Technique Failure Research Articles

Efficacy of gastric per-oral endoscopic myotomy remains similar after failure of interventional techniques in refractory gastroparesis

Background and aimsGastric per-oral endoscopic myotomy (G-POEM) is a new therapeutic option for the treatment of refractory gastroparesis. However, the outcome of G-POEM after the failure of gastric electrical stimulation (GES) or other pylorus-targeting therapies has been poorly reported. MethodsData were collected from patients referred for G-POEM for refractory gastroparesis. The efficacy in patients with previous interventional techniques was compared to patients naïve to instrumental technique. The primary endpoint was the 6-month clinical success rate, defined as at least a 1-point decrease in the Gastroparesis Cardinal Symptom Index (GCSI). ResultsAmong 48 patients referred for G-POEM, 32 patients had had previous instrumental treatments (66%): 15 (31%) had had GES, and 17 (35%) had had pyloric endoscopic dilation or toxin injection. The technical success rate was 100%. At 6 months, clinical success was achieved in 25/48 patients (52%) and the GCSI decreased from 3.38 (2.94–3.95) to 2.25 (1.11–3.36) (p < 0.001). The 6-month success rate was similar in patients with or without previous instrumental treatment (50.0% vs 56.3%; p = 0.41). The complication rate was also similar in the two groups (6.3% vs 12.5%; p = 0.59), with only one severe adverse event. The only predictive factor for success at 6 months was a higher body mass index (OR = 1.14 [1.01–1.32]; p = 0.05). ConclusionG-POEM is safe and remains effective after GES or previous pyloric treatment failure, with 50% efficacy at 6 months. The therapeutic strategy in refractory gastroparesis remains to be defined.

Airway management for endoscopic treatment of laryngotracheal stenosis

ObjectivesTo describe the airway management techniques used during endoscopic management of laryngotracheal stenosis (LTS), and to identify patient, surgical, and clinician factors that are associated with use of jet ventilation, transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE), and intermittent apnea, including primary technique success vs failure and complications. MethodsRetrospective review of electronic medical records was performed for all patients undergoing direct laryngoscopy for LTS over a seven-year period. Patients with an existing tracheostoma at the time of surgery were excluded. Univariate chi-squared analyses were performed to identify patterns in airway management based on patient and surgical factors. ResultsA total of 92 endoscopic surgeries for 41 unique patients were identified. Airway management techniques differed based on the procedure performed (P < 0.001). Jet ventilation and THRIVE were particularly associated with subglottic procedures, and transtracheal jet ventilation with supraglottic procedures. There were no differences in complication rate based on airway management technique. The rate of primary airway plan failure was 50 % for THRIVE, 15 % for jet ventilation, 2 % for intermittent apnea, and 0 % for endotracheal intubation (p = 0.002). The presence of an anesthesiologist specializing in head and neck anesthesia was associated with significantly greater rates of jet ventilation and THRIVE (41 % vs 7 % for jet ventilation, 9 % vs 4 % for THRIVE; p = 0.002). ConclusionPatient and surgical factors play an important role in airway management planning for patients undergoing endoscopic laryngotracheal procedures. The presence of a head and neck anesthesiologist was associated with a more diverse array of airway management options for these patients.

Application of Privacy Engineering Techniques in Software Development for the National Privacy Commission

The study investigated the implementation of privacy engineering in software development at the National Privacy Commission (NPC) with a specific focus on the Data Breach Notification Management System (DBNMS). Objectives include identifying the factors that contribute to the success or failure of privacy engineering in the NPC's software development context, to provide valuable insights into the integration of privacy measures. This includes the development of actionable guidance for the effective integration of privacy and security in software engineering at the NPC, tailored specifically for NPC engineers and encompassing methodologies for incorporating privacy engineering throughout the software development life cycle. This is to empower NPC software engineers with practical tools and strategies to create a secure and privacy-respecting environment. Qualitative methodology and thematic analysis approach were utilized to assess the effectiveness of privacy engineering techniques. To gather insights, semi structured interviews were conducted with both internal and external stakeholders composed of software developers, data protection officers, and other internal and external users of the DBNMS. Evaluation yielded positive remarks both from internal and external participants. Factors that contributed to the success and failure of privacy engineering techniques in software development include rapid evolution of technology, lack of funds, and stakeholder engagement, among others. Overall, the findings are expected to contribute to the broader discourse on privacy engineering and have implications for policymakers, software development practitioners, and organizations looking to enhance their privacy practices in the digital age.

Association of Social Deprivation Index with Home Dialysis Technique Failure: A Single Center Experience.

Despite offering several advantages to patients and healthcare systems, utilization of home dialysis modalities (HDM) remains low, particularly among racial and ethnic minorities, and those with increased sociodemographic stress. Providers' apprehension towards adverse outcomes and home dialysis failure remains a barrier to HDM referral. We investigated the relationship sociodemographic factors have on HDM use and technique failure. We performed a retrospective cohort study of adult incident ESRD patients over a six-year period at the University of Rochester to evaluate the association between demographic factors, social deprivation index (SDI), and co-morbidity burden on HDM utilization and technique failure. Person-time incidence rates were calculated to compare outcome variables, and rates were compared using a Poisson Rate Ratio Test. A univariate Cox regression was used to examine predictors impacting technique failure. Of the 873 patients, 102 started dialysis with HDM, 79 patients converted to HDM, and 692 remained on in-center hemodialysis (ICHD). Age, race, and SDI scores were significantly different between patients starting on ICHD, peritoneal dialysis (PD) and home hemodialysis (HHD) with no significant difference in comorbidity burden. Black patients represented 32% of the overall cohort, but only 16% of the initial home dialysis population. Compared to those that remained on ICHD, individuals converting from ICHD to HDM were younger and had significantly different SDI scores. SDI was not associated with HDM technique failure. Historically underrepresented racial populations are less represented in those starting home dialysis, however there was no racial difference in the group transitioning to HDM after initiating ICHD. Social deprivation scores were higher in those on ICHD compared to PD. Neither social deprivation nor race predicted success on home therapy. These findings demonstrate a disparity in initial modality, and a disconnect between sociodemographic factors associated with home dialysis use and those predicting HDM technique failure.

Endoscopic retrograde cholangiopancreatography using a pediatric colonoscope in patients with Roux‑en‑Y gastrectomy and an intact major duodenal papilla.

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastrectomy and an intact major duodenal papilla is challenging and difficult, with unsatisfactory outcomes using various endoscopes. Limited data are available regarding the outcomes of ERCP using a pediatric colonoscope in such patients. To evaluate the efficacy of a pediatric colonoscope in patients with Roux-en-Y gastrectomy and an major duodenal intact papilla, 93 consecutive patients with Roux-en-Y gastrectomy and an intact major duodenal papilla who underwent ERCP using a pediatric colonoscope at the Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, (Nanjing, China) between January 2018 and December 2022 were retrospectively reviewed. Following the failure of bile duct cannulation, a double-guidewire or precut technique was utilized for advanced cannulation. Interventions were performed using standard ERCP therapeutic accessories. The results indicated that distal gastrectomy with Roux-en-Y reconstruction was performed in 38 out of 93 patients, while 55 patients underwent total gastrectomy with Roux-en-Y reconstruction. The success rates associated with endoscope insertion, endoscopic cannulation and therapeutic ERCP were 88.17% (82/93), 85.37% (70/82) and 95.71% (67/70), respectively, while the clinical intervention success and complication rates were 72.04% (67/93) and 7.53% (7/93), respectively. The endoscope insertion time was 40.78±10.04 min, and the ERCP procedure time was 88.55±16.38 min. Student's t-test showed that the endoscope insertion time and the ERCP procedure time in patients undergoing distal gastrectomy were longer than those in patients undergoing total gastrectomy (P<0.05). Binary logistic regression analysis showed that age and number of previous abdominal surgeries were independent risk factors associated with endoscope insertion failure. In conclusion, the present study demonstrated that the use of a pediatric colonoscope is efficacious and safe for patients with Roux-en-Y gastrectomy and an intact major duodenal papilla undergoing ERCP.

Early Anuria in Incident Peritoneal Dialysis Patients: Incidence, Risk Factors, and Associated Clinical Outcomes

Rationale & ObjectiveThe development of anuria was linked to worse clinical outcomes in patients undergoing peritoneal dialysis (PD). Our objective was to investigate the incidence, risk factors, and associated clinical outcomes of anuria within the first year after PD. Study DesignRetrospective Cohort Study. Setting & ParticipantsPatients who started continuous ambulatory peritoneal dialysis (CAPD) at our center between 2006 and 2020 were included and followed up until January 31, 2023. ExposureAge, gender, diabetes, temporary hemodialysis, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARBs), diuretics, baseline urine volume, serum albumin, daily glucose exposure, peritonitis, and incremental PD. OutcomesThe primary outcome was early anuria, defined as 24-hour urine volume ≤ 100mL within the first year of PD initiation. Secondary outcomes included all-cause mortality, cardiovascular disease (CVD) mortality, technique failure, and peritonitis. Analytical ApproachCox proportional hazards model. ResultsA total of 2592 CAPD patients aged 46.7 ± 14.9 years were recruited. Among them, 58.9% were male, 24.0 % had diabetes. Within the first year of PD therapy, 159 (6.13%) patients developed anuria, with a median duration of 7.53 (interquartile range [IQR] 3.93-10.0) months. Higher baseline urine volume (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.90-0.97), higher serum albumin (HR 0.92, 95% CI 0.88-0.95), with diabetes before PD (HR 0.57, 95% CI 0.35-0.92), and prescribed incremental PD (HR 0.27, 95% CI 0.14-0.51) were associated with a reduced risk for early anuria, while a higher level of daily glucose exposure (HR 1.01, 95% CI 1.00-1.01) was identified as a risk factor for early anuria. Subgroup analyses showed that using ACEI/ARBs was linked to a lower risk of early anuria (HR 0.25, 95% CI 0.09-0.69) in diabetic patients. Treating early anuria as a time-dependent covariate, early anuria was associated with a higher risk for all-cause mortality (HR 1.69, 95% CI 1.23-2.32) and technique failure (HR 1.43, 95% CI 1.00-2.04) after adjusting for confounding factors. LimitationsSingle-center and observational study. ConclusionsThe incidence of early anuria in our center was 6.13%. Higher baseline urine volume, higher serum albumin, a history of diabetes, incremental PD start, and lower daily glucose exposure were associated with lower risks of early anuria. In patients with diabetes mellitus, non-use of ACEI/ARBs was associated with early anuria. Early anuria was related to a higher risk for all-cause mortality and technique failure.

Impact of glycemic control on residual kidney function and technique failure associated with volume overload in diabetic patients on peritoneal dialysis.

It is unclear whether poor glycemic control contributes to residual kidney function (RKF) decline and consequent volume overload in diabetic patients on peritoneal dialysis (PD). This retrospective analysis included 80 diabetic patients who started PD at a single center. The first 2 years of patient data were collected to investigate the impact of glycemic control on RKF and volume overload in the early stages of PD. We used the time-averaged glycated hemoglobin (HbA1c) levels to estimate glycemic control. RKF loss was measured as the slope of RKF decline and time to anuria. To assess the association between glycemic control and volume overload, we examined technique failure (TF) associated with volume overload (TFVO), defined as TF due to excessive fluid accumulation. Multivariable linear regression and Cox regression analysis were performed to assess how glycemic control affects RKF and TFVO. Over the first 2 years, the mean rate of RKF decline was -3.25 ± 3.94 mL/min/1.73 m2 per year. Multivariable linear regression showed that higher time-averaged HbA1c was associated with a rapid RKF decline (β = -0.95; 95% confidence interval [CI], -1.66 to -0.24; p = 0.01). In the adjusted Cox regression analysis, higher time-averaged HbA1c increased the risk of progression to anuria (adjusted hazard ratio [HR], 1.97; 95% CI, 1.29-3.00; p = 0.002) and TFVO (adjusted HR, 2.88; 95% CI, 1.41-5.89; p = 0.004). Poor glycemic control is associated with rapid RKF decline and leads to volume overload in diabetic patients on PD.

Retroperitoneal leakage as an important cause of acquired ultrafiltration decline in peritoneal dialysis: clinical characteristics and related risk factors.

Peritoneal dialysis (PD) is a widely-used renal replacement therapy while low ultrafiltration volume usually results in technique failure. Retroperitoneal leakage has been reported to be one of the causes of acquired decline in ultrafiltration. The present study investigated retroperitoneal leakage in PD patients and explored related risk factors. This study was designed as a prospective, observational study. A total of 420 PD patients regularly followed up at our center were enrolled from May 2011 to July 2021 and followed until December 2021. Retroperitoneal leakage was determined by magnetic resonance peritoneography and was used as the endpoint. Patients with retroperitoneal leakage were given intermittent PD or temporary hemodialysis (HD) as therapy. Cox regression models were used to identify risk factors for retroperitoneal leakage. The cohort was followed up for up to 125.0months (median: 46.4months; interquartile range: 16.6months). During the follow-up, 68 patients developed retroperitoneal leakage, with 31 (45.6%) cases occurring within the first year after PD initiation. A total of 62 (91.2%) patients recovered from retroperitoneal leakage and resumed their original PD regimen. Multivariate Cox regression analysis revealed that age and gender were independent predictors for retroperitoneal leakage. Younger males were more likely to develop retroperitoneal leakage. In females, waistline and body mass index (BMI) were found to be risk factors for retroperitoneal leakage. Retroperitoneal leakage was common in PD patients with ultrafiltration insufficiency and was usually reversible after appropriate treatment. Age and gender were independent risk factors for retroperitoneal leakage.

Artificial intelligence and machine learning in peritoneal dialysis: a systematic review of clinical outcomes and predictive modeling.

The integration of artificial intelligence (AI) and machine learning (ML) in peritoneal dialysis (PD) presents transformative opportunities for optimizing treatment outcomes and informing clinical decision-making. This study aims to provide a comprehensive overview of the applications of AI/ML techniques in PD, focusing on their potential to predict clinical outcomes and enhance patient care. This systematic review was conducted according to PRISMA guidelines (2020), searching key databases for articles on AI and ML applications in PD. The inclusion criteria were stringent, ensuring the selection of high-quality studies. The search strategy comprised MeSH terms and keywords related to PD, AI, and ML. 793 articles were identified, with nine ultimately meeting the inclusion criteria. The review utilized a narrative synthesis approach to summarize findings due to anticipated study heterogeneity. Nine studies met the inclusion criteria. The studies varied in sample size and employed diverse AI and ML techniques, reflecting the breadth of data considered. Mortality prediction emerged as a recurrent theme, demonstrating the significance of AI and ML in prognostic accuracy. Predictive modeling extended to technique failure, hospital stay prediction, and pathogen-specific immune responses, showcasing the versatility of AI and ML applications in PD. This systematic review highlights the diverse applications of AI/ML in peritoneal dialysis, demonstrating their potential to enhance predictive accuracy, risk stratification, and decision support. However, limitations such as small sample sizes, single-center studies, and potential biases warrant further research and external validation. Future perspectives include integrating these AI/ML models into routine clinical practice and exploring additional use cases to improve patient outcomes and healthcare decision-making in PD.

Direct position determination algorithm based on wideband array signal model in external illuminator system

Abstract Target location and tracking are among the most critical applications for external illuminator systems. Most traditional array signal direct position determination (DPD) techniques are based on narrowband signals. With the advancement of communication technology, various wideband signals are extensively utilized in communication systems, leading to the failure of some traditional DPD techniques. To address this issue, this article proposes a new DPD algorithm for wideband array signals. First, we suppress the direct wave (DW) interference in the received signal. Then, a cost function for the target coordinate is constructed based on the Maximum Likelihood (ML) criterion, and a phase matching matrix is created for the problem of unknown signal transmission time. Finally, the position estimation is obtained from the peak of the cost function. Simulation results demonstrate that the proposed algorithm outperforms traditional two-step localization methods based on the time difference of arrival of signals, particularly in cases where DW interference is present in the received signal.

#494 Analysis of technique failure and reasons for the end of follow-up in a peritoneal dialysis unit

Abstract Background and Aims Currently, there are various definitions for peritoneal dialysis technique failure, and several related factors are described. There is controversy regarding whether mortality should be considered a form of technique failure or not, as it involves an event of a different nature. Besides, the exit form peritoneal dialysis (PD) technique can occur due to the transition to hemodialysis (HD), kidney transplantation or the patient's death in general. The aim of this study was to investigate which factors are associated with survival in peritoneal dialysis technique. Method A retrospective study was conducted with 111 incident PD patients in the dialysis unit of Hospital Universitario Virgen de las Nieves, in Granada, Spain, between 2015 and 2020. A survival curve was obtained, evaluating the association of different variables with technique failure and the end of follow-up. By identifying mortality as a competitive risk for technique failure, a Fine and Gray competitive risks model was applied. Results A total of 111 patients were analyzed, with an annual technique survival of 90%, being it 83% at two years, and 74% at three years. Table 1 reflects the demographic and clinical characteristics of the patients. The main causes of technique failure were psychosocial causes (19%), peritoneal catheter mechanical issues (12%), ultrafiltration failure (9.52%), and peritonitis (9.52%). The main reasons for the end of follow-up were kidney transplantation (55%), transfer to HD (26%), and death (12.6%). Among the deceased, 64% were of cardiovascular origin, and 21% were infectious. Technique failure was more observed in patients over 65 years old, in those with a Charlson index higher than 4 points, with diabetes, a history of cardiovascular disease (CVD) and heart failure (HF), in former smokers, and in diabetic kidney disease. Conclusion Technique survival in our center was 90% at one year and 83% at two years, similar to previous Spanish records. The reasons for technique exit were: 55% due to kidney transplantation, 26% due to transfer to hemodialysis, and 19% due to for psychosocial causes. Risk factors related to technique failure were advanced age, Charlson index, diabetes, and a history of cardiovascular disease (CVD) and heart failure (HF).

#2650 A novel approach for exit site care reduces peritoneal dialysis catheter related infections

Abstract Background and Aims Peritoneal dialysis (PD) related infections, including peritonitis and catheter related infections, are associated with significant morbidity and technique failure. Various exit site care protocols are available, most allow to shower in running water after the exit site is well healed. Following an increase in exit site infections (ESI) in our dialysis unit, partially resulting from water derived organisms, we implemented a novel exit site care protocol. The protocol included complete avoidance of water exposure using stoma bag during shower; and change in antibiotic treatment from gentamycin to mupirocin. We aimed to evaluate its efficacy to decrease ESI episodes. Method A prospective single center trial. Study group included PD patients between June 2018 - May 2021 who implemented the new exit-site care protocol. They were compared to a historical control group that included all PD patients between January 2016 to May 2018. In the control group, exit-site care included a daily shower with a bactericidal cleanser containing chlorhexidine 4%, thereafter local gentamycin 0.1% was applied with sterile gauze dressing. In the study group, water exposure during daily wash was avoided using a stoma bag sealed around the catheter exit-site and the tubing. Thereafter, the exit-site was cleaned with a chlorhexidine 0.5%- alcohol 70% solution and local mupirocin 2% was applied with a sterile gauze cover. Primary outcome was catheter related infections, including ESI and tunnel infection. Secondary outcomes were peritonitis and technique loss. Results A total of 113 patients were included, 58 patients in control and 55 in study group. Mean follow up time was 13.28 ± 9.5 months in control and 16.4 12.7 months in study group. ESI rate was significantly lower in study group (0.11/patient year) compared to control group (0.71/ patient year), p&amp;lt;0.001. Time to first ESI was significantly longer in study group, χ² (1) = 25.104, p &amp;lt; 0.001 (Fig. 1). On multivariate logistic regression analysis confirmed the protective effect of the intervention on ESI risk (p &amp;lt;0.001). Longer PD vintage and active cancer predicted ESI (p = 0.01 and 0.02, respectively). There were no tunnel infections during study period compared to 3 episodes during control. Peritonitis rate was significantly lower in study group (0.19/patient years) compared to control group (0.40/patient years), p=0.011. There was no difference in time to first peritonitis episode between groups χ² (1)=2.32, p=0.128. Nine patients were lost to PD due to PD related infection in control group, compared to 5 in study group. Peritonitis related mortality occurred in one patient in control group. Conclusion Protection of exit site from water exposure in conjunction with local Mupirocin cream reduced significantly ESI and peritonitis episodes in peritoneal dialysis patients. This protocol may be more beneficial in areas of poor water quality.

#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 (&amp;gt;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 (&amp;gt;5 lines) did not show a higher level of SeCA-125 (22.2 ± 9.50 vs 16 ± 4.16; p &amp;gt; 0.05), VCI diameter (1.6 ± 9.43 vs 2 ± 0.27; p &amp;gt; 0.05), OH/TBW ratio (8.4 ± 8.55 vs 2.55 ± 4.13; p &amp;gt; 0.05) or Log NT-proBNP (0.91 ± 0.76 vs 3.19 ± 0.91; p &amp;gt; 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.

#1217 Reinsertion of peritoneal dialysis catheter in a patient with Nocardial peritonitis: a case report

Abstract Background and Aims Peritonitis is a major drawback in patients on PD leading to technique failure, change in modality to hemodialysis, mortality. Nocardia infections are rare and occur mainly in immunocompromised individuals. Eleven cases of Nocardial peritonitis only have been reported. Given the rarity of the condition, duration of medical treatment, time at which catheter reinsertion can be done after treatment are not clear. We describe a case of nocardial peritonitis which presented with tunnel abscess and septic shock. Method Our patient is a 65 yr/M, DM &amp; HT, initiated on CAPD due to multiple access failure elsewhere. He was also on treatment with directly acting antiviral for HCV infection. He presented with fever, abdominal pain and cloudy peritoneal fluid. Vitals were HR 98/min, BP 90/ 60 mmHg, temperature 100 F. Abdominal examination showed insertion and exit site pus with tenderness (Fig. 1a,b). USG screening showed tunnel abscess. Labs showed hemoglobin 7.2 g/dL, white blood cell count 6200 cells/cu mm, platelet count 1.4 lakh/cu mm, SGOT 23 U/L, SGPT 15 U/L and peritoneal dialysis fluid count 1570. CT abdomen showed no intraabdominal abscess. He was started on intravenous antibiotic and ionotropic support. Emergent PD catheter removal was done in view of septic shock &amp; was dialysed via femoral tunneled catheter. Pus and peritoneal fluid culture grew Nocardia spp after six days of incubation. Intravenous cotrimoxazole was given for 2 weeks and intravenous ceftriaxone was given for 4 weeks followed by oral cotrimoxazole 960 mg thrice weekly. Results Following 7 months of treatment with cotrimoxazole, PD catheter was inserted laparoscopically after omentectomy and adhesiolysis. Peritoneal biopsy was taken at the time of catheter insertion, histopathology showed fragments of peritoneal tissue with scattered chronic inflammatory cells, culture was negative for Nocardia. PD catheter outflow dysfunction was noted after initiation of exchanges. CT abdomen showed migration of PD catheter tip following which catheter tip repositioning was done laparoscopically. During procedure, nodules were noted over peritoneum and bowel. Biopsy of the nodules were revealed foreign body granuloma and culture did not grow Nocardia (Fig. 2). Patient was initiated on three exchanges with 2.5% dextrose per day after a break-in period of 14 days. He continues to be on PD with good ultrafiltration. Conclusion There is not much data on reinsertion of PD catheter after nocardial peritonitis. One case of Nocardial peritonitis reported in literature, in which PD catheter was reinserted. Jamie Kendrick-Jones et al. [1] reported a case of Nocardial peritonitis in which catheter was reinserted after 1 year. To our knowledge this is the first case of Nocardial peritonitis which presented with tunnel abscess. Catheter was removed due to septic shock. Patient was treated with cotrimoxazole for seven months after which PD catheter insertion was done. Return to PD is feasible if Nocardial infection is identified and treated appropriately.

#2857 Home hemodialysis training time: associated factors and impact on technique survival

Abstract Background and Aims The optimal training time for Home Hemodialysis (HHD), its related factors and its impact in the technique survival are not well established. Our objective was to analyze the risk factors associated with longer duration of HD training and to assess the impact of training time on the survival of the technique. Method Single-center observational study in which all patients seen in our HHD program from January 2013 to November 2023 were included. Training time was defined as the total number of dialysis treatments undertaken for instructional purposes, regardless of prior experience. Patients were divided into two groups, according to standard (≤31 days) or prolonged (&amp;gt;31 days) training duration. Sociodemographic and clinical variables were compared between the two groups, and the factors associated with prolonged training were analyzed using binary logistic regression. HDD failure was the composite of technique failure (defined as transfer to in-center HD for ≥ 30 consecutive days) and death. Results We analyzed 50 patients (women: 18, 36%) with a mean age of 55.1 ± 12.6 years and a median length of time on dialysis of 33 (IQR 3-369) months. The median training time was 31 (IQR 24-45) days. 14 (28%) patients were single, 22 (44%) were actively working and the percentage of primary, middle and university education was 20%, 56% and 24%, respectively. In the univariate analysis, a younger age, and the presence of a care partner were associated with a shorter HHD training time, whereas the type of vascular access, the educational level, the marital status, the gender, and the need for a care partner were similar in both standard and prolonged training duration groups. After a multivariate logistic regression analysis, the only factor independently associated to a longer training time was the age (OR: 1.08, 95% CI: 1.02-1.14; p = 0.01). After a median follow-up of 27 (IQR: 15-50) months, HDD failure was observed in 12 (27%) of patients. Although in the crude analysis the technique survival tended to be lower in the prolonged training duration group (Fig. 1), this finding was not confirmed after adjusting for age. Conclusion In our experience, the older age was the only factor independently associated with longer HDD training time, whereas a longer training time did not impact in the HDD survival. These data suggest that HHD training should be especially careful in elderly patients, whose learning may require greater use of time and resources.

#1438 Review of the use of peritoneal catheter sealing in peritonitis

Abstract Background and Aims Relapsing peritonitis is a new episode of peritonitis caused by the same microorganism occurring less than 4 weeks after the end of treatment of the previous one. It is associated with the formation of biofilm formation in the lumen of the peritoneal catheter and may lead to its removal. It is associated with increased technique failure, morbidity and mortality and health care costs. The aim of this study is to demonstrate the efficacy of peritoneal catheter sealing with taurolidine-heparin (T-H) in the prevention of relapsing peritonitis and thus avoid more aggressive measures in these cases, such as catheter removal. Method We performed a single-center retrospective analysis study. We analyzed episodes of peritonitis in our peritoneal dialysis (PD) unit over a 5-year period from January 1st 2019 to December 31st 2023. We collected demographic data and risk factors during this period: age, sex, CKD etiology, diabetes, modality, assisted PD, and S. aureus nasal carrier status. We documented peritonitis during the period, causative germs, treatment performed, and catheter sealing. We documented sealing patterns and evolution (cure, recurrence, catheter removal). We performed T-H sealing with a full abdomen and once the treatment had been completed. The catheter sealing with antibiotics was performed right after the intraperitoneal antibiotics’ doses during the treatment. Results We analyzed a total of 84 patients. Demographic characteristics were: mean age 66.5 years (range 24-88 years), 71.4% male, 28.6% diabetic, 45.2% on APD, 11.9% assisted PD, 5.9% nasal S. aureus carriers. Etiology of CKD: 66.7% unaffiliated etiology, 11.9% glomerulonephritis, 7.1% ADPKD, 5.9% chronic tubulo-interstitial nephritis and 1.2% vasculitis, multiple myeloma, anephritis, acute tubular necrosis, lupus, Alport syndrome and nephronophthisis. There were 71 episodes of peritonitis, in 32 patients. The causative germs were: 36.6% coagulase negative staphylococci, 21.1% streptococci, 19.7% negative culture, 7% enterobacteria, 7% polymicrobial, 4.2% S. aureus, 2.8% enterococci and 1.4% corynebacteria. We performed some type of sealing in 47 peritonitis cases: 34% with antibiotic alone, 21.3% with antibiotic plus T-H and 44.6% with T-H alone. A total of 55.3% of the sealings were performed in peritonitis caused by coagulase-negative staphylococci, 65.4% of which were sealed with T-H or antibiotic plus T-H (Table 1). Two of the peritonitis relapsed with conventional treatment (unsealed or sealed with antibiotic) and, after sealing the peritoneal catheter with T-H, no recurrence was observed. The catheter was removed from a patient with peritonitis plus S. aureus tunnelitis, a new catheter was placed deferred, but he had a new episode of peritonitis with S. aureus tunnelitis and the catheter was removed again; this patient's case is special as he has not maintained adequate hygiene measures in addition to lack of adherence to therapy. Conclusion Peritoneal catheter sealing, especially with T-H, appears to be effective in the treatment and prevention of relapsing peritonitis. In our case, we did not observe any recurrent peritonitis after its use. Despite its widespread use, there are hardly any studies on its use and the most recommendable guidelines for its use, which is why we believe that further studies should be conducted to establish guidelines and methods for its use.

Vascular Access Considerations in Home Hemodialysis.

There is a global interest in expanding home dialysis utilization among patients with ESKD. Home hemodialysis (HHD) is an appealing KRT option for this population because of its multiple clinical and quality of life benefits. Central to successful HHD is the establishment and maintenance of a functioning vascular access that serves as a patient's lifeline while on therapy. While the selection of a vascular access type is influenced by individual patient circumstances, the arteriovenous fistula is generally the preferred access method. Training patients to use their dialysis access requires attention to safety, risk management, and monitoring for complications to minimize adverse events and technique failure. Policies incorporating systematic frameworks for quality improvement and assurance, in conjunction with the measurement of metrics relating to vascular access, are tools that should be used by HHD programs to enhance the value of care delivered. In this perspective, we aim to describe what is currently known about the various vascular access options in HHD and to elucidate what needs to be taken into consideration in the selection and care of this access.

Higher N-terminal pro-brain natriuretic peptide level at onset of peritoneal dialysis-related peritonitis is a risk factor for technique failure.

Recent studies have suggested that the N-terminal fragment of B-type natriuretic peptide (NT-proBNP) level serve as a significant risk factor for mortality in patients with end-stage renal disease. However, the relationship between NT-proBNP levels and technique failure in peritoneal dialysis-associated peritonitis (PDAP) remains unclear. This study investigated the relationship between NT-proBNP levels at the onset of PDAP and the risk of technique failure in patients with PDAP. A retrospective analysis was conducted on patients with PDAP from December 1, 2009, to December 31, 2021, at our peritoneal dialysis center. We recorded all demographic and baseline clinical data at the time of admission for each PDAP episode. Logistic and Cox regression analyses were performed to assess the association between NT-proBNP levels and technique failure. Of 485 PDAP episodes included in this study, 130 episodes of technique failure were observed. Multivariate logistic analysis revealed that hospital stay, Na and NT-proBNP levels, and peritoneal dialysate white blood cell counts on days 3 and 5 were independently associated with technique failure. The receiver operating characteristic curve demonstrated that the NT-proBNP level was a better indicator than the other four variables in indicating technique failure. In the multivariate Cox regression analysis, after adjusting for confounding factors, higher NT-proBNP levels (HR of 3.020, 95% CI 1.771, 5.150, P < 0.001) were associated with PDAP technique failure. This retrospective study identified the serum NT-proBNP level at the onset of PDAP as an independent risk factor for technique failure in these patients.

Cognitive Dysfunction Screening in Peritoneal Dialysis Patients: A Cross-Sectional Study.

Mild cognitive impairment (MCI) in peritoneal dialysis (PD) patients has been described as a risk factor for worse outcomes such as peritonitis, technique failure, and mortality. In this study, we aimed to determine the prevalence of MCI in a population of PD patients and identify the possible risk factors associated with MCI. We performed an observational, cross-sectional study to evaluate cognitive function using the Montreal Cognitive Assessment (MOCA) test and the Mini Mental State Examination (MMSE) test in PD patients. Patients with diagnosis of dementia or severe neurologic impairment, active cancer, or infection were excluded. We evaluated 66 patients (mean age 60 years); 53% were male. Prevalence of MCI assessed by MOCA test and MMSE test was 65% and 33%, respectively. Predictors of MCI with MOCA test were higher age (P = 0.0001), lower education level (P = 0.005), need of a helper (P = 0.009), and continuous ambulatory PD modality (P = 0.019). Higher Charlson comorbidity index (P = 0.002), coronary artery disease (P = 0.006), and peripheral artery disease (P = 0.033) were also associated with MCI. Lower Kt/V (P = 0.012) and lower levels of normalized protein catabolic rate (nPCR; P < 0.000) were related to MCI. MCI patients had more episodes of peritonitis (P = 0.047). Multivariable analysis showed that lower education, Kt/V, and nPCR were the most relevant factors connected to MCI (P = 0.029, P = 0.037, and P = 0.019, respectively). In our PD population, MCI was detected in more than half of the patients. Patients with MCI were older, had lower education level, more disease burden, and higher risk for developing peritonitis. Lower Kt/V and nPCR levels were associated with MCI.

Electro-Metabolic Coupling of Cumulus-Oocyte Complex.

Oocyte-cumulus cell interaction is essential for oocyte maturation and competence. The bidirectional crosstalk network mediated by gap junctions is fundamental for the metabolic cooperation between these cells. As cumulus cells exhibit a more glycolytic phenotype, they can provide metabolic substrates that the oocyte can use to produce ATP via oxidative phosphorylation. The impairment of mitochondrial activity plays a crucial role in ovarian aging and, thus, in fertility, determining the success or failure of assisted reproductive techniques. This review aims to deepen the knowledge about the electro-metabolic coupling of the cumulus-oocyte complex and to hypothesize a putative role of potassium channel modulators in order to improve fertility, promote intracellular Ca2+ influx, and increase the mitochondrial biogenesis and resulting ATP levels in cumulus cells.