ahead

Abstract Background and Aims Adequate small solute clearance and ultrafiltration (UF) are the main requirements for fluid and salt homeostasis on peritoneal dialysis (PD). New automated peritoneal dialysis (APD) systems that allow remote patient monitoring in terms of PD treatment analysis have the potential to improve clinical outcomes. UF on APD although dependent on PD prescription, i.e. fill volumes and glucose concentration, exhibits substantial intra- and interindividual variation, even day-by-day. As conventional statistical methods are not able to assess these complex non-linear relationships adequately, we aimed to build a deep learning algorithm to predict ultrafiltration trajectories of individual patients 12 weeks ahead. Method Data on daily UF and PD prescriptions (i.e., glucose concentration, fill volumes) was extracted from the APD cycler management software (PD Link, Baxter, IL, USA) and patient charts at the Medical University of Vienna, for a secondary analysis of this cohort. The Keras high-level API for TensorFlow in R software (R Core Team 2023) was used to create a Long Short-Term Memory (LSTM) recurrent neural network based on historic prescription and gcUF data of 26 weeks (after the first 90 days of APD) to predict individual UF trajectories for the following 12 weeks. Results APD machine readouts from a total of 123 patients, with a mean time on PD of 117 (±73) days, were retrieved. The final recurrent neural network consisted of four LSTM layers with 64 cells each, sigmoid activation. The final model was fit using 30 epochs, 49 steps per epoch, and recurrent dropout to avoid overfitting. A 40-40-20% data split was used to train, validate, and test the model adequately. This deep learning algorithm was able to predict individual UF values, for each day of the upcoming 12 weeks, with an accuracy of at mean 201ml. Upon visual inspection, predicted individual UF trajectories smoothly resemble the overall day-by-day trajectory of the patient but fail to account for extreme spikes in either direction. Conclusion In conclusion, historic daily APD cycler and prescription data in coalescence with respective daily measurements of membrane function (i.e., gcUF) can be used to predict individual daily ultrafiltration values and trajectories of APD patients 12 weeks ahead using a deep learning algorithm. Therefore, continuous collection of PD prescription data and UF measurements may be used to monitor peritoneal membrane function of patients on APD and alert clinical teams upon detection of relevant changes of UF trajectories already 12 weeks ahead to facilitate early intervention. In contrast to current “screening” methods on PD, i.e., Peritoneal Equilibrium Test, these methods could reduce treatment burden.

#2519 Technical complications assessment of the novel SILENCIA© APD cycler

Abstract Background and Aims A new gravimetric peritoneal dialysis (PD) cycler, SILENCIA (Fresenius Medical Care, Bad Homburg, Germany), has been reported to achieve not only an adequate dialysis dose, but it is proposed also to be easy to use, cost-effective, and silent. In this study, we explored the alarms, cautions and number of terminated treatments due to potential errors and malfunctions of this new cycler. Method Over a period of 6 months, technical related device data was collected remotely, via a cloud-based infrastructure, including a Gateway and a Card Reader. The technical related data was then analyzed and visualized in a Dashboard. In special occasions, e.g., in case of device issues additional further technical data was collected on-site at patients’ home by a Service Technician. Results In total, 1860 technical related device data sets were collected in 3 different countries (Chile, Ecuador, and Turkey) from the treatments of 18 PD patients. 15 out of 32 patients were between 31 and 50 years old, and the mean PD duration was 2.14 years (n = 32). In total 9 alarms (5 per 1000 treatments) occurred, 5 being related to software bugs, 4 undetermined. 99.5% of the treatments were performed without alarms. In average, 5.3 cautions per 1000 treatments were observed, 94.7% due to blocked tubing system. Power failures only occurred in 4% of the treatments, with an average duration of 38.6 minutes. During power failures, the device does not wake up patients, proceeds as the power is back and treatment stays within schedule due to FlexPoint. A detailed list of alarms, cautions and power failures is presented in Table 1. Conclusion The results of this study demonstrate that SILENCIA supports PD treatment with a low number of alarms and cautions, which may help to achieve a smooth therapy for the patients, especially considering that the treatments are mainly performed during the night.

#2969 One-year longitudinal changes in nutritional parameters associated with low-protein diets in patients starting with incremental PD

Abstract Background and Aims Starting peritoneal dialysis (PD) with an incremental approach, that is, a low dose of PD (1-2 dwells a day in continuous ambulatory PD and until 5 sessions a week in automated PD) based on residual kidney function, is a common strategy to increase the acceptance of dialysis for patients affected by advanced chronic kidney disease (CKD) requiring renal replacement therapy. However, no study has provided evidence on the optimal protein intake in patients treated with a low dose of PD. Indeed, patients starting dialysis require an increased protein intake to supply protein loss by dialysis. On the other hand, patients beginning with a low dose of dialysis and a high protein intake may lead to toxins accumulation and metabolic acidosis. Therefore, the maintenance of protein restriction could be indicated as long as malnutrition does not occur. Method The I-COPE study was designed to assess in 24 PD units in Italy the time to full-dose PD in patients undergoing integrated conservative therapy with low-dose PD. Patients who reached full-dose, switched to hemodialysis, received transplant, or died were censored. No specific recommendation on protein intake was included in the study protocol due to the lack of guidelines on this issue, so the prescription was left to decision of each participating center. This is an ad-interim analysis of the I-COPE study aimed at evaluating the longitudinal changes at one year of BMI and serum albumin. Two groups of nutritional interventions were identified a posteriori: non-low protein diet (NLPD, dietary protein intake &amp;gt; 0.6 g/Kg/day) vs low protein diet (LPD, dietary protein intake ≤ 0.6 g/Kg/day) on two visits after baseline (months 6 and 12). We used a mixed linear regression model to evaluate changes in variables over time in the two diet groups, assuming an unstructured covariance matrix; this was done to consider the correlation between repeated measures and missing points for patients not completing the analysis. Results The I-COPE study included 222 patients (age 63.6 ± 14.2 ys, males 65.3%, diabetes 29.2%). LPD was prescribed in 46.3%, while NLPD in 53.7%. At baseline, no intergroup difference was reported for age (P = 0.51), gender (P = 0.94), and diabetes (P = 0.11). 150 patients had at least an evaluation after baseline. The mixed regression model showed no difference in BMI (P = 0.668) and serum albumin (P = 0.297) adjusted for age, gender, diabetes, and GFR at the start of dialysis. As depicted in Fig. 1, serum albumin level was maintained at 12 months in either group. Conclusion We provide first-time observation that LPD may be safely associated with stable serum albumin and BMI over one year of incremental PD treatment. Therefore, in patients with advanced CKD requiring renal replacement therapy, LPD combined with a low dose of PD may provide a suitable nutritional approach to reduce waste metabolic products without increasing the risk of malnutrition.

#1288 Bioinformatic analysis of phosphate transporters in peritoneal cells and tissues and phosphate transport kinetics in vitro

Abstract Background and Aims Hyperphosphatemia is frequent in peritoneal dialysis (PD) patients due to limited dialytic clearance, and significantly increases cardiovascular risk. Molecular mechanisms of phosphate removal across the peritoneal membrane remain unclear, PD specific in vitro models for phosphate transport and modulator studies are not established. Method Phosphate transporter expression was assessed by RNAseq in mesothelial cells (HPMC, MeT5A) and human venous and microvascular endothelial cells (HUVEC, HCMEC). Transcriptome profiles of microdissected omental arterioles from 10 children with normal kidney function (NKF), 15 with chronic kidney disease (CKD5), and 10 children on PD were analyzed for phosphate transporter expression. Specific phosphate transporter localization and abundance in parietal peritoneum membranes and in the cell lines were assessed by immunostaining. In Transwell system, a phosphate transport model across polarized monolayers was established. Cell viability and integrity were verified by MTT assay and transepithelial resistance measurement (TER). Results Out of nine identified phosphate transporters, PiT1 (SLC20A1) and PiT2 (SLC20A2) exhibited high expression in all four cell lines, while SLC34A2 was specific in HPMC and SLC34A3 in MeT5A. In human arterioles, four phosphate transporters, SLC34A1, PiT1, PiT2, and SLC17A1, were detected. Arteriolar PiT1 was two-fold more abundant in PD patients treated with low glucose degradation product (GDP) fluids compared to those with CKD5 and NKF. In parietal peritoneal membranes, PiT1 was abundant in mesothelial and endothelial cells, with no difference between children with NKF, CKD5 and low GDP PD treatment. Concentration and time dependent phosphate kinetics across polarized mesothelial cells were studied in Transwells. Upon increased phosphate concentration in medium (1 mM and 2 mM vs. 0.1 mM), cells didn´t show signs of impaired viability, reduced TER or junction dysregulation (ZO-1 abundance) for up to 12 h. Independent of the added phosphate concentration, 60% of expected equilibrium was achieved after 12 h. Addition of PFA (SLC20/34 sodium-phosphate cotransporter inhibitor) alone or in combination with Tenapanor (an NHE3 blocker inhibiting paracellular phosphate transport) reduced phosphate transport across mesothelial cells by 10% and 20%, respectively. Conclusion We describe phosphate transporter expression and localization in peritoneal cells, in arterioles and parietal peritoneal tissues, and the impact of CKD5 and PD. The Transwell system allowed for quantification of phosphate transport across cell barriers and demonstrated the role of peritoneal sodium-phosphate cotransporter and of the paracellular route for phosphate transport across the mesothelial cell barrier. Further, yet unknown phosphate transport mechanisms should be active.

Patient adherence to Continuous Ambulatory Peritoneal Dialysis treatment in a low-resource setting: An interventional study

Patient adherence to Continuous Ambulatory Peritoneal Dialysis treatment in a low-resource setting: An interventional study