Survival In Peritoneal Dialysis Patients Research Articles

#426 “Predict-PD”: a machine learning tool to predict patient survival in peritoneal dialysis patients

Abstract Background and Aims With the rising prevalence of chronic kidney disease (CKD), particularly among the elderly, the need for effective renal replacement therapy has become increasingly crucial. Peritoneal dialysis (PD), recognized as a gentler alternative to haemodialysis, offers advantages in cognitive preservation and overall quality of life. Patient survival on PD, a tangible outcome measure, gains particular importance, especially in an aging demographic confronting end-stage kidney disease. Predicting survival thus becomes vital in facilitating individualized treatment planning and has implications on resource allocation and patient counseling. Method Our study analysed data from the UK Renal Registry and included 22 711 incident dialysis patients choosing PD between 2007 and 2022. Our objective was to employ Artificial Intelligence (AI) algorithms in developing an advanced risk stratification indicator with high predictive capabilities, specifically tailored for use in the United Kingdom's transplant selection procedure. We conducted experiments using three distinct machine learning models and evaluated their performance in terms of calibration and discrimination, utilizing metrics such as the integrated Brier score (IBS) and Harrell's concordance index. We assessed the potential clinical utility using decision curve analysis. Results The XGBoost model demonstrated excellent predictive efficacy for patient survival, with a concordance of 0.78. Further scrutiny revealed AUC values at 1 year (0.81), 3 years (0.78), and 5 years (0.77). The integrated Brier score, a comprehensive measure of predictive accuracy, was 0.09. There was no statistical difference between the actual and predicted survival probabilities (P = 0.72). Decision curve analysis accentuated the model's clinical applicability. Conclusion This study illustrates the potential of machine learning in prognosticating patient survival in PD, offering a pathway towards individualized patient-centric management in nephrology. The findings advocate for the integration of data-driven methodologies in clinical decision-making, paving the way for enhanced personalized care in CKD management and can serve as a guide for future research.

#1683 Gut permeability, circulating bacterial fragments, and left ventricular strain in peritoneal dialysis

Abstract Background and Aims There are limited data on the association of gut permeability, circulating bacterial fragment load, left ventricular strain in patients on peritoneal dialysis (PD). We aimed to measure circulating bacterial fragments, NT-proBNP, calprotectin and zonulin levels, and to evaluate their association with gut permeability, circulating bacterial fragment load, left ventricular strain and clinical outcomes on PD patients. Method We performed a single-center prospective cohort study. Patients who were planned for peritoneal dialysis were recruited. Serum endotoxin, bacterial DNA, NT-proBNP, calprotectin and zonulin levels were measured. Primary outcomes were technical and patient survival, secondary outcomes were hospitalization data. Results One hundred and eight patients were recruited. No correlations between circulating bacterial fragments, NT-proBNP, calprotectin and zonulin levels in PD patients. Circulating bacterial fragments, calprotectin and zonulin levels are positively correlated with insulin resistance index (bacterial DNA: P = .002, calprotectin: P = .014, zonulin: P = .006), while NT-proBNP level is associated with volume overload in PD patients (volume of overhydration: P = .000, E:I ratio: P = .000), peritoneal characteristics (D/P4: P = .004, MTAC: P = .048). NT-proBNP level have a negative correlation with nutritional characteristics (albumin: P = .000, hemoglobin: P = .033) and residual GFR (P = .000). In univariate analysis of PD patient survival, NT-proBNP is associated with patient survival (P = .003), but this association become insignificant after multivariate analysis of clinical confounding factors. NT-proBNP is the strongest independent predictor of technical survival rate in PD patients (P = .005). Patients in the highest tertiles of NT-proBNP and calprotectin have lower technical survival rates, but only patients in the highest tertiles of NT-proBNP, not calprotectin, have lower patient survival. NT-proBNP is also correlated with the number of hospitalizations per year (P = .004) and total hospitalization time (P = .012) in PD patients. Endotoxin and bacterial DNA levels in PD patients have no predictive value for PD patient survival, technical survival, number of hospitalizations per year, and total hospitalization time. Conclusion There is no correlation between gut permeability, circulating bacterial fragments, and impairment of left ventricular function in PD patients. Circulating bacterial fragments levels and gut permeability are associated with insulin resistance, while impairment of left ventricular function is associated with solution overload. Bacterial fragment levels have no predictive value on survival rate, technical survival rate and hospitalizations data in PD patients. NT-proBNP is the strongest independent predictor of technical survival rate in PD patients.

Clinical characteristics and antibiotic treatment of peritoneal dialysis-associated peritonitis caused by Pseudomonas species: a review of 15 years' experience from southern China.

Although the incidence of peritoneal dialysis-associated peritonitis caused by Pseudomonas is very low, it seriously affects the technique survival of peritoneal dialysis patients. However, there are few studies and reports on Pseudomonas peritonitis in the Chinese mainland area. Therefore, the purpose of this study is to describe the clinical characteristics, the regimens of antibiotic, drug resistance, and outcome of peritoneal dialysis patients in southern China in the past 15 years and summarize the clinical experience in the treatment of Pseudomonas peritonitis.

The Importance of Blood Pressure Control in the Survival of Peritoneal Dialysis Patients Using a Multistate Model

Since less attention has been paid to the effect of passing blood pressure states on the survival of peritoneal dialysis (PD) patients, this study aimed to inves­tigate the survival of PD patients with and without hypertension, estimate the probability of hypertension and determine the influential factors. In this retro­spective cohort study, the data of 700 patients visiting dialysis centers from all provinces of Iran from 1997-2009 were analyzed. For data analysis, the multistate survival model was used. The median survival time (months) and five-year survival were 75% and 56%, respectively. Males had a higher probability of hypertension (63%) than females (52%). The risk of death in normotensive patients increased with age and fast blood sugar (FBS) (age: HR = 1.02, p-va­lue <0.001; FBS: HR = 1.03, p-value = 0.034) and decreased with increasing albumin (HR = 0.60, p-value = 0.015). When experiencing hypertension, the death risk increased with age (age: HR = 1.03, p-value<0.001); also, higher serum albumin and blood urea nitrogen (BUN) had a protective effect against mortality (albumin: HR = 0.66, p-value = 0.038; BUN: HR = 0.99, p-value = 0.014). Paying attention to age, obesity, and blood sugar in PD patients seems necessary.

Association between sarcopenic obesity and mortality in patients on peritoneal dialysis: a prospective cohort study.

Whether sarcopenic obesity had unfavorable effect on survival of peritoneal dialysis (PD) patients is unknown. We aimed to investigate the association between sarcopenic obesity and survival in PD patients. This was a prospective observational study. Eligible PD patients from November 2016 to December 2017 were enrolled and followed until August 31, 2023. Sarcopenia was defined following the recommendations of the Asian Working Group for Sarcopenia (AWGS) as low appendicular skeletal muscle mass index (ASMI) and handgrip strength (HGS). Obesity was defined using the percentage of body fat (PBF). Survival analysis was conducted using the Kaplan-Meier and log-rank test. The Cox regression and the cumulative incidence competing risk (CICR) analyzes were used to investigate the association between sarcopenic obesity and all-cause mortality. A total of 223 patients were enrolled with 133 (59.6%) males, a median age of 57.5 (44.6, 65.7) years, a median dialysis vintage of 20.3 (6.4, 57.7) months and 48 (21.5%) who had comorbid diabetes mellitus. Among them, 46 (20.6%) patients were sarcopenic, and 25 (11.2%) patients were diagnosed with sarcopenic obesity. After followed up for 51.6 (25.6, 73.9) months, the Kaplan-Meier curve showed the sarcopenic obesity (log-rank = 13.527, p < 0.001) group had significant lower survival rate compared to the nonsarcopenic non-obesity group. For multivariate analysis, the CICR method showed patients with sarcopenic obesity had significantly higher mortality rate (HR: 2.190, 95% CI: 1.011-4.743, p = 0.047) compared to those with nonsarcopenic non-obesity. Sarcopenia is not uncommon in PD patients, with a considerable proportion having sarcopenic obesity. There is a significant association between sarcopenic obesity and an increased risk of mortality in PD patients.

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

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

Investigation of Factors Affecting Clinical Outcome of Peritoneal Dialysis Patients.

End-stage kidney disease (ESKD) is a global issue. Although the use of kidney replacement therapy measures has improved outcomes for patients with ESKD, the mortality rate remains significant. Identifying modifiable factors that affect patient outcomes can help improve their survival. The aim of this study was to investigate the factors affecting the clinical outcome of peritoneal dialysis patients. This prospective cohort study was conducted between 2018 and 2021.Participants: Patients aged between 18 and 75 years with a history of peritoneal dialysis (PD) for at least six months were included. Demographic data, kt/v ratio, medical history, serum levels of albumin, creatinine, triglycerides, total cholesterol, calcium, phosphorus, parathyroid hormone, hemoglobin, and ferritin were recorded before starting PD and during the follow-up period, along with clinical outcomes. To describe the data, the central index of mean, frequency, and relative frequency was used, and for analytical statistics, Chi-square test, analysis of variance, and Kruskal-Wallis were used. A total of 64 patients with a mean age of 51.78 ± 15.31 years were included. Of these, 27 (42.18%) had a history of diabetes mellitus, and 38 (59.37%) had a history of hypertension (HTN). 48 (75%) patients survived until the end of the study, while 47 (73.4%) participants experienced peritonitis. Our findings indicate that variables such as sex, marital status, weight, history of HTN, and serum levels of hemoglobin and ferritin significantly affect outcomes. We found that factors including sex, marriage, normal weight, HTN, normal hemoglobin, and ferritin can lead to better survival in PD patients. Recurrent peritonitis was the most crucial cause of PD to HD shifts.

Phase Angle as a Risk Factor for Mortality in Patients Undergoing Peritoneal Dialysis

Phase angle (PhA) is measured using bioimpedance analysis and calculated using body reactance and resistance in the waveform at 50 kHz. Further studies are necessary to clarify the predictive efficacy of PhA in the mortality of peritoneal dialysis (PD) patients. The objective of this study was to assess the utility of PhA for predicting patient mortality and technique failure and compare the predictability of PhA with other risk factors. Our study had a retrospective cohort design. Our center routinely evaluates bioimpedance measurements for all prevalent PD patients (n = 199). The PhA was measured using multifrequency bioimpedance analysis. Our study evaluated patient and technique survival. There were 66, 68, and 65 patients in the low, middle, and high tertiles of PhA, respectively. The PhA values of the low, middle, and high tertiles were 3.6° (3.4–3.9), 4.4° (4.2–4.7), and 5.5° (5.2–6.0), respectively. The 5-year patient survival rates for the high, middle, and low tertiles were 100%, 81.7%, 69.9%, respectively (p &lt; 0.001). The 5 year technique survival rates for the high, middle, and low tertiles were 91.9%, 74.8%, 63.7%, respectively (p = 0.004). Patient and technique survival increased as the PhA tertiles increased. Both univariate and multivariate Cox regression analyses demonstrated a consistent pattern. The prediction of patient or technique survival was better in PhA than in the other classical indicators. The present study demonstrated that PhA may be an effective indicator for predicting patient or technique survival in PD patients. Furthermore, it suggests that routine measurement of PhA and pre-emptive intervention to recover PhA according to causes of low PhA may help improve patient or technique survival in PD patients.

Significance of 1,25-Dihydroxyvitamin D3 on Overall Mortality in Peritoneal Dialysis Patients with COVID-19

In previous publications, we pointed out the importance of mannosylation of fibrinogen for the development of cardiovascular complications and fucosylation as a predictor of peritoneal membrane dysfunction in patients on peritoneal dialysis (PD). After a follow-up period of 30 months from the onset of the COVID-19 pandemic, we evaluated the significance of 1,25-dihydroxyvitamin D3 (calcitriol) therapy, primary disease, biochemical and hematologic analyzes, and previously performed glycan analysis by lectin-based microarray as predictors of mortality in this patient group. After univariate Cox regression analysis, diabetes mellitus (DM) and calcitriol therapy were found to be potential predictors of mortality. Additional multivariate Cox regression analysis confirmed that only DM was a predictor of mortality. Nevertheless, the use of calcitriol in therapy significantly reduced mortality in this patient group, as shown by the Kaplan–Meier survival curve. The presence of DM as a concomitant disease proved to be a strong predictor of fatal outcome in PD patients infected with SARS-CoV-2. This is the first study to indicate the importance and beneficial effect of calcitriol therapy on survival in PD patients with COVID-19 infection. In addition, this study points to the possibility that adverse thrombogenic events observed in PD patients during the pandemic may be caused by aberrant fibrinogen glycosylation.

Longitudinal association between dietary protein intake and survival in peritoneal dialysis patients

Background Decreased dietary protein intake (DPI) may lead to protein-energy malnutrition and may be associated with increased mortality risk. We hypothesized that longitudinal changes in dietary protein intake have independent associations with survival in peritoneal dialysis (PD) patients. Methods 668 stable PD patients were selected in the study from January 2006 to January 2018 and were followed up until December 2019. Their three-day dietary records were collected at the baseline (the sixth month after PD) and thereafter every 3 months for two and a half years. The latent class mixed models (LCMM) were used to identify subgroups of PD patients with similar longitudinal trajectories of DPI. The relation between DPI (baseline and longitudinal data) and survival was examined using Cox model to estimate death hazard ratios. Meanwhile, different formulae were used to assess nitrogen balance. Results The results showed that baseline DPI ≤ 0.60g/kg/day was associated with the worst outcome in PD patients. Patients with DPI 0.80–0.99g/kg/day and DPI ≥ 1.0g/kg/day both presented positive nitrogen balance; patients with DPI 0.61–0.79g/kg/day presented obviously negative nitrogen balance. Longitudinal association between time-dependent DPI and survival was found in PD patients. The consistently low DPI' (0.61–0.79g/kg/d) group was correlated with increased death risk as compared with the 'consistently median DPI' group (0.80–0.99g/kg/d, HR = 1.59, p = 0.008), whereas there was no difference in survival between 'consistently median DPI' group and 'high-level DPI' group (≥1.0 g/kg/d, p > 0.05). Conclusion Our study revealed that DPI ≥ 0.8 g/kg/day was beneficial to the long-term outcome for the PD population.

Polypharmacy Predicts Onset and Transition of Frailty, Malnutrition, and Adverse Outcomes in Peritoneal Dialysis Patient.

Polypharmacy, frailty and malnutrition are known predictors of adverse outcomes in dialysis patients. Little has reported about their interaction and composite prognostic values. We aimed to describe the interaction between polypharmacy, frailty, nutrition, hospitalization, and survival in peritoneal dialysis patients. In this prospective cohort study, we recruited 573 peritoneal dialysis patients. Drug burden was measured by medication number and daily pill load. Frailty and nutrition were assessed by the validated Frailty Score (FQ) and Subjective Global Assessment (SGA) respectively. All patients were followed for two years. Primary outcome was all-cause mortality. Secondary outcomes were fall and fracture episodes, hospitalization, change in FQ and SGA. At baseline, each patient took 7.5 ± 2.6 medications with 15.5 ± 8.5 tablets per day. Medication number, but not daily pill load predicted baseline FQ (p = 0.004) and SGA (p = 0.03). Over 2 years, there were 69 fall and 1,606 hospitalization episodes. In addition, 148 (25.8%) patients died, while FQ and SGA changed by 0.73 ± 4.23 and -0.07 ± 1.06 respectively in survivors. Medication number (hospitalization: p = 0.02, survival: p = 0.005), FQ (hospitalization: p < 0.001; survival: p = 0.01) predicted hospitalization and survival. Medication number also predicted fall episodes (p = 0.02) and frailty progression (p = 0.002). Daily pill load did not predict any of these outcomes. Drug burden is high in peritoneal dialysis patients, and it carries important prognostic implication. Medication number but not pill load significantly predicted onset and progression of frailty, malnutrition, fall, hospitalization, and mortality.

Associations between liver function parameters and poor clinical outcomes in peritoneal dialysis patients.

Patients with end-stage renal disease (ESRD) have significantly lower survival rates compared with the general population of the same age. Peritoneal dialysis (PD) is an effective treatment for patients with ESRD, but the clinical outcome of PD patients is still not promising. The survival of PD patients is associated with various clinical factors, and exploring some valid risk predictors may be beneficial for this population. In this review, by integrating the latest research, we summarized the association of some common and novel liver function parameters (ALT, AST, ALP, GGT, serum bilirubin, pre-albumin, albumin, albumin-globulin ratio [AGR], serum ferritin, and hyaluronic acid) with clinical outcomes in PD patients. It may contribute to a better understanding of potential risk factors and help to develop strategies to prevent the disease progression.

Risk factors for mortality in patients undergoing peritoneal dialysis: a systematic review and meta-analysis

Aim Inconsistent investigations of the risk factors for all-cause mortality in patients undergoing peritoneal dialysis (PD) were reported. The present meta-analysis aimed to assess the impact of some clinical characteristics on the risk of mortality in PD patients. Methods PubMed and Embase were systematically searched for studies evaluating the risk factors for all-cause mortality in PD patients. Hazard ratio (HR) and 95% confidence interval (CI) were derived using a random-effect or fixed-effect model considering the heterogeneity across studies. Result A total of 26 studies were included in this meta-analysis in accordance with the inclusion and exclusion criteria. Age, primary cardiovascular diseases, diabetes mellitus, and high level of alkaline phosphatase showed significant positive associations with elevated risk of all-cause and cardiovascular mortality in PD patients, while hemoglobin acted as a benefit factor. Furthermore, early onset of peritonitis, high peritoneal transport status, elevated body mass index and high-sensitivity C-reactive protein could also considerably increase the risk of all-cause mortality. The absolute serum level of magnesium, potassium, and uric acid required to improve survival in PD patients should be verified further. Conclusions Multiple factors could affect the risk of mortality in PD patients.

Elevated TG/HDL-C and non-HDL-C/HDL-C ratios predict mortality in peritoneal dialysis patients

Background and aimsDyslipidemia is common in patients with chronic kidney disease and particular prevalent in patients receiving peritoneal dialysis. However, whether markers of atherogenic dyslipidemia correlate with outcomes in dialysis patients as in the general population is uncertain. The aim of this study was to explore the prognostic value of the serum triglyceride/HDL cholesterol (TG/HDL-C) ratio and non-HDL-C/HDL-C ratio to predict mortality in peritoneal dialysis patients.MethodsTwo hundred fourteen peritoneal dialysis patients were retrospectively analyzed from January 2011 to December 2015, with a median follow-up of 59 months. We used receiver operating curves (ROC) to determine the optimal threshold for TG/HDL-C and non-HDL/HDL-C ratios at baseline to predict overall survival during follow-up. Prognostic values were accessed by univariate and multivariate COX regression analysis and Kaplan-Meier curve. A predictive nomogram was developed to predict prognosis for overall survival, and the predictive accuracy was evaluated by concordance index (c-index).ResultsThe optimal cut-off values for TG/HDL-C ratio and non-HDL-C/HDL-C ratio to predict mortality were 1.94 and 2.86, respectively. A high TG/HDL-C ratio and a high non-HDL-C/HDL-C ratio strongly correlated with worse overall survival in peritoneal dialysis patients. Multivariate analysis demonstrated that elevated TG/HDL-C ratio (HR 3.57, 95% CI 1.99, 6.39, P < 0.000) as well as non-HDL/HDL-C ratio (HR 2.58, 95%CI 1.39–4.81, P = 0.003) were independent markers to predict reduced OS. A nomogram was constructed to predict overall survival, with a c-index for predictive accuracy of 0.795.ConclusionTG/HDL-C ratio and non-HDL-C/HDL-C may serve as potential prognostic biomarkers in PD patients.

Public health investments and mortality risk in Brazilian peritoneal dialysis patients.

BackgroundEnd-stage kidney disease (ESKD) treatment is very costly and accounts for a significant percentage of public healthcare expenditures. Beyond direct costs, dialysis patients use other healthcare levels, but the impact of public investment on each of these levels is unclear. This study aimed to investigate the association between direct financing at different healthcare levels and overall mortality in peritoneal dialysis (PD) patients.MethodsWe included all adult incident PD patients from a Brazilian prospective, nationwide PD cohort. Overall mortality was the primary outcome of interest. We used a three-level multilevel survival analysis to investigate whether mortality was associated with the investments destined to different levels of healthcare complexity: (i) primary, (ii) medium and high and (iii) professional healthcare training and community awareness.ResultsWe evaluated 5707 incident PD patients from 78 Brazilian cities, which were divided into four quartiles for each healthcare level (Groups I–IV). After taking the highest quartile (Group IV) as a reference, investment in the primary health level was not associated with patient survival. Otherwise, medium and high complexity levels were associated with higher mortality risk. Also, investment in healthcare manager training and community awareness had an impact on patient survival.ConclusionsInvestments in different levels of the healthcare system have distinct impacts on PD patient survival. Investment in healthcare manager training and community awareness seems to be a promising strategy on which to focus, given the relatively low cost and positive impact on outcome.

P1182PROGNOSTIC VALUE OF CHARLSON COMORBIDITY INDEX IN PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims Mortality risk is very high in the dialysis population and the Charlson Comorbidities Index (CCI) is considered as an useful risk stratification tool in these patients. The purpose of this study was to examine the accuracy of CCI for predicting mortality in peritoneal dialysis (PD) patients and to compare the prognostic power of CCI with that of a risk prediction model jointly including a clinical score of malnutrition and the NYHA classes. Method We analyzed this problem in a series of 66 consecutive PD patients on follow-up in our unit. Their mean age was 69±14 years, 64% were male, 36% were diabetic. The median dialysis vintage was 39 months (Interquartile range 23-67 months). Results During follow-up period, 37 patients died. On univariate Cox regression analysis, CCI largely failed to predict mortality [Hazard ratio (HR): 1.08, 95% CI: 0.94-1.24, P=0.30) and this relationship did not improve (HR: 0.93, 95% CI: 0.79-1.08, P=0.32) also after data adjustment for malnutrition and NYHA classes. In the same model, malnutrition (HR: 1.98, 95% CI 1.20-3.27, P=0.007) and NYHA classes (HR: 3.15, 95% CI 1.67-5.94, P&amp;lt;0.001) were strongly and significantly related to the risk of death. Of note, the prognostic accuracy of the model based on malnutrition and NYHA classes (ROC curve area: 74%) was higher than that provided by CCI alone (ROC curve area: 54%) and did not materially differ from that of an expanded model including CCI, malnutrition and NYHA classes (ROC curve area: 78%) Conclusion In this study, CCI did not predict survival in PD patients whereas malnutrition and NYHA score displayed a relevant prognostic accuracy for death in the same patient-population. These results generate the hypothesis, to be confirmed in a larger PD population, that CCI solely for risk stratification is unwarranted in PD patients.

P1166DOES PERITONEAL PROTEIN LOSS AFFECT CARDIOVASCULAR MORTALITY OF PERITONEAL DIALYSIS PATIENTS ?

Abstract Background and Aims Peritoneal protein loss (PPL) through peritoneal effluent has been a well-recognized detrimental result of peritoneal dialysis (PD). The amount of protein lost will depend on dialysis time, protein size, its serum concentration and other factors including patients’ clinical status. Peritoneal protein loss may be a manifestation of endothelial dysfunction, as with another type of capillary protein leakage, microalbuminuria, a recognized endothelial dysfunction marker. The aim of this study was to retrospectively evaluate the influence of PPL on cardiovascular mortality of peritoneal dialysis patients Method This is a single center retrospective study of 84 PD patients (m=54, f=30) with mean age of 65.2±17 years, mean PD duration of 43.2±24.9 months conducted for the time period from 2006 to 2019 (13 years). The patients were divided into two groups according to the amount of protein excreted during the modified Peritoneal Equilibration Test (PET) procedure using PD solution of 3.86% DW, 2 Lt infusion volume for total time of 4 hours. The total amount of proteins excreted was calculate from PET by multiplying the concentration of proteins at the end of the test with the total volume of PD fluid at the same time. Group A excreted a total amount of proteins &amp;lt; 1.55 gr (median value) at the end of PET test and Group B &amp;gt; 1.55 gr. The cumulative all-cause and cardiovascular survival of the PD patients was calculated by Kaplan Meier while the possible effect of any parameter in survival rates was evaluated by using Cox Regression analysis Results There was not any statistically significant difference between the two groups according to PD duration, age, dialysis adequacy targets, Residual Renal Function(RRF), BMI, ultrafiltration volume during PET and their transport status. The cumulative all-cause survival using Kaplan-Meier analysis revealed no statistically significant deference between the two groups (Log Rank p=0.55) even though mortality risk was adjusted for several factors (Cox Regression). When cardiovascular survival, using Cox Regression analysis, was adjusted for age, sex, Diabetes, PD modality, dialysis Kt/V and RRF we found that Group A (with protein excretion &amp;lt; 1.55 gr) had statistically significant better cardiovascular survival (p=0.029) compared to Group B. We confirm these results while trying to find among the total of our patients the possible risk factors for cardiovascular mortality. Using Cox Regression analysis, the amount of protein excreted during PET procedure and the type of PD solutions (high or low in GDPs) used were statistically significant (p=0.019 and p=0.04 respectively) independent risk factors for cardiovascular survival in our patients. Conclusion These results indicate that protein loss during peritoneal dialysis procedure has negative impact on cardiovascular mortality and survival of PD patients. Additionally, the use of PD solutions with low Glucose Degradation Products (GDPs) and AGEs may improve PD patient’s cardiovascular survival. Randomized interventional studies are encouraged to address the pathological concern of PPL in the future, namely its effects on cardiovascular conditions or its role as marker and effort to reduce PPL using ACE inhibitors or vit D should be considered only if it diminishes cardiovascular morbidity or mortality.

P1527SURVIVAL COMPARISON:HEMODIALYSIS VS PERITONEAL DIALYSIS: TEN YEARS OBSERVATIONAL STUDY

Abstract Background and Aims Survival comparison between peritoneal dialysis (PD) and hemodialysis (HD) is still controversial. While some retrospective studies have shown better survival in PD, particularly in the first year, others have not identified this difference. The only RCT published so far showed a 3-year mortality rate similar between two groups. However, the number of patients was too small to provide sufficient statistical power to identify any survival differences between the two dialysis techniques. Aim of this study was to compare HD and PD in term of survival rate and factors possibly involved in a ten-years observational study. Method We retrospectively evaluated all the incident patients that started a dialytic treatment, either HD or PD, due to uremia from 01-01-2008 to 31-12-2018 at the U.O. Nephrology ASST Spedali Civili of Brescia. Exclusion criteria were: duration of dialysis treatment less than 3 months, and previous dialytic treatment or kidney transplantation. For each patient anthropometric, clinical-anamnestic data and comorbidities at dialysis start were recorded. Results One thousand and six patients were identified. 130 patients were excluded due to dialysis treatment less than 3 months. A total 876 patients were analyzed. 77% of patients started dialysis on HD while 23% chose PD. Age was significantly higher in HD patients (69±15 vs 65±16 years; p&amp;lt;0.05). No differences were found in the incidence of: ischemic heart disease (HD 24%, PD 25%, p=0.90), diabetes (32% vs 32%, p=0.83), cancer (20% vs 17%, p=0.37), cardiac arrhythmia (20% vs 25%, p=0.08) and peripheral vascular disease (25% vs 25%, p=0.89). An increased incidence of COPD (HD 17% vs PD 8%, p&amp;lt;0.05) and hypertension (73% vs 87%, p&amp;lt;0.05) was present in PD patients. During follow-up, 17% of patients treated with PD shifted to HD due to catheter malfunction, recurrent infections, insufficient dialytic adequacy or ultrafiltration failure. Kidney transplants were performed more frequently in PD patients (HD 12%; PD 24%, p&amp;lt;0.05). At an intention to treat analysis of the data, univariate analysis showed better survival in PD patients (p&amp;lt;0.05, Figure 1). This difference was not confirmed at multivariate analysis (Figure 2), where age, cardiac arrhythmia, cirrhosis, diabetes and peripheral vascular disease were independently associated with an increased risk of mortality. No independent influence on mortality of the dialysis treatment modality was found. Conclusion This ten years observational study shows that HD and PD are similar in term of patient survival. Age and comorbidities seem to play the most important role in patient survival.

SAT-294 The relationship between peritoneal dialysis mortality and the Chinese medical insurance

There are two major medical insurance models in China: the Urban Basic Medical Insurance (UBMI) and the New Cooperative Medical Scheme (NCMS). We have observed that Chinese medical insurance type may affect the outcomes of patients treated with hemodialysis. The aim of the present study was to evaluate the association of the medical insurance type of patients undergoing peritoneal dialysis (PD) with their survival. We retrospectively analyzed the end-stage renal disease (ESRD) adult patients initiating PD between January 2008 and December 2016 in Zhejiang province, followed up through December 31, 2017. Patients had received continuous ambulatory PD for over 3 months, whom were divided into two groups according to their medical insurance type. Demographic, education level, clinical data, biochemical parameters and primary clinical outcomes including all-cause mortality, switch to hemodialysis and kidney transplant were analyzed. The survival rates were calculated by using the Kaplan-Meier method. A total of 8065 patients were enrolled, which is the largest cohort in China so far. There were 3523 patients (2090 males(59.3%)) with UBMI and 4542 (2317 males (51.0%)) with NCMS enrolled from 92 peritoneal dialysis units. Compared with UBMI, patients with NCMS were older (50 (IQR: 41-62) years old vs. 53 (IQR: 44-64)years old, P<0.001), had lower education level, smaller proportion of diabetic nephropathy and malignancy, more severe anemia, and more frequent hypoalbuminemia and hypocalcemia. The 1-, 3- and 5-year overall survival rates were 97.5%, 88.9%, and 81.5% in UBMI group, 95.9%, 85.9%, and 76.7% in NCMS group, respectively. Patients with NCMS showed higher all-cause mortality compared with UBMI (P<0.001). In multivariate Cox proportional hazards model, NCMS was independently associated with higher mortality (AHR=1.288; 95% CI 1.110,1.494). The medical insurance model was independently associated with PD patient survival, NCMS was associated with increased mortality among patients undergoing maintenance peritoneal dialysis in China.

Unilateral nephrectomy versus renal arterial embolization and technique survival in peritoneal dialysis patients with autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder associated with progressive enlargement of the kidneys and liver. ADPKD patients may require renal volume reduction, especially before renal transplantation. The standard treatment is unilateral nephrectomy. However, surgery incurs a risk of blood transfusion and alloimmunization. Furthermore, when patients are treated with peritoneal dialysis (PD), surgery is associated with an increased risk of temporary or definitive switch to haemodialysis (HD). Unilateral renal arterial embolization can be used as an alternative approach to nephrectomy. We performed a multicentre retrospective study to compare the technique of survival of PD after transcatheter renal artery embolization with that of nephrectomy in an ADPKD population. We included ADPKD patients treated with PD submitted to renal volume reduction by either surgery or arterial embolization. Secondary objectives were to compare the frequency and duration of a temporary switch to HD in both groups and the impact of the procedure on PD adequacy parameters. More than 700 patient files from 12 centres were screened. Only 37 patients met the inclusion criteria (i.e. treated with PD at the time of renal volume reduction) and were included in the study (21 embolized and 16 nephrectomized). Permanent switch to HD was observed in 6 embolized patients (28.6%) versus 11 nephrectomized patients (68.8%) (P = 0.0001). Renal artery embolization was associated with better technique survival: subdistribution hazard ratio (SHR) 0.29 [95% confidence interval (CI) 0.12-0.75; P = 0.01]. By multivariate analysis, renal volume reduction by embolization and male gender were associated with a decreased risk of switching to HD. After embolization, a decrease in PD adequacy parameters was observed but no embolized patients required temporary HD; the duration of hospitalization was significantly lower [5 days [interquartile range (IQR) 4.0-6.0] in the embolization group versus 8.5 days (IQR 6.0-11.0) in the surgery group. Transcatheter renal artery embolization yields better technique survival of PD in ADPKD patients requiring renal volume reduction.