Technique Failure Rates Research Articles

Systemic and local complement activation in peritoneal dialysis patients via conceivably distinct pathways.

Despite several advantages compared to haemodialysis (HD), peritoneal dialysis (PD) remains an underused dialysis technique due to its high technique failure rate related to membrane fibrosis and peritonitis events. Previous work has suggested a harmful role for the complement system in these processes, highlighting the need for a more comprehensive examination in PD. Plasma levels of C1q, mannose-binding lectin (MBL), Properdin, Factor D, C3d/C3-ratio and soluble membrane attack complex (sC5b-9) were determined in PD patients (n = 55), HD patients (n = 41), non-dialysis chronic kidney disease (CKD) patients (n = 15) and healthy controls (n = 14). Additionally, C1q, MBL, Properdin, Factor D and sC5b-9 levels were assessed in the peritoneal dialysis fluid (PDF). In a subgroup, interleukin-6, matrix metalloproteinase-2 (MMP-2), myeloperoxidase (MPO) and elastase were measured in the PDF. PD patients had significantly higher systemic levels of sC5b-9 compared to healthy controls, CKD and HD patients (p < 0.001). Plasma levels of C1q and C3d/C3-ratios were significantly associated with systemic sC5b-9 levels (p < 0.001). Locally, sC5b-9 was detected in the PDF of all PD patients, and levels were approximately 33% of those in matched plasma, but they did not correlate. In the PDF, only Properdin levels remained significantly associated with PDF sC5b-9 levels in multivariate analysis (p < 0.001). Additionally, PDF levels of sC5b-9 positively correlated with elastase, MPO and MMP-2 levels in the PDF (p < 0.01). Our data reveal both systemic and local complement activation in PD patients. Furthermore, these two processes seem independent considering the involvement of different pathways and the lack of correlation.

Postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis

BackgroundThoracic epidural analgesia is commonly used for upper gastrointestinal surgery. Intrathecal morphine is an appealing opioid-sparing non-epidural analgesic option, especially for laparoscopic gastrointestinal surgery.MethodsFollowing ethics committee approval, we extracted data from the electronic medical records of patients at Royal North Shore Hospital (Sydney, Australia) that had upper gastrointestinal surgery between November 2015 and October 2020. Postoperative morphine consumption and pain scores were modelled with a Bayesian mixed effect model.ResultsA total of 427 patients were identified who underwent open (n = 300), laparoscopic (n = 120) or laparoscopic converted to open (n = 7) upper gastrointestinal surgery. The majority of patients undergoing open surgery received a neuraxial technique (thoracic epidural [58%, n = 174]; intrathecal morphine [21%, n = 63]) compared to a minority in laparoscopic approaches (thoracic epidural [3%, n = 4]; intrathecal morphine [12%, n = 14]). Intrathecal morphine was superior over non-neuraxial analgesia in terms of lower median oral morphine equivalent consumption and higher probability of adequate pain control; however, this effect was not sustained beyond postoperative day 2. Thoracic epidural analgesia was superior to both intrathecal and non-neuraxial analgesia options for both primary outcomes, but at the expense of higher rates of postoperative hypotension (60%, n = 113) and substantial technique failure rates (32%).ConclusionsWe found that thoracic epidural analgesia was superior to intrathecal morphine, and intrathecal morphine was superior to non-neuraxial analgesia, in terms of reduced postoperative morphine requirements and the probability of adequate pain control in patients who underwent upper gastrointestinal surgery. However, the benefits of thoracic epidural analgesia and intrathecal morphine were not sustained across all time periods regarding control of pain. The study is limited by its retrospective design, heterogenous group of upper gastrointestinal surgeries and confounding by indication.

Catheter insertion techniques for improving catheter function and clinical outcomes in peritoneal dialysis patients.

Catheter insertion techniques for improving catheter function and clinical outcomes in peritoneal dialysis patients.

PS-C18-1: SLEEP SCORE AMONG HEALTH-RELATED QUALITY OF LIFE SUBSCALES PREDICTS TECHNIQUE SURVIVAL IN PATIENTS WITH PERITONEAL DIALYSIS

Purpose: There is sufficient evidence that peritoneal dialysis (PD) is superior to hemodialysis in terms of health-related quality of life (HRQOL), and higher HRQOL scores are associated with better clinical outcomes in patients with PD, however, the specific HRQOL subscales that predict prognosis remain uncertain. Design and method: In addition to various PD-related parameters and exercise capacity, HRQOL of outpatients with PD were assessed using Kidney Disease Quality of Life-Short Form Japanese version 1.3 from March 2017 to March 2018, and the association of HRQOL items with technique survival was prospectively analyzed until June 2021. Result: Among the 50 recruited PD outpatients, age and PD vintage were 63.8 ± 9.6 and 3.8 ± 2.8 years, respectively, and 21 patients discontinued PD and transferred to hemodialysis during the study period. In a univariate Cox proportional hazards model, higher scores (per 10) for symptoms, sleep, and vitality among HRQOL subscales were significantly associated with lower technique failure rate (Hazard Ratio(HR) 0.66, P = 0.002; HR 0.70, P = 0.006; and HR 0.80, P = 0.04, respectively). In multivariate analysis adjusted for Charlson comorbidity index, incremental shuttle walk test distance, and baseline PD vintage, only higher sleep score was significantly associated with lower technique failure rate (HR 0.68 per 10, P = 0.003). Among PD-related parameters, serum potassium level was significantly inversely correlated with sleep score (r = -0.34, P = 0.01). Discussion and Conclusion: Our results suggest that sleep score among HRQOL subscales is particularly useful as a predictor of technique survival in patients with PD. Improvement in sleep quality may improve technique survival in prevalent PD patients.

Syndesmotic Suture Button Fixation Results in Higher Tegner Activity Scale Scores When Compared to Screw Fixation: A Multicenter Investigation

Category: Ankle Introduction/Purpose: Injuries of the syndesmosis may occur in isolation or association with rotational ankle fractures. The use of suture button 'tight-ropes' versus metal screws for fixation across the syndesmosis has become a highly debated topic. Previous authors have compared subjective, functional, and radiographic outcomes between the two fixation methods with good outcomes reported. The primary aim of this study is to compare clinical outcomes of syndesmotic suture button fixation versus syndesmotic screw fixation for operative management of syndesmotic injuries. A secondary aim is to determine failure rates of both fixation techniques requiring revision syndesmosis surgery. We hypothesize that there will be no difference in subjective outcomes or activity scores when comparing screw versus suture button. This study is to improve patient care and outcomes. Methods: In this multi-center, retrospective cohort study, we identified patients with syndesmotic injuries who underwent surgical treatment at two separate academic referral centers from 2010 through 2017. All patients were diagnosed by attending orthopaedic surgeons at the participating study sites, and where their syndesmotic injuries were treated with either suture-button fixation or metal screw fixation based on surgeon preference. Patients were matched by age, gender, and OTA fracture classification. The primary subjective outcome measure was the Tegner activity level, and the secondary subjective outcomes measures were the Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL) subscale, FAAM sport subscale, and patient satisfaction score. The primary objective outcomes included failure and reoperation rate. Results: 41 patients treated with a suture button (71% male, mean age 39.7 years) and 21 patients treated with metal screws (67% male, mean age 43.7 years) were included in the study. Patient demographics were similar between groups. There was no significant difference in FAAM ADL scores between patients based on surgical procedure for the treatment of a syndesmosis injury (suture button versus metal screw fixation), t (50) = 1.373 (p =0.176). There was a significant difference in Tegner activity scale scores, with patients who underwent suture button fixation reporting significantly higher Tegner activity level scores on average than those who underwent syndesmosis repair with screw fixation (U = 141, p =0.002) (Figure 1). Conclusion: In this multi-center study, we report higher mean Tegner activity scale scores in patients treated with suture button fixation when compared to patients treated with metal screws for unstable syndesmotic injuries. Patients in both treatment cohorts reported similar FAAM ADL scores. The authors believe that both syndesmotic fixation techniques are acceptable in the treatment of syndesmosis of injuries, but recommend consideration given to suture button fixation in patients with higher activity levels.

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

To understand the potential and limitations of the different available surgical techniques used to treat large, long-bone diaphyseal defects by focusing on union, complication, re-intervention, and failure rates, summarizing the pros and cons of each technique. A literature search was performed on PubMed, Web of Science, and Cochrane databases up to March 16th, 2022; Inclusion criteria were clinical studies written in English, of any level of evidence, with more than five patients, describing the treatment of diaphyseal bone defects. The primary outcome was the analysis of results in terms of primary union, complication, reintervention, and failure rate of the four major groups of techniques: bone allograft and autograft, bone transport, vascularized and non-vascularized fibular graft, and endoprosthesis. The statistical analysis was carried out according to Neyeloff et al., and the Mantel–Haenszel method was used to provide pooled rates across the studies. The influence of the various techniques on union rates, complication rates, and reintervention rates was assessed by a z test on the pooled rates with their corresponding 95% CIs. Assessment of risk of bias and quality of evidence was based on Downs and Black’s “Checklist for Measuring Quality” and Rob 2.0 tool. Certainty of yielded evidence was evaluated with the GRADE system. Seventy-four articles were included on 1781 patients treated for the reconstruction of diaphyseal bone defects, 1496 cases in the inferior limb, and 285 in the upper limb, with trauma being the main cause of bone defect. The meta-analysis identified different outcomes in terms of results and risks. Primary union, complications, and reinterventions were 75%, 26% and 23% for bone allografts and autografts, 91%, 62% and 19% for the bone transport group, and 78%, 38% and 23% for fibular grafts; mean time to union was between 7.8 and 8.9 months in all these groups. Results varied according to the different aetiologies, endoprosthesis was the best solution for tumour, although with a 22% failure rate, while trauma presented a more composite outcome, with fibular grafts providing a faster time to union (6.9 months), while cancellous and cortical-cancellous grafts caused less complications, reinterventions, and failures. The literature about this topic has overall limited quality. However, important conclusions can be made: Many options are available to treat critical-size defects of the diaphysis, but no one appears to be an optimal solution in terms of a safe, satisfactory, and long-lasting outcome. Regardless of the bone defect cause, bone transport techniques showed a better primary union rate, but bone allograft and autograft had fewer complication, reintervention, and failure rates than the other techniques. The specific lesion aetiology represents a critical aspect influencing potential and limitations and therefore the choice of the most suitable technique to address the challenging large diaphyseal defects.

MO700: Outcomes of Remote Patient Monitoring among Peritoneal Dialysis Population in the Covid-19 ERA

Abstract BACKGROUND AND AIMS Automated peritoneal dialysis (APD) is a growing PD modality but as with other home dialysis methods, the lack of monitoring of patients' adherence to prescriptions is a limitation with potential negative impact on clinical outcome parameters. Remote patient monitoring (RPM-PD) allowing the clinical team to have access to dialysis data and adjust the treatment may overcome this limitation. As a result of the coronavirus disease 2019 (COVID-19) pandemic, the importance of RPM programs has raised to allow the physicians ensure optimal care of PD patients. In addition, to avoid the increased risk of complications or technique failure, the present study sought to determine clinical outcomes associated with RPM use in patients on APD therapy. METHOD We performed a systematic review in PubMed, MEDLINE, Embase and Cochrane databases to select studies that met the inclusion criteria. The search terms used were: peritoneal dialysis, remote monitoring, sharesource, outcomes, peritonitis, hospitalization, technique failure and adherence. These search terms were individually used and then combined in different databases. References within the chosen studies were reviewed. We followed the recommendations of Cochrane collaboration and the Quality of Reporting of Meta-analyses guidelines. STATA package-15 was used. We combined all study-specific estimates using inverse-variant weighted averages of logarithmic relative risk in random effects model. Confidence interval including the value of 1 was used evident for statistically significant estimate. Heterogeneity was evaluated using the Higgins I² statistic. Heterogeneity was estimated when the level of P-value was &amp;lt; 0.1. Results of the random effects model were spread out on the forest plot graph. RESULTS Twenty-two studies were included in our meta-analysis. In qualitative analysis: five studies showed that RPM in APD patients had lower hospitalization rates compared to traditional PD. Five studies showed better adherence in the RPM-PD group. Five studies showed better outcomes among RPM-APD patients in terms of symptom control, management of fluid balance, blood pressure control, dialysis prescription and electrolyte management. Five studies showed that RPM-APD had better outcomes in terms of patient independence, quality of life, patient and caregiver satisfaction. Five studies showed better cost-effectiveness in RPM-PD compared to traditional PD. Four studies showed better cost-effectiveness in RMP-PD. Three studies showed lower technique failure rates in RPM-PD compared to traditional PD. Three studies showed lower mortality rates in RPM-PD compared to traditional PD. Three studies showed better quality of life and patient satisfaction in RPM-PD. In quantitative analysis, RPM-PD patients had lower rates of technique failure (log relative risk = −0.32, 95% CI: −0.59 to −0.04), lower hospitalization rates (SMD = −0.84, 95% CI: −1.24 to −0.45), lower mortality rates (log RR = −0.26, 95% CI: −0.44 to −0.08) in comparison to traditional PD. CONCLUSION RPM-PD has better outcomes in terms of cost-effectiveness, patient adherence, hospital admissions, rate of peritonitis, technique failure, mortality rates, symptom control, quality of life, patient and caregiver satisfaction.

Technique failure in peritoneal dialysis: Modifiable causes and patient-specific risk factors.

Technique survival is a core outcome for peritoneal dialysis (PD), according to Standardized Outcomes in Nephrology-Peritoneal Dialysis. This study aimed to identify modifiable causes and risk factors of technique failure in a large Dutch cohort using standardised definitions. Patients who participated in the retrospective Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes cohort study and started PD between 2012 and 2016 were included and followed until 1 January 2017. The primary outcome was technique failure, defined as transfer to in-centre haemodialysis for ≥ 30 days or death. Death-censored technique failure was analysed as secondary outcome. Cox regression models and competing risk models were used to assess the association between potential risk factors and technique failure. A total of 695 patients were included, of whom 318 experienced technique failure during follow-up. Technique failure rate in the first year was 29%, while the death-censored technique failure rate was 23%. Infections were the most common modifiable cause for technique failure, accounting for 20% of all causes during the entire follow-up. Leakage and catheter problems were important causes within the first 6 months of PD treatment (both accounting for 15%). APD use was associated with a lower risk of technique failure (hazard ratio 0.66, 95% confidence interval 0.53-0.83). Infections, leakage and catheter problems were important modifiable causes for technique failure. As the first-year death-censored technique failure rate remains high, future studies should focus on infection prevention and catheter access to improve technique survival.

POS-694 THE ROLE OF INTRAPERITONEAL AMPHOTERICIN B IN PERITONEAL DIALYSIS-RELATED FUNGAL PERITONITIS. EXPERIENCE FROM A MALAYSIAN CENTER

Fungal peritonitis (FP) is an uncommon complication of peritoneal dialysis (PD) and is associated with high mortality and technique failure rate. The optimal treatment for FP is still not well established and intraperitoneal (IP) amphotericin B has been reported to cause chemical peritonitis. This study aims to investigate the role of IP amphotericin B in treating FP and the factors affecting the outcomes of FP.

Superior capsule reconstruction: anatomy, biomechanics, indications, and graft treatment.

Superior capsule reconstruction: anatomy, biomechanics, indications, and graft treatment.

Patients undergoing assisted peritoneal dialysis to show a better technique survival: A competing risk analysis.

To compare patient mortality and technique survival between patients undergoing assisted peritoneal dialysis (aPD) and self-care peritoneal dialysis (sPD). Patients who underwent peritoneal dialysis (PD) at the dialysis center of Second Affiliated Hospital of Soochow University from January 1, 2012 to December 31, 2016, were included and followed to December 31, 2019. Subjects were divided into aPD and sPD groups according to whether the patient could independently complete the PD procedure. Differences in mortality and technique failure rates were compared using competing risk analysis. A total of 384 patients were included in this study, with 274 patients in the sPD group and 110 patients in the aPD group. The multivariate competing risk regression analysis revealed that age (HR 1.03,95%CI 1.01-1.05, P<.001), aPD (HR 1.84,95%CI 1.10-3.08, P=.02), diabetes (HR 1.51, 95%CI 1.00-2.30, P=.05), residual renal function (HR 0.89, 95%CI 0.82-0.97, P=.005) and serum albumin level (HR 0.92, 95% CI 0.89-0.96, P<.001) were the independent risk factors for mortality. Besides, technique failure in aPD patients was lower than in the sPD group (HR 0.85, 95% CI 0.68-0.97, P=.03). These results found that aPD patients had higher mortality rates but lower technique failure rates than sPD patients. Higher mortality in aPD is probably related to the negative selection of the more comorbid patients. ​ ​.

POS-640 FUNGAL PERITONITIS IN AUTOMATED PERITONEAL DIALYSIS : AN 18-YEAR SINGLE CENTRE EVALUATION

Infectious peritonitis is the most serious complication of peritoneal dialysis (PD). Its origin is often bacterial. Fungal peritonitis (FP) is rare but always devastating, accounting for high rates of technique failure, morbidity and mortality. It is therefore important to know its microbiological and clinical profile and its evolution in order to establish preventive and therapeutic strategies. The aim of our study is to determine the FP frequency and to describe its clinical, microbiological and therapeutic aspects in patients treated with automated peritoneal dialysis (APD), APD being the most frequent PD modality in our centre. This was a single-centre retrospective study carried out in the PD unit of Charles Nicolle Hospital in Tunis from January 01, 2000 to December 31, 2018, on patients treated with APD and having presented at least one fungal peritonitis. Clinical, biochemical characteristics and detailed data on peritonitis episodes were recorded. Six cases of FP were identified, ie 3% of all infectious peritonitis that occurred during the study period. The patients' sex ratio was 2. Their mean Charlson score at onset of APD was 3 [Extremes: 2-6]. Only one patient was diabetic. Their mean age at the time of peritonitis was 40 +/- 16 years. Candida albicans was the most frequently (50%) detected yeast followed by candida non albicans (2 patients). Aspergillus has been isolated in one patient. This group experienced an average of 2 bacterial peritonitis before FP. All FP were preceded by bacterial peritonitis: In five patients, they were diagnosed following refractory peritonitis mainly due to Enterobacteria (4 patients). In one case, the patient had a history of three episodes of bacterial peritonitis, FP presented as a new episode of infectious peritonitis occurring 5 months after the third peritonitis. All Candida peritonitis were treated with intravenous fluconazole for an average of 13 days. Aspergillary peritonitis was treated with amphotericin B for 15 days. The PD catheter was removed in all cases. Four patients were transferred to hemodialysis. APD was retried in the other two patients. They were switched to hemodialysis after 1 and 7 months, respectively, of placement of the second PD catheter for loss of ultrafiltration and catheter dysfunction. FP are certainly rare, but they are an ineluctable cause of PD failure.

Serum potassium, albumin and vitamin B12 as potential oxidative stress markers of fungal peritonitis

Background Biomarkers of oxidative stress (OS) have been poorly explored in fungal peritonitis (FP). Potassium is a regulator of pro-oxidants and antioxidants. Albumin and vitamin B12 (B12) are vital antioxidant agents in the circulatory system. This study aimed to investigate the antioxidative role of serum potassium, albumin and B12 in FP. Methods Serum levels of potassium, albumin and B12 were retrospectively analyzed in 21 patients with a confirmed diagnosis of FP, 105 bacterial peritonitis (BP) patients and 210 patients receiving peritoneal dialysis without peritonitis. Results Serum levels of potassium, albumin and B12 were lower in FP patients than in BP patients. Serum potassium concentration was statistically related to albumin concentration in peritonitis patients. Univariate and multivariate binary logistic regression analysis suggested that serum level of potassium and albumin were independent risk factors of FP when compared with BP. Lower potassium and B12 levels were independently associated with higher rates of technique failure in peritonitis. Conclusion These findings suggest lower serum potassium, albumin and B12 as potential oxidative stress markers of FP and raise the hypothesis that an increased level of OS could contribute to FP. KEY MESSAGES FP remains a serious complication of peritoneal dialysis (PD), with higher morbidity (1–23.8%) and mortality (2–25%), and oxidative stress plays a role in it. Our study suggested serum potassium, albumin and vitamin B12 as potential oxidative stress markers of fungal peritonitis.

Technique failure in remote patient monitoring program in patients undergoing automated peritoneal dialysis: A retrospective cohort study.

Remote patient monitoring (RPM) programs in automated peritoneal dialysis (APD) allow clinical teams to be aware of many aspects and events of the therapy that occur in the home. The present study evaluated the association between RPM use and APD technique failure. A retrospective, multicentre, observational cohort study of 558 prevalent adult APD patients included between 1 October 2016 and 30 June 2017 with follow-up until 30 June 2018 at Renal Therapy Services network in Colombia. Patients were divided into two cohorts based on the RPM use: APD-RPM (n = 148) and APD-without RPM (n = 410). Sociodemographic and clinical characteristics of all patients were summarized descriptively. A propensity score was used to create a pseudo-population in which the baseline covariates were well balanced. The association of RPM with technique failure was estimated adjusting for the competing events death and kidney transplant. Five hundred fifty-eight patients were analyzed. 26.5% had APD-RPM. In the matched sample comprising 148 APD-RPM and 148 APD-without RPM patients, we observed a lower technique failure rate of 0.08 [0.05-0.15] episodes per patient-year in APD-RPM versus 0.18 [0.12-0.26] in APD-without RPM cohort; incidence rate ratio = 0.45 95% confidence interval: [0.22-0.91], p-value = 0.03. The use of an RPM program in APD patients may be associated with a lower technique failure rate. More extensive and interventional studies are needed to confirm its potential benefits and to measure other patient-centered outcomes.

Predictors of technique failure and mortality on peritoneal dialysis: An analysis of New Zealand peritoneal dialysis registry data.

Technique failure is a major disadvantage associated with peritoneal dialysis (PD). This study aimed to analyse the demographic and risk predictors of technique failure and mortality in patients on PD. All incidental PD patients registered on the New Zealand Peritoneal dialysis registry (NZPDR) from January 1995 to December 2014 were included in the study. The primary outcomes were time to technique failure and its specific causes, while as the secondary outcome was time to death. Risk predictors of technique failure and mortality were analysed using multivariate Cox proportional hazards (PH) regression model. Besides, competitive risk regression analysis was undertaken to analyse the effect of death as a competing event to technique failure. Of 6379 patients, there were 2993 (46.9%) episodes of technique failure and 2684 (42%) deaths. The crude technique failure and mortality rates were 165 ± 5.90 and 147.9 ± 5.50 (mean ± SD)/1000 patient-years, respectively. Hazards of technique failure were lower in older individuals above 60 years, HR 0.72 (95% CI 0.67-0.79), larger centres, HR 0.89 (95% CI 0.79-1.00) and higher with coiled catheters, HR 1.26 (95% CI 1.16-1.37). Early nephrology referral, continuous ambulatory peritoneal dialysis (CAPD) and Asian ethnicities were associated with better technique survival. Infections were the major cause of technique failure (58.4%) with peritonitis being the leading cause (30.2%). There are multiple factors associated with risk of technique failure, therefore it is persuasive to construct a mathematical model for early prediction, for a planned transition to HD.

Arthroscopic Superior Capsule Reconstruction With Doubled Autologous Semitendinosus Tendon Graft

Massive and irreparable rotator cuff tears remain a difficult condition to treat. Fatty infiltration of the muscles and excessive retraction of the tendons predispose to high failure rates of arthroscopic repair techniques. In recent years, studies on the superior capsule have shown that it plays a key role in reducing superior humeral head translation and restoring balance to the force couples required for dynamic shoulder function. Superior capsule reconstruction has become common in clinical practice. Several techniques with different types of grafts have been described, such as fascia lata autograft, dermal allograft patch, and long head of the biceps tendon autograft. More recently, an open technique with semitendinosus tendon autograft has been proposed. Our aim is to describe an all-arthroscopic technique for superior capsule reconstruction using a doubled semitendinosus tendon autograft in a box-shaped configuration. We believe that the technique can combine the advantages of other techniques, such as graft availability, low harvest-site morbidity, limited cost, and mechanical strength.

Comparison of patient survival and technique survival between continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

This retrospective cohort study compared patient survival and technique survival between patients on continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) using recent data at a single tertiary medical center in Taiwan. From medical records, we identified incident 459 CAPD patients and 266 APD patients on dialysis for at least 90 days and aged more than 18 years to estimate mortality and technique failure rates, and related hazard ratio (HR) and 95% confidence interval (CI) from 2007 to 2018. There were more women (52.3%) in the CAPD group, whereas patients in the APD group were younger. Compared to CAPD patients, APD patients had a lower mortality rate (2.83 vs. 5.79 per 100 person-years) with an adjusted HR of 0.69 (95% CI = 0.47-1.02), and a lower technique failure rate (9.70 vs. 17.52 per 100 person-years) with an adjusted HR of 0.65 (95% CI = 0.51-0.83). Further subgroup analyses revealed that, compared to CAPD, APD was associated with a significant lower risk of technique failure in male patients, patients aged 50-65 years, diabetic patients, patients without cardiovascular disease (CVD), patients with higher peritoneal permeability, or patients initiating PD in an earlier era. The mortality risk was not significant between CAPD and APD patients. APD is associated with a lower risk of technique failure than CAPD, particularly for male patients, and patients aged 50-65 years, with diabetes, without CVD, with high or high average peritoneal permeability, or initiating PD in an earlier era.

P1444CHANGES IN TREATMENTS AND OUTCOMES OF PATIENTS INITIATING PERITONEAL DIALYSIS DURING THE LAST 10 YEARS: DATA FROM SWEDISH RENAL REGISTRY

Abstract Background and Aims The recent years have witnessed several therapeutic improvements regarding both peritoneal dialysis (PD) treatment itself and the prevention and management of complications. We evaluated trends in implementation of therapeutic improvements and their relationship with survival and other relevant clinical outcomes in PD patients from Sweden. Method Using the Swedish Renal Registry (SRR), clinical data from all patients initiating PD in Sweden between 2006 and 2015 were linked to other national healthcare registries to obtain information on vital status, hospitalization and diagnoses during in and out-patient care, along with information on all dispensed drugs, from inclusion to the end of 2017. We first evaluated trends in the use of PD-related treatments and of selected key medications within 2-year blocks. We then evaluated the incidence of death, major cardiovascular events (MACE), technique failure, transplantation and peritonitis episodes within one and two years from PD initiation using standardized incidence rates via logistic regression to account for differences in patient characteristics over time. In subsequent Cox regression models, we studied whether adjustment for implementation of these therapeutic changes modified observed trends in clinical outcomes. Finally, patient survival was compared against the age-sex matched general Swedish population using standardized incidence ratios (SIR). Results 3,312 patients (mean age 63±15 years; 34% women) initiated PD in Sweden during the study period. Across 2-year time blocks, there was no difference over time in the distribution of age, sex or comorbidities with the exception of an increased proportion of patients with chronic pulmonary disease. The proportion of patients undergoing automated peritoneal dialysis and using icodextrin increased over time, while mean standard Kt/V and weekly creatinine clearance did not change. The use of non-calcium phosphate binders, cinacalcet and calcium-channel blockers increased, and the use of angiotensin-converting enzyme inhibitors /angiotensin receptor blockers, erythropoietin, iron, and calcium supplements showed decreasing trends. After standardization for differences in demography and comorbidities, the one-year incidence of peritonitis decreased by 13% and the rate of kidney transplantation increased by 52% in 2014/15 compared to 2006/07. The rates of death, MACE or technique failure did not show differences over time. Similar results were observed with 2-years of follow up and when applying Cox models; Per 2-year period, the risk of peritonitis within one year decreased by 8% (HR 0.92, 95% CI 0.87-0.98) regardless of age, sex, comorbidity and the abovementioned therapeutic changes. The risk of death for PD patients was in 2006/2007 4 times higher [SIR 4.08 (3.15–5.29)] and in 2014/15 3.7 times higher [SIR 3.65 (2.70–4.94)] than the general population, corresponding to a reduction of SIR by 11%. Conclusion During the last 10 years, there has been a gradual implementation of new and established evidence-based treatments in patients starting PD in Sweden. Although survival rates are improving compared to the general population, there were no clear differences in the rates of technique failure, MACE or death across PD patients over time. We observed, however, consistent improvements in peritonitis frequency and access to transplantation.

P1129PERITONEAL DIALYSIS TECHNIQUE FAILURE IN A LARGE POPULATION IN COLOMBIA

Abstract Background and Aims Peritoneal dialysis (PD) is a renal replacement therapy widely used in the world; about 197,000 patients use it. The main limitation of the use is related to technique failure. Extending time free of technique failure remains a long-term challenge in PD. To estimate the incidence of technique failure in PD and, describe the main reasons for failure. Method A historical, multicenter, observational cohort study of all adult patients starting PD between January 1, 2010, and December 31, 2015, with follow-up until December 31, 2018, at Renal Therapy Services (RTS) network. The definition of technique failure applied when a patient was switched to Hemodialysis (HD) for at least 30 days. Socio-demographic and clinical characteristics of all patients were summarized descriptively by PD modality. We estimate the failure rate with an analysis of Kaplan Meier and analysis that incorporate competing risks as death and transplant. Results 6452 patients met the inclusion criteria for data analysis, 67% were in CAPD modality. The mean age was 59 years, 54% were male, and 53.7% had a history of diabetes, see Table 1. There were 1462 technique failures events with a rate of 10.67 events per 100 patients-year [95% CI, 10.14 – 11.24]. The median technique survival time was 5.8 years [ 95% CI: 5.11 to 5.45]. Technique failure rates did not differ by PD modality (Wilcoxon test = 0.4986), Figure 1. In the presence of competing events, the cumulative incidence of technique failure for the first year was 6.9 events per 100 persons-risk [95% CI: 6.27 to 7.56], Table 2. The most common causes of technique failure were catheter complications, followed by psychological and medical indications, Table 3. Conclusion The incidence of PD technique failure is around ten events per 100 patient-year, and this is lower than the previous cohort reports in the literature. Catheter problems remain the leading cause of technique failure

P1151CLINICAL OUTCOMES IN REMOTE PATIENT MONITORING IN AUTOMATED PERITONEAL DIALYSIS : A COLOMBIAN EXPERIENCE

Abstract Background and Aims Patients with remote monitoring are followed-up daily by clinical teams, allowing early detection and correction of problems, which could result in improvements in therapy outcomes. Aims: To evaluate the association between Remoted Patient Monitoring (RPM) program and clinical outcomes (technique failure and peritonitis rates). Method A historical, multicenter, observational cohort study in Automatized Peritoneal Dialysis (APD) prevalent patients, included between October 1, 2016, and June 30, 2017 with follow-up until June 30, 2018, at Renal Therapy Services (RTS) network. Patients were older than 18 years, divided into two cohorts based on the RPM use: 1) APD-RPM cohort: patients using the HomeChoice Claria® device with Sharesource® technology (Baxter Healthcare, Deerfield, USA) and 2) APD-Without RPM cohort: patients using APD systems HomeChoice Legacy® without RPM. Socio-demographic and clinical characteristics of all patient were summarized descriptively. Propensity score matching 1:1 was used. Results 558 patients met the inclusion criteria for data analysis. The mean age was 54 years, 40% were female, 26% had APD RPM, see Table 1. After propensity score matching, APD therapy with RPM (n=148) as compared to APD-Without RPM (n=148) was associated with significant reduction in technique failure, IRR= 0.46 95% CI: [0.24 - 0 .89], and a trend in peritonitis rate reduction, IRR= 0.87 [0.41 - 1.00], P= 0.051, see table 2. Main reasons of technique failure are presented in table 3. Conclusion The use of RPM program in APD patients is associated with lower technique failure rate, supporting the role of this technology as performance enhancer.