May 25, 2018 - RESULTS: Hyperphosphatemia was noticed in 36 patients (45.57%). Patients ... hyperphosphatemia had lower weekly peritoneal Ph clearance ...
Nephrology Dialysis Transplantation 33 (Supplement 1): i515–i528, 2018 doi:10.1093/ndt/gfy104
P. PERITONEAL DIALYSIS
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SP492 POSSIBLE IMPLICATIONS OF SURGICAL VERSUS PERCUTANEOUS TENCKHOFF CATHETER PLACEMENT: A RETROSPECTIVE ANALYSIS ^ni Gonc¸alves1, Francisco Ferrer1, Karina Lopes1, Ivan Luz1, Ana Rita Alves1, Herna Ana Lobos1 1 Nephrology, Centro Hospitalar Me´dio Tejo, Torres Novas, Portugal INTRODUCTION AND AIMS: In Peritoneal Dialysis (PD) infectious and mechanical catheter complications are an important issue with potential impact on patient morbidity and drop-out. The aim of this study was to evaluate how surgical versus percutaneous approaches relates with catheter complications and survival. METHODS: We studied 82 patients who placed swan neck double-cuff Tenckhoff catheter between 2007 and 2017 and started PD at the same period. We defined two groups: the group of percutaneous approach and the group of surgical approach and then compared clinical and demographic characteristics, infectious and mechanical complications and catheter survival. Data was analyzed using SPSS (Version 23 for Mac OSX). RESULTS: The study involved 82 patients with an average age of 53,9 6 14,1 years, 55 (67,1%) were male, 22 (26,8%) had diabetes, 75 (91,5%) hypertension, 13 (16,3%) congestive heart failure, 10 (12,2%) ischemic cardiopathy, 13 (16,3%) peripheral vascular disease, 14 (17,1%) previous abdominal surgery and 10 (12,2%) were obese. From all 100 catheters placed, 82 were first catheters: 48 (58,5%) percutaneous and 34 (41,5%) surgical and 18 were second catheters: 4 (22,2%) percutaneous and 14 (77,8%) surgical. Comparing the type of catheter implantation technique with clinical characteristics, complications and catheter survival only age of patients (percutaneous: 56,6 6 14,4 years versus surgical: 50,2 6 12,9 years) and the number of tunnel infections (percutaneous: 0,5 6 0,92 versus surgical: 1,53 6 1,56) were significantly different (p < 0,05) between both groups. The survival of catheter concerning the implantation approach almost reached a statistical difference (percutaneous: 16,2 6 16,36 months versus surgical: 22,5 6 16,43 months, p¼0,065). Using a Kaplan-Meier analysis we also found no difference regarding the time to first peritonitis (percutaneous: 17,3 6 2,9 months versus surgical: 15,0 6 3,0 months, p¼0,521). CONCLUSIONS: The implantation of a Tenckhoff catheter is a critical step for a successful program of peritoneal dialysis. In this observational study the results suggest that surgical approach was frequently performed in younger patients and associated with a significantly higher rate of tunnel infection, perhaps a result of a longer catheter survival and a preferred option for second catheter. According to our study percutaneous and surgical approaches appear to be equivalent for PD catheter placement.
MCP-1 and TNFa in the PD and PDGC rats were significantly lower than those in the control group. The levels of IL-1b and TNFa in the serum of GC rats were significantly lower than those of the control group. CONCLUSIONS: Early peritoneal dialysis improves acute lung injury and systemic inflammation induced by blast injury.
SP494 PHOSPHATE HANDLING IN PERITONEAL DIALYSIS Aleksandra Kezic1,2, Jelena Stojanovic2, Kosana Stisovic2, Marko Baralic1, Dijana Jovanovic1,2 1 Clinic for Nephrology, Clinical Center of Serbia, Belgrade and 2Internal Medicine, Nephrology, School of Medicine, University of Belgrade, Belgrade INTRODUCTION AND AIMS: Phosphate control in peritoneal dialysis (PD) patients is of great relevance for reduction of cardiovascular mortality. When residual renal function declines, this control is dependent on modifiable factors determining phosphate removal by peritoneal dialysis. The aim of this study was to evaluate factors associated with phosphate control in PD-treated patients. METHODS: Weekly phosphate (Ph) and creatinine (Cr) clearance calculated from 24hour peritoneal effluent together with Ph and Cr dialysate/plasma (D/P) ratio were determined in 79 prevalent patients in addition to dialysis adequacy tests. RESULTS: Hyperphosphatemia was noticed in 36 patients (45.57%). Patients with hyperphosphatemia had lower weekly peritoneal Ph clearance comparing to patients with normal serum Ph level (41.21 6 11.68 vs. 47.72 6 11.91 L/wk; P¼0.02). The presence of hyperphosphatemia was significantly lower in patients treated by CAPD comparing to patients treated by CCPD and APD (P¼000). Loss of residual renal function was not associated with hyperphosphatemia. In a multiple regression analysis weekly Ph clearance was independently, negatively associated with serum phosphate levels (P¼0.017). Peritoneal Ph clearance correlated positively with D/PCr and D/PPh (r¼0.252, P¼0.029 and r¼0.302, P¼0.011 respectively), and peritoneal Cr clearance (r¼0.858, P¼0.000), although there were not differences in serum Ph level and peritoneal Ph clearance between slow and fast transporters. CONCLUSIONS: In order to achieve optimal phosphate removal by peritoneal dialysis, peritoneal phosphate transport status should be considered in PD regime prescription, notwithstanding precise analysis of all factors contributing to hyperphosphatemia must include daily intake of phosphate-rich foods, vitamin D supplements and phosphate-binders.
SP495 SP493 EARLY PERITONEAL DIALYSIS AMELIORATES ACUTE LUNG INJURY INDUCED BY BLAST INJURY IN RATS Kehong Chen3, Wei Hu1, Yani He2 Department of Nephrology, Daping Hospital, Research Institute of Surgery, Chongqing, China, 2Department of Nephrology, Daping Hospital, Research Institute of Surgery, Third Military Medical University, Chongqing, China and 3Department of Nephrology, Daping Hospital, Third Military Medical University, Chongqing, China
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INTRODUCTION AND AIMS: Blast injury frequently occurs in wars and disasters. Blast lung injury is the most common type of blast injury with a remarkable lack of effective treatment. Blast lung injury manifested as pulmonary hemorrhage, edema and secondary systemic inflammation. This study aimed to investigate the therapeutic efficacy and mechanism of peritoneal dialysis in rats with blast lung injury. METHODS: 75 SD rats were randomly divided into five groups: control group, sham group, glucocorticoid (GC) group, peritoneal dialysis (PD) group, PDþGC (PDGC) group. All rats were injured by bio-shock tube (BST-I) apparatus. PD group was treated with continuous peritoneal dialysis for 6 hours. GC group were injected with a small dose of methylprednisolone. Lung function, pathological changes and pneumonedema in rats were detected after 24h treatment. Inflammatory cytokine levels in serum were determined by the technology of Milliplex. RESULTS: 37 rats (49.3%) survived at 24 hours after blast injury. There was no significant difference in the mortality rate between the groups. Lung water content of rats in PD and PDGC groups were significantly lower than that of the control group. Pathological staining showed that the degree of pulmonary interstitial edema in PD and PDGC rats was significantly lower than that in the control group. Pulmonary function (FVC, functional residual capacity, oxygen saturation, arterial oxygen pressure, oxygenation index, and maximal mid expiratory flow) in PD and PDGC groups was significantly higher than that of the control group. The serum levels of IL-1b, IL-6,
Tiago Carvalho1, Patrıcia Branco1, Ana Rita Martins1, Maria Augusta Gaspar1 Nephrology, Hospital de Santa Cruz, Carnaxide, Portugal
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INTRODUCTION AND AIMS: The incidence and prevalence of elderly patients undergoing renal replacement therapy have been continuously increasing. The outcomes and risk factors of chronic peritoneal dialysis (CPD) in elderly patients are controversial. Some studies showed that older CPD patients have worse survival than younger CPD patients, while others found no difference in overall survival when comparing CPD patients according to age. Our aim was to evaluate the outcomes and identify predictors of mortality in elderly patients on CPD. METHODS: We retrospectively reviewed the charts of patients who initiated CPD from 1 January 2012 to 31 December 2016. Patients were divided into two groups (64 years, 65 years). Baseline variables included demographics, information on primary kidney disease, comorbidities and biochemical data such as albuminemia, calcium (corrected for protein), phosphate, hemoglobin (Hb), total cholesterol and triglycerides. The effects of these variables on survival were studied using a univariate procedure and then a multivariate Cox proportional hazards model to evaluate their independent relation to mortality. RESULTS: 97 patients, among whom 66 (68%) were 64 years old and 31 (32%) were 65 years old. Mean actuarial (death-censored) technique survival for the overall study population was 51.4762.09 months (95% confidence interval [CI]: 66.3-78.5); in the 64 and 65 year-old groups mean survivals were 4762.19 and 5463.10 months, respectively. The death-censored technique survival for the elderly patients was not statistically significantly different from that in young patients (p¼0.390). In the overall study population, the mean patient survival was 48.662.25 months (95% CI 64.276.6), while the mean survivals for the 64 and 65-year-old groups were 44.9862.70 and 51.5863.20 months, respectively. There were no differences in hospitalizations, cardiovascular events or peritonitis rates between the two groups. Surprisingly, survival of elderly patients on CPD is longer than that of younger ones. Lower initial serum
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CHRONIC PERITONEAL DIALYSIS IN ELDERLY PATIENTS: OUTCOMES AND MORTALITY
Abstracts nPCR as well as higher initial calcaemia were associated with mortality in the elderly population. CONCLUSIONS: In our cohort, CPD is a successful dialysis option for elderly patients with ESRD. Measures to improve their nutritional state and achieve normal calcaemia could improve their survival. Factors affecting mortality in elderly patients included lower serum nPCR as well as higher calcaemia at CPD baseline.
SP496 THE KINETICS AND ROLE OF CARNITINE FRACTIONS IN PATIENTS UNDERGOING PERITONEAL DIALYSIS Sakuya Ito1, Yusuke Kaida1, Tomofumi Moriyama1, Goh Kodama1, Yuka Kurokawa1, Kyoko Tashiro2, Takahiro Inokuchi2, Kei Fukami1 1 Division of Nephrology, Kurume University School of Medicine, Kurume-shi, Japan and 2 Research Institute of Medical Mass Spectrometry, Kurume University School of Medicine, Kurume-shi, Japan INTRODUCTION AND AIMS: Carnitine is an essential factor for the membrane transport of acyl-CoA compounds, followed by b-oxidation of long chain fatty acid in mitochondria. Recently, we have reported that the concentration of carnitine in the serum of hemodialysis (HD) patients was significantly decreased because of the loss of carnitine through dialysis membrane. However, the pharmacokinetics of carnitine in the serum, urine, and peritoneal dialysis fluid (PDF) in patients undergoing peritoneal dialysis (PD) has not been known. Thus, we investigated the kinetics of carnitine in PD patients. METHODS: We enrolled 28 PD patients (age: 62.669.5 years old, duration of PD: 515.16382.5 days) and 102 healthy subjects in this study. Serum, urine, and PDF levels of free carnitine (Fc) and acyl carnitine (Ac) were measured by an enzyme cycling method. Further, we evaluated daily Fc and Ac quantities in the urine and PDF. Further, we investigated whether residual renal function (RRF), peritoneal dialysis efficiency, and the dialysate-to-plasma ratio of creatinine (D/P Cr) were associated with the dynamics of carnitine in PD patients. RESULTS: Fc levels in the serum significantly decreased in PD patients compared with those in control subjects (33.469.5 vs 47.568.5 lmol/L; P
