Status In Peritoneal Dialysis Patients Research Articles

#2774 Association of serum CA-125 and lung ultrasound with other markers of volumen status in peritoneal dialysis patients

Abstract Background and Aims Volume overload (VO) represents the main risk factor for cardiovascular death in peritoneal dialysis (PD) patients. The lack of objective methods and validated markers constitutes the basis for the high prevalence, which is one of the main causes of technique failure. The use of lung ultrasound, VExUS score and serum CA-125 (SeCA-135), has emerged to assess volume in heart failure patients. In this pilot study, we explored the association of these novel approaches with classical markers of VO Method A cross-sectional cohort study was conducted on fourteen PD outpatients, in which volume status was simultaneously assessed through SeCA-125 levels along with standardized 28-site lung ultrasound, VExUS Score (excluding renal Doppler), NT-proBNP levels, and bioimpedance spectroscopy (BIS). Clinical and physical examination parameters were collected simultaneously, and echocardiographic measures were collected from the clinical history in the previous 6 months. The inclusion criteria were: patients over 18 years old, in a PD program for at least 6 months, with good adherence to the technique. The exclusion criteria were: cardiovascular event in the three months prior to the study initiation, active uncontrolled neoplastic disease, or active infection or intercurrent illness in the 2 months prior to evaluation. Because NT-ProBNP does not follow the normal distribution, we used the Ig transformation (LgNT-proBNP) in the statistical process. Results The mean age was 68.9 ± 14.9 years, with an average of 29.9 ± 19.61 months on dialysis, a mean residual diuresis of 1.22 ± 0.88 liters, and the mean weekly KT/V was 2.10 ± 0.63. 28.6% of the patients have Congestive Heart Failure, 57.1% have Diabetes Mellitus and 100% have hypertension. The patients had a mean Charlson Index of 5.7 ± 2.1 and were using an average of 2.4 ± 1.1 antihypertensive drugs. 28.6% of the patients presented dyspnea, 14.3% had pulmonary crackles, and 35.7% had peripheral edema. Mean ECW/TBW was 0.48 ± 0.02, and overhydration by BIS was 1.18 ± 1.46 L. The mean number of B-lines was 8.79 ± 6.43, Se-CA-125 was 20.42 ± 8.66 IU/mL, and NT-proBNP was 3950 (172-35,000) ng/L. SeCA125 was positively associated with left atrial volume (r = 0.823, p = 0.01), estimated PASP (r = 0.787, p = 0.03), LogNT-proBNP (r = 0.614, p = 0.02) and negatively correlated with TAPSE (r = −0.77, p = 0.05). Likewise, LogNT-proBNP was positively associated with CRP (r = 0.54, p = 0.05), and ECW/TBW ratio (r = 0.57, p = 0.03) and negatively correlated with albumin (r = −0.66, p = 0.01). There was no correlation between the number of B-lines and Se-CA-125 with the diameter or collapsibility of the IVC, pulsatility portal vein, or analysis of Doppler hepatic vein, VExUs grade, ECW/TBW ratio, NT-proBNP levels, renal residual function or the presence of edema or pulmonary crackles. Patients with overhydration by BIS (>7.5% OH/TBW) showed more B-lines (13 ± 6.32 vs. 5.57 ± 5.028 p = 0.04). Patients diagnosed as overloaded by B-lines (>5 lines) did not show a higher level of SeCA-125 (22.2 ± 9.50 vs 16 ± 4.16; p > 0.05), VCI diameter (1.6 ± 9.43 vs 2 ± 0.27; p > 0.05), OH/TBW ratio (8.4 ± 8.55 vs 2.55 ± 4.13; p > 0.05) or Log NT-proBNP (0.91 ± 0.76 vs 3.19 ± 0.91; p > 0.05). Conclusion The number of B-lines in lung ultrasound can detect patients with VO earlier compared to BIS. SeCA-125 levels are sensitive to changes in the echocardiogram. The use of both methods can help us detect early signs of volume overload in peritoneal dialysis patients.

Diabetes mellitus modifies the association between chronic kidney disease-mineral and bone disorder biomarkers and aortic stiffness in peritoneal dialysis patients.

This study aimed to investigate the relationship of four chronic kidney disease-mineral and bone disorder (CKD-MBD) biomarkers, including intact parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), soluble klotho, and fetuin-A, with aortic stiffness in peritoneal dialysis (PD) patients, comparing those with and without diabetes mellitus (DM). A total of 213 patients (mean age 58 ± 14years; 81 (38.0%) patients with DM) were enrolled. Their aortic pulse wave velocity (PWV) was measured using pressure applanation tonometry, while serum intact PTH, FGF23, α-klotho, and fetuin-A levels were measured using enzyme-linked immunosorbent assay. Overall, patients with DM had higher aortic PWV than those without (9.9 ± 1.8 vs. 8.6 ± 1.4m/s, p < 0.001). Among the four CKD-MBD biomarkers, FGF23 levels were significantly lower in DM group (462 [127-1790] vs. 1237 [251-3120] pg/mL, p = 0.028) and log-FGF23 independently predicted aortic PWV in DM group (β: 0.61, 95% confidence interval: 0.06-1.16, p = 0.029 in DM group; β: 0.10, 95% confidence interval: - 0.24-0.45, p = 0.546 in nonDM group; interaction p = 0.016). In conclusion, the association between FGF23 and aortic PWV was significantly modified by DM status in PD patients.

Quality of life and nutritional status in peritoneal dialysis patients: a cross-sectional study from Palestine

BackgroundEnd-stage renal disease (ESRD) is a growing cause of morbidity worldwide. Protein malnutrition is common among patients with ESRD. Peritoneal dialysis (PD) offers greater lifestyle flexibility and independence compared to the widely used treatments for ESRD. This study aimed to assess the nutritional status and the quality of life (QOL) of Palestinian patients undergoing PD, as well as the variables affecting these two outcomes.MethodsA cross-sectional study was conducted on patients receiving PD at An-Najah National University Hospital, Palestine. The malnutrition-inflammation scale (MIS) was used to measure malnutrition, and the QOL score was evaluated using the Dutch WHOQOL-OLD module. Univariate and multivariate linear regressions were performed to check the association between the QOL and MIS scores.ResultsThe study included 74 patients who were undergoing PD, with an average age of 50.5 ± 16.38. The majority of the patients were females. The study found a significant correlation between malnutrition and lower quality of life (QOL) scores, as measured by the WHOQOL-OLD questionnaire (p < 0.001). Furthermore, younger patients and those who had an occupation were more likely to report a good QOL (p = 0.01). Conversely, patients with pitting edema and diabetes were at higher risk of reporting a lower QOL (p < 0.001).ConclusionsGiven the elevated risk of malnutrition and diminished QOL among elderly patients, those with pitting edema, and individuals with diabetes, it is imperative to conduct thorough assessments for these groups. We strongly recommend that general practitioners, dietitians, and specialists collaborate to develop tailored programs and interventions to provide these patients with the focused care and attention they require.

Relationship between gut microbiota and nutritional status in patients on peritoneal dialysis

Malnutrition is a common complication in the dialysis population, both hemodialysis and peritoneal dialysis (PD). We report our exploratory study on the characteristics of intestinal microbiota and nutritional status in PD patients. The nutritional status of our PD patients were evaluated, and their feces were collected for 16S rRNA gene V3-V4 regions amplification and high-throughput sequencing. The characteristics and differences of microbiota between the well-nourished (W) and malnourished (M) groups were compared. We studied the genera and the operational taxonomic units (OTUs) within the genus of our patients, initially comparing the malnourished and the well- nourished groups and later on reanalyzing the whole group using these OTUs. At the OTU level, 6 bacteria were significantly correlated with the serum albumin level. The abundances of 2 OTUs (OTU208 Lachnospiraceae_incertae_sedi and OTU4 Bacteroides) were more in W group. Meanwhile, 4 OTUs (OTU225 Akkermansia, OTU87 Megasphaera, OTU31 Peptostreptococcaceae_incertae_sedi and OTU168 Clostridium_sensu_strictu) displayed higher abundance among individuals in M group. Notably, the OTU168 Clostridium_sensu_stricto was the only bacteria that significantly correlated with serum albumin (r = − 0.356, P = 0.05), pre-albumin (r = − 0.399, P = 0.02), and SGA (r = 0.458, P = 0.01). The higher the OTU168 Clostridium_sensu_strictu, the lower serum albumin and pre-albumin and a higher score of SGA signifying a worse nutritional status. Our preliminary findings suggested a relationship between the nutrition status and microbiota in PD patients. Our results provide a basis for further exploration of the interactions between malnutrition and intestinal flora in PD patients with potential interventions using probiotics and prebiotics.

Multifrequency bioimpedance by spectroscopy vs. routine methods in the management of hydration status in peritoneal dialysis patients: A randomized control trial.

BackgroundOverhydration (OH) is common in peritoneal dialysis (PD) and increases the cardiovascular risk. Multifrequency bioimpedance spectroscopy (BIS) has been proposed to estimate the hydration in dialysis. Our objective was to evaluate if BIS is superior than control based on clinical assessment plus single-frequency bioimpedance (SF-BIA) on the fluid control and intermediate cardiovascular outcomes.MethodsRandomized controlled study in adult PD patients, with a 9-month follow-up, allocated into two groups: control and BIS. Data were collected from medical records. SF-BIA and BIS, laboratory exams, ambulatory blood pressure monitoring, echocardiography (ECHO), and pulse wave velocity (PWV) were evaluated. The BIS data were available to the medical team only in BIS group.Results34 patients completed the study, 17 in each group. At the endpoint the BIS group had a significant (p < 0.05) greater proportion of patients with OH/extracellular water (OH/ECW%) ≤ 15% than the control (94.1% vs. 52.9%), and a lower OH mean (2.1 ± 1.6 vs. 0.9 ± 1.1 L). The control group has a significant increase in the tumor necrosis factor alpha median concentration from baseline to six [11.9 (6.0–24.1) vs. 44.7 (9.4–70.6) pg/ml] and 9 months [11.9 (6.0–24.1) vs. 39.4 (27.9–62.6) pg/ml], and in the N-terminal fragment of pro-B-type natriuretic peptide median [239 (171.5–360.5) vs. 356 (219–1,555) pg/ml]. For cardiovascular parameters, BIS group presented a significant reduction in radial PWV [7.7 (6.9–9.2) vs. 6.5 (5.5–8.4) m/s] at 9 month, while in the control presented a significant increase in mean central systolic blood pressure (BP) (106.8 ± 11.2 vs. 117.6 ± 16.5 mmHg) and in central diastolic BP (90.4 ± 9.8 vs. 103.3 ± 12.5 mmHg) at 9 months. The left ventricular mass (LVM)/body surface presented a significant reduction in the control (109.6 ± 30.8 vs. 101.2 ± 28.9 g/m2) and BIS group (107.7 ± 24.9 vs. 96.1 ± 27.0 g/m2) at 9 months.ConclusionThe results suggest BIS is superior than the clinical evaluation plus SF-BIA for the fluid control of PD patients.Clinical trial registration[https://www.ClinicalTrials.gov], identifier [RBR-10k8j3bx].

MO689: Relationship between Peritoneal/Renal Function and Nutritional Status in Peritoneal Dialysis Patients

Abstract BACKGROUND AND AIMS The positive impact of nutritional status on the health and treatment adequacy of peritoneal dialysis (PD) patients has been well established. There are several accepted strategies for stratifying malnutrition in PD, such as laboratory markers [serum albumin and normalized protein catabolic ratio (nPCR)] and the recent use of bioimpedance spectroscopy (BIS). The aim of this study was to assess the nutritional status of PD patients upon the start of the therapy. We also aimed to establish a potential relationship between peritoneal/renal function, obtained by a peritoneal equilibration test (PET), and nutritional markers. METHOD We studied a cohort of patients from a single PD unit between 1 July 2011 and 31 August 2021, who had one BIS measurement and a PET in the first 3 months after the beginning of PD. We also collect laboratory data within 6 months from the BIS reading (albumin, C-reactive protein and phosphorus). Demographic parameters (age, dialysis vintage, presence or absence of diabetes mellitus) and body mass index were also evaluated. RESULTS The study included 91 incident PD patients. The mean age of patients was 65.40 $ \pm $ 13.88 years, 59.3% were male and 28% had diabetes. Regarding baseline renal and peritoneal parameters, weekly total kt/v median was 1.99 (IQR 0.99–2.59) residual renal function (eGFR) median 3.2 (IQR 2.12–7.75) mL/min/1.73 m2 daily diuresis median 1500 (IQR 1000–2100), fluid removal (FR) median 2.23 (IQR 1.86–2.65) L/day and 41.8% had a dialysate/plasma (D/P) creatinine higher than 0.77. Lean tissue index was low in 36.3% and fat tissue index was high in 52.2%. Serum albumin median was 3.7 (IQR 3.3–4) g/dL and nPCR median 0.84 (IQR 0.72–1.04) g/kg/day. Hypervolemic patients had significantly lower lean tissue index (13.77 ± 3.25 versus 16.87 ± 3.82, P = 0.003). In a univariate analysis, patients with nPCR &amp;lt; 1.2 g/kg/day (79.1% from the complete cohort with no age difference) had lower baseline weekly total kt/v (2.17 ± 0.43 versus 6.62 ± 4.45, P &amp;lt; 0.001, lower daily diuresis (1261 ± 753 versus 1687 ± 958, P = 0.047), lower FR (2.05 ± 0.57 versus 2.40 ± 0.80, P = 0.043), and also significantly lower D/P creatinine (0.74 ± 0.1 versus 0.97 ± 0.27, P &amp;lt; 0.001). Furthermore, patients with serum albumin &amp;lt;3.8 g/dL had a lower ultrafiltration proof (326 ± 192 versus 511 ± 267, P = 0.028) and those with low lean tissue index had a lower daily diuresis (1405 ± 825 versus 1823 ± 1025, P = 0.045). In a multivariate analysis, patients with nPCR &amp;lt; 1.2 g/kg/day were older [exp (B) 0.19, 95% CI 0.8–0.9, P = 0.012] and had lower weekly total kt/v [exp (B) 0.18, 95% CI 0.6–0.9, P = 0.017]. CONCLUSION This study showed some relationships between kidney/peritoneal function parameters and body composition parameters. The level of nPCR, a measure of nutritional status, was significantly and positively associated with indicators of dialysis adequacy (kt/v), daily diuresis and, also with transport type. Further research regarding nutrition must be undertaken to help improve health outcomes in PD patients.

Assessment of Alveolar Bone and Periodontal Status in Peritoneal Dialysis Patients.

Chronic kidney disease (CKD) affects 8–13% of the global population and has become one of the largest burdens on healthcare systems around the world. Peritoneal dialysis is one of the ultimate treatments for patients with severe CKD. Recently, increasing severe periodontal problems have been found in CKD patients. Periodontitis has been identified as a new variable risk factor for CKD. The aim of this study was to investigate the periodontal status and severity of alveolar bone loss in CKD patients with peritoneal dialysis (PD). One hundred and six patients undergoing PD (PD group) and 97 systemically healthy periodontitis patients (control group) were enrolled. The differences in the dimensions of the alveolar bone between two groups were compared, and the distribution of alveolar bone defects was analyzed by cone-beam computed tomography (CBCT). Gingival index (GI), plaque index (PLI), periodontal probing depth (PPD), and attachment loss (AL) were recorded. The levels of inflammatory factors in gingival crevicular fluid were assessed by ELISA. Compared to control group, there was a higher degree of alveolar bone loss in maxillary premolars, maxillary 2nd molar and mandibular 1st molar in patients with PD (p < 0.05). A comparison of bone loss in different sites revealed that the area with the highest degree of bone loss were on the mesial-buccal, mid-buccal, distal-buccal, and mesial-lingual site in PD patients. The expression levels of inflammatory factors were higher in PD group (p < 0.01). In conclusion, PD patients presented more severe periodontal and inflammatory status than systemically healthy periodontitis patients. The loss of the alveolar bone differed between the two groups. Different sites and teeth exhibited a diverse degree of bone loss. This study highlights that clinicians should pay close attention to periodontal status of peritoneal dialysis patients and provides a new thinking to improve healthcare for CKD.

Serum CA125 a potential marker of volume status for peritoneal dialysis patients?

Introduction:Serum cancer antigen 125(SeCA125) has been reported to be increased in patients with heart failure and correlate with both extracellular water (ECW) overload and poor prognosis. Ultrafiltration failure and ECW overload are a major cause of peritoneal dialysis (PD) technique failure. We wished to determine whether SeCA125 could also be a marker of volume status in PD patients.Methods:We contemporaneously measured SeCA125, serum N terminal brain natriuretic peptide (NTproBNP) and ECW by bioimpedance in adult PD patients attending for outpatient assessment of peritoneal membrane function.Results:The median SeCA125 was 19 (12–33) U/mL in 489 PD patients, 61.3% male, median age 61.5 (interquartile range 50–75) years. SeCA125 was positively associated with the ratio of ECW/total body water (TBW) (r = 0.29, p < 0.001), 4-h peritoneal dialysate to serum creatinine ratio (r = 0.23, p < 0.001), NTproBNP) (r = 0.18, p < 0.001), and age (r = 00.17, p = 0.001) and negatively with 24-h PD ultrafiltration volume (r = −0.28, p < 0.001) serum albumin (r = −0.22, p < 0.001), and echocardiographic left ventricular ejection fraction (r = −0.20, p < 0.001), but not with residual renal function or C-reactive protein. Patients with above the median SeCA125, had greater median ECW/TBW 0.403(IQR 0.394–0.410) vs 0.395(0.387–0.404), p < 0.001 and NTproBNP (6870 (IQR 1936–20096) vs 4069 (1345–12291) vs) pg/mL, p = 0.03.Conclusion:Heart failure studies have reported SeCA125 is a marker of ECW overload. Our retrospective analysis suggests that SeCA125 is also associated with ECW volume in PD patients. Further studies are required to determine whether serial measurements of SeCA125 trend with changes in ECW status in PD patients and can be used to aid volume assessments.

POS-652 TIME-AVERAGED RELATIVE HYDRATION INDEX PREDICTED PATIENT AND TECHNIQUE SURVIVAL IN CHINESE PERITONEAL DIALYSIS PATIENTS: A LONGITUDINAL STUDY OVER 5 YEARS

Previous studies which investigated volume status by bioimpedance spectroscopy (BIS) and the outcome of peritoneal dialysis (PD) patients were limited by cross-sectional design. We aimed to describe the longitudinal change in volume status in PD patients in Chinese PD patients, and determine its association with clinical outcomes. We performed a single-center, retrospective analysis of all PD patients who underwent repeated BIS from 2010 to 2015. The evolution of volume status was assessed by mixed linear regression model .Volume status was represented by relative hydration index (RHI) (volume of overhydration adjusted by extracellular water), and variability of volume status (VVS) was denoted by the standard deviation of all RHI. The association of time-averaged RHI and VVS on patient and technique survival was examined by a competing risk model. A total of 269 patients were followed up for a median of 47.1 months. At baseline, FO (RHI >7%) was present in 222 patients (82.5%). The mean time-averaged RHI and mean VVS was 17.6 ± 10.2% and 6.9 ± 5.2%, respectively. Although RHI of the entire cohort remained stable over time, this relation was significantly modified by baseline volume status (RHI >7% vs. ≤7%, Pinteraction =0.001) and residual urine output (<200ml/day vs. ≥ 200ml/day, Pinteraction =0.04). Persistent moderate (time-averaged RHI >15.0% to 25.0%) and persistent severe FO (time-averaged RHI>25%) was associated with significant increased risk of death (subdistribution hazard ratio [SHR] 2.65, 95% CI 1.13-6.22; SHR 4.62, 95% CI 1.98-10.76, respectively) and a trend towards technique failure (SHR 1.77, 95% CI 0.80-3.93; SHR 2.30, 95% CI 0.97-5.48). On the other hand, VVS was not a significant predictor for both patient and technique survival. Persistent FO is a strong predictor of patient and technique failure. Repeated bioimpedance measurements of volume status provide important prognostic information in PD patients.

Is there a relationship between oral hygiene and nutritional status in peritoneal dialysis patients?

Brackground: in the early stages of kidney disease, oral manifestations (gingivitis and periodontitis) may cause premature tooth loss and limit food intake. There is scarce evidence of the relationship of oral hygiene and nutritional status in patients on Peritoneal Dialysis (PD). Objective: we aimed to assess the relationship of oral hygiene with nutritional, clinical, and physical performance parameters in PD patients. Methods: this cross-sectional study included outpatients aged 34-69 years. Oral health questionnaire, nutritional, functional, and clinical assessment tools such as Malnutrition Inflammation Score (MIS), Subjective Global Assessment (SGA), handgrip strength, and Gastrointestinal Symptoms Questionnaire (GSQ) were applied. Patients were divided according to debris, calculus, and Simplified Oral Hygiene Index (OHI-S) in two groups: "clean-slightly dirty" and "dirty-very dirty". Results: in total, 41 patients were included, those in the "dirty-very dirty" group had a worse nutritional status with higher scores on the MIS tool and worse nutritional diagnosis with SGA as compared to the "clean-slightly dirty" group. The handgrip strength was higher in patients in the best category of oral hygiene, and those with the worst hygiene presented greater severity of gastrointestinal symptoms. The risks of malnutrition in the three indices of oral hygiene with the worst category were statistically significant. Conclusion: poor oral hygiene was associated with poorer nutritional status, lower handgrip, and worse GSQ. Poor oral hygiene might be related to persistent inflammation status and catabolism that favored protein-energy wasting.

The effect of sodium exchange and dialytic biochemical parameters on blood pressure, arterial stiffness, and endothelial functions in patients with peritoneal dialysis.

This study aimed to investigate the relationship between fluid and sodium excretion and blood pressure, echocardiographic parameters, and arterial stiffness in peritoneal dialysis (PD) patients and to evaluate the effect of sodium excretion on patients' survival. This study was conducted as a single-centered, prospective study in the Department of Nephrology in Erciyes University. The patients included in the study were followed up for 3 years. Seventy PD patients were included in the study. We recorded demographic characteristics, biochemical parameters, urine and peritoneal ultrafiltration volumes, peritoneal equalization tests, ambulatory blood pressure measurements, and echocardiographic measurements. We measured the amount of total sodium excretion of the patients and arterial stiffness using pulse wave velocity (PWV). Patients were divided into two groups based on the amount of total sodium excretion: low group and high group. We compared these groups in terms of cardiac and biochemical parameters. When demographic data and biochemical values were compared, there was no significant difference between the two groups. NT-proBNP level, systolic blood pressure, and mean arterial pressure were significantly higher in the low group (p: 0.02, p: 0.031, p: 0.05, respectively). Net ultrafiltration was significantly higher in the high group (p: 0.03), was also found to be high in patients with high sodium excretion (p: 0.001). Negative correlations were found between sodium excretion and net ultrafiltration, NT-Pro BNP, and PWV. At the end of the 3-year follow-up, the survival rate was shorter and the mortality rate was higher in the low group (p: 0.042). Fluid status in PD patients can affect arterial stiffness both directly and through hypertension. Correction of hypervolemia has the potential to not only prevent hypertension and left ventricular hypertrophy, but also to improve arterial stiffness, a well-known cardiovascular risk factor. The mortality rate was higher in PD patients with low total sodium excretion. Therefore, these patients should be followed more closely to ensure volume control.

Relationship Between Thyroid Hormones and Left Ventricular Mass in Peritoneal Dialysis Patients.

Introduction. Non-thyroidal illness is prevalent in patients with advanced stages of chronic kidney disease and could be considered as a risk factor for cardiovascular mortality; this relation is partially explained by malnutrition and the concomitant condition of high inflammation. This study is designed to investigate the relationship between left ventricular mass and thyroid hormone abnormalities and evaluate this relationship after adjustment of inflammatory factors and nutritional status in peritoneal dialysis patients. Methods. A total of 71 patients undergoing maintenance peritoneal dialysis were included. Serum concentration of total and free triiodothyronine (fT3), total and free thyroxine (fT4), and TSH were measured. LV mass index and the structural properties of heart including LVEDD, LVESD, PWD, and EF were assessed by transthoracic echocardiography. The Surrogates of Inflammation, including IL-6, albumin, and hs-CRP were measured. The nutritional status of patients was assessed by one point SGA scoring and biochemical data. The relation between thyroid hormones and echocardiographic variables, inflammatory and nutritional markers was determined. Results. LVMI was significantly higher in the group with lower fT3 levels. Linear regression analyses showed statistically significant univariate association between fT3, tT3, and tT4; and LVMI. In multiple linear regression analysis adjusted for albumin, hs-CRP, IL- 6, and ferritin; only fT3 level had a meaningful negative correlation (P < .05) with LVMI, free T3 level was positively correlated with rGFR (P < .05, c = 0.39) and KT/V (P < .05, c = 0.27). Conclusion. Low fT3 level was negatively and significantly associated with LVML even after adjustments for known risk factors in peritoneal dialysis patients.

P1185LUNG COMETS AND EVALUATION OF HYDRATION STATUS IN PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims Assessment of optimal hydration status in patients with end-stage renal disease (ESRD) on peritoneal dialysis (PD) is a challenge. Multiple diagnostic options to determine hydration status in PD patients are available. Multifrequency bioimpedance spectroscopy (MBIS) is a cheap, simple and non-invasive method of estimating body composition, including estimates of total body water (TBW), extracellular water (ECW), intracellular water (ICW) and the ratio between both spaces (ECW/ICW). Lung ultrasonography (LUS) and lung B-lines (lung comets) can be used for the evaluation of extravascular lung water. Ultrasound evaluation of inferior vena cava (UIVC) provides rapid, non-invasive assessment of a patient's hemodynamic and volume status. N-terminal pro-brain natriuretic peptide (NT-proBNP) is related to fluid status and fluid distribution. The aim of our study was to assess fluid status in PD patients comparing four different methods: MBIS, LUS, UIVC and NT-proBNP. Method We performed a single-centre cohort study in 19 PD patients. The body composition was measured using the portable whole-body MBIS device, Body Composition Monitor-BCM(®) (Fresenius Medical Care, Bad Homburg, Germany), LUS with portable US device (VScan, General Electrics Corporate), UIVC index with SonoSite US device. NT-proBNP was measured in a one-step sandwich chemiluminescent immunoassay (Dimension Vista® System 1500, Siemens Healthcare Diagnostics Inc., Newark, NJ, USA). Results The mean age of patients was 54 ± 10 years, mean dialysis vintage 53 (10-194) months, 63% were men. Thirteen (68.4%) patients had fluid overload (FO) &amp;gt; 1.1 L. Data of patients are presented in table 1. We found a statistically significant correlation between the number of lung comets and ECW/ICW ratio (r = 0.496, P = 0.031) and NT-proBNP (r = 0.759, P &amp;lt; 0.0001). In contrast, there was no significant correlation between the number of lung comets and UIVC (r = 0.221, P &amp;lt; 0.364). Conclusion According to our results, LUS with lung comets, MBIS with ECW/ICW ratio and NT-proBNP are useful and complementary methods for evaluation of fluid status in PD patients.

P1187THE NUTRITIONAL STATUS IN PERITONEAL DIALYSIS PATIENTS: HOSPITALIZATION AND MORTALITY

Abstract Background and Aims The worldwide medical public attention focuses on the problems associated with decreasing morbidity frequency and improving of survival of patients with the end stage renal disease (ESRD). Peritoneal dialysis (PD), including continuous ambulatory peritoneal dialysis (CAPD), one of the known modality of renal replacement therapy (RRT). Several studies demonstrated that namely nutritional. The aim of this study was to explore the relationship between the nutritional status in PD patients and their morbidity and mortality. Method This study was an observational, prospective, epidemiological tracking by clinical examination. The study included 105 patients with ESRD who started CAPD treated in single dialysis center of Ukraine (during 2012 - 2018). Fifty three (50.5%) patients were male, median age 60 (range 25–85 years) and the most common cause of ESRD was glomerulonephritis (63 patients, 60.0%). Median follow-up was 29 months (range 6- 132 months). Nutritional status (NS) indicators defined basing on the calculation of the subjective global assessment (SGA, points). Patients were classified into four groups according to their NS. Group 1 included 51 patients with normal NS, group 2- 30 patients with a light degree of malnutrition, group 3 (13 patients) and group 4 (11 patients) with moderate and severe degree of nutritional disorders, respectively. During follow-up, all hospital admissions and all causes of mortality were documented and compared for nutritional disorders versus normal NS. Results During follow up the 62 hospitalization cases (30 cardiovascular events, 15 PD-peritonitis, 13 other bacterial infections, 2 stroke and 2 - others) and 46 deaths among all patients were detected. The odds ratio for all-cause hospitalization in the group 3 (12/85.7% vs. 26/ 51.0%) were significantly higher than in the group 1 (OR = 5.7692, 95% CI: 1.1712 - 28.4178; р= 0.0312). A significant increasing of the hospitalization incidences both due infectious comorbidity (7/63.64% vs. 8/15.7%; χ²= 8.880, p = 0.003) among patients with severe degree of malnutrition compared with patients group 1. At the same time, cardiovascular (CVD) hospitalization rate was significantly higher in patients group 3 (8/57.1% vs. 10/ 19.6%; χ²= 5.968, p = 0.015) than in the group1. Mortality rate was significantly higher in patients group with moderate (11/84.6% vs 16/31.37%, χ²= 12.041, p &amp;lt;0.0001; OR =12.031; 95% CI: 2.3843 - 60.7105) and a light degree of nutritional disorders (11/84.6% vs 13/43.4%, χ²= 6.267, p= 0.013; OR = 7.1923; 95% CI: 1.352- 38.2367) than with normal NS. Similarly, patients with a severe degree of malnutrition (group 4) showed a higher mortality rate versus patients group1: 8/72.7%% vs. 16/31.37%,; χ²= 6.522, р= 0.011 (OR = 5.8333, 95% CI: 1.3645-24.9376). Cardiovascular disease was the leading cause of death (22/47.8%). Conclusion Thus, the obtained findings suggest that nutritional disorders at PD initiation have a significant negative effect on prognosis. The results of our study demonstrated the predictive role of assessing nutritional status in all-cause mortality and hospital admissions in ESRD population.

P1177THE INFLUENCE OF PERITONEAL GLUCOSE LOAD ON LEAN AND ADIPOSE TISSUE MASS IN PERITONEAL DIALYSIS PATIENTS USING A NOVEL AND QUANTITATIVE INDEX

Abstract Background and Aims There is now widespread consensus among nephrologists to increase the number of patients on peritoneal dialysis (PD). Most of the PD dialysis solutions are based on glucose as an osmotic agent. The peritoneal glucose load can damage the peritoneal membrane, increases its permeability to water, glucose and electrolytes leading to the development of fluid overload, hypertension, stimulation of the inflammatory process and metabolic disturbances. This study aims to verify the influence of glucose exposure load on lean and adipose tissue mass in PD patients using a novel and quantitative index. Method This is a retrospective and analytical study based on the medical records. The study examined the entire population of PD patients who were treated at the Peritoneal Dialysis Unit at the Galilee Medical Center in north of Israel during the last eight years (from January 1, 2010 through December 31, 2017). The clinical and laboratory data of these patients were collected from their medical records and analyzed. The main variables examined included peritoneal glucose load index (PGLI), lean tissue index (LTI) and Fat Tissue Index (FTI). LTI was calculated as the quotient of LTM/Height?(kg/m? and FTI was defined as the quotient of ATM/Height?(kg/m?. LTI and FTI were assessed using the Fresenius Medical Care Body Composition Monitor (BCM) device, based on Bio-impedance technology Results 187 assessments of the nutritional status in PD patients, using the BCM device, were evaluated. Among PD patients, 52.4% were men, 54% were treated with continuous ambulatory peritoneal dialysis (CAPD) and 46% had diabetes mellitus as primary renal disease. The average age was 57.8 ± 11.3 years, peritoneal dialysis vintage 31.36 ± 16.69 months, body mass index (BMI) 28.1 ± 4.4 kg/m2, daily urinary output 1040.0 ± 649.8 ml/day, hemoglobin 10.84 ± 1.02 g/dl, HbA1c 7.05 ± 1.09 %, Kt/V 1.89 ± 0.17, PGLI 3.11 ± 1.13 g/kg/day, residual renal function 6.68 ± 2.46 ml/min/1.73m2. A significant and positive correlation between the PGLI and FTI (r=0.28, p&amp;lt;0.001) and, a significant and negative association between PGLI and LTI (r=-0.24, p&amp;lt;0.001) were found. Conclusion Peritoneal glucose load may adversely influence the nutritional status of PD patients by increasing the adipose tissue mass and decreasing lean tissue mass.

Geriatric nutritional risk index is associated with mortality in peritoneal dialysis patients

Malnutrition is one of the most common complications among dialysis patients. The Geriatric Nutritional Risk Index (GNRI) is rarely used in dialysis patients, especially peritoneal dialysis (PD). To use the GNRI to evaluate the initial nutritional state of PD patients and to examine the association between the GNRI and mortality in chronic PD patients. We retrospectively examined the medical records at our centre to identify all adults (≥18 years) who had undergone PD for over 3 months before recruitment from January 2005 to December 2017. The correlation between the GNRI and mortality was examined by Kaplan-Meier and Cox proportional hazards analyses. A total of 1804 patients was enrolled in the study. Significant correlations were noted between the initial GNRI and Charlson index, uric acid, blood calcium, potassium, triglycerides, low-density lipoprotein cholesterol, haemoglobin and so on. Multivariate Cox proportional hazards analyses demonstrated that the GNRI was associated with all-cause mortality (hazard ratio = 0.96, P < 0.001, 95% confidence interval: 0.95-0.98) after adjustment. Compared with the lowest GNRI group, all-cause mortality decreased significantly for each level of GNRI after adjusting for various influencing factors, and the mortality risk of the highest GNRI grade decreased by 66%. The Kaplan-Meier analysis survival rate was significantly different among the four groups in terms of all-cause mortality and cardiovascular and cerebrovascular mortality (log-rank test, P < 0.05). These results demonstrated that the GNRI is significantly associated with mortality and can be a simple, clinically useful marker for the assessment of nutritional status in PD patients.

Dialysate cell-free mitochondrial DNA fragments as a marker of intraperitoneal inflammation and peritoneal solute transport rate in peritoneal dialysis

BackgroundMitochondrial DNA (mtDNA) released into extracellular subsequent to cell injury and death can promote inflammation in patients and animal models. However, the effects of peritoneal dialysate cell-free mtDNA on intraperitoneal inflammation and peritoneal solute transport rate (PSTR) in peritoneal dialysis (PD) patients remain unclear.MethodsWe select the incident patients who began PD therapy between January 1, 2009, and December 30, 2010. Peritoneal dialysate was collected at the time of peritoneal equilibration test. The cell-free mtDNA, IL-6, IL-17A, TNF-α and IFN-γ were measured. All patients were followed till December 2017. The results were compared with PSTR and patient survival.ResultsOne hundred and eighty-nine patients were included in the study. The average age was 47.1 ± 13.5 years, 55.6% of the patients were males. The average PSTR was 0.66 ± 0.12, the median dialysate mtDNA levels were 4325 copies/ul. The median concentrations of IL-6, IL-17A, TNF-α and IFN-γ were 25.9, 10.8, 25.8 and 17.9 pg/ml, respectively. We found that dialysate mtDNA was significantly correlated with PSTR (r = 0.461, P < 0.001), IL-6 (r = 0.568, P < 0.001), TNF-α (r = 0.454, P < 0.001) and IFN-γ (r = 0.203, P = 0.005). After adjustment for multiple covariates, dialysate mtDNA levels were independently correlated with IL-6 and PSTR. Dialysate mtDNA levels were not associated with patient survival.ConclusionsWe found that dialysate mtDNA levels correlated with the degree of intraperitoneal inflammatory status in PD patients. Peritoneal effluent mtDNA was an independent determinant of PSTR but did not affect patient survival.

Factors associated with nutritional status in peritoneal dialysis patients

The aim of our study was to examine the relationship between nutritional status (NS) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and dialysis-related factors.Methods. 105 patients who were treated by CAPD were included in this observational study. To assess the NS we determined the level of serum albumin, body mass index (BMI) and subjective global assessment (SGA). The study was carried out in two stages. At the first stage of the work PD patients’ nutrition status was examined. For further analysis, the patients were divided into four groups according to the condition of the NS: the first group (n = 54) consisted of patients without disturbance of nutrition, the second (n = 27) with mild nutrition disorders, the third (n = 13) - with an average degree and the fourth (n = 11) with a severe degree of malnutrition. At the second stage of the work specialty of the nutritional status and residual renal function, frequency of PD-peritonitis, transport characteristics of the peritoneum were studied.Results. Nutritional disorders were observed in 54 (51.4 %) patients. A mild malnutrition was diagnosed in 28.7 % of patients, medium and severe in 12,38 % and 10,48% of patients, respectively. Parameters of NS, except BMI, were higher in patients without nutrition disorders (ND) comparing with the patients who had it. RRF was higher in patients without ND; but anuria was observed practically in all patients with severe ND. We receive direct relationship between the level of serum albumin and RRF (r = 0.53; p &lt;0,001), and SGA and RRF (r = 0.52; p &lt;0,001). Number of PD – peritonitis was lower in patients with normal NS and the highest in patients with severe ND. Strong correlation between the level of serum albumin, SGA, and the frequency and duration of peritonitis was established (r = - 0.59; p&lt;0,001 and r = - 0.59; p &lt;0,001 respectively). High transport characteristic of peritoneum was associated with lower degree of serum albumin and SGA (p &lt;0,001). There was no relationship established between SGA, serum albumin, BMI, age, duration of CAPD treatment, gender, and main nosology.Conclusions: Thus, ND were diagnosed in more than 50% of the examined patients. ND were associated with reduce of RRF, frequency and duration of PD-peritonitis, high transport characteristics of the peritoneum. There was no correlation between level of serum albumin, SGA and gender, duration of CAPD, main nosology and age. BMI did not have correlation with any parameters. The received data testify the necessity of constant monitoring of laboratory and functional parameters of the nutrition status.

Aldosterone antagonist therapy and its relationship with inflammation, fibrosis, thrombosis, mineral-bone disorder and cardiovascular complications in peritoneal dialysis (PD) patients

BackgroundHigh aldosterone level may contribute to pathogenesis of hypertension, vessels damage and cardiovascular system deterioration in chronic kidney disease patients. Besides its classical action via mineralocorticoid receptor, aldosterone is also involved in cell growth, inflammation, oxidative stress, endothelial dysfunction and exerts fibroproliferative effects. The aim of the study was to assess whether aldosterone antagonist treatment may influence serum level of inflammatory, fibrosis, thrombosis and mineral-bone metabolism markers in peritoneal dialysis (PD) patients and blood pressure, aortic stiffness, echocardiographic indices after 12 months of treatment.MethodsTwenty-two patients on PD were assigned to spironolactone treatment in dose of 50 mg daily during 12 months. Fifteen PD patients were assigned to control group. Echocardiographic indices, PVW, SBP, DBP (mean values from ABPM) and biochemical parameters such as: aldosterone, osteopontin, IL-6, selectin-P, TGF-β, PTH, MMP-2 were performed at the beginning and after 12 months in spironolactone and control group.ResultsThere were no statistically significant differences in echocardiographic indices, PWV, BP (ABPM readings) and biochemical markers: MMP-2, serum aldosterone, TGF-β, IL-6, selectin-P, PTH level after 12 months of spironolactone treatment. There was statistically significant rise in osteopontin level after 12 months of spironolactone treatment. Episodes of life-threatening hyperkalemia were not reported.ConclusionsAldosterone antagonists use in PD patients seems to be safe. Longer duration or higher dosage of spironolactone seems to be more effective in improving cardiovascular system status in PD patients. Further studies are required to determine relationship between mineralocorticoid receptor blockade and mineral-bone disturbances in PD patients.

Assessment of Nutritional Status and Metabolic Syndrome in Peritoneal Dialysis Patients: A Pilot Study

Aim : Nutritional deficiencies and metabolic syndrome (MS) is challenge in chronic kidney disease patients with peritoneal dialysis(PD). This study was planned in order to assess the nutritional status and metabolic syndrome in PD patients. Methods: This study was performed on clinically stable patients that were undergoing PD therapy. Energy and nutrient intakes were determined with consequently three days dietary record. The statement of MS was identified according to MS criteria adopted for PD patients. Results: The prevalence of MS was found 64.3%. The mean duration of PD in with-MS(35.4±25.23mo.) was lower than without-MS(44.3±30.99mo.) (p>0.05). Patients with MS had significantly greater systolic/diastolic blood pressure and lower high-density-lypoprotein cholesterol levels (HDL-C) (p<0.05). According to the body mass index (BMI), the 83.3% of patients’ with-MS and 30% without-MS were found overweight and body fat mass was significant higher in patients with-MS(p<0.05). The mean daily protein intakes per kilograms of body weight determined lower with-MS patients (0.8±0.25g/kg) than without-MS (0.9±0.29 g/kg). Conclusion: The prevalence of MS is remarkably high. The daily dietary energy and protein intakes were found under the recommended levels. Inadequate energy and protein intake increase loss of muscle mass and also excessive energy intake leads to obesity. Monitoring of nutritional status of PD patients is important both in prevention and progression of MS.