Technique Survival Research Articles

SURG-37. ADVANCING GLIOBLASTOMA RESEARCH THROUGH RESECTION MODELS

Abstract Regardless of its cellular and molecular heterogeneity, glioblastoma (GBM) tumors share a common hallmark: an infiltrative growth pattern that poses challenges to surgical resection and leads to incomplete tumor removal. As part of the current standard-of care treatment, patients undergo surgery in addition to temozolomide and radiation therapy. In GBM research, mice are often used to replicate tumor development and test treatments, but this approach typically omits the crucial aspects of surgical intervention, and thus fails to recapitulate important aspects of human GBM disease progression at the surgical margin. Here we address this challenge by developing a technique for tumor resection in mice. First, we implant the infiltrative patient derived GBM cell line Akaluc G16302 in the frontal cortex, specifically at anteroposterior 2mm, mediolateral 0.5mm, dorsoventral 1mm starting from bregma. After 6 weeks, we anesthetize the mouse and do a craniotomy at the injection site, approximately 3-4mm in diameter. We perform a circumferential cut using a curved Fukushima scissor at the edges of the craniotomy area and scoop the tumor core, mimicking surgical resection. Mice survive the surgery and are alive up to 37 days post-resection. Histology confirms resection of tumor cells and a surgical tumor margin remaining in the xenograft animal. In our pilot study, mice undergoing resection displayed significantly increased overall survival compared to mice without surgery (log-rank p-value = 0.0448; n=6; survival range of 91-100 days for control and 97-107 days for resected mice), recapitulating survival benefit also seen in humans. This preliminary data demonstrates the feasibility of the technique and resection-associated survival benefit. Such advancements enable researchers to more accurately replicate the biology of GBM progression and treatment response observed in human patients, bringing us closer to modeling the clinical scenario in mice. Key words: Glioblastoma, resection, biopsy

Establishing a peritoneal dialysis technique survival core outcome measure: A standardised outcomes in nephrology-peritoneal dialysis consensus workshop report.

Technique survival, also reported with negative connotations as technique failure or transfer from peritoneal dialysis to haemodialysis, has been identified by patients, caregivers and health professionals as a critically important outcome to be reported in all trials. However, there is wide variation in how peritoneal dialysis technique survival is defined, measured and reported, leading to difficulty in comparing or consolidating results. We conducted an online international consensus workshop to establish a core outcome measure of technique survival. Discussions were analysed thematically. Fifty-five participants including 14 patients and caregivers from 13 countries took part in facilitated breakout discussions using video-conferencing. The following themes were identified: capturing important aspects of the outcome (requiring a core event to define the outcome, distinguishing temporary from permanent events, recognising heterogeneous experiences of transfers), adopting appropriate neutral nomenclature (conveying with clarity, avoiding negative connotations), and ensuring feasibility and applicability (capturing data relevant to clinical and research settings, ease of adoption). The suggested definitions for the core outcome measure were 'the event of a transfer to haemodialysis', or 'discontinuation of peritoneal dialysis'. Applying the principles described within the workshop, defining the outcome measure as a 'transfer to haemodialysis' was preferable. It is proposed that the core outcome of technique survival is redefined as 'transfer to haemodialysis' and that its components are standardised using simple, neutral terminology Components considered important by stakeholders included recording the reasons for transfer from peritoneal dialysis, and focussing on permanent events whilst ensuring the outcome remains easy to implement.

Comparison of clinical outcomes based on dialysis modality and icodextrin usage in patients on peritoneal dialysis.

There is no conclusive evidence regarding the survival benefits of automated peritoneal dialysis (APD) or the use of icodextrin. This study aimed to evaluate patient and technique survival among four groups divided based on peritoneal dialysis modality and icodextrin use over 1 year. We specifically included patients who underwent a single peritoneal dialysis modality for at least 1 year during that period (n = 148). The participants were categorized into four groups for comparison: continuous ambulatory peritoneal dialysis (CAPD) without icodextrin (CAPD-ET, n = 39); CAPD with icodextrin (CAPD+ET, n = 35); APD without icodextrin (APD-ET, n = 40); and APD with icodextrin (APD+ET, n = 34). The CAPD+ET group had a higher patient survival rate than that of the APD-ET group and also had a higher technique survival trend than that of the APD-ET group, despite no statistical significance. In patients without diabetes mellitus (DM), the APD-ET group had a poorer patient survival trend than those of the APD+ET or CAPD+ET groups. In patients without DM, the APD+ET group had a higher technique survival than the APD-ET group. In addition, the APD+ET group showed a higher technique survival trend than did the CAPD-ET group, despite non-statistical significance. The edema index after 1 year of follow-up was higher in the APD-ET group than in the other groups. The present study demonstrated that patients undergoing APD without icodextrin had poor patient and technique survival trends, which may be caused by poor volume control.

Experience of Continuous Ambulatory Peritoneal Dialysis In Remote Area of Southeast Bangladesh

Background: Chronic kidney disease (CKD) is a major public health problem that continues to increase in prevalence globally. The prevalence of chronic kidney disease is increasing day by day in low to middle income countries (LMICs). People living in LMICs have the highest need for renal replacement therapy (RRT) despite they have lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, very much infrastructure, dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. To authors knowledge there was scarcity of data regarding CAPD performance in remote area of Bangladesh. This study was aimed to report the characteristics and outcomes of CAPD in ESRD patients lived in least developed area of Bangladesh. Methods: This prospective study was conducted in Cox’sbazar Medical College Hospital, Cox’sbazar and Parkview hospital Ltd, Chattogram, Bangladesh. Data were collected by questionnaire from the patients of any age with end-stage renal disease (ESRD) who underwent CAPD in 2018–2021. The baseline characteristics, PD-related complication as well as patient and technique survivals were analyzed. Results: Out of 31 patients who underwent CAPD, 18 (58%) were male on the age range of 15–79 years. The mean follow-up duration was 18 months. Mortality was inversely related with the EF of echocardiography. The peritonitis rate was 0.48 episodes per patient per year. The 1, 3 and 4-year patient survival rates were 64.34% (95% CI = 52.5–81.5), 23.79% (95% CI = 17.9 – 57.4) and 3.22% (95% CI = 31.2–77.5) respectively. Conclusions: In this study, CAPD performance was poorer than usual reference. Cardiac compromised patient and inappropriate dwell might be the main contributing factors behind this scenario. The peritonitis rate was nearly similar to that of developed countries. CAPD was cost effective than HD in remote area. Some accessible measures may be taken to make CAPD a more acceptable RRT modality with improved outcomes in poor socioeconomic backgrounds area. J Dhaka Med Coll. 2023; 32(1) : 24-31

Dyslipidemia in Peritoneal Dialysis: Implications for Peritoneal Membrane Function and Patient Outcomes.

Dyslipidemia is a common metabolic complication in patients undergoing peritoneal dialysis (PD) and has traditionally been viewed primarily in terms of cardiovascular risk. Current guidelines do not recommend initiating lipid-lowering therapy in dialysis patients due to insufficient evidence of its benefits on cardiovascular mortality. However, the impact of dyslipidemia in PD patients may extend beyond cardiovascular concerns, influencing PD-related outcomes such as the peritoneal ultrafiltration rate, residual kidney function, PD technique survival, and overall mortality. This review challenges the traditional perspective by discussing dyslipidemia's potential role in PD-related complications, which may account for the observed link between dyslipidemia and increased all-cause mortality in PD patients. It explores the pathophysiology of dyslipidemia in PD, the molecular mechanisms linking dyslipidemia to peritoneal membrane dysfunction, and summarizes clinical evidence supporting this hypothesis. In addition, this paper examines the potential for therapeutic strategies to manage dyslipidemia to improve peritoneal membrane function and patient outcomes. The review calls for future research to investigate dyslipidemia as a potential contributor to peritoneal membrane dysfunction and to develop targeted interventions for PD patients.

CT data analysis of catheter morphology and displacement in peritoneal dialysis: an exploratory study.

Catheter displacement is a common complication of peritoneal dialysis. The aim of this study was to explore the correlation between catheter morphology and displacement by analyzing CT data, providing a scientific basis for optimizing catheter morphology within abdominal wall layers. We retrospectively analyzed the clinical data of 94 patients. The parameters for analyzing catheter morphology were defined based on six key points identified from CT images. The covariates considered in the analysis included demographics, primary disease, body size, peritoneal dialysis method, and total weekly urea clearance index. During a mean follow-up period of 1056 ± 480 days, only the angle of the intramuscular part (IM angle) of the catheter significantly correlated with the time to first catheter displacement according to the multivariate analysis (hazard ratio [HR]: 1.039, 95% confidence interval [CI] 1.02-1.058, 0.01). When the cut-off value of IM angle was 39.4 , the area under receiver-operating characteristic (ROC) curve for predicting catheter displacement was 0.791 (95% CI 0.701-0.881, 0.01), with a sensitivity and specificity of 82.9% and 66.0%, respectively. Kaplan-Meier survival curves showed that the catheter survival rate was significantly higher in the group with an IM angle < 39.4 than in the group with an IM angle > 39.4 (log-rank =19.479, 0.01). None of the catheter morphology parameters were significantly correlated with technique survival in the multivariate analysis. There is a correlation between catheter morphology and catheter displacement. An IM angle > 39.4 is an independent risk factor for catheter displacement, while the position and angle of the subcutaneous part are not correlated with catheter displacement.

Technique Survival after Relapsing Peritonitis: Experience from a Center in Mexico

Technique Survival after Relapsing Peritonitis: Experience from a Center in Mexico

Comparison of outcomes of incremental vs. standard peritoneal dialysis: a systematic review and meta-analysis

BackgroundIncremental peritoneal dialysis (IPD) refers to the use of less than standard full-dose peritoneal dialysis (SPD) in end-stage renal disease patients. While the use of IPD is being reported in the literature, its safety and efficacy vs. SPD is unclear. We hereby performed a systematic review of studies comparing mortality, peritonitis, technique survival, anuria-free survival and residual renal function (RRF) between IPD and SPD.MethodsAll comparative studies published on PubMed, Embase, CENTRAL, Scopus, and Web of Science databases from inception to 5th September 2023 and reporting on given outcomes were eligible.ResultsTen studies were included. Definitions of IPD were heterogenous and hence mostly a qualitative synthesis was undertaken. Majority of studies found no difference in patient survival between IPD and SPD. Meta-analysis of crude mortality data also presented no significant difference. Peritonitis and technique survival were also not significantly different between IPD and SPD in the majority of studies. Data on RRF was conflicting. Some studies showed that IPD was associated with the preservation of RRF while others found no such difference.ConclusionIPD may be a safe alternative to SPD in incident dialysis patients. There seems to be no difference in patient survival, peritonitis, and technique survival between the two modalities. However, the impact of IPD on RRF is still questionable. Evidence is heterogeneous and conflicting to derive firm conclusions.

Transitioning to peritoneal dialysis: it does not matter where you come from.

Patients with end-stage renal disease (ESRD) frequently change renal replacement (RRT) therapy modality due to medical or social reasons. We aimed to evaluate the outcomes of patients under peritoneal dialysis (PD) according to the preceding RRT modality. We conducted a retrospective observational single-center study in prevalent PD patients from January 1, 2010, to December 31, 2017, who were followed for 60 months or until they dropped out of PD. Patients were divided into three groups according to the preceding RRT: prior hemodialysis (HD), failed kidney transplant (KT), and PD-first. Among 152 patients, 115 were PD-first, 22 transitioned from HD, and 15 from a failing KT. There was a tendency for ultrafiltration failure to occur more in patients transitioning from HD (27.3% vs. 9.6% vs. 6.7%, p = 0.07). Residual renal function was better preserved in the group with no prior RRT (p < 0.001). A tendency towards a higher annual rate of peritonitis was observed in the prior KT group (0.70 peritonitis/year per patient vs. 0.10 vs. 0.21, p = 0.065). Thirteen patients (8.6%) had a major cardiovascular event, 5 of those had been transferred from a failing KT (p = 0.004). There were no differences between PD-first, prior KT, and prior HD in terms of death and technique survival (p = 0.195 and p = 0.917, respectively) and PD efficacy was adequate in all groups. PD is a suitable option for ESRD patients regardless of the previous RRT and should be offered to patients according to their clinical and social status and preferences.

Rationale and design of ELIXIR, a randomized, controlled trial to evaluate efficacy and safety of XyloCore, a glucose-sparing solution for peritoneal dialysis.

Peritoneal dialysis adoption and technique survival is affected by limitations related to peritoneal membrane longevity and metabolic alterations. Indeed, almost all peritoneal dialysis fluids exploit glucose as an osmotic agent that rapidly diffuses across the peritoneal membrane, potentially resulting in metabolic abnormalities such as hyperglycemia, hyperinsulinemia, obesity, and hyperlipidemia. Moreover, glucose-degradation products generated during heat sterilization, other than glucose itself, induce significant morphological and functional changes in the peritoneum leading to ultrafiltration failure. The partial substitution of glucose with osmotic agents characterized by a better local and systemic biocompatibility has been suggested as a potential strategy to innovate peritoneal dialysis fluids. The approach aims to minimize glucose-associated toxicity, preserving the peritoneal membrane welfare and counteracting common comorbidities. In this work, we report the clinical trial design of ELIXIR, a phase III randomized, controlled, blinded outcome assessment study comparing Xylocore®, an innovative formulation based on Xylitol and l-carnitine, to standard glucose-based regimens, in end-stage kidney disease patients treated with continuous ambulatory peritoneal dialysis; 170 patients will be randomized (1:1) to receive XyloCore® or to continue their pre-randomization peritoneal dialysis (PD) therapy with glucose-only PD solutions, for 6 months. The primary study's objective is to demonstrate the noninferiority of XyloCore® in terms of Kt/V urea, for which a clinically acceptable noninferiority margin of -0.25 has been determined, assuming that all patients will be treated aiming to a minimum target of 1.7 and an optimal target of 2.0.

Effects of Sodium-Glucose Cotransporter 2 Inhibitors in Diabetic and Non-Diabetic Patients with Advanced Chronic Kidney Disease in Peritoneal Dialysis on Residual Kidney Function: In Real-World Data.

Background and Objectives: Peritoneal dialysis (PD) is a renal replacement therapy modality in which the dialysis dose can be individually adapted according to the patients' residual kidney function (RKF). RKF is a crucial factor for technique and patient survival. Pharmacological strategies aimed at slowing the loss of RKF in patients on PD are limited. Therefore, we aimed to assess the potential effects and safety of sodium-glucose cotransporter 2 (SGLT-2) inhibitors on the preservation of RKF in patients with and without type 2 diabetes mellitus (T2DM) on PD during an average follow-up of 6 months. Materials and Methods: In this retrospective observational, single-center study on real-world data, we included patients from the Peritoneal Dialysis Unit of the Hospital General Universitario de Ciudad Real, who started treatment with SGLT-2 inhibitors during the period from December 2022 to December 2023. Data on analytical and clinical parameters, RKF, and peritoneal membrane transport function were retrospectively collected at months 0, 3, and 6. Results: Out of 31 patients in our unit, 16 prevalent patients initiated treatment with SGLT-2 inhibitors (13 empagliflozin and 3 dapagliflozin). A total of 62.5% were male and the mean age was 67.3 years. The baseline peritoneal ultrafiltration was higher in the non-diabetic patient (NDMP) group than in the diabetic patient (DMP) group. However, the residual diuresis volume, 24 h residual renal clearance rate of urea in urine, and 24 h proteinuria were higher in the DMP group than in the NDMP group. At the sixth month, patients in both groups preserved RKF and diuresis, with a trend towards a non-significant reduction in proteinuria and blood pressure. Only two patients of the DMP group presented adverse effects. Conclusions: The use of SGLT-2 inhibitors in our sample of patients with and without T2DM on PD appears to be safe and effective to preserve RKF.

Transfers from home to facility-based dialysis: comparisons of HHD, assisted PD and autonomous PD.

Home dialysis therapies such as peritoneal dialysis (PD) and home hemodialysis (HHD) are beneficial for quality of life and patient empowerment. The short technique survival time partly explains their low prevalence. We aimed to assess the risk of transfer to facility-based hemodialysis in patients treated with autonomous PD, assisted PD and HHD. This was a retrospective study using data from the REIN registry of patients starting home dialysis in France from 2002 to 2019. The risks of transfer to facility-based hemodialysis (HD) were compared between three modalities of home dialysis (HHD, nurse-assisted PD, autonomous PD) using survival models with a propensity score (PS)-matched and unmatched cohort of patients. The study included 17909 patients: 628 in the HHD group, 10214 in the autonomous PD group, and 7067 in the assisted PD group. During the follow-up period, there were 5347 transfers to facility-based HD. The observed number of transfers was 2458 (13.7%) at 1 year and 5069 (28.3) at 5 years after the start of home dialysis, including 3272 (32%) on autonomous PD, 1648 (23.3%) on assisted PD, and 149 (23.7) on HHD. Owing to clinical characteristics differences, only 38% of HHD patients could be matched to patients from the others group. In the PS-matched cohort, the adjusted Cox model showed no difference in the risk of transfer for assisted PD (cs-HR 1.04, 95% CI 0.75-1.44) or HHD (cs-HR 1.07, 95% CI 0.77-1.48) compared with autonomous PD. Unlike results from other countries, where nurse assistance is not fully available for PD-associated care, there was no difference in technique survival between autonomous PD, nurse-assisted PD, and HHD in France. This discrepancy may be attributed to our inclusion of a broader spectrum of patients who derive significant benefits from assisted PD.

Survival and its relationship with the type of peritoneal solute transfer rate, in patients with chronic kidney disease incident on peritoneal dialysis therapy in RTS Colombia between the years 2007–2017

IntroductionIn some studies, the peritoneal solute transfer rate (PSTR) through the peritoneal membrane has been related to an increased risk of mortality. It has been observed in the literature that those patients with rapid diffusion of solutes through the peritoneal membrane (high/fast transfer) and probably those with high average transfer characterized by the Peritoneal Equilibrium Test (PET) are associated with higher mortality compared to those patients who have a slow transfer rate. However, some authors have not documented this fact. In the present study, we want to evaluate the (etiological) relationship between the characteristics of peritoneal membrane transfer and mortality and survival of the technique in an incident population on peritoneal dialysis in RTS Colombia during the years 2007–2017 using a competing risk model. Materials and methodsA retrospective cohort study was carried out at RTS Colombia in the period between 2007 and 2017. In total, there were 8170 incident patients older than 18 years, who had a Peritoneal Equilibration Test (PET) between 28 and 180 days from the start of therapy. Demographic, clinical, and laboratory variables were evaluated. The (etiological) relationship between the type of peritoneal solute transfer rate at the start of therapy and overall mortality and technique survival were analyzed using a competing risk model (cause-specific proportional hazard model described by Royston-Lambert). ResultsPatients were classified into four categories based on the PET result: Slow/Low transfer (16.0%), low average (35.4%), high average (32.9%), and High/Fast transfer (15.7%). During follow-up, with a median of 730 days, 3025 (37.02%) patients died, 1079 (13.2%) were transferred to hemodialysis and 661 (8.1%) were transplanted. In the analysis of competing risks, adjusted for age, sex, presence of DM, HTA, body mass index, residual function, albumin, hemoglobin, phosphorus, and modality of PD at the start of therapy, we found cause-specific HR (HRce) for high/fast transfer was 1.13 (95% CI 0.98–1.30) p = 0.078, high average 1.08 (95% CI 0.96–1.22) p = 0.195, low average 1.09 (95% CI 0.96–1.22) p = 0.156 compared to the low/slow transfer rate. For technique survival, cause-specific HR for high/rapid transfer of 1.22 (95% CI 0.98–1.52) p = 0.66, high average HR was 1.10 (95% CI 0.91–1.33) p = 0.296, low average HR of 1.03 (95% CI 0.85–1.24) p = 0.733 compared with the low/slow transfer rate, adjusted for age, sex, DM, HTA, BMI, residual renal function, albumin, phosphorus, hemoglobin, and PD modality at start of therapy. Non-significant differences. ConclusionsWhen evaluating the etiological relationship between the type of peritoneal solute transfer rate and overall mortality and survival of the technique using a competing risk model, we found no etiological relationship between the characteristics of peritoneal membrane transfer according to the classification given by Twardowski assessed at the start of peritoneal dialysis therapy and overall mortality or technique survival in adjusted models. The analysis will then be made from the prognostic model with the purpose of predicting the risk of mortality and survival of the technique using the risk subdistribution model (Fine & Gray).

A rapid protocol for inducing acute pancreatitis in zebrafish models

Acute pancreatitis (AP) is an inflammatory disorder that occurs in the exocrine pancreas associated with tissue injury and necrosis. Experimental models of AP typically involve rodents, such as rats or mice. However, rodents exhibit divergent pathophysiological responses after the establishment of AP between themselves and in comparison, with human. The experiments conducted for this manuscript aimed to standardize a new AP model in zebrafish and validate it. Here, we provide a protocol for inducing AP in zebrafish through intraperitoneal injections of synthetic caerulein. Details are provided for solution preparation, pre-injection procedures, injection technique, and monitoring animal survival. Subsequently, validation was performed through biochemical and histological analyses of pancreatic tissue. The administered dose of caerulein for AP induction was 10 μg/kg applied four times in the intraperitoneal region. The histological validation study demonstrated the presence of necrosis within the first 12 h post-injection, accompanied by an excess of zymogen granules in the extracellular milieu. These observations align with those reported in conventional rodent models. We have standardized and validated the AP model in zebrafish. This model can contribute to preclinical and clinical studies of new drugs for AP treatment. Therefore, this novel model expands the toolkit for exploring faster and more effective preventive and therapeutic strategies for AP.

How long do transport infrastructure last: evidences from Norwegian roads and rail network

How long will transport infrastructure generate benefits for the society (the appraisal period) is an essential assumption in transport appraisals. However, there are considerable differences in the recommended appraisal periods used in cost–benefit analysis between countries. In this paper, we therefore examine how long transport infrastructure was used in the past before it was replaced, closed, or substantially improved. We label this period the ex-post appraisal period. The study considers rail and roads in Norway and analyses how long they were used using the statistical technique survival analysis. The results show that motorways build in the 1960s was used around 40 years before being upgraded, while most of railroad infrastructure have lasted more than 100 years. If these results are applicable for the future use it may indicate that the use of long appraisal periods (more than 50 years) in some countries could be optimistic for roads and rather conservative for railroads.

#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.

#2771 Peritoneal dialysis after kidney graft loss … and now, what?

Abstract Background and Aims The evolution of peritoneal dialysis (PD) as renal replacement therapy (RRT) after graft loss is not well defined. Method Retrospective analysis of the Andalusian Renal Registry of patients who received their first kidney transplant (KT) in Andalusia (Spain) and returned to dialysis between 1978-2023. Patients who lost follow-up and those who underwent preemptive re-KT were excluded of the study. We compared clinical characteristics and evolution between those who started hemodialysis (HD) and peritoneal dialysis (PD) after graft loss. Secondly, we analyzed technique and patient survival in those who started PD post-KT versus patients on PD as their first renal replacement therapy (RRT) We performed multivariate analysis for PD technique and patient survival risk factors using Cox regression. Results During this period, we followed 11868 KT recipients in Andalusia. Of these, 3148 (26.52%) lost the graft: 2768 started HD and 298 PD. 82 patients underwent preemptive re-KT. Patients who returned to DP were younger (p &amp;lt; 0.001) and glomerulonephritis as cause of chronic kidney disease (CKD) was more frequent (p = 0.019). The pre-KT RRT was HD in 96.3% of patients starting HD post-KT and PD in 48.3% of patients who returned to PD after KT (p &amp;lt; 0.001). Survival of patients in the HD group was lower than those who started PD (p = 0.026). In the multivariate analysis, older age when dialysis restarted, male sex and diabetes were risk factors for patient death and not the type of dialysis. When comparing only the post-KT PD group (n = 298) versus patients on PD as their first RRT (n = 5312), patients on the first group were younger (57.1 vs. 41.9; p &amp;lt; 0.001) and time on PD was longer (24.4 vs. 19 months; p &amp;lt; 0.001). The causes of PD drop-out also varied between groups (p &amp;lt; 0.001). During this period, 269 post-KT PD patients left the technique mainly due to re-KT (34.3%) and in the PD group as the first RRT, there were 4919 technique drop-outs, mainly due to transfer to HD (35.3%) and death (30%). The percentage of peritonitis was higher in the post-KT PD group, although without significant differences (post-KT PD 27.9% vs. PD as first RRT 23.25%; p = 0.061). Survival of the DP technique in post-KT PD group was 78.2% at 1 year and 38.5% at 5 years, and 77.7% and 42.1% respectively in the DP group as the first DP RRT (p = 0.059). In the multivariate analysis, patient age and diabetes as a cause of CKD, behaved as risk factors for patient survival. Conclusion Almost half of the patients starting PD after KT had been on PD prior to transplantation. They tend to have more peritonitis although survival of the technique and complications were very similar to those observed in patients on PD as first RRT.

#1832 Unraveling enteric peritonitis risk factors: the role of nutrition

Abstract Background and Aims Malnutrition estimated to have a prevalence of 30-50% among peritoneal dialysis (PD) patients. It independently correlates with increased patient morbidity and a lower technique survival, and it is exacerbated by protein loss through peritoneal fluid. Enteric-origin peritonitis in PD patients represents a severe complication also linked to elevated morbidity, hospitalizations, and inferior technique survival. However, the association between both is not well established. This study aims to analyze malnutrition-related as well as general risk factors and their association with peritonitis type (enteric/cutaneous). Method A longitudinal and retrospective observational analysis was conducted on PD patients with peritonitis at Hospital La Fe from 2012 to 2023. Demographic data (age, gender, obesity, diabetes, immunosuppression, polycystic kidney disease), analytical parameters (albumin, total proteins, potassium, phosphorus), number of exchanges, adequacy, surgical interventions, and/or catheter placement 6 months prior were analyzed for their association with peritonitis type (Cutaneous/Enteric/Mixed). Recurrences and peritonitis without microbial isolation were excluded. Results We collected data about 109 peritonitis cases; 59.6% cutaneous, 38.5% enteric, and 1.8% mixed, from 61 predominantly male patients (68.9%) with a mean age of 61.35 years. Common germs were S. epidermidis in cutaneous peritonitis and E. coli in enteric peritonitis. Obesity (27.9% of the sample), immunosuppression (16.4%), and hypoalbuminemia (56%) were statistically significantly associated with enteric peritonitis development (p 0.08, p 0.039, and p 0.036, respectively). No statistically significant differences were found for peritonitis type and gender, diabetes, residual renal function, hypokalemia, hypophosphatemia, and underdialysis. 85.3% of peritonitis cases involved manual exchanges, and 14.7% automated PD. While no statistically significant association was found between modality and peritonitis type, more manual exchanges correlated with increased peritonitis cases. Peritoneal catheter insertion and other surgical interventions in the previous 6 months were not significantly related to peritonitis type. Conclusion The presence of malnutrition-related factors such as hypoalbuminemia and obesity increases the risk of developing enteric peritonitis, likely linked to digestive bacterial translocation to peritoneal fluid facilitated by malnutrition. Ensuring preventive nutritional strategies is imperative for these patients.

#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).

Impact of compliance with salt management guidelines before dialysis introduction on peritoneal dialysis technique survival: The importance of pre-dialysis care and education.

Peritoneal dialysis (PD) is a mode of therapy in which the patients themselves actively participate in the care of their own disease. We examined a possible association of salt reduction before starting dialysis with PD technique survival. This retrospective cohort study included 42 patients who started PD between April 2014 and March 2018. Participants were allocated to two groups based on their estimated daily salt intake before the initiation of dialysis: patients with an estimated daily salt intake <6 g/day were allocated to the appropriate salt intake group (AS group), while the rest were assigned to the high salt intake group (HS group). During a median follow-up of 47 months, PD technique survival, defined by death or transition to hemodialysis, was significantly lower in the HS group compared to the AS group. Successful salt reduction before dialysis introduction is associated with better PD technique survival.