Peritoneal Dialysis Treatment Research Articles

INFLUENCE OF SECONDARY HYPERPARATHYROIDISM ON THE CALCIFICATION OF HEART VALVES IN PATIENTS WITH CHRONIC KIDNEY DISEASE VD STAGE

The aim of this work was to study the relationship of elevated levels of parathyroid hormone (PTH) with cardiovascular changes (calcification of the heart valves) and to identify possible risk factors of calcification in the group of patients receiving renal replacement therapy.
 Materials and methods. The study included 96 patients with ESRD: 1-st group receives the treatment of peritoneal dialysis (PD) (45 patients), 2-nd group haemodialysis (HD) (51 patients). In serum determined concentration of calcium, phosphorus, PTH. All patients underwent echocardiographic examination.
 Results. The prevalence of secondary hyperparathyroidism in PD-patients reached 72%, in HD-patients 83%. Calcification of heart valves in both groups occurred in patients with high PTH level (greater than 400 PG/ml). Patients in both groups were significantly more frequent in the combined mitrale-aortic calcification. Isolated mitral calcification was detected more often aortic. Predictors of progression of calcification of heart valves in patients on PD is the age, in patients on HD - level average BP and the duration of dialysis therapy.
 Conclusions. Echocardiological data and clinical and laboratory examination of patients with ESRD allowed us to estimate the prevalence and structure of mitrale-aortic calcification and its relationship with secondary hyperparathyroidism.

PERITONEAL DIALYSIS TECHNIQUE SURVIVAL: A SINGLE-CENTER EXPERIENCE ANALYSIS OF THE PERITONEAL DIALYSIS TREATMENT IN A SINGLE CENTER

The aim of the study was to evaluate retrospectively the survival of the peritoneal dialysis (PD) technique survival and identify the factors that affect it.
 Patients and methods. A total of 38 patients with end-stage renal disease treated with PD from 2005 to May 2017 have been included in retrospective, study (average age 49.6 ± 5.6). Data were collected from medical records.
 Results. The average survival rate of the PD method in our center was 53.3 ± 7.4 months, and in patients with nondiabetic kidney disease it was significantly higher. During the follow-up only 11/38 (28.9 %) patients continue treatment of PD, 12/38 (31.6 %) were changed to HD, 4/38 (10.6 %) patients kidney transplantation was performed and 11/38 %) died. The main reason of the letal cases was cardiovascular complications (36.6 %). The patient mortality was significantly depended on the diuresis volume and the level of GFR at the time of PD initiation.
 Conclusions. PD technique survival in our center correlate with the results of the PD treatment patients worldwide.

DYSLIPIDEMIA AS A FACTOR FOR PROGRESSION OF RENAL OSTEODYSTROPHY AND CORONARY HEART DISEASE IN PATIENTS WITH CHRONIC KIDNEY DISEASE ON PERITONEAL DIALYSIS

Numerous studies of the last years focused on various links of pathogenesis and factors for progression of coronary heart disease (CHD) and chronic kidney disease (CKD) allowed to find intersection, such as progression of atherosclerosis or phosphorus and calcium and lipid imbalance, which lead to vascular calcareous infiltration, development of renal osteodystrophy and rising of cardiac risks.
 Purpose of the research: To define indicators of lipid exchange in patients on peritoneal dialysis which can be factors for progression of renal osteodystrophy and ischemic heart disease.
 Materials and methods. Indicators of lipid exchange, various types of renal osteodystrophy and clinical types of ischemic heart disease in 114 patients receiving peritoneal dialysis therapy in the Regional Clinical Center of Urology and Nephrology of V.I.Shapoval were analysed.
 Results. Having analysed changes in blood lipid profile of patients on peritoneal dialysis (PD), we found out a reliable growth of high-density lipoproteins (HDL) in a group of patients without signs of ischemic heart disease and in a group of patients having stable angina, whose primary types of renal osteodystrophy were osteoporosis and fibrous ostitis. Reliable differences had also very-low-density lipoproteins (VLDL) which also were the highest in a group of patients having stable angina without signs of cardiac decompensation. The average duration of PD treatment of patients of this group was 12,3 months.
 Conclusion. The results of the research confirmed that calcareous infiltration of vessels and heart valves on early stages of PD therapy is mainly caused by dyslipidemia and atherosclerotic changes and less by phosphorus and calcium imbalance which importance increases with duration of PD treatment.

The effect of dialysis type on left atrial functions in patients with end-stage renal failure: A propensity score-matched analysis.

Despite the widespread use of both hemodialysis (HD) and peritoneal dialysis (PD), there is no study comparing the effects of these dialysis methods on the left atrial (LA) volume and functions. In this study, we investigated the impact of different dialysis methods on the LA volume and function in the patients exposed to chronic pressure overload and volume overload. This study was carried out on the patients who received dialysis treatment at our healthcare center between March, 2015 and January, 2016. Twenty-eight patients receiving hemodialysis (HD) treatment and 24 patients under PD treatment were enrolled into the study. Patients were divided into 2 groups according to the dialysis therapy, and the atrial volumetric and mechanical functions were investigated. As the basal demographical characteristics of patients in the PD and HD groups were significantly different, 44 patients matched on a 1:1 basis were taken for final analysis (22 HD, 22 PD, and the average age of 42.4±4.8; 73% was male). After propensity score matching analysis, it was determined that left atrial volume index (LAVi) was higher in the HD group while peak LA strain and LA contraction strain were higher in the PD group. Additionally, both strain parameters showed a good negative correlation with LAVi. We demonstrated that the left atrial structure and functions were better in the PD group suggesting that PD may be a relatively better option for the preservation and maintenance of the left atrial functions as compared to HD.

Successful peritoneal dialysis using a percutaneous tube for peritoneal drainage in an extremely low birth weight infant: a case report

BackgroundPeritoneal dialysis (PD) for acute kidney injury (AKI) of newborns has been performed safely. AKI occurs in 8 to 24% of extremely low birth weight (ELBW) infants. Although PD has only been used occasionally in ELBW infants, prognosis is poor for ELBW infants with AKI. Several reports have described successful PD in these infants, but no guideline-based evidence concerning indications for renal replacement therapy in ELBW infants are currently available. Here, we report on our experience with PD in an ELBW infant with AKI resulting from septic shock.Case presentationA male was born at 24 weeks and 3 days gestation weighing 264 g by emergency cesarean section due to complications of pregnancy in a patient with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. On day of life (DOL) 15, the inability to ventilate, along with cardiovascular dysfunction, acute kidney injury, and ascites under tension led to the tentative diagnosis of abdominal compartment syndrome (ACS). On DOL 17, placement of a percutaneous drainage tube immediately released compression of the tense abdomen. Although intra-abdominal pressure reduction with percutaneous drainage temporarily improved respiratory status, circulatory impairment persisted and infections were not well controlled. Finally, the patient developed anuria. On DOL 21, peritoneal dialysis (PD) was started by initially inserting a drainage tube. Although the patient had catheter-associated peritonitis, urine output improved by DOL 44 and PD was discontinued on DOL 53. On DOL 75, extubation was conducted without circulatory dysfunction. The patient was discharged on DOL 224.ConclusionsWe emphasize that starting PD treatment before the onset of anuria is important in ELBW infants with AKI. Although the catheter used in our case was initially inserted for drainage of ascites, this type of catheter is sufficiently useful for PD in ELBW infants, and PD using a drainage tube may represent a safe, effective, and minimally invasive treatment for ELBW infants. To our knowledge, this is the first report to describe the use of a percutaneous tube to conduct successful PD for peritoneal drainage in an ELBW infant. This is the lowest-weight ELBW infant with successful PD reported to date.

Clinical observation of umbilical cord mesenchymal stem cell transplantation for treating patients receiving peritoneal dialysis.

This study aims to observe the outcome and safety of umbilical cord-mesenchymal stem cell (UC-MSC) treatment for continuous ambulatory peritoneal dialysis (CAPD) patients. A total of 24 CAPD patients, who underwent UC-MSC treatment from June 2011 to December 2012, were selected for this study. These patients were followed up until June 2015. Results revealed a significant increase in hemoglobin, erythropoietin and albumin levels, a decrease in C-reactive protein levels, and marked improvement in cystatin C and urine volume within three months after UC-MSC transplantation; and the difference was statistically significant (P<0.05). However, the difference in residual glomerular filtration rate, serum creatinine, peritoneal KT/V and remnant kidney KT/V was not statistically significant (P>0.05). Clinical indicators of patients with CAPD can be partially improved through UC-MSC treatment.

PD VS HD in Post-Economic Crisis Greece—Differences in Patient Characteristics and Estimation of Therapy Cost

The aim of this study was to investigate patient characteristics and make an estimation of the cost of peritoneal dialysis (PD) and hemodialysis (HD) to Greek society during the economic crisis. We recorded the characteristics and the total cost of dialysis treatment in 100 patients on PD and 100 on HD. Total costs included dialysis procedure, consumables, drugs, laboratory tests, food, and transportation fees (only HD), covered by patients' insurance. Also included were medical and administrative salaries, purchase and maintenance of equipment and sanitary material, all covered by the state hospital. The mean patient age was 64.5 ± 16.8 years (PD) and 62.8 ± 15.1 (HD) (p < 0,001). The most common cause of end-stage renal disease (ESRD) was diabetes (32% for PD and 24% for HD patients). A total of 35% of the PD patients were employed vs 4% of the HD patients (p < 0,001). The mean distance from home for PD patients was 41.6 ± 17.3 km, while for HD patients, it was 9.4 ± 1.5 km (p < 0,001). Mean monthly cost for PD and HD treatment per patient was €4,019.20 ± 1,126.30 and €3,254.30 ± 37.50, respectively, both fully covered by patients' insurance. Mean monthly cost for PD or HD dialysis unit maintenance was €11,660.80 and €56,270.50, respectively, also fully covered by the state. There is likely to be a considerable difference in terms of total cost of PD vs HD therapy, owing to the fact that the operational cost of a PD unit appears to be significantly lower than that of a HD unit.

Significance of new membrane formation in peritoneal biopsies of peritoneal dialysis patients: a case\u2013control study

BackgroundNewly formed membrane (NFM) on the peritoneal membrane proper is a unique pathological hallmark of encapsulating peritoneal sclerosis (EPS), but its definition and diagnostic significance have not been well described. This study investigated the pathological features of NFM in EPS and prevalence of NFM in peritoneal biopsy at catheter removal.MethodsThis multicenter retrospective, observational study was conducted by the Japanese Society of Peritoneal Dialysis and enrolled ten patients with and 52 without EPS at peritoneal biopsy during enterolysis surgery or catheter removal. All patients were treated using conventional, acidic peritoneal dialysis (PD) solutions. Thirty of the 52 non-EPS patients perform peritoneal lavage once daily after completing PD to prevent the development of EPS and 22 discontinued PD without lavage. NFM was defined as additional membrane structure on the peritoneum that is properly characterized by exudative or fibrous matrices and fibroblast-like cells. Immunostaining of fibrin and podoplanin was performed for the evaluation of NFM.ResultsNFM was confirmed histologically in eight of the ten patients with EPS. It was also detected in 13 of the 30 patients (43.3%) in the post-PD lavage group and in one of the 22 patients (4.5%) in the non-lavage group. The NFM histology showed various stages of EPS pathology, from early exudative changes with fibrin deposition (stage I; n = 5), progressing to proliferative and fibrosing changes with podoplanin-positive fibroblast-like cells (stage II; n = 9), and finally resulting in adhesive and fibrous scar formation (stage III; n = 8). Immunostaining of fibrin and podoplanin was helpful for evaluating the stage of the NFM.ConclusionsNFM contributes the encapsulation of intestines and is a pathological hallmark of EPS, but can be detected microscopically in patients without EPS, especially those with peritoneal lavage after PD. New membrane formation starts insidiously in peritoneal membrane damaged by PD treatment, but does not necessarily lead to the development of EPS.

In Memoriam of Henry Tenckhoff

In Memoriam of Henry Tenckhoff

Relationship between trajectories of serum albumin levels and technique failure according to diabetic status in peritoneal dialysis patients: A joint modeling approach

BackgroundIn peritoneal dialysis, technique failure is an important metric to be considered. This study was performed in order to identify the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure on end-stage renal disease patients according to diabetic status. Furthermore, this study was performed to reveal predictors of serum albumin and technique failure simultaneously.MethodsThis retrospective cohort study included 300 (189 non-diabetic and 111 diabetic) end-stage renal disease patients on continuous ambulatory peritoneal dialysis treated in Al-Zahra Hospital, Isfahan, Iran, from May 2005 to March 2015. Bayesian joint modeling was carried out in order to determine the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure in the patients according to diabetic status. Death from all causes was considered as a competing risk.ResultsUsing joint modeling approach, a relationship between trajectories of serum albumin with hazard of transfer to hemodialysis was estimated as −0.720 (95% confidence interval [CI], −0.971 to −0.472) for diabetic and −0.784 (95% CI, −0.963 to −0.587) for non-diabetic patients. From our findings it was showed that predictors of low serum albumin over time were time on peritoneal dialysis for diabetic patients and increase in age and time on peritoneal dialysis, history of previous hemodialysis, and lower body mass index in non-diabetic patients.ConclusionThe results of current study showed that controlling serum albumin over time in non-diabetic and diabetic patients undergoing continuous ambulatory peritoneal dialysis treatment can decrease risk of adverse outcomes during the peritoneal dialysis period.

Osteoprotegerin Is the Strongest Predictor for Progression of Arterial Calcification in Peritoneal Dialysis Patients

Background: Arterial calcification (AC) is frequent in patients with end stage renal disease and is also considered a risk factor for later morbidity and mortality. However, long-term factors associated with the process are not well known. We analyzed the trends over time of biomarkers related with development and progression of AC in incident patients on peritoneal dialysis (PD). Methods: We performed a prospective study with 186 patients on PD followed up for 1 year. We analyzed the progression of AC in the abdominal aorta and pelvic vessels by calcification score (CaSc), using16-cut computerized multidetector tomography at baseline and 1 year. Variables related with PD treatment, inflammation, and mineral metabolism were measured at baseline, 6, and 12 months of follow-up. Changes in biochemical variables were analyzed for their relationship with changes in AC. Results: Over 1 year, the number of patients with AC increased from 47 to 56%, and CaSc from 355 (interquartile range [IQR] 75-792) to 529 (IQR 185-1632). A total of 43.5% of patients remained free of calcification, 11.7% had new calcifications, and 44.8% had progression of calcification. Older age, diabetes, high systolic blood pressure, body mass index, cholesterol, and osteoprotegerin (OPG), as well as lower levels of albumin, serum creatinine, and osteocalcin, were associated with development of new, and rapid progression of, calcification. In multivariate logistic analysis, OPG remained the most significant (OR 1.27, 95% CI 1.11-1.47, p < 0.001). Conclusion: OPG was the strongest risk factor associated with new development and rapid progression of AC in incident PD patients.

THE ASSOCIATION OF DYSLIPIDEMIA WITH INTRAPERITONEAL INFLAMMATION AND PERITONEAL DIALYSIS TECHNIQUE SURVIVAL

The aim of the study was to determine the relationship between the dyslipidemia, intraperitoneal inflammation and peritoneal dialysis (PD) survival.&#x0D; Patients and methods. A total of 40patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis (PD) have been included in a prospective, observational study (average age was 49.3 ± 12.7). All patients were determined the blood lipid spectrum and IL-10, TNF-a, MCP-1 levels in peritoneal dialysis effluent (PDE). PD adequacy indicators evaluated by determining the concentration of urea and creatinine in plasma, urine and dialysate, calculated weekly creatinine clearance (CrCl), dialysis (Kt/ Vd), renal (Kt/ Vr) and total weekly urea clearance (Kt/ V).&#x0D; Results. Dyslipidemia defined as increase of atherogenic lipoprotein fractions and inhibition ofHDL cholesterol was identified in 70% of the PD-patients. LDL cholesterol level and, accordingly, an atherogenic index (AI) were significantly dependent on the duration of PD treatment (R2 = 2.18 ± 0.15 (95% CI 1.87, 2.5), p &lt; 0,0001 and R2 = 2.77 ± 0.27(95% CI 2.2, 3.3), p &lt; 0,0001). The blood levels of total cholesterol, LDL-C and TG in the patients with diabetes were significantly higher compared with the diabetes-free patients (p = 0.007, p = 0.001 andp = 0.02, respectively).&#x0D; Reducing the HDL cholesterol level was associated with high intraperitoneal production of pro-inflammatory mediators TNF-a (r = - 0.53;p = 0.001) and anti-inflammatory IL-10 (r = - 0.783;p &lt;0.0001), whereas hypertriglyceridemia and high VLDL cholesterol are associated with an increase of MCP-1 (r = 0.6;p = 0.0003 and r = 0.55;p = 0.002, respectively).&#x0D; The Cox proportional hazards regression analysis demonstrated the significant effect of VLDL cholesterol, LDL cholesterol and AI on the survival of PD technique survival (x2 = 24.8; p &lt; 0.0001). The results of the Kaplan–Meier analysis and log-rank test also identified that there was a significant difference in the cumulative technical survival rate between the patients with AI level &lt; 3.5 and &gt; 3.5 (log-rank test: x2 = 19.8, P = 0.001.&#x0D; Conclusions. Our results can be considered dyslipidemia in PD-patients not only as a traditional risk factor for CVD, but also as a predictor of chronic intraperitoneal inflammation and decrease of PD technical survival.

Characterization and proteomic profile of extracellular vesicles from peritoneal dialysis efflux.

Peritoneal Dialysis (PD) is considered the best option for a cost-effective mid-term dialysis in patients with Chronic Renal Failure. However, functional failure of the peritoneal membrane (PM) force many patients to stop PD treatment and start haemodialysis. Currently, PM functionality is monitored by the peritoneal equilibration test, a tedious technique that often show changes when the membrane damage is advanced. As in other pathologies, the identification and characterization of extracellular vesicles (EVs) in the peritoneal dialysis efflux (PDE) may represent a non-invasive alternative to identify biomarkers of membrane failure. Using size-exclusion chromatography, we isolated EVs from PDE in a group of patients. Vesicles were characterized by the presence of tetraspanin markers, nanoparticle tracking analysis profile, cryo-electron microscopy and mass spectrometry. Here, we report the isolation and characterization of PDE-EVs. Based on mass spectrometry, we have found a set of well-conserved proteins among patients. Interestingly, the peptide profile also revealed remarkable changes between newly enrolled and longer-treated PD patients. These results are the first step to the identification of PDE-EVs based new markers of PM damage, which could support clinicians in their decision-making in a non-invasive manner.

Psychosocial Factors Predict Nonadherence to PD Treatment: A Hong Kong Survey.

♦ BACKGROUND: Nonadherence to hand hygiene and aseptic regimen, dialysis environment guidelines, and catheter and exit-site care guidelines are risk factors of peritonitis. However, little is known about the psychosocial factors that account for the nonadherent behavior of patients undergoing peritoneal dialysis (PD). Applying the health belief model, this study seeks to enhance the understanding of psychosocial influences on patients' nonadherent behavior to the 3 regimen components. ♦ METHODS: Through referrals by 7 Hong Kong renal patient support groups, we surveyed patients undergoing PD treatment. ♦ RESULTS: A total of 244 Hong Kong PD patients completed the questionnaires. About 90% of the patients reported no deviation from catheter and exit-site care guidelines. However, the nonadherence rates of hand hygiene and aseptic regimen and of dialysis environment guidelines were 30.3% and 23%, respectively. Longer time on PD treatment and lower family monthly income were associated with nonadherence to dialysis environment guidelines. Employed patients tended toward nonadherence to catheter and exit-site care guidelines twice as much as unemployed patients. Of the 5 health beliefs, perceived benefits, perceived barriers, and efficacy belief were significant predictors of nonadherence to the 3 regimen components. ♦ CONCLUSIONS: The findings of this study inform the design of intervention to change patients' behavior in regimen nonadherence for preventing peritonitis. To identify the target audience for adherence intervention based on the 3 regimen components, the results suggest dividing patients into subgroups according to their sociodemographic background. To foster behavioral change, health communicators should address patients' health beliefs when formulating intervention strategies.

Sustained low peritoneal effluent CCL18 levels are associated with preservation of peritoneal membrane function in peritoneal dialysis.

Peritoneal membrane failure (PMF) and, ultimately, encapsulating peritoneal sclerosis (EPS) are the most serious peritoneal dialysis (PD) complications. Combining clinical and peritoneal transport data with the measurement of molecular biomarkers, such as the chemokine CCL18, would improve the complex diagnosis and management of PMF. We measured CCL18 levels in 43 patients’ effluent and serum at baseline and after 1, 2, and 3 years of PD treatment by retrospective longitudinal study, and evaluated their association with PMF/EPS development and peritoneal risk factors. To confirm the trends observed in the longitudinal study, a cross-sectional study was performed on 61 isolated samples from long-term (more than 3 years) patients treated with PD. We observed that the patients with no membrane dysfunction showed sustained low CCL18 levels in peritoneal effluent over time. An increase in CCL18 levels at any time was predictive of PMF development (final CCL18 increase over baseline, p = .014; and maximum CCL18 increase, p = .039). At year 3 of PD, CCL18 values in effluent under 3.15 ng/ml showed an 89.5% negative predictive value, and higher levels were associated with later PMF (odds ratio 4.3; 95% CI 0.90–20.89; p = .067). Moreover, CCL18 levels in effluent at year 3 of PD were independently associated with a risk of PMF development, adjusted for the classical (water and creatinine) peritoneal transport parameters. These trends were confirmed in a cross-sectional study of 61 long-term patients treated with PD. In conclusion, our study shows the diagnostic capacity of chemokine CCL18 levels in peritoneal effluent to predict PMF and suggests CCL18 as a new marker and mediator of this serious condition as well as a new potential therapeutic target.

Peritoneal Dialysis to Treat Patients with Acute Kidney Injury-The Saving Young Lives Experience in West Africa: Proceedings of the Saving Young Lives Session at the First International Conference of Dialysis in West Africa, Dakar, Senegal, December 2015.

In December 2015, as part of the First African Dialysis Conference organized in Dakar, Senegal, 5 physicians from West African countries who have participated in the Saving Young Lives Program reviewed their experiences establishing peritoneal dialysis (PD) programs to treat patients with acute kidney injury (AKI). Thus far, nearly 200 patients have received PD treatment in these countries. The interaction and discussion amongst the participants at the meeting was meaningful and informative. The presentations highlighted the creativity, conviction, and determination of the physicians in overcoming the various barriers and challenges they encountered to establish PD/AKI programs. Hopefully, these successes and the increased awareness of the importance of early diagnosis and treatment of AKI will inspire much needed support from government, hospital, and international organizations.

Dialysis access: issues related to conversion from peritoneal dialysis to hemodialysis and vice versa.

ABSTRACTHemodialysis (HD) and peritoneal dialysis (PD) represent two complementary modalities of renal replacement therapy (RRT) for end-stage renal disease patients. Conversion between the two modalities is frequent and more likely to happen from PD to HD. Every year, 10% of PD patients convert to HD, suggesting the need for recommendations on how to proceed with the creation of a vascular access in these patients. Criteria for selecting patients who would likely fail PD, and therefore take advantage of a backup access, are undefined. Creating backup fistulas at the time of PD treatment start to allow emergency access for HD has proved to be inefficient, but it may be considered in patients with progressive difficulty in achieving adequate depuration and/or peritoneal ultrafiltration. A big challenge is represented by patients switching from PD to HD for unexpected infectious complications. Those patients need to start HD with a central venous catheter (CVC), but an alternative approach might be using an early cannulation graft, provided that infection has been cleared by the circulation. An early cannulation graft might also be used to considerably shorten the time spent using a CVC. In patients who need a conversion from HD to PD, urgent-start PD is now an accepted and well-established approach.

Risk Factors Affecting Graft and Patient Survivals After Transplantation From Deceased Donors in a Developing Country: A Single-Center Experience

AimThe aim of this study was to evaluate risk factors affecting graft and patient survival after transplantation from deceased donors. MethodsWe retrospectively analyzed the outcomes of 186 transplantations from deceased donors performed at our center between 2006 and 2014. The recipients were divided into two groups: Group I (141 recipients without graft loss) and Group II (45 recipients with graft loss). Kaplan-Meier, log-rank test, and Cox proportional hazard regressions were used. ResultsThe characteristics of both groups were similar except renal resistive index at the last follow-ups. When graft survival and mortality at the first, third, and fifth years were analyzed, tacrolimus (Tac)-based regimens were superior to cyclosporine (CsA)-based regimens (P < .001). Risk factors associated with graft survival at the first year included cardiac cause of death (versus cerebrovascular accident [CVA]; hazard ratio [HR], 6.36; 95% confidence interval [CI], 1.84–22.05; P = .004), older transplant age (HR, 1.05; 95% CI, 1.02–1.08; P < .001), and high serum creatinine level at 6 months post-transplantation (HR, 1.74; 95% CI, 1.48–2.03; P < .001), whereas younger donor age decreased risk (HR, 0.97; 95% CI, 0.95–1.00; P = .019). Also, the Tac-based regimen had a 3.63-fold (95% CI, 1.47–8.97; P = .005) lower risk factor than the CsA-based regimen, and 2.93-fold (95% CI, 1.13–7.63; P = .027) than other regimens without calcineurin inhibitors. When graft survival at 3 years was analyzed, diabetes mellitus was lower than idiopathic causes and pyelonephritis (P = .035). In Cox regression analysis at year 3, older transplantation age (HR, 1.20; 95% CI, 1.04–1.39; P = .014) and serum creatinine level at month 6 post-transplantation (HR, 1.65; 95% CI, 1.42–1.90; P < .001) were significant risk factors for graft survival. Hemodialysis (HD) plus peritoneal dialysis (PD) treatment was 2.22-fold (95% CI, 1.08–4.58; P = .03) risk factor than only HD before transplantation. When graft survival and mortality at year 5 were analyzed, diabetes mellitus was lower compared with all other diseases. In Cox regression analysis at year 5, younger donor age (HR, 0.73; 95% CI, 0.62–0.86; P < .001) was protective for graft survival, whereas older transplantation age (HR, 1.40; 95% CI, 1.20–1.64; P < .001) and serum creatinine level at month 6 of post-transplantation (HR, 1.39; 95% CI, 1.19–1.61; P < .001) were significant risk factors. PD increased 3.32 (95% CI, 1.28–8.61; P = .014) times the risk than HD. In Cox regression analysis at year 1, cardiac cause of death (versus CVA; HR, 5.28; 95% CI, 1.37–20.31; P = .016), CsA-based regimen (versus Tac; HR, 4.95; 95% CI, 1.78–13.78; P = .002), HD plus PD treatment (versus alone HD; HR, 3.26; 95% CI, 1.28–8.30; P = .013), older transplantation age (HR, 1.08; 95% CI, 1.04–1.11; P < .001), serum creatinine level at month 6 post-transplantation (HR, 1.34; 95% CI, 1.11–1.62; P = .003), and low HLA mismatches (HR, 1.67; 95% CI 1.01–2.70; P = .044) were risk factors for mortality. At year 3, CsA-based regimen (versus Tac; HR, 3.54; 95% CI, 1.32–9.47; P = .012), PD (versus HD; HR, 5.04; 95% CI, 1.41–18.05; P = .013), HD plus PD treatment (versus alone HD; HR, 3.51; 95% CI, 1.37–9.04; P = .009), and older transplantation age (HR, 1.27; 95% CI 1.05–1.53; P = .015) were risk factors for mortality. At year 5, older age at transplantation (HR, 1.47; 95% CI, 1.23–1.77; P < .001), PD (versus HD; HR, 9.21; 95% CI, 3.09–27.45; P < .001), and CsA-based regimen (versus Tac; HR, 2.75; 95% CI, 1.04–7.23; P = .041) were risk factors for mortality, whereas younger donor age decreased risk (HR, 0.71; 95% CI, 0.56–0.86; P < .001). ConclusionDeath of donor with cardiac cause, CsA-based immunosuppressive regimen, donor age, serum creatinine level at month 6 post-transplantation, and renal replacement therapy before transplantation affected mortality and graft survival in deceased donors.

71: HEALTH RELATED QUALITY OF LIFE IN PATIENTS UNDERGOING HEMODIALYSIS OR PERITONEAL DIALYSIS TREATMENT

Background and aims:Modern societies include increasing proportions of elderly people, with a resulting increase in the incidence and duration of chronic illnesses. Quality of life (QOL) has recently been explored...

Bioimpedance and Fluid Status in Children and Adolescents Treated With Dialysis

Assessment of hydration status in patients with chronic kidney failure treated by dialysis is crucial for clinical management decisions. Dilution techniques are considered the gold standard for measurement of body fluid volumes, but they are unfit for day-to-day care. Multifrequency bioimpedance has been shown to be of help in clinical practice in adults and its use in children and adolescents has been advocated. We investigated whether application of multifrequency bioimpedance is appropriate for total-body water (TBW) and extracellular water (ECW) measurement in children and adolescents on dialysis therapy. A study of diagnostic test accuracy. 16 young dialysis patients (before a hemodialysis session or after peritoneal dialysis treatment) from the Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, and the Emma Children's Hospital-Academic Medical Center, Amsterdam, the Netherlands. TBW and ECW volumes assessed by multifrequency bioimpedance. TBW and ECW volumes measured by deuterium and bromide dilution, respectively. Mean TBW volumes determined by multifrequency bioimpedance and deuterium dilution were 19.2±8.7 (SD) and 19.3±8.3L, respectively; Bland-Altman analysis showed a mean bias between the 2 methods of-0.09 (95% limits of agreement,-2.1 to 1.9) L. Mean ECW volumes were 8.9±4.0 and 8.3±3.3L measured by multifrequency bioimpedance and bromide dilution, respectively; mean bias between the 2 ECW measurements was+0.6 (95% limits of agreement,-2.3 to 3.5). Participants ingested the deuterated water at home without direct supervision by investigators, small number of patients, repeated measurements in individual patients were not performed. Multifrequency bioimpedance measurements were unbiased but imprecise in comparison to dilution techniques. We conclude that multifrequency bioimpedance measurements cannot precisely estimate TBW and ECW in children receiving dialysis.