TY - JOUR
AB - MP410 CRP AS AN INDICATOR OF INFLAMMATION IN PATIENTS WITH LOW AND HIGH PERITONEAL PERMEABILITY AND ITS RELATION WITH CAROTID ATHEROSCLEROSIS Ozlem Yayar Ozlem Yayar 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Mehmet Büyükbakkal Mehmet Büyükbakkal 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Baris Eser Baris Eser 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Tolga Yildirim Tolga Yildirim 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Zafer Ercan Zafer Ercan 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Bulent Erdoğan Bulent Erdoğan 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Alattin Kali Alattin Kali 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Ozgur Merhametsiz Ozgur Merhametsiz 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Ayhan Haspulat Ayhan Haspulat 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Ibrahim Akdag Ibrahim Akdag 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Mehmet Deniz Ayli Mehmet Deniz Ayli 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Abstract Introduction and Aims: High permeability in peritoneal dialysis (PD) patients had been reported to be associated with increased mortality. Cardiovascular disease is the most important cause of morbidity and mortality in patients with end-stage renal disease. The inflammation is thought to take part in development of atherosclerosis. The aim of this study is to investigate the relationship of peritoneal permeability type with carotid intima media thickness (CIMT) in PD patients. Methods: Based on the standard peritoneal equilibration test, 56 PD patients (28 male/28 female) were divided in two transporter groups: LOW (Low+Low average) and HIGH (High+High average) permeability. C-reactive protein (CRP) was measured as a marker of inflammation and CIMT was evaluated by high-resolution B-mode ultrasonography. Results: 21 patients were LOW and 35 were HIGH transporters. Mean CRP level was significantly higher in the HIGH permeability group compared to LOW group (1.62±1.7mg/L vs. 0.84±1.00mg/L respectively, p=0.006). CIMT was higher in the HIGH group but this difference did not reach statistical significance (0.81±0.16 vs. 0.74±0.16, p=0.16). Conclusions: CRP, an indicator of inflammation, was found to be higher in the high transporter group. Also CIMT was found to be higher in high transporter group although it was not statistically significant. One of the causes of increased mortality rate in this group of patients may be explained by inflammation and atherosclerosis. MP411 RADIOLOGICAL INSERTION OF TENCKHOFF CATHETERS FOR PERITONEAL DIALYSIS: A ONE YEAR SINGLE CENTRE EXPERIENCE Trung Quach Trung Quach 1Department of Renal Medicine, The Alfred Hospital, Melbourne, Victoria, Australia Peter Tregaskis Peter Tregaskis 1Department of Renal Medicine, The Alfred Hospital, Melbourne, Victoria, Australia Solomon Menahem Solomon Menahem 1Department of Renal Medicine, The Alfred Hospital, Melbourne, Victoria, Australia Jim Koukounaras Jim Koukounaras 2Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia Nigel Mott Nigel Mott 2Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia Rowan Walker Rowan Walker 1Department of Renal Medicine, The Alfred Hospital, Melbourne, Victoria, Australia Abstract Introduction and Aims: Peritoneal dialysis is an important home based dialysis modality in patients with end stage kidney disease. The initiation of peritoneal dialysis requires the timely insertion of a reliable Tenckhoff catheter. Traditionally at our centre, Tenckhoff catheters were inserted laparoscopically by surgeons, under a general anaesthetic. This may often be a time consuming process requiring prior surgical and anaesthetic review, as well as operating theatre time and inpatient bed availability. Radiological insertion of Tenckhoff catheters potentially allows for improved access to the procedure as it can be performed as a day case (ie. same day admission) under local anaesthetic and sedation. We report our one year experience following the introduction of this technique to our dialysis programme. Methods: We performed a retrospective review of all Tenckhoff catheters inserted in the radiology department over a twelve month period. The procedure was first introduced in December 2011. Catheters were inserted percutaneously with the assistance of ultrasound and fluoroscopy. We recorded patient demographics including age, gender, body mass index, previous abdominal surgery and cause of end stage kidney disease. Details of the insertion procedure were also obtained including discharge from hospital on the day of procedure, side of insertion, early complications and time to first use. Results: A total of 30 Argyle swan neck Tenckhoff catheters were inserted until the end of December 2012. Mean (+/-SD) age of patients was 56 years (+/-14). Male to female ratio was 2:1. Mean BMI was 25.7kg/m2 (+/- 4.8). Peritoneal dialysis was the initial dialysis modality in 22 (73.3%) patients. Of the 30 patients, 14 (46.7%) had previously undergone extraperitoneal abdominal surgery. All catheters were inserted successfully and were performed as a day case. Catheters were left for at least 10 days to reduce the risk of leakage: in two cases the catheters were used within five days, both without leaking. There were no cases of peritonitis or exit site infection. Catheter migration occurred in four patients (13.3%) but only one required surgical intervention. Minor pain issues were noted in six patients (20%) and bleeding around the exit site requiring suture in two patients (6.7%). Conclusions: Radiological insertion of Tenckhoff catheters for peritoneal dialysis potentially provides improved access to catheter placement in a timely manner. It has a high technical success rate even in patients with prior abdominal surgery and can be performed safely as a day procedure. Establishing Tenckhoff catheters this way also has the potential to improve the uptake and initiation of this important home based dialysis modality. MP412 VIDEOLAPAROSCOPIC REVISION OF MALFUNCTIONING PERITONEAL CATHETERS IS COST-EFFECTIVE IN CONFRONT TO HAEMODIALYSIS Matthias Zeiler Matthias Zeiler 1Nephrology, Ospedale Carlo Urbani, Jesi, Italy Stefano Santarelli Stefano Santarelli 1Nephrology, Ospedale Carlo Urbani, Jesi, Italy Giorgio Degano Giorgio Degano 2General Surgery, Ospedale Carlo Urbani ,Jesi, Italy Tania Monteburini Tania Monteburini 1Nephrology, Ospedale Carlo Urbani, Jesi, Italy Rosa M. Agostinelli Rosa M. Agostinelli 1Nephrology, Ospedale Carlo Urbani, Jesi, Italy Rita Marinelli Rita Marinelli 1Nephrology, Ospedale Carlo Urbani, Jesi, Italy Emilio Ceraudo Emilio Ceraudo 2General Surgery, Ospedale Carlo Urbani ,Jesi, Italy Abstract Introduction and Aims: Videolaparoscopy is the gold standard for revision of persistent malfunctioning peritoneal catheters. The surgical intervention aims to regain effective catheter function in order to proceed with peritoneal dialysis (PD). The aim of the study is to analyze the cost-effectiveness of videolaparoscopy revision based on a simulation of reimbursement costs. Methods: Reimbursement costs of catheter malfunction management, based on diagnosis related groups and out-patient interventions in the Italian national health system, are calculated for the following two simulations: Hospitalization for videolaparoscopic revision and follow up in daily automated home PD versus termination of PD, placement of a temporary central venous catheter, creation of an arterio-venous fistula and in-center bicarbonate haemodialysis (HD) with highly biocompatible membranes three times a week. The break-even point of the two strategies, indicating the time after intervention at equivalence of costs, is calculated. Videolaparoscopy interventions for catheter malfunction, performed between 2002 and 2011, were analyzed and followed up to 2012 with regard to permanence on PD and drop out. Results: The break-even point of the two strategies (videolaparoscopy intervention 8597 Euro + PD 383 Euro/week versus vascular access 4551 Euro + HD 496 Euro/week) was determined at 36 weeks after intervention. Forty-three videolaparoscopy revisions were performed during the observation period. Twelve patients were still on PD at the end of the observation period (prolongation of catheter function: median 87 weeks), whereas the remaining 31 cases terminated PD in median 43 weeks after revision. The total number of weeks remaining on PD after intervention was 4068 weeks, in confront to 1548 weeks (43 cases x 36 weeks) needed to reach break-even, corresponding to a gain in favor of videolaparoscopy of 2520 weeks. Theoretical savings amount to 284.760 Euro (2520 weeks x difference of costs between HD and PD 113 Euro/week) during the observation period of ten years. This is equivalent to annual reimbursement costs of 14 patients on automated PD, respectively 16 patients on continuous ambulatory PD. Conclusions: PD is generating minor costs in confront to to HD from the view point of the national health system. The need of videolaparoscopy revision at persisting catheter malfunction annuls this economic advantage. A cost-effective videolaparoscopy intervention has to result in a prolongation of catheter function and stay on PD of at least 36 weeks. The retrospective analysis of our videolaparoscopy program confirms the cost-effectiveness of the procedure. MP413 CREATININE TRANSPORT ACROSS CHEMICAL MODIFIED PERITONEAL MEMBRANE IN VITRO - INFLUENCE OF HYALURONAN Teresa Grzelak Teresa Grzelak 1Chemistry and Clinical Biochemistry, Poznan University of Medical Sciences, Poznan, Poland Marta Kramkowska Marta Kramkowska 1Chemistry and Clinical Biochemistry, Poznan University of Medical Sciences, Poznan, Poland Marcelina Walczak Marcelina Walczak 1Chemistry and Clinical Biochemistry, Poznan University of Medical Sciences, Poznan, Poland Krystyna Czyzewska Krystyna Czyzewska 1Chemistry and Clinical Biochemistry, Poznan University of Medical Sciences, Poznan, Poland Abstract Introduction and Aims: Hialuronan is an essential component of peritoneal extracellular matrix. Its high molecular fractions participate in restoring of peritoneal integrity and remodeling of peritoneum, which have been changed by prolonged peritoneal dialysis and returning incidents of peritonitis. Methods: We performed in vitro experiments with the isolated rabbit parietal peritoneum (placed inside a modified Ussing-type chamber), taken from the anterior abdominal wall of white Hyplus 59 rabbits to evaluate the importance of chemical modification of mesothelium and interstitium to the peritoneal transport of creatinine in the present or absent of exogenous high molecular hyaluronan. Values for transfer from the interstitial (I) to the mesothelial (M) side of membrane (I->M) and in the opposite direction (M->I) were calculated using the mathematical model of mass transport and are expressed as a coefficient of diffusive permeability [P (in centimeters per second)]. Two separate series of experiments were done with the applying chemical modified tissues (due to three minutes long 0.104 g/dL deoxycholate sodium acting on the mesothelial side of peritoneal membrane. In the first series, we examined creatinine (0.1 g/dL) across chemically modified tissue (for 120 minutes). In the second series, transport of this uremic toxin was measured before (15-60 min) and after (75-120 min) hyaluronan (0.1 g/dL, molecular weight 2,000 kDa) application in to the experimental system from mesothelial side of membrane. Results: In the first series, the rate of creatinine transfer remained constant, and no differences were observed for I->M transport and in the opposite direction (M->I). The mean value of P (± standard error of the mean) was 2.667 ± 0.162 [× 0.0001, cm/s] for bidirectional transport (n=15). Application of hyaluronan sodium on the mesothelial side of membrane (n=14) lowered I->M transfer of creatinine by a mean of 27% (p < 0.003) and in the opposite direction by a mean of 18% (p < 0.03). Conclusions: These results show that, in vitro, high molecular fractions of hyaluronan decrease bidirectional creatinine transport across the chemical modification peritoneal membrane. These observations may have clinical importance, especially in patients with disorders of peritoneal permeability, such peritonitis. MP414 TECHNICAL SURVIVAL IN PERITONEAL DIALYSIS PATIENTS: QUALITY OF LIFE AND OTHER RELATED FACTORS Ibrahim Güney Ibrahim Güney 1Nephrology Department, Konya Research and Training Hospital, Konya, Turkey Kültigin Türkmen Kültigin Türkmen 2Nephrology Department, Mengucek Gazi Training and Research Hospital, Erzincan University, Erzincan, Turkey Raziye Yazıcı Raziye Yazıcı 1Nephrology Department, Konya Research and Training Hospital, Konya, Turkey Sevket Arslan Sevket Arslan 1Nephrology Department, Konya Research and Training Hospital, Konya, Turkey Lütfullah Altıntepe Lütfullah Altıntepe 1Nephrology Department, Konya Research and Training Hospital, Konya, Turkey Mehdi Yeksan Mehdi Yeksan 3Nephrology Department, University of Necmettin Erbakan, Meram Medical Faculty, Konya, Turkey Abstract Introduction and Aims: Despite the improvements in peritoneal dialysis (PD), the impairment of both HRQoL and depression were found to be associated with technical survival in this population. We aimed to investigate the association between HRQoL, depression, other factors and technical survival in PD patients who were followed for 7 years. Methods: Onehundred and five PD patients were included and followed for 7 years in this prospective study. Results: Of 105 PD patients, 18 (17.1%) maintained PD, 87 (82.9%) shifted to hemodialysis (HD). The etiology of patients who shifted to HD were PD failure (41, 47.1%), peritonitis (33, 37.9%), leakage (6, 6.9%), cathater dysfunction (3, 3.4%), self willingness (4, 4.6%).There wasn't statistically significant difference between HD and PD patients in terms of age, gender, body mass index, hemoglobin, serum albumin, calcium, phosphorus, cholesterol, triglyseride, parathormone levels and education (p>0.05 for all). There were statistically significant difference between two groups in terms of PD duration, residual urine, co-morbidity and employment status (p=0.007, p=0.0018, p=0.028, p=0.008, respectively). When the groups were compared regarding health related quality of life (HRQoL) scores, HD patients who shifted from PD had lower physical functioning (58.7±30.4 vs 81.7±21.4, p=0.001), role-physical (22.4±33.5 vs 43.1±42.7, p=0.0039), physical component scale (PCS) (47.9±20.7 vs 62±15.9, p=0.007). BDI scores of PD and HD patients were not found to be statistically significant (p>0.05 for all). Employment status, age, PD duration, residual urine, diabetes, creatinine, urea, Kt/V and PCS were entered in the model of Cox-regression analysis. Among these parameters, increase of 1 mg/dL of creatinine, PCS (decrease of 1 point) and employment status were found to be the independent predictors of technical survival. Conclusions: We conclude that increase in PCS, decrease in serum creatinine and employment status were associated with higher technical survival in PD patients after 7 years of following period. MP415 PERITONEAL DIALYSIS - RISK FACTOR FOR GLYCEMIC VARIABILITY Cristina Vaduva Cristina Vaduva 1Haemodialysis Center, Emergency Hospital Craiova, Craiova, Romania Simona Popa Simona Popa 2Clinical Centre of Diabetes, Nutrition, Metabolic Diseases, University of Medicine and Pharmacy Craiova, Craiova, Romania Maria Mota Maria Mota 2Clinical Centre of Diabetes, Nutrition, Metabolic Diseases, University of Medicine and Pharmacy Craiova, Craiova, Romania Eugen Mota Eugen Mota 3Nephrology Department, University of Medicine and Pharmacy Craiova, Craiova, Romania Abstract Introduction and Aims: In patients with chronic kidney disease insulin resistance is a quasi-permanent associated condition which is a fundamental cause of type 2 diabetes mellitus and aterosclerotic vascular disease. Glucose daily load in peritoneal dialysis (PD) patients is an additional risk factor for metabolic disorders in these patients. Aims of study is to analyze the influence of peritoneal dialysis on glycemic variability certain indices recorded by CGMS (continuous glucose monitoring system) in non diabetic uraemic patients on peritoneal dialysis vs healthy subjects. Methods: We have studied 23 subjects: 9 non diabetic PD patients (4 M, 5 F) and 14 volunteers healthy subjects (3 M, 11 F) . The mean age of PD was 4.40 ± 1.97 years. All PD patients were adequately dialyzed with Kt /V> 1.7. Patients had different dialitic treatment regimens, four of them used Icodextrine in nocturnal exchange and four had only glucose 1.36% for all exchanges. CGMS was performed in all subjects over a period of 72 hours using the DexCom SEVEN CGMS device. Were analyzed following parameters: HbA1c, BMI, interstitial glucose, standard deviation (SD) ,% CV - percentage coefficient of variation calculated as SD / glucose mean ratio, CONGA (Continuous overall net glycemic action) 1h, 2h, 4h or 6h – assesing glycemic variability in predetermined time window. CGMS parameters were analyzed in two consecutive days of recording. Results: Nondiabetic PD patients had significantly higher values of HbA1c (5.57 ± 0.26% vs 5.27 ± 0.26%, p = 0.01) glucose mean and SD on both days compared with healthy subjects. BMI was higher in PD patients compared with healthy subjects (28.58 ± 4.56 vs 22.83 ± 1.99, p = 0.005). Nondiabetic PD patients showed significantly higher values of % CV both in the first days (15.3 ± 3.80 vs 10.52 ± 2.87, p = 0.02), and the second day (14.83 ± 3.43 vs 10.38 ± 3.56, p = 0.008). compared with healthy subjects. CONGA at 1h, 2h, 4h, 6h had higher values on both study days in PD patients compared with healthy subjects, the differences were statistically significant. The exclusive glucose dialysis exchanges was associated with mean glucose values, standard deviation, CONGA 1h, 2h, 4h, 6h significantly higher compared with healthy subjects and with PD patients with only three glucose exchanges and one icodextrine exchange , but not statistically significant. Conclusions: Non-diabetic uraemic PD patients had both higher glycemic variability and metabolic disorders more emphasized compared with healthy subjects, these differences can be explained at least in part by daily intake of glucose. MP416 HYPONATRAEMIA PREDICTS 1-YEAR MORTALITY IN STABLE PERITONEAL DIALYSIS PATIENTS Wan Ahmad Hafiz Wan Md Adnan Wan Ahmad Hafiz Wan Md Adnan 1Nephrology Unit, Department of Medicine, University Malaya, Kuala Lumpur, Malaysia Nur Lisa Zaharan Nur Lisa Zaharan 2Pharmacology Department, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia Abstract Introduction and Aims: Hyponatraemia has been associated with increased mortality in patients with heart failure and liver failure, as well as those who were hospitalised. The link between death and hyponatraemia in patients with kidney disease is not well established, especially in peritoneal dialysis (PD) cohort. The aim of this study is to determine whether hyponatraemia independently predicts 1-year all cause mortality in patients on PD. Methods: This is a single-centre, retrospective cohort study involving patients who were initiated on PD as the treatment modality for end stage kidney disease from 1st January 2006 until 31st December 2011 (n=209). 1 year all-cause mortality was determined as death between 3 months and 12 months of PD initiation and was retrieved from the hospital record. Those who died, transferred out or converted to HD within 3 months of PD were excluded (n=37). The serum sodium was taken as a single laboratory reading 3-6 months after initiation of PD. Those with serum sodium <135 mmol/L were categorized as hyponatraemic. Cox proportional hazard regression was used to calculate the hazard ratio (HR with 95% confidence interval (CI)) of 1-year mortality in the cohort of PD patients with hyponatraemia compared to those with normal serum sodium values, Age, gender, diabetes status and biochemical parameters (renal function test, bone profiles and full blood count) were adjusted as covariates. SPSS version 20 were used for statistical analysis. Results: 172 patients were included in the final analysis (55% males, mean age 57.9 ± 15.2 years). 20% (n=36) of patients died within 1 year of PD initiation (50% males, mean age 61.4 ± 17.2 years). Mean serum sodium was 137 ± 5 mmol/L. 28% of patients were categorized as hyponatraemic. 35% 1-year mortality was observed in the hyponatraemic group compared to 15% in those with normal sodium (p=0.003). There was a significant increased risk of 1-year mortality in those with hyponatraemia compared to those with normal serum levels in PD (adjusted hazard ratio=3.75 (95% CI 1.47, 9.47), p=0.003. No other factors were found to be significantly associated with 1 year mortality in our cohort of PD patients. Conclusions: Hyponatraemia in stable peritoneal dialysis patients is associated with higher mortality at 1 year. MP417 SAVING DAMAGED PERITONEAL CATHETERS WITH THE REPAIR-KIT Mercedes Moreiras-Plaza Mercedes Moreiras-Plaza 1Nephrology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain Raquel Blanco-García Raquel Blanco-García 1Nephrology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain Laura Beato-Coo Laura Beato-Coo 1Nephrology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain Cynthia Cossio-Aranibar Cynthia Cossio-Aranibar 1Nephrology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain Isabel Martin-Baez Isabel Martin-Baez 1Nephrology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain Abstract Introduction and Aims: Catheter damage and breakage is an infrequent complication of peritoneal dialysis. Early and appropriate intervention can save broken catheters without interrupting peritoneal dialysis.We present our experience using the Quinton Peri-Path Repair Kit® (Quinton Instrument Co, Tyco Healthcare Group LP. Mansfield, MA. U.S.A). Methods: The Peri-Path Repair Kit® contains a silicone rubber catheter extension with a double barbed connector inserted in one end, and a beta-cap adapter inserted in the other end.1 View largeDownload slide View largeDownload slideThe kit also includes a plastic glue mold with a plastic locking ring, a catheter cap, a clamp and sterile adhesive (Figure 1a) The repair procedure must be performed using an aseptic technique and avoiding alcohol-based disinfectants because they affect negatively the adhesive process. The steps for the procedure are the following: -the catheter is clamped between the skin line and the site of damage, and carefully cut at the site of breakage conserving as much as catheter length as possible. -the barbed connector of the extension tubing is inserted into the indwelling catheter until the catheter abuts the plastic hub of the connector. (FIGURE 1b) -the clamp is opened to allow drainage of some mL of dialysate for washing out any contaminants, and then, a new peritoneal dialysis transfer tube is connected to beta-cap adapter -the glue mold is wrapped around the connector and secured with the locking ring (FIGURE 1c) -the sterile silicone glue is applied through the locking ring and the mold is filled (FIGURE 1d) -The glue mold must be removed after 48-72 hours. -instructions from the fabricant say that routine peritoneal dialysis can be performed while the adhesive is curing. Results: We presented here 4 salvage procedures on 4 silicone damaged peritoneal catheters. The catheters had been in situ for one month, 6 years, 6 years, and 5 years respectively before the damage. In patients 1 and 3, the broken catheter was repared using the kit under prophylactic antibiotic therapy.The kit was used in patient 2, with an incomplete catheter perforation, for preventing future complications. A personal application was used in patient 4 for alleviating his problems with the cycler. None of the patients suffered peritonitis or had dialysate leakage after several months of follow up. Conclusions: - The breakage of the catheter enhances the risk of contamination and peritonitis and may lead to discontinue the technique and to remove the catheter. - Repair of the damaged catheter using the Peri-path Repair Kit extends catheter life and prevents its replacement, allowing the patient to continue on PD. MP418 PROTEIN NITROGEN APPEARANCE: HOW TO NORMALIZE AND WHICH TARGET? Maria Teresa Santos Maria Teresa Santos 2Nephrology, IPO Porto, Porto, Portugal Isabel Fonseca Isabel Fonseca 1Nephrology, Hospital Santo António, Porto, Portugal Olivia Santos Olivia Santos 1Nephrology, Hospital Santo António, Porto, Portugal Pedro Aguiar Pedro Aguiar 1Nephrology, Hospital Santo António, Porto, Portugal Maria João Rocha Maria João Rocha 1Nephrology, Hospital Santo António, Porto, Portugal Maria João Carvalho Maria João Carvalho 1Nephrology, Hospital Santo António, Porto, Portugal António Cabrita António Cabrita 1Nephrology, Hospital Santo António, Porto, Portugal Anabela Rodrigues Anabela Rodrigues 1Nephrology, Hospital Santo António, Porto, Portugal Abstract Introduction and Aims: Protein Nitrogen Appearance (PNA) is routinely determined in Peritoneal Dialysis (PD) Patients. Controversy still exists to what body weight PNA should be normalized. The aim of this cross-sectional study was to evaluate the difference between PNA normalized to actual dry body weight (PNAABW) and to ideal body weight (PNAIBW), and to compare PNAIBW between several subgroups of patients (diabetic, anuric, overweight, elderly). Methods: IBW was calculated according Butheau and Metropolitan Life Insurance formulas. Multifrequency Bioimpedance analysis (BIA) was used to measure patient body composition and hydration status. Results: We studied 54 PD patients (50% female), aged 56±14 years, with mean time on PD of 38 months. Thirty two patients (59%) were overweight considering BMI>25 Kg/m2, and 39 (72%) were obese considering fat mass measured by BCM (% fat mass >25% in male and > 30% in female). Mean nPNAABW was 1.06 ±0.39 g/Kg and mean nPNAIBW 1.12 ± 0.34 g/Kg (a mean increase of 7.6%). nPNAABW was lower than 1 g/Kg in 27 patients (50%), and in 25 patients (46%) when normalization was done for IBW (only 8 patients had nPNAIBW <0.8 g/Kg). Mean differences between nPNAIBW and nPNAABW were positive and significantly higher for overweight patients (overestimation of nPNA when ABW is used for normalizing). No correlation was found between nPNAIBWand age, time on PD, BMI, albumin, PCR, lean and fat mass. nPNAIBWwas only correlated with residual and total ClCreat and Kt/V residual. Exploring subgroups of risk patients no significant differences were found in nPNAIBW in elderly (>65 years old), diabetic, overhydrated (BCM®, relative OH > 15%), overweight (BMI>25), and obese patients considering %fat mass by BCM. The anuric patients (diuresis < 100ml) had significantly higher time on PD, nPNAIBW, and fat mass but lower lean mass. Patients with nPNAIBW<0.8 g/Kg had lower lean mass. By multivariable analysis the variables associated to lean mass after adjusting for C-reactive protein, patient age, time on PD, and overhydration, nPNAIBWwas an independent predictor of lean mass deviation from the reference (B=2.23, CI 95% 0.26-4.21). Conclusions: Even normalizing PNA by IBW, values under 1g/kg per day as recommended, are widely prevalent in our patients, but levels under 0.8 g/Kg per day were present in only 9%. As most of our patients were overweight or obese by measuring fat mass (anabolic state), we hypothesize that maybe some patients need lower values of nPNA than the recommended to achieve positive nitrogen balance. MP419 METABOLITE PROFILING OF PREITONEAL DILAYSIS EFFLUENT BETWEEN LOW AND HIGH-AVERAGE TRANSPORT PATIENT- A PILOT STUDY Zhiyong Guo Zhiyong Guo 1Dept. Neprology, Changhai Hospital, Shanghai, China Xueli Lai Xueli Lai 1Dept. Neprology, Changhai Hospital, Shanghai, China Abstract Introduction and Aims: It is known that outcome of peritoneal dialysis (PD) patient is associated with the capacity of solutes and water clearance. However the high molecular weight solutes in peritoneal dialysis effluent (PDF) and their clinical consequences have not been well studied. This study aims to explore the endogenous metabolite remove by PD, especially under different characteristics of peritoneal membrane transport. Methods: A pilot study collected PDF from no-diabetic continuous ambulatory peritoneal dialysis patients underwent fast peritoneal equilibration test in a single centre from March 2012 to November 2012. Among patients with characteristic of high-average transport (HA) and low-average transport (LA), paired cases were selected, based on the gender, age, PDKt/V, residual renal function (RRF) and duration of treatment. Ultra-performance liquid chromatography (UPLC) coupled with Q-TOF mass spectrometry were performed to investigated the metabolic profile in the PDF sample. After raw data acquisition and transformation by Agilent Masshunter Qualitative Analysis software, paired t-test and fold change analysis were conducted to screen feature difference. The different metabolites were defined by Agilent Mass Profiler Pro software finally. Results: Twenty paired PDF samples from cases (female/male, 8/12; age, 58.4±16.3 years; dialysis duration, 14.3±5.6 months) with feature of HA and LA were defined. The metabolomics analysis indicated that distribution of 14 metabolites from 6 metabolic pathway (energy metabolism, lipid metabolism, carbohydrate metabolism, tricarboxylic acid cycle and amino acids metabolism) between HA and LA group had significant difference (p<0.05). No  Identification  mass  Corrected p-value  Pathway  1  Phenylalanine  165.169  0.047  amino acids metabolism  2  Histidine  155.070  0.040  amino acids metabolism  3  Pyruvic acid  88.016  0.026  amino acids metabolism  4  isoleucine  131.095  0.047  amino acids metabolism  5  glutaminate  145.062  0.043  amino acids metabolism  6  Tryptophan  204.225  0.001  amino acids metabolism  7  Glycine  75.032  0.047  amino acids metabolism  8  α-oxoglutarate  146.022  0.026  tricarboxylic acid cycle  9  Taurine  125.015  0.017  amino acids metabolism  10  3-hydroxybutyric acid  104.047  0.043  lipid metabolism  11  citrate  192.027  0.017  tricarboxylic acid cycle  12  glucose  180.156  0.009  carbohydrate metabolism  13  Acetoacetate  101.024  0.015  energy metabolism  14  phosphorylcholine  219.043  0.019  lipid metabolism  No  Identification  mass  Corrected p-value  Pathway  1  Phenylalanine  165.169  0.047  amino acids metabolism  2  Histidine  155.070  0.040  amino acids metabolism  3  Pyruvic acid  88.016  0.026  amino acids metabolism  4  isoleucine  131.095  0.047  amino acids metabolism  5  glutaminate  145.062  0.043  amino acids metabolism  6  Tryptophan  204.225  0.001  amino acids metabolism  7  Glycine  75.032  0.047  amino acids metabolism  8  α-oxoglutarate  146.022  0.026  tricarboxylic acid cycle  9  Taurine  125.015  0.017  amino acids metabolism  10  3-hydroxybutyric acid  104.047  0.043  lipid metabolism  11  citrate  192.027  0.017  tricarboxylic acid cycle  12  glucose  180.156  0.009  carbohydrate metabolism  13  Acetoacetate  101.024  0.015  energy metabolism  14  phosphorylcholine  219.043  0.019  lipid metabolism Different Metabolites and involved pathway between HA and LA group. 2 View largeDownload slide View largeDownload slide3D PCA plots with the scores of principal components between HA (red) and LA (blue) group. Conclusions: Current metabonomics results provided new insight into the effect of solutes remove by PD in clinical outcome. MP420 LONG-TERM EXPERIENCE WITH PERCUTANEOUSLY PERITONEAL CATHETER PLACEMENT Marios Theodoridis Marios Theodoridis 1Department of Nephrology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Evros, Greece Stylianos Panagoutsos Stylianos Panagoutsos 1Department of Nephrology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Evros, Greece Elias Thodis Elias Thodis 1Department of Nephrology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Evros, Greece Michail Karanikas Michail Karanikas 1Department of Nephrology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Evros, Greece Alexandros Mitrakas Alexandros Mitrakas 1Department of Nephrology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Evros, Greece Pelagia Kriki Pelagia Kriki 1Department of Nephrology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Evros, Greece Konstantia Kantartzi Konstantia Kantartzi 1Department of Nephrology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Evros, Greece Ploumis Passadakis Ploumis Passadakis 1Department of Nephrology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Evros, Greece Vassilis Vargemezis Vassilis Vargemezis 1Department of Nephrology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Evros, Greece Abstract Introduction and Aims: The successful placement of the peritoneal catheter is directly related to peritoneal dialysis (PD) technique survival. The methods used in peritoneal catheter insertion are distinguished in the surgical method with small laparotomy, in the laparoscopic method and in the percutaneous method as well. The latter is performed either with the Seldinger approach, or by using a trocar. There are conflicting data to date regarding the effectiveness of the various methods of PD catheter placement. Methods: The aim of this study is to estimate the survival of peritoneal catheters inserted percutaneously in our unit with a Tenckhoff trocar at bedside, during the last twenty years, from 1989 to 2010. For this purpose, we retrospectively studied the complications and the survival of the peritoneal catheters placed in our PD patients with end stage renal disease (ESRD). Catheter survival was assessed by Kaplan-Meier method and the causes of catheter loss were also recorded. Results: A total of 360 Tenckhoff peritoneal catheters were placed in 322 patients (177 men, 145 women) with a mean age of 63±13 years old. Of the 360 catheters, 337 were inserted by a nephrologist with the percutaneous-trocar method and 23 catheters were inserted by a surgeon with the small-laparotomy technique. There was not any serious early or late complication related to the insertion technique. The survival of catheters placed with a trocar was 86% at the first year, 71% at 3 years, 61% at 5 years and 49% at 8 years respectively. Causes of catheter loss were the following: infection (peritonitis, exit site infection, subcutaneous tunnel infection) in 71 cases (19,7%), technique failure (ultrafiltration failure, dialysis inadequacy) in 61 patients (16,9%), mechanical causes (dysfunction, obstruction, leakage, hernias) in 38 cases (10,5%), transplantation in 19 patients (5,4%), while in 171 cases (47,5%) catheter loss occurred due to patients' death. Conclusions: We conclude that the percutaneously insertion of peritoneal catheters by expertise in the method nephrologists remains a safe and effective method, without the need of an operating room as used by surgical methods, while providing an equivalent catheter survival. MP421 INCIDENCE AND RISK FACTORS OF INFECTIOUS PERITONITIS IN PERITONEAL DIALYSIS PATIENTS: A SWISS SINGLE CENTER EXPERIENCE Nima Vakilzadeh Nima Vakilzadeh 1Nephrology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland Menno Pruijm Menno Pruijm 1Nephrology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland Michel Burnier Michel Burnier 1Nephrology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland Georges Halabi Georges Halabi 1Nephrology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland Abstract Introduction and Aims: Despite the improvement of peritoneal dialysis (PD) techniques, PD-peritonitis remains one of the most frequent complications. Data on PD peritonitis incidence and related risk factors in Switzerland are sparse. Methods: This is a single-center, retrospective study including all patients who underwent peritoneal dialysis between 1995 and 2010 in the university hospital of Lausanne (CHUV). Patient records were used to collect patient characteristics, details on peritonitis episodes and their outcome. The proportion of patients free of peritonitis episodes over time was estimated using Kaplan-Meier analysis, censored for death or transplantation. Cox regression analysis was used to assess the influence of possible risk factors on the incidence of PD-peritonitis. Results: All 108 patients (65 men and 43 women) who underwent PD between 1995 and 2010 in our center were included in this analysis, leading to an observation time of 2932 patient months. 81.6% performed exchanges autonomously and 12.9% were helped by a family member or nurse. The median (min-max) age was 53 (22-87) years, the mean (±SD) Body Mass Index (BMI) was 24.2±4 kg/m², 29.7% of patients had an initial Charlson-score over 5, and 26.9% suffered from diabetes mellitus. A total of 113 episodes of PD-peritonitis were recorded, corresponding to an incidence of one episode per 26 patient-months. Median peritonitis-free survival time was 23.6 months. The most frequently isolated pathogen was Staphylococcus epidermidis (23.9%). In Cox-regression analysis, adjusted for age and sex, factors associated with increased risk of PD-peritonitis were diabetes (Hazard Ratio 2.6 (95% CI 1.4-4.6), p= 0.003), a Charlson score >5 (HR 4.1 (1.6-10.8), p=0.004), and autonomously performed PD-exchanges (HR 3.3(1.6-8.3),p=0.013), whereas age, gender and previous transplantation were not. One patient died because of peritonitis. Conclusions: The rate of PD-peritonitis reported in this Swiss single-center study is well below the maximal acceptable rate of the ISPD (International Society for Peritoneal Dialysis), as is peritonitis-related mortality. Autonomously performed PD, diabetes and a high Charlson comorbidity score were associated with a higher risk of PD-peritonitis. MP422 ANURIA: THE VILLAIN IN QUALITY OF LIFE AND SEXUAL DYSFUNCTION IN PERITONEAL DIALYSIS PATIENTS? Pedro Azevedo Pedro Azevedo 1Nephrology Department, Centro Hospitalar do Porto (CHP-HSA), Porto, Portugal Olivia Santos Olivia Santos 1Nephrology Department, Centro Hospitalar do Porto (CHP-HSA), Porto, Portugal Maria Carvalho Maria Carvalho 1Nephrology Department, Centro Hospitalar do Porto (CHP-HSA), Porto, Portugal António Cabrita António Cabrita 1Nephrology Department, Centro Hospitalar do Porto (CHP-HSA), Porto, Portugal Anabela Rodrigues Anabela Rodrigues 1Nephrology Department, Centro Hospitalar do Porto (CHP-HSA), Porto, Portugal Abstract Introduction and Aims: There are several studies that address the quality of life of patients on peritoneal dialysis. Sexual dysfunction, anxiety and depression are highly prevalent in patients undergoing peritoneal dialysis (PD), but studies focusing these particular issues are scarce, especially, in an integrated approach to the patient with anuria. This study aims to evaluate sexual dysfunction and its predictors among PD patients, particularly in patients without residual renal function. Methods: In this observational, cross-sectional study, all chronic PD patients in our Center were asked to complete a self-reported questionnaire: the International Index of Erectile Function (IIEF) for men and the Index of Female Sexual Function (IFSF) for women. Both groups answered the Hospital Anxiety and Depression Scale (HADS) to evaluate the prevalence of depression and anxiety and the EQ5D to measure the health outcome. The data collection consisted in several demographic, clinical and laboratory variables and others related to DP technique. Data analysis was performed in SPSS 20. Mann Whitney U and Chi-square tests were used for group comparisons. We assessed confounding variables with multivariate regression analysis. Results: We evaluated 57 PD patients (50,9% males), with a mean age of 53,9±15,7 years and 27,6% with diabetes. Anuric patients comprised 24.6% of the total. This risk group had higher C Reactive Protein (p=0,011), lower serum uric acid (p=0,034) and lower nPCR (p=0,002). Sexual dysfunction was present in 78,6% of anuric patients (p=0,036) and 46,5% of non anurics. Anuric males had a worse quality of life (p 0,014) and erectile function (p=0,04). In a multivariate analysis, anuria, diabetes and smoking showed a statistically significant and independent negative contribution to the worse IIEF score (p <0.001), in a model that accounts for 56% of sample variation (adjusted R square). The same was not true with the FSFI score in anuric women. On the other hand we did not find a significant impact of anuria under PD in depression and anxiety scores. Conclusions: Although PD is feasible in anuric patients, this study emphasizes the importance of addressing sexual dysfunction, co-morbidities and the prevention of cardiovascular risk factors, in particular, of the anuric male, in order to provide a better and more dignified quality of life under PD. MP423 PERITONEAL DIALYSIS (PD): IS THE AGEING POPULATION REALLY A BARRIER IN EUROPE? Suzanne Laplante Suzanne Laplante 1EMEA Health Outcomes, Baxter Healthcare Corporation, Braine l'Alleud, Belgium Peter Rutherford Peter Rutherford 2EMEA Medical Affairs, Baxter Healthcare Corporation, Zurich, Switzerland Abstract Introduction and Aims: PD is associated with significant benefits for patients and healthcare systems, but its usage varies greatly across Europe. Population characteristics (especially age) are often suggested as an explanation of this variation. The aim of this analysis was to verify if age was a limitation to the usage of PD in European countries. Methods: The age distribution of ESRD patients and PD usage per age group in incident and prevalent patients were extracted from the 2010 ERA-EDTA registry report. Linear regressions were used to assess the association between PD usage and age and compared countries when clustered by their PD usage. Results: In the 2010 ERA-EDTA registry report, 19.0% of the incident and 13.9% of the prevalent adult dialysis patients were on PD. The usage of PD patients declined with age in a linear way in incident (p=0.0034) and prevalent (p=0.0171) patients. Analysis by clusters (cluster 1: Nordics & Netherlands plus UK for incident patients only; cluster 2: other countries) showed that the usage of PD patients was significantly higher for all age groups in cluster 1 versus cluster 2 (p=0.0001). In older age groups (65-74 & 75+ age groups), PD use was 1.9-2.1 times higher in prevalent and 1.4-1.6 higher in incident patients in cluster 1 than in cluster 2 (vs 1.5-1.8 in other age groups). This creates a potential gap of 617 incident and 5568 prevalent older age group patients in cluster 2 countries (average per country: 88 incident; 696 prevalent) that could receive home treatment. Conclusions: PD use significantly declines with age in countries submitting to the ERA-EDTA registry. However, data from cluster 1 countries show that PD usage could be significantly higher than what is currently achieved in cluster 2 countries, including in older patient groups, provided the health status of these older patients is similar across countries. Furthermore, as not all European countries are reporting to the ERA-EDTA registry, e.g., Germany where PD usage is low, these estimations are likely to be very conservative. MP424 OPTIMIZATION PERITONEAL DIALYSIS TREATMENT Evgeny Shutov Evgeny Shutov 1Clinical Hospital Named after S.P. Botkin, Moscow, Russian Federation Alina Isachkina Alina Isachkina 2North-Western State Medical University named after I.I. Mechnikov, St. Peterburg, Russian Federation Elena Gorelova Elena Gorelova 1Clinical Hospital Named after S.P. Botkin, Moscow, Russian Federation Abstract Introduction and Aims: Conventional regime of continuous ambulatory peritoneal dialysis (CAPD) for most patients includes 4 exchanges with 3 equally short dwell daytime (4-5 hours) and a long dwell time at night ( 8-9 hours). The majority of patients are treated with glucose-based peritoneal dialysis (PD) fluids. This mode of treatment has the following problems: 1) rapid changes of transport characteristics, 2) difficulties in organizing work for patients, because they have to make exchange in themiddle of their workday. We investigate how the new regime exchange (NMRE) - two short dwell times (every 3 hours) and two long dwell times (every 9 hours), which gives patients the opportunity to work, can influence peritoneal transport characteristics and adequacy of treatment. Methods: We examined 30 patients on NMRE during 6 months. Patients were tested weekly for peritoneal KT|V urea, daily ultrafiltration, ratio of the concentration of creatinine in the dialysate to its concentration in the blood (D / P creat) in the PET test. These parameters were checked every 3 months. The control group had 30 patients on standard regime exchange (SRE) with same ages, sex and time CAPD treatment. All patients used identical concentrations of glucose in PD solutions and fill volume (2l) . Results: Index adequacy KT|V in NMRE group was 2,3±0,2 initially and it didn't change after 3 - 6 months. Patients on SRE had KT|V - 2,1±0,2 initially and it didn't change either with the observation time. Volume ultrafiltration daily (UF) in NMRE group was 1,3 ±0,4l and it didn't change, but in SRE group daily UF declined from 1,5±0,34 to 1,3±0,3l (p‹0,05). D / P creat grew from 074±0,04 to 0,75±0,04 (p=0,05) after 3 months and it grew to 0,77±0,04 after 6 months (p=0,003). Whereas D / P creat didn't change in NMRE group. Conclusions: NMRE regime can reduce negative influence glucose–based peritoneal dialysis solutions on the peritoneum. This situation was confirmed by the lack of change in D / P creat in NMRE group compared with the SRE group; it can be explained by decrease in the time exposure of high concentration of glucose. Also NMRE regime gives a patient opportunity to use long dwell daytime for work without exchanging dialysis solution. MP425 PERITONEAL REABSORPTION WITH THE PROLONGED PERITONEAL TEST FROM 4 TO 8 HOURS WITH GLUCOSE 1,36%, 2,27% AND 3,86% Maria-Isabel Troya Maria-Isabel Troya 1Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain Josep Teixidó Josep Teixidó 1Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain Guillermo Pedreira Guillermo Pedreira 1Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain Milagros Del Rio Milagros Del Rio 1Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain Ramón Romero Ramón Romero 1Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain Josep Bonet Josep Bonet 1Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain Abstract Introduction and Aims: The peritoneal ultrafiltration failure (UFF) in peritoneal dialysis (PD) has improved with the determination of the free water transport. However the peritoneal or lymphatic reabsorption does not have a standardized and easy method applicable in clinical practice. The aim of the study was to calculate the peritoneal reabsorption (without distinction between the interstitial or lymphatic) from 4 to 8 hours in a prolonged peritoneal equilibration test (PPT) with 1,36, 2,27 and 3,86% glucose. Methods: Thirty-two stable patients of a tertiary hospital were studied. Age 54.6±16.6 years; Male/female: 19/13, PD vintage: 20.44±18.02 months. ESRD: GN 16%, Interstitial nephropathy 16%, Policystic Disease 6%, Vascular and nephroangiosclerosis 9%, diabetes mellitus 6%, unknown 34% and other 16%. Charlson index 5.34 ±2.56. Modality: CAPD 18, APD 10, Incremental PD 4 patients. Methods: The night bag previous to the test was 2,27% glucose. The peritoneal tests (1,36%, 2,27%, 3,86% glucose) were done in random order in a period less than one month. During the PPT the peritoneal volume was emptied and reinfused at 60' and 240' and finally voided at approximately 480'. A blood sample at 240' and peritoneal samples at 0', 60', 120', 240' and 480' were withdrawn. Urea, creatinine, glucose, Na+, K+ were determined in all samples. B-2-microglobulin, albumin, total protein, IgA and IgG were analysed at 240'. Data were processed in an Excel file. The PD-Adequest was also calculated. Additionally a Personal Dialysis Capacities test was carried out. Results: The PPT showed no significant differences in solute transport parameters among the different glucose concentrations except in D/Do Glu (p<0.001), MTC Urea (p<0.001) and MTC K+ (p<0.01). The correlation with PD-Adequest was good, but less with the PDC. Water transport: All parameters were significantly different among the 3 glucose solutions: net Uf, Na+ dip, small pore water transport, free water transport at 60' and 240'. However the 4-8 h. volume reabsorption (G1,36%: 265 ml CI 214-316; G2,27%: 226 ml CI 159-292; G3,86%: 277 ml CI 220-292) and the Peritoneal reabsorption rate (G1,36%: 1.03 ml/min CI: 0.83-1.24; G2,27%: 0.86 ml/min CI 0.60-1.11; G3,86% 1.05 ml/min CI 0.77-1.33) were not significantly different. The paired t-test between the peritoneal reabsorption volumes and rates of the different glucose concentrations were not significantly different. Their respective Spearman's correlation coefficients were good. Conclusions: 1. The peritoneal reabsorption from 4 to 8 hours with different glucose concentrations is not different. 2. The Prolonged Peritoneal Test could be a practical method to standardize the peritoneal reabsorption rates. MP426 ZINC TRANSPORTER 7 INDUCED BY HIGH GLUCOSE ATTENUATES EPITHELIAL-TO-MESENCHYMAL TRANSITION OF PERITONEAL MESOTHELIAL CELLS Xiuli Zhang Xiuli Zhang 1Department of Nephrology, Department of Nephrology, The First Affiliated Hospital, China Medical University, 155th Nanjing North Street, Shenyang, Liaoning China Jianfei Ma Jianfei Ma 2Department of Nephrology, Department of Nephrology, The First Affiliated Hospital, China Medical University, 155th Nanjing North Street, Shenyang, Liaoning, China Abstract Introduction and Aims: Zinc (Zn) is an essential micronutrient and cytoprotectant involved in preventing many types of epithelial-to-mesenchymal transition (EMT)-driven fibrosis in vivo. The zinc-transporter family SLC30A (ZnT) is a pivotal factor in the regulation of Zn homeostasis. However, its function in EMT in peritoneal mesothelial cells (PMCs) remains unknown.This study explored the regulation of zinc transporters and the role they play in cell EMT, particularly in rat peritoneal mesothelial cells (RPMCs)), surrounding glucose concentrations and the molecular mechanism involved. Methods: The effects of high glucose (HG) on zinc transporter gene expression were measured in RPMCs by real-time PCR. We explored ZnT7 (Slc30A7): the effect of ZnT7 over expression and siRNA-mediated knock-down on HG-induced EMT was investigated as well as the underlying molecular mechanisms. Results: Over-expression of ZnT7 resulted in significantly inhibited HG-induced EMT in RPMCs, while inhibition of ZnT7 expression using a considerable siRNA-mediated knock-down of RPMCs increased the levels of EMT. Furthermore, over-expression of ZnT7 is accompanied by down-regulation of TGF-β /Smad pathway, phospho-Smad3,4 expression levels. The finding suggests that the zinc-transporting system in RPMCs is influenced by the exposure to HG. Conclusions: The ZnT7 may account for the inhibition of HG-induced EMT in RPMCs, likely through targeting TGF-β /Smad signaling. MP427 A NEW CONNECTOR DECREASES THE PERITONEAL DIALYSIS RELATED PERITONITIS Youngsu Kim Youngsu Kim 1Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Gyunggi-do, Republic of Korea Jwa-Kyung Kim Jwa-Kyung Kim 1Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Gyunggi-do, Republic of Korea Young Rim Song Young Rim Song 1Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Gyunggi-do, Republic of Korea Sung Gyun Kim Sung Gyun Kim 1Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Gyunggi-do, Republic of Korea Hyung Jik Kim Hyung Jik Kim 1Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Gyunggi-do, Republic of Korea Abstract Introduction and Aims: Peritonitis remains the leading cause of technical failure and a significant cause of morbidity in patients with peritoneal dialysis (PD). Contamination during fluid exchange is a common cause of peritonitis. A small lightweight connector for PD transfer set (Staysafe Catheter Extension Luer-Lock, Fresenius Medical Care, Germany) protected by pin and disinfection cap minimizing the risk of contamination has been developed. This study was to determine the new connector could decrease the incidence of PD-related peritonitis. Methods: All incident PD patients (n=30) between May and October 2008 were into the new connector group, was compared with the conventional connector group of all incident patients (n=36) in same months of year 2007. Primary end point was PD-related peritonitis rate. Secondary end points were exit site infection rate and peritonitis free survival. Results: Comparing to the conventional group, the new connector group showed significantly lower peritonitis rate (one episode per 21.76 patient-months vs. one per 56.52 patient months, respectively, p=0.044) and higher 1-year peritonitis free survival rate(55.6 vs. 80.0%, respectively, p=0.031). Exit site infection rate, however, was not different between two groups (one episode per 51.68 patient months vs. one per 113.03 patient months, respectively, p=0.147). There were no differences in basic characteristics, causative microorganisms, prescribed antibiotics and managements between two groups. Conclusions: This study suggests that the use of the new connector system decrease the rate of PD-related peritonitis. MP428 APD DOES NOT GIVE SUPERIOR MASS REMOVAL COMPARED TO CAPD DESPITE THE HIGHER NUMBER OF DWELLS IN APD Sunny Eloot Sunny Eloot 1Nephrology, Ghent University Hospital, Gent, Belgium Raymond Vanholder Raymond Vanholder 1Nephrology, Ghent University Hospital, Gent, Belgium Wim Van Biesen Wim Van Biesen 1Nephrology, Ghent University Hospital, Gent, Belgium Abstract Introduction and Aims: Two observational studies showed more solute removal of protein bound solutes with hemodialysis, while time averaged plasma concentrations were not strikingly higher or even markedly lower in peritoneal dialysis (PD) patients. Furthermore, analogous discrepancies were found among PD modalities, with equal solute removal but higher time averaged concentrations in automated PD (APD) versus continuous ambulatory PD (CAPD). Next to being contradictory, equal removal between APD and CAPD seems remarkably in view of the higher dialysate volume used with APD, especially in cases of high transporter PD membranes and/or small solutes. To clarify those discrepancies, a cross-over study of APD and CAPD treatment was performed investigating solute removal and time averaged concentrations. Methods: Fifteen chronic kidney disease patients on either CAPD (n=8) or APD (n=7) were included in a cross-over study performing ad random once 24h of CAPD(4*2L) and APD (5*2L over 8 hours and 2L during the day) at midweek. PD effluent and urine were collected and stored at -80°. A blood sample was taken before each 24h test session and immediately centrifuged, and plasma was stored at -80°C until analysis, to derive the time averaged concentration (TAC). Determinations of concentrations of the small water soluble solutes urea, creatinine (CREA), phosphorus (P), and uric acid (UA), the middle molecule beta-2-microglobulin (β2M), and the protein-bound solutes hippuric acid (HA), 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF), indoxyl sulfate (IS), indole acetic acid (IAA), and p-cresylsulfate (PCS) were performed on all samples. Mass removal (i.e. sum of removal in PD effluent and urine, calculated as concentration times volume) and total clearance K (i.e. sum of dialyser clearance and renal clearance, calculated as mass removal during 24h divided by the TAC) were calculated for each PD modus. Results: PD drained dwell volume was significantly higher for APD (13.3±0.5L) compared to CAPD (8.5±0.7L) (P<0.001), while urine output was significantly higher for CAPD (1.4±0.6L) compared to APD (1.0±0.5L) (P=0.001). For all solutes, no differences were found for the TAC. Total mass removal, however, was significantly higher in CAPD for the small water soluble solutes CREA (P=0.001) and P (P=0.005), and borderline significant for urea (P=0.057) and UA (P=0.051), with an average increase in removal of 10% (urea), 15% (CREA), 7% (UA), and 17% (P). Total clearance was higher in CAPD for urea (P=0.041) and CREA (P=0.008), while renal clearance was higher in CAPD for even more solutes: urea (P=0.009), CREA (P=0.005), UA (P=0.005), P (P=0.025), and β2M (P=0.020). Protein-bound solutes and β2M were not found being removed differently by both PD modalities. Conclusions: Although total volume of used and drained dialysate is higher in case of APD, CAPD showed better mass removal for small water soluble solutes, but no difference for other solutes, and this independent of transport status. High volume APD just to increase clearance should not be recommended. MP429 EFFECTS OF PROTEIN LOSSES IN PERITONEAL DIALYSIS James Heaf James Heaf 1Dept. of Nephrology B, University of Copenhagen Hospital at Herlev, Herlev, Denmark Christina Pedersen Christina Pedersen 1Dept. of Nephrology B, University of Copenhagen Hospital at Herlev, Herlev, Denmark Anders Elgborn Anders Elgborn 1Dept. of Nephrology B, University of Copenhagen Hospital at Herlev, Herlev, Denmark Abstract Introduction and Aims: Several studies have shown that a high peritoneal albumin clearance is a risk factor for death in PD patients. This may be causal in that it may lead to increased protein loss, with consequent malnutrition, reduced immune competency, and death. We hypothesised that increased use of “dry” periods would reduce albumin losses, with consequent clinical benefit. Methods: 201 incident PD patients were included in a prospective investigation. Peritoneal characteristics, including the area parameter and large pore clearance (LPC) were determined shortly after initiation using the Personal Dialysis Capacity (PDC) algorithm. High transporters were preferentially treated with APD, slow with CAPD. Every six months standard Kt/V analyses were performed, including determination of peritoneal albumin losses and peritoneal albumin clearance. Factors affecting s-albumin and peritoneal albumin loss, and their effect on prognosis were determined. Results: Factors disposing towards low s-albumin were high age, high comorbidity, a high LPC, and a high albumin clearance. No independent effects of treatment prescription (APD/CAPD, dry/wet days) were seen. The use of dry days significantly reduced albumin loss, but usually only by <1 g/d. In patients treated with APD with wet days, albumin loss was significantly associated with dialysate volume. LPC was a significant independent risk factor for technique failure and death (relative risk 1.64, p<0.05). There was no independent effect of albumin losses or treatment prescription on prognosis. Significant univariate and multivariate correlations to plasma albumin (g/l), with examples.   Univ CC  Multiv CC  Group 1  P-albumin  Group 2  P-albumin  Age  -0.20b  -0.20b  <30 years  39.2 ±5.4  >70 years  34.9 ±5.1  Diabetic nephropathy  -0.16a  -0.21c  No  35.5 ±4.8  Yes  30.8 ±8.3  Heart disease  -0.20b    No  35.3 ±5.0  Yes  34.2 ±4.7  Arteriosclerosis  -0.10    No  35.3 ±5.0  Yes  34.2 ±4.5  Other comorbidity  -0.15a    No  35.5 ±4.7  Yes  34.2 ±5.1  Area Parameter  -0.19b    <150 m  35.5 ±4.8  >300 m  33.6 ±5.5  Large Pore Clearance  -0.24c  -0.19b  <0.05 ml/min  36.6 ±5.4  >0.25 ml/min  30.7 ±4.7  Peritoneal albumin loss  -0.30c    <5 g/d  34.8 ±5.1  >10 g/d  32.6 ±5.0  Peritoneal albumin clearance  -0.38c  -0.26c  <50 ml/d  37.4 ±4.4  >350 ml/d  29.9 ±9.0  Urine albumin loss  -0.13    <1 g/d  35.1 ±4.9  >5 g/d  28.6 ±3.0  CRP (mg/l)  -0.27c    <10 mg/l  35.5 ±5.0  >100 mg/l  29.8 ±8.1    Univ CC  Multiv CC  Group 1  P-albumin  Group 2  P-albumin  Age  -0.20b  -0.20b  <30 years  39.2 ±5.4  >70 years  34.9 ±5.1  Diabetic nephropathy  -0.16a  -0.21c  No  35.5 ±4.8  Yes  30.8 ±8.3  Heart disease  -0.20b    No  35.3 ±5.0  Yes  34.2 ±4.7  Arteriosclerosis  -0.10    No  35.3 ±5.0  Yes  34.2 ±4.5  Other comorbidity  -0.15a    No  35.5 ±4.7  Yes  34.2 ±5.1  Area Parameter  -0.19b    <150 m  35.5 ±4.8  >300 m  33.6 ±5.5  Large Pore Clearance  -0.24c  -0.19b  <0.05 ml/min  36.6 ±5.4  >0.25 ml/min  30.7 ±4.7  Peritoneal albumin loss  -0.30c    <5 g/d  34.8 ±5.1  >10 g/d  32.6 ±5.0  Peritoneal albumin clearance  -0.38c  -0.26c  <50 ml/d  37.4 ±4.4  >350 ml/d  29.9 ±9.0  Urine albumin loss  -0.13    <1 g/d  35.1 ±4.9  >5 g/d  28.6 ±3.0  CRP (mg/l)  -0.27c    <10 mg/l  35.5 ±5.0  >100 mg/l  29.8 ±8.1  a:p<0.05; b:p<0.01; c:p<0.001 Relationship to treatment prescription.   CAPD dry  CAPD wet  APD dry  APD wet  Peritoneal albumin loss (g/d)  4.27 ±3.58  4.37 ±2.82  3.41 ± 3.02a  3.93 ±2.75  Albumin Clearance (ml/d)  125 ±125  132 ±108  102 ±91a  118 ±82    CAPD dry  CAPD wet  APD dry  APD wet  Peritoneal albumin loss (g/d)  4.27 ±3.58  4.37 ±2.82  3.41 ± 3.02a  3.93 ±2.75  Albumin Clearance (ml/d)  125 ±125  132 ±108  102 ±91a  118 ±82  a:p<0.05 vs. CAPD wet. Conclusions: The results confirm previous findings that a high LPC is a risk factor for death and technique failure. Alterations in treatment regimes were able to alter albumin losses, but no independent clinical effects of albumin losses or treatment prescription were seen. The results suggest that a high LPC is a marker of peritoneal vascular pathology, and that peritoneal albumin loss per se has no major harmful effects. MP430 COMPARISON OF SYSTEMIC ORAL MALODOR IN PATIENTS UNDERGOING HEMODIALYSIS AND PERITONEAL DIALYSIS Taner Arabaci Taner Arabaci 1Department of Periodontology, Ataturk University, Faculty of Dentistry, Erzurum, Turkey 2Department of Nephrology, Ataturk University, Faculty of Medicine, Erzurum, Turkey Gulnihal Emrem Gulnihal Emrem 1Department of Periodontology, Ataturk University, Faculty of Dentistry, Erzurum, Turkey 2Department of Nephrology, Ataturk University, Faculty of Medicine, Erzurum, Turkey Mustafa Keles Mustafa Keles 2Department of Nephrology, Ataturk University, Faculty of Medicine, Erzurum, Turkey Alper Kizildag Alper Kizildag 2Department of Nephrology, Ataturk University, Faculty of Medicine, Erzurum, Turkey Abstract Introduction and Aims: Chronic renal failure is one of the major cause of systemic oral malodor depending on uremia. Hemodialysis (HD) and periotoneal dialysis (PD) are the important procedures in the management of patients with end-stage renal disease (ESRD). In this study it was aimed to compare the systemic oral malodor in patients undergoing HD and PD. Methods: 74 patients (40 HD and 34 PD) recently diagnosed with ESRD were selected. This study were not included the patients with poor oral hygiene and had oral malodor depending on any intraoral etiology such as caries, periodontal disease and impacted teeth. Oral hygiene index (OHI)scores of the patients were calculated in order assess oral health. Systemic oral malodor of the patients were evaluated using organoleptic method. All measurements were performed pre-dialysis and post-dialysis (3 months after dialysis therapy) procedures. Results: There were no statistically significant differences between the groups according to OHI scores (p>0.05). The Oral malodor scores were found lower at post-dialysis measurements than the baseline measurements in both group (p<0.05). The results of organoleptic measurements indicated that systemic oral malodor were higher in HD group (2.67±0.81) compared to PD group (1.98±0.57) (p<0.05). Conclusions: This study revealed that PD was more effective than HD in decreasing of systemic oral malodor in ESRD patients. MP431 THE PRESENCE OF CAREGIVER DOES NOT AFFECT THE OUTCOMES OF PERITONITIS IN PERITONEAL DIALSYSIS PATIENTS Francesca Martino Francesca Martino 1Nephrology, Dialysis, Transplantation, San Bortolo Hospital, Vicenza, Italy Gianpaolo Amici Gianpaolo Amici 2Nephrology, Dialysis, Transplantation, Santa Maria dei Battuti Hospital, Treviso, Italy Maria Pia Rodighiero Maria Pia Rodighiero 1Nephrology, Dialysis, Transplantation, San Bortolo Hospital, Vicenza, Italy Carlo Crepaldi Carlo Crepaldi 1Nephrology, Dialysis, Transplantation, San Bortolo Hospital, Vicenza, Italy Claudio Ronco Claudio Ronco 1Nephrology, Dialysis, Transplantation, San Bortolo Hospital, Vicenza, Italy Abstract Introduction and Aims: Peritonitis is an important cause of morbidity and mortality in PD patients. A long list of factors was evaluated to discover the possible risk factors of peritonitis, with some studies evaluating the influence of caregivers in peritonitis rate among these factors. Currently no study evaluated the influence of caregiver in the outcome of peritonitis episode. The purpose of the present study was to assess the difference in term of outcome of peritonitis episodes in the patients who need caregiver help in the management of peritoneal dialysis (caregiver group) and in those patients who provide by themselves (self-care group). Methods: We performed a retrospective, case-control study between caregiver group and self-care group. We analysed baseline patients conditions such as dialysis issue, comorbidity, residual renal function, BMI, albumin, haemoglobin, CRP. Furthermore, we evaluated the rate of healing and complications, including relapsing, catheter removal, and mortality. To reduce the interference of age on the outcomes, statistical analysis was performed in two classes of age: below and over 75 years old. All continuous parametric variables were presented as mean and standard deviation, while continuous nonparametric variable were reported as the median values and interquartile range (IQR). Normality of variable distribution was tested by Shapiro-Wilk W test. All categorical variables were reported as percentage. T Student test, Kruskal Wallis test, and Pearson's chi-square test were used to compare continuous and categorical variables, as appropriate. Results: We had 217 episodes of peritonitis in 42 months of observation, 87 (40.1%) occurred in the caregiver group. In <75-yr patients, we found a significant difference between caregiver and self-care patients in term of diabetes (p<0.001), prevalence of Gram positive bacteria (p=0.028), haemoglobin (p=0.042) and dialysis adequacy (p=0.021), while we found significant difference in type of dialysis (p=0.001) in >75-yr patients. We did not appreciate any significant outcome difference in <75-yr patients, regardless of basal conditions. Conversely, we observed a lower rate of peritoneal catheter removal (p=0.017) in caregiver group for patients older than 75 yrs. Out-come  Caregiver group  Self-care group  p  < 75-yr patients        rate of healing  68  70.4  0.97  rate of relapsing peritonitis  6.6  16.1  0.11  rate of catheter removal  16.1  20  0.55  rate of death  8  2  0.074  > 75-yr patients        rate of healing  71.4  58.3  0.39  rate of relapsing peritonitis  16.6  25  0.67  rate of catheter removal  6  33.3  0.017  rate of death  11.9  0  0.21  Out-come  Caregiver group  Self-care group  p  < 75-yr patients        rate of healing  68  70.4  0.97  rate of relapsing peritonitis  6.6  16.1  0.11  rate of catheter removal  16.1  20  0.55  rate of death  8  2  0.074  > 75-yr patients        rate of healing  71.4  58.3  0.39  rate of relapsing peritonitis  16.6  25  0.67  rate of catheter removal  6  33.3  0.017  rate of death  11.9  0  0.21  Conclusions: The presence of caregiver to manage peritoneal dialysis does not seem to affect negatively the outcome of peritonitis episode. MP432 LATE REFERRAL TO NEPHROLOGISTS IS ASSOCIATED WITH ELEVATED BLOOD PRESSURE IN PERITONEAL DIALYSIS PATIENTS Hiroshi Tanaka Hiroshi Tanaka 1Division of Nephrology, Department of Internal Medicine, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan Shoji Tsuneyoshi Shoji Tsuneyoshi 1Division of Nephrology, Department of Internal Medicine, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan Keisuke Yamasaki Keisuke Yamasaki 1Division of Nephrology, Department of Internal Medicine, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan Yasunori Daijo Yasunori Daijo 1Division of Nephrology, Department of Internal Medicine, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan Narihito Tatsumoto Narihito Tatsumoto 1Division of Nephrology, Department of Internal Medicine, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan Abstract Introduction and Aims: Hypertension is known to be highly prevalent in peritoneal dialysis (PD) patients. Not only fluid overload but several predialysis factors may possibly predispose to elevation in blood pressure. This study was performed to elucidate pathogenesis of and a better approach to the hypertension in PD patients. Methods: A retrospective cohort study was done including patients that had been followed for 2 years or more after initiation of PD in our Department. Blood pressure (AvMBP) was calculated as an average of mean blood pressure collected at the monthly clinic visit during the whole PD period. Independent variables include baseline laboratory data at the initial nephrology clinic visit, antihypertensive medications, fluid status assessed by echocardiogram and chest Xray film, and body weight and urinary volume which were averaged during the whole PD period. Results: Univariate analysis showed significant correlations between AvMBP and the following factors: predialysis followup period by nephrologists (R^2=0.27, P=0.027), baseline eGFR (R^2=0.45, P=0.0024), predialysis eGFR slope (R^2=0.43, P=0.0028) and patients' age at initiation of PD (R^2=0.51, P<0.001). Fluid status, body weight, urinary volume or a number of anti-hypertensive medications were not found to be significantly correlated with AvMBP. Multivariate analysis showed significant correlation (P=0.003) between AvMBP and the baseline eGFR at the initial visit to nephrologists, where lower initial eGFR was associated with higher AvMBP. Using an ROC curve, a cutoff eGFR of 9.0mL/min/1.73m2 had 94% specificity and 100% sensitivity against AvMBP 100mmHg or more. Conclusions: Patients of late referral to nephrologists, i.e. at the eGFR of 9 mL/min/1.73m2 or less, should be considered to carry a high risk for hypertension after PD and need to be aggressively treated to avoid hypertension. MP433 ADDED LOW DOSE OF SPIRONOLACTONE IN MANAGING HIGH BLOOD PRESSURE IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS Nabieh Al-Hilali Nabieh Al-Hilali 1Medicine, Nile Badrawi Hospital Medicare Middle East, Cairo, Egypt Naser Hussain Naser Hussain 2Medicine, Mubarak Al Kabeer Hospital, Kuwait City, Kuwait Vivian Fathy Vivian Fathy 2Medicine, Mubarak Al Kabeer Hospital, Kuwait City, Kuwait Hany Negm Hany Negm 1Medicine, Nile Badrawi Hospital Medicare Middle East, Cairo, Egypt Mohammed Alhilali Mohammed Alhilali 3General Medicine, The Queen Elizabeth the Queen Mother Hospital, Margate, United Kingdom Abstract Introduction and Aims: Hypertension and left ventricular hypertrophy contribute significantly to mortality and morbidity in dialysis patients. Blockade of the aldosterone effect with spironolactone is being used more frequently in the treatment of hypertension. We performed this study to assess the effect of spironolactone on blood pressure and its safety in continuous ambulatory peritoneal dialysis. Methods: Thirty eight patients on continuous ambulatory peritoneal dialysis were selected for the study. Eligible patients received 25 mg spironolactone tablets daily. Tablets were decreased to 25 mg, three times weekly, according to serum potassium and were discontinued in severe hyperkalemia (>6 mmol/l). No changes were made to regular medications. Biochemical, blood pressure and medication data were collected. Results: Table 1 below shows controlled blood pressure was achieved after 6 months (p<0.001) and 12 months (p<0.001) compared with the baseline. Blood Pressure (BP)  Baseline  After 6 Months  After 12 Months  Systolic BP Median (Percentiles 25,75)  151.5 (140,156.2)  140 (138,143.5)*  139.5 (136.7,140)*  Diastolic BP Median(Percentiles 25,75)  79 (75,83)  75 (70,80)*  74.5 (70,76)*  Blood Pressure (BP)  Baseline  After 6 Months  After 12 Months  Systolic BP Median (Percentiles 25,75)  151.5 (140,156.2)  140 (138,143.5)*  139.5 (136.7,140)*  Diastolic BP Median(Percentiles 25,75)  79 (75,83)  75 (70,80)*  74.5 (70,76)*  The mean potassium level was 4.34±0.63mmol/l at baseline and 4.45±0.24 mmol/l at study completion (=0.24). There was no effect by spronolactone on aldosterone concentration. Gynecomastia was noted in one patient. Conclusions: This study demonstrates that spironolactone therapy is effective in reducing blood pressure without producing hyperkalemia in continuous ambulatory peritoneal dialysis. MP434 PREDICTORS OF CARDIAC TROPONIN T (cTnT) IN CAPD PATIENTS Alicja Grzegorzewska Alicja Grzegorzewska 1Department of Nephrology, University of Medical Sciences, Poznan, Poland Krzysztof Cieszyński Krzysztof Cieszyński 2Eurodial Dialysis Center, Ostrow Wlkp., Poland Andrzej Kaczmarek Andrzej Kaczmarek 3Fresenius Dialysis Center, Pleszew Poland Anna Sowińska Anna Sowińska 4Department of Statistics, University of Medical Sciences, Poznan, Poland Abstract Introduction and Aims: Dialysis patients show elevated high-sensitivity (hs) cTnT. Peritoneal membrane is more permeable than artificial membranes used for regular extracorporeal dialysis treatment. Therefore, loss of cTnT with dialysate could have an impact on serum cTnT and contribute to lower cTnT in CAPD patients than that shown in extracorporeal dialysis patients. Our aim was to establish predictors of serum hs-cTnT in CAPD patients and to compare hs-cTnT between CAPD, on-line hemodiafiltration (HDF), high-flux hemodialysis (HF-HD) and low flux hemodialysis (LF-HD) patients. Methods: In multiple regression analyses, demographic, clinical, and laboratory data in various combinations were chosen as possible predictors of hs-cTnT in CAPD patients (n=27), including D/P, peritoneal loss and clearance of hs-cTnT. Serum hs-cTnT of CAPD group was compared with hs-cTnT determined in 54 HDF, 35 HF-HD and 158 LF-HD patients. Results: Peritoneal loss of cTnT was 91.7 (37.4 - 819) ng/day and correlated with serum cTnT (r=0.823, p<0.001), clearance was 1.96 (0.64 – 5.0) mL/min. In the best model for the logistic regression analysis (corrected R2 0.914, p<0.013), predictors of serum hs-cTnT in CAPD patients were age (β 0.421, p=0.032), arterial hypertension (β 0.513, p=0.023), diabetic nephropathy (β 0.506, p=0.021), total cholesterol (β 0.554, p=0.013), triacylglycerols (β -0.527, p=0.033), and bicarbonate concentration (β -0.740, p=0.024), whereas history of myocardial infarction, CAPD duration, serum albumin, P, PTH, and daily peritoneal cTnT loss were insignificant in this model. In the other model (corrected R2 0.559, p<0.004), significant predictors of cTnT were serum albumin (β -0.372, p=0.040) together with age, hypertension, diabetic nephropathy, and bicarbonate concentration, but not total cholesterol and triacylglycerols. Serum hs-cTnT (ng/mL, median and range) in CAPD, HDF, HF-HD and LF-HD patients were respectively 0.045 (0.003 - 0.380), 0.050 (0.003 - 0.315), 0.032 (0.008 - 0.595), and 0.047 (0.004 - 0.410). These hs-cTnT were similar in CAPD and extracorporeal dialysis patients (non-adjusted p = 0.199, Kruskal-Wallis test; p=0.060 with adjustment for parameters which significantly differed groups: prevalence of coronary artery disease and cardiomyopathies, RRT vintage, serum albumin, hs-CRP, AST, Ca, P, ALP, bicarbonate, total cholesterol, HDL-Ch, triacylglycerols, and ALT). Logistic analysis also did not show significant differences in prevalence of increased hs-cTnT (>0.014 ng/mL) in relation to dialysis modality. Conclusions: Peritoneal loss of cTnT, although varies in wide range in correlation to serum cTnT, is not a predictor of serum cTnT, and CAPD patients have similar cTnT levels like extracorporeal dialysis patients. Serum hs-cTnT is dependent on clinical parameters and related laboratory indices, but is not associated with dialysis modality. MP435 THE RATE OF CENTER'S RESPONSE TO REGISTRY AND ITS RELATION TO PATIENT AND TECHNIQUE SURVIVAL IN IRANIAN CAPD PATIENTS Tayebeh Soleymanian Tayebeh Soleymanian 1Nephrology, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of) Iraj Najafi Iraj Najafi 1Nephrology, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of) Mohammad Reza Ganji Mohammad Reza Ganji 1Nephrology, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of) Farrokhlegha Ahmadi Farrokhlegha Ahmadi 1Nephrology, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of) Fereshteh Saddadi Fereshteh Saddadi 1Nephrology, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of) Monirsadat Hakemi Monirsadat Hakemi 1Nephrology, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of) Manouchehr Amini Manouchehr Amini 1Nephrology, Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of) Abstract Introduction and Aims: The essential objective of the registry system is not only establishment of a comprehensive database but also facilitation and improvement the quality of patient management. Methods: Data on 1472 patients CAPD patients which were monthly collected through questionnaires were analyzed. In 14 eligible center response rate to108 defined questions was considered. Mean response rate denotes the average of responses to all questions in all patients of a particular center. Cox regression analysis was used to compare patient and technique survival in groups with different percentage of response rate. Results: The highest mean response rate for the 14 centers was 70%, the lowest was 19%, and the average for all centers was 47%. Cox regression analysis showed that patient survival was significantly higher in the center with the highest response rate in comparison with the lowest one (HR: 2.65; P=0.007), similar result was found for technique survival (HR=3.09; P=0.004). Likewise, patient and technique survival for the centers with average response rate of less than 60% was significantly lower compared to centers with more than 60% response rate (HR=1.48, P=0.022 and HR=1.98, P=0.001, respectively). The analyses also disclosed that the better patient and technique survival in the center with highest response rate (the best center) is not due to its' better patient characteristics in comparison with our overall CAPD patients (P> 0.05). Conclusions: The quality of patient care and survival in a PD center 'may be accessed through the level of response rate to questionnaires. Improvement in patient and technique survival then possibly could be achieved through medical team education and center instructive programs. MP436 CHARACTERISTICS OF INFECTING PATHOGENS AND THEIR ANTIMICROBIAL SUSCEPTIBILITIES IN PERITONEAL DIALYSIS RELATED PERITONITIS: REPORT OF RELATED EPISODES IN A MEDICAL CENTER OVER TEN YEARS Li N.M.N. Tong Li N.M.N. Tong 1Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China He N.M.N. Yongcheng He N.M.N. Yongcheng 1Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China Wan N.M.N. Qijun Wan N.M.N. Qijun 1Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China Luan N.M.N. Shaodong Luan N.M.N. Shaodong 1Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China Abstract Introduction and Aims: To investigate the characteristics of infecting pathogens,their changes and antimicrobial susceptibilities on CAPD related peritonitis in our peritoneal dialysis center in the past 10 years. Methods: 103 CAPD related peritonitis episodes in 87 patients from 2008 to 2012 were analyzed and compared with 82 episodes from 2003 to 2007. The causative pathogens, their antimicrobial susceptibilities and outcomes on CAPD related peritonitis from the two periods were retrospectively reviewed and compared. Results: Culture negative rate decreased from 68.2% in 2003s to 41.5% in the last five years(P=0.021). Among culture positive peritonitis episodes, the incidence of gram positive bacteria peritonitis increased from 24.5% to 39.3%(P=0.052). This was mainly due to a significant increase in coagulase-negative staphylococcus peritonitis, which significantly increased from 5.2% to 34.5%(P=0.009). Gram negative bacteria peritonitis decreased slightly(46.3% vs 35.1%,P=0.295). The incidence of Klebsiella pneumoniae peritonitis significantly decreased(12.8% vs 3.5%,P=0.033), while Pseudomonas aeruginosa and Escherichis coli peritonitis rates slightly increased(4.7% vs 9.3%,P=0.338;7% vs 18.7%,P=0.072). The decrease of fungal peritonitis rate was not significant (30.2% vs 17.6%,P=0.123). The comparison of clinical outcomes showed an improvement of total recovery rate from 68.8% in 2003s to 73.9% for 2008-2012(P=0.09). The catheter removal rate decreased from 19.2% to 14.3%(P=0.238), and the mortality from 10.1% to 5.4%(P=0.118). In both periods, fungal peritonitis had the poorest results, which all the patients either withdrew from peritoneal dialysis or died. Conclusions: Compared with that in 2003s, the culture positive rate for CAPD related peritonitis in 2008-2012 has been greatly improved. Coagulase-negative staphylococcus is the most common causative pathogen. The mortality and catheter removal rate have been markedly reduced in the last five years. Fungal peritonitis is the most important reason for patients'dropout. MP437 TECHNICAL SURVIVAL OF PERITONEAL DIALYSIS CATHETERS: 16-YEARS EXPERIENCE OF A SINGLE CENTER Arzu Velioglu Arzu Velioglu 1Nephrology, Marmara University, School of Medicine, Istanbul, Turkey Muserref Albaz Muserref Albaz 1Nephrology, Marmara University, School of Medicine, Istanbul, Turkey Hakki Arikan Hakki Arikan 1Nephrology, Marmara University, School of Medicine, Istanbul, Turkey Serhan Tuglular Serhan Tuglular 1Nephrology, Marmara University, School of Medicine, Istanbul, Turkey Cetin Ozener Cetin Ozener 1Nephrology, Marmara University, School of Medicine, Istanbul, Turkey Abstract Introduction and Aims: Bedside percutaneous peritoneal dialysis catheter placement performed by the nephrologists is a well-tolerated procedure in the clinical practice. However, in some patients, surgical technique is preferred. In this study, technical survival of peritoneal dialysis catheters was evaluated regarding the mode of insertion. Methods: Between May 1996 and May 2012, a total of 178 permanent peritoneal dialysis catheters were placed into 170 patients with end stage renal disease. Of these, 130 were placed with percutaneous technique by nephrology staff (Group P) and 48 were placed with surgical technique by surgical staff (group S). Mechanical and infectious complications and technical survivals for the two groups were compared. Results: The total accumulated experience was 8494 patient-months: 6147 patient-months in group-P and 2347 patient-months in group-S. The mean age of patients in group-P was 55.7±17 years and in group-S was 51.6±13.1 years (p=0.025). There was no differences between groups regarding sex (F/M, group-P: 74/56; group-S: 27/21, p=0.534). The mechanical complication rate was higher in group-S (p = 0.020). The most common mechanical complications were malposition and leakage. There was no difference between the two groups in terms of infectious complications. Follow-up time was 175 month in group-P and 182 month in group S. The catheter survival rate was 24% in group-P and 19% in Group-C but, there was no significant difference in Kaplan-Meier analysis (long-rank = 0.366, p = 0.545) (Figure 1).3 View largeDownload slide View largeDownload slide Conclusions: Percutaneous peritoneal dialysis insertion technique is favorable than surgical technique. We thought that filling the abdominal cavity with dialysis fluid before catheter insertion and fixing inner cuff to anterior rectus sheath with suture may explain the lower incidence of malposition and leakage, respectively. MP438 THE EFFECTS OF SERUM LEPTIN LEVELS ON THROMBOCYTE AGGREGATIONS IN PERITONEAL DIALYSIS PATIENTS Serkan Bakirdogen Serkan Bakirdogen 1Nephrology, Kocaeli University, Kocaeli, Turkey Necmi Eren Necmi Eren 2Nephrology, Kocaeli University, Kocaeli, Turkey Ozgur Mehtap Ozgur Mehtap 3Hematology, Kocaeli University, Kocaeli, Turkey Sibel Gokcay Bek Sibel Gokcay Bek 4Nephrology, Kocaeli University, Kocaeli, Turkey Mustafa Baki Cekmen Mustafa Baki Cekmen 5Biochemistry, Kocaeli University, Kocaeli, Turkey Ahmet Yilmaz Ahmet Yilmaz 6Nephrology, Kocaeli University, Kocaeli, Turkey Abstract Introduction and Aims: The most important causes of mortality and morbidity in chronic kidney disease (CKD) are cardiovascular diseases. The invention of leptin hormone thrombocyte membrane receptor (Ob-Rb) on thrombocytes promoted new investigations about the effect of leptin on thrombocyte function. Serum leptin levels of patients with CKD have been detected higher than normal population. Patients recieving peritoneal dialysis (PD) appear to have the levels of serum leptin higher than CKD patients treated with hemodialysis and without dialysis. The aim of this study is to investigate the effects of serum leptin levels on thrombocyte aggregations in PD patients. Methods: Forty-three PD patients and 15 healthy controls were included into this study. Thrombocyte aggregation was calculated from the whole blood by using Multiplate analyzer, subsequently the effects of different concentrations of human recombinant leptin hormone (25, 50, 100 ng/ml) on thrombocyte aggregations were investigated. While leptin hormone was not added into the 1 st (C1) cell, concentration of 25, 50, 100 ng/ml leptin was added into the 2nd(C2), 3rd(C3), 4th(C4) test cells, respectively. Serum leptin levels were measured by ELISA. Results: It was determined that aggregation of the thrombocytes was inhibited by recombinant leptin hormone in both PD patients and control group. Area under the curve, velocity and aggregation values were found statistically significant in 1st test cell when compared to 2nd, 3rd, 4th test cells in PD patients (p=0,000). When compared 2ndtest cell to 3rd and 4th test cells, and 3rd test cell to 4th test cell we could not find any significant differences for area under the curve, velocity and aggregation mean values statistically in PD patients. Area under the curve, velocity and aggregation values were found statistically significant in 1st test cell when compared to 2nd, 3rd, 4th test cells in control group. P values of C1vsC2, C1vsC3 and C1vsC4 for area under the curve and aggregation values were found 0.001, and p values of velocity value were found 0.016, 0.004 and 0.000 for the same compared test cells respectively. When compared 2ndtest cell to 3rd and 4th test cells, and 3rd test cell to 4th test cell we could not find any significant differences for area under the curve, velocity and aggregation mean values statistically in control group. Conclusions: The inhibitor effect of recombinant leptin hormone on thrombocyte aggregation were proceeding when leptin concentrations was more than 25 ng/ml however it was not significant statistically. More further researches including more PD patients are required to prove the action of leptin hormone on thrombocyte aggregation or its effects on bleeding tendency. MP439 RESISTANCE TO STIMULATING ERYTHROPOIESIS IN PATIENTS ON PERITONEAL DIALYSIS Mara Lisbet L. Cabana Carcasi Mara Lisbet L. Cabana Carcasi 1Nephrology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain Anxo Fernandez Ferreiro Anxo Fernandez Ferreiro 1Nephrology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain Manuel Fidalgo Diaz Manuel Fidalgo Diaz 1Nephrology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain Vanesa Becerra Mosquera Vanesa Becerra Mosquera 1Nephrology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain Rafael Alonso Valente Rafael Alonso Valente 1Nephrology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain Abstract Introduction and Aims: Several studies indicate a satisfactory response to treatment of anemia with erythropoiesis-stimulating agents (ESAs) in patients with chronic kidney disease. Resistance to these agents is associated with increased morbidity and mortality. The aim of this study is to identify possible factors involved in resistance to ESAs in patients on peritoneal dialysis. Methods: A retrospective observational study in one year. Included 53 patients on peritoneal dialysis with minimum of 10 months. Patients with active infection, cancer, surgery or transfusion in the last 3 months were excluded. The study divided the patients into two groups: untreated and treated with ESAs. Treated patients were subdivided, based on the resistance index (RI) in sensitive or resistant to ESAs, being resistant those with IR> 9. Results: The mean age of patients was 50.2 years, 57% were male. 49% were on automated peritoneal dialysis and 51% on manual therapy. Statistically significant differences were found in the group treated with ESAs versus non treated group.    NOT TREATED WITH  ESAs  TREATED WITH ESAs  P VALUE  Time on PD (months)  16,6 (11,7_21,6)  29,9 (22,9_37,0)  0,038  Kt/V  2,48 (2,1_2,8)  2,03 (1,9_2,1)  0,076  Weekly CCr  113,55 (85,7_141,3)  76,26 (64,1_88,3)  0,007  RRF  18,1 (-1,8 _38,1)  3,76 (2,4_5,0)  0,001  Not Fe  16,7% (n=2)  43,9% (n=18)  0,001  Oral Fe  41,7% (n=5)  2,4% (n=1)  0,001  IV Fe  41,7% (n=5)  53,7% (n=22)  0,001  Albumin  4,1 (3,8_4,4)  3,7 (3,63_3,92)  0,026  Prealbumin  46,7 (41,4_52,0)  39,5 (36,7_42,4)  0,019  β2 mcg  16,8 (13,9_19,7)  32,1 (26,3_38,0)  0,012  Creatinine  6,5 (5,3_7,7)  9,0 (8,0_10,0)  0,040  Tryglicérides  165,4 (122,5_208,3)  127,2 (109,18_145,2)  0,041    NOT TREATED WITH  ESAs  TREATED WITH ESAs  P VALUE  Time on PD (months)  16,6 (11,7_21,6)  29,9 (22,9_37,0)  0,038  Kt/V  2,48 (2,1_2,8)  2,03 (1,9_2,1)  0,076  Weekly CCr  113,55 (85,7_141,3)  76,26 (64,1_88,3)  0,007  RRF  18,1 (-1,8 _38,1)  3,76 (2,4_5,0)  0,001  Not Fe  16,7% (n=2)  43,9% (n=18)  0,001  Oral Fe  41,7% (n=5)  2,4% (n=1)  0,001  IV Fe  41,7% (n=5)  53,7% (n=22)  0,001  Albumin  4,1 (3,8_4,4)  3,7 (3,63_3,92)  0,026  Prealbumin  46,7 (41,4_52,0)  39,5 (36,7_42,4)  0,019  β2 mcg  16,8 (13,9_19,7)  32,1 (26,3_38,0)  0,012  Creatinine  6,5 (5,3_7,7)  9,0 (8,0_10,0)  0,040  Tryglicérides  165,4 (122,5_208,3)  127,2 (109,18_145,2)  0,041 17% of the patients treated showed resistance to ESAs compared to the sensitive patients.    ESAs RESISTANT  ESAs SENSITIVE  P VALUE  Resistance index to ESAs  14,2 (10,4_17,9)  3,2 (2,63_3,9)  0.001  Weekly dosing (UI/Kg)  254,5 (62,6_446,3)  63,4 (47,3_79,5)  0.001  Prealbumin  32,4 (22,9_41,9)  41,1 (38,3_44,0)  0.030  Tryglicérides  91,5 (56,4_126,7)  135,2 (114,9_155,5)  0.038  Bicarbonate  29,3 (28,14_30,5)  26,2 (25,1_27,3)  0.003  Hemoglobin  29,3 (28,14_30,5)  11,6 (11,24_12,1)  0,028    ESAs RESISTANT  ESAs SENSITIVE  P VALUE  Resistance index to ESAs  14,2 (10,4_17,9)  3,2 (2,63_3,9)  0.001  Weekly dosing (UI/Kg)  254,5 (62,6_446,3)  63,4 (47,3_79,5)  0.001  Prealbumin  32,4 (22,9_41,9)  41,1 (38,3_44,0)  0.030  Tryglicérides  91,5 (56,4_126,7)  135,2 (114,9_155,5)  0.038  Bicarbonate  29,3 (28,14_30,5)  26,2 (25,1_27,3)  0.003  Hemoglobin  29,3 (28,14_30,5)  11,6 (11,24_12,1)  0,028 Not appreciate, against that expected, notable differences between groups with respect to degree of hyperparathyroidism, or use of drugs that inhibit the renin angiotensin aldosterone or relating to hematological parameters. Conclusions: The need to administer ESAs depends on several factors. In our study the time on peritoneal dialysis, proved to be a determining factor in whether or not receiving ESAs, so that patients receiving ESAs remained almost twice as long on a dialysis program than those who are not treated with ESAs. Preserving residual renal function and adequate nutritional status are key factors about not treatement with ESAs and if is necessary, an optimal quality of dialysis as assessed by Kt/V and weekly CCr, will mean that exogenous erythropoietin requirements are lower with the cost savings that entails. MP440 THE EFFECT OF AMBIENT TEMPERATURE ON THE PERITONEAL DIALYSIS RELATED INFECTION RATES IN MALTA Jesmar Buttigieg Jesmar Buttigieg 11Nephrology Department Mater Dei Hospital, Msida, Malta Angela Borg Cauchi Angela Borg Cauchi 2Nephrology Department Mater Dei Hospital, Msida, Malta Marilyn Rogers Marilyn Rogers 3Medical Department Mater Dei Hospital, Msida, Malta Louis Buhagiar Louis Buhagiar 4Nephrology Department Mater Dei Hospital, Msida, Malta Joseph Farrugia Agius Joseph Farrugia Agius 5Nephrology Department Mater Dei Hospital, Msida, Malta Mario Pio Vella Mario Pio Vella 6Nephrology Department Mater Dei Hospital, Msida, Malta Emanuel Farrugia Emanuel Farrugia 7Nephrology Department Mater Dei Hospital, Msida, Malta Abstract Introduction and Aims: There are limited studies involving the effect of ambient temperature and seasons on the rate of Peritoneal Dialysis (PD) related infections especially in the Mediterranean basin. Malta; situated in the middle of the Mediterranean Sea has a typical Mediterranean Climate. To study for any variability in the rate of peritoneal dialysis (PD) related infections with different ambient temperatures and seasons in Malta. Methods: All PD related infections (both exit site and peritoneal) which occurred between Jan 2008 and Dec 2012 in Malta were retrospectively studied. Mean monthly temperatures were obtained from the Maltese Meteorological Office. The cumulative number of PD related infections were studied in both warm and cold months of the year. The total monthly infections were also correlated with the mean monthly temperatures. Results: The warmest months in Malta are May to October, the coldest being November to April with mean monthly temperatures ranging from 19.6°C-27.1°C and 12.3°C-17.5°C respectively. There were a total of 150 peritoneal infections (including culture negative peritonitis) and 158 exit site infection episodes. 45.6% and 52.0% of the exit site infections and peritoneal infections respectively occurred during the warm period of the year whilst 54.4% and 48.0% of the exit site infection and peritoneal infections respectively occurred during the cold period of the year (p=NS). The correlation coefficient of the cumulative monthly number of infections and the mean monthly temperatures of both the exit site infections and peritoneal infections was -0.36 and -0.03 (p=NS). 48.21% and 51.79% of the gram negative infections occurred in the warm and cold period respectively (p=NS) while 56.21% and 43.79% of gram positive infections occurred in the warm and cold period respectively (p=0.039). Conclusions: There was no overall significant difference in the number of exit site and peritoneal infections between the cold and warm months in Malta. Nevertheless a significant warm period peak was observed with Gram positive organisms, not so with gram negative organisms. This may be attributed to various factors such as: increased outdoor activities, increased perspiration with consequent transportation of skin commensals to the PD catheter site, and possibly increased virulence of these organisms in warm environments. MP441 THE INFLUENCE OF PERITONEAL DIALYSIS MODALITY ON THE 1-YEAR RATE OF DECLINE OF RESIDUAL RENAL FUNCTION Jae Hyun Han Jae Hyun Han 1Department of Internal Medicine, Division of Nephrology, Severance hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Hyeong Rae Kim Hyeong Rae Kim 1Department of Internal Medicine, Division of Nephrology, Severance hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Kwang Il Ko Kwang Il Ko 1Department of Internal Medicine, Division of Nephrology, Severance hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Chan Ho Kim Chan Ho Kim 1Department of Internal Medicine, Division of Nephrology, Severance hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Hyang Mo Koo Hyang Mo Koo 1Department of Internal Medicine, Division of Nephrology, Severance hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Fa Mee Doh Fa Mee Doh 1Department of Internal Medicine, Division of Nephrology, Severance hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Mi Jung Lee Mi Jung Lee 1Department of Internal Medicine, Division of Nephrology, Severance hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Hyung Jung Oh Hyung Jung Oh 1Department of Internal Medicine, Division of Nephrology, Severance hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Seung Hyeok Han Seung Hyeok Han 1Department of Internal Medicine, Division of Nephrology, Severance hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Tae-Hyun Yoo Tae-Hyun Yoo 1Department of Internal Medicine, Division of Nephrology, Severance hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Shin-Wook Kang Shin-Wook Kang 1Department of Internal Medicine, Division of Nephrology, Severance hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Kyu Hun Choi Kyu Hun Choi 1Department of Internal Medicine, Division of Nephrology, Severance hospital, Yonsei University College of Medicine, Seoul, Republic of Korea Abstract Introduction and Aims: The use of automated peritoneal dialysis (APD) has increased substantially over the last years. However, the influence of different PD modalities on the decline in residual renal function (RRF) is unclear due to inconsistencies among studies. In particular, the effect of APD modalities [continuous cyclic peritoneal dialysis (CCPD) and nightly intermittent peritoneal dialysis (NIPD)] on RRF has not been examined in a large cohort of patients. Methods: We conducted a single-center retrospective study to investigate the association between PD modalities and decline in RRF in 142 incident PD patients (34 on CCPD, 36 on NIPD, and 72 on CAPD). RRF was assessed as the average of the 24-hour urine urea and creatinine clearance measured within 2 months from PD start and at 1 year after PD initiation. We defined the 1-year decline rate of RRF as the change in RRF between baseline and the 1-year follow-up. Results: There were no statistically significant differences in baseline characteristics, including baseline RRF (CCPD vs. NIPD vs. CAPD: 3.53±2.83 vs. 5.31±3.09 vs. 4.61±2.54 ml/min/1.73m², P= 0.149). The RRF at 1 year after PD initiation was 1.98±2.20 ml/min/1.73m² in CCPD patients and 3.63±3.67 ml/min/1.73m² in NIPD patients, which were moderately lower than 4.23±3.51 ml/min/1.73m² in CAPD patients (P = 0.064). Moreover, there was no significant difference in the 1-year rate of decline of RRF between CCPD and NIPD patients, although APD patients had a faster 1-year RRF decline rate than CAPD patients (CCPD and NIPD vs. CAPD: -45.68 and -36.69 vs. 1.17 %/year, P = 0.045). APD was associated with a more rapid decline in RRF in patients with ESRD undergoing PD, although multivariate analysis attenuated the significance of this finding (β = - 40.50; 95% CI, -81.80 to 0.801; P = 0.054). Conclusions: Our results suggest that CAPD might be more helpful than APD for preserving RRF during the first year of dialysis therapy, although there was no significant difference in the 1-year rate of decline of RRF between the two APD modalities. MP442 AGE AS A RISK FACTOR OF OVERHYDRATION IN PATIENTS ON PERITONEAL DIALYSIS Dorota Sikorska Dorota Sikorska 1Department of Nephrology, Transplantology and Internal Diseases, Poznan, University of Medical Sciences, Poznan, Poland Dorota Frankiewicz Dorota Frankiewicz 1Department of Nephrology, Transplantology and Internal Diseases, Poznan, University of Medical Sciences, Poznan, Poland Patrycja Kłysz Patrycja Kłysz 1Department of Nephrology, Transplantology and Internal Diseases, Poznan, University of Medical Sciences, Poznan, Poland Krzysztof Schwermer Krzysztof Schwermer 1Department of Nephrology, Transplantology and Internal Diseases, Poznan, University of Medical Sciences, Poznan, Poland Krzysztof Hoppe Krzysztof Hoppe 1Department of Nephrology, Transplantology and Internal Diseases, Poznan, University of Medical Sciences, Poznan, Poland Justin Nealis Justin Nealis 1Department of Nephrology, Transplantology and Internal Diseases, Poznan, University of Medical Sciences, Poznan, Poland Jolanta Kaczmarek Jolanta Kaczmarek 1Department of Nephrology, Transplantology and Internal Diseases, Poznan, University of Medical Sciences, Poznan, Poland Ewa Baum Ewa Baum 1Department of Nephrology, Transplantology and Internal Diseases, Poznan, University of Medical Sciences, Poznan, Poland Maria Wanic-Kossowska Maria Wanic-Kossowska 1Department of Nephrology, Transplantology and Internal Diseases, Poznan, University of Medical Sciences, Poznan, Poland Krzysztof Pawlaczyk Krzysztof Pawlaczyk 1Department of Nephrology, Transplantology and Internal Diseases, Poznan, University of Medical Sciences, Poznan, Poland Andrzej Oko Andrzej Oko 1Department of Nephrology, Transplantology and Internal Diseases, Poznan, University of Medical Sciences, Poznan, Poland Abstract Introduction and Aims: Chronic overhydration is a prevalent problem in patients with end stage renal disease and is associated with numerous complications. The main aim of this study was to assess the impact of age on overhydration, and its' relationship with markers of cardiovascular risk in peritoneal dialysis (PD) patients. Methods: The study was performed on 59 PD patients. The patients were divided into two groups depending on their age (group A, 27 patients, <65 years old, mean age 49.41±11.63 years; group B, 22 patients, ≥65 years old, mean age 67.78±13.98). In both groups the degree of overhydration was assessed with the use of bioimpedance analysis and clinical criteria. NT-proBNP concentration in the serum and the nutritional status (SGA) were measured. Echocardiography and chest X-ray examination were performed to assess the presence of cardiovascular complications. Results: There was a clear correlation between age with clinical features of overhydration (r=0.26; p=0.04) and with the results of bioimpedance analysis (BIA) (r=0.25; p=0.05). The older group of patients had significantly higher BIA overhydration (1.52±2.59 vs. 1.86±2.12 kg; p<0.05), presented with more aortic atherosclerotic changes (6 vs. 18; p<0.01) and had a reduced ejection fraction (EF 58% vs. 49%; p=0.02). In both groups high comparable NT-proBNP concentration in the serum were observed (3368±8198 vs. 5333±5662 pg/ml; ns). A significant relationship between age and nutritional status was demonstrated (r= 0.39; p<0.01). Conclusions: Older age seems to be a potential predictor for higher fluid overload. Overhydration may be potential risk factor for the development of cardiovascular complications. In PD patients, bioimpedance analysis seems to be a better method for the assessment of overhydration, dry body weight and cardiovascular risk than with other methods. However, further research in this area is necessary. MP443 RANDOMISED PROSPECTIVE CLINICAL STUDY ON OUTCOME OF PERITONEAL DIALYSIS IN PATIENTS USING NORMAL VERSUS REDUCED GLUCOSE DIALYSIS SOLUTION Marcus Hiss Marcus Hiss 1Nephrology, Hannover Medical School, Hannover, Germany Franziska Gerstein Franziska Gerstein 1Nephrology, Hannover Medical School, Hannover, Germany Hermann Haller Hermann Haller 1Nephrology, Hannover Medical School, Hannover, Germany Faikah Gueler Faikah Gueler 1Nephrology, Hannover Medical School, Hannover, Germany Abstract Introduction and Aims: Patients on peritoneal dialysis have a better survival if residual renal function is preserverd. This study was a randomized prospective study to evaluate normal versus reduced glucose content in the dialysis solution. Patients were followed over 12 months. Methods: In this prospective randomized clinical study patients starting with peritoneal dialysis were assigned to a treatment regimen with normal or reduced glucose content in the dialysis solution. Each group contained 10 patients. Baseline characteristics, clinical chemistry, markers of endothelial function (Tie-2, Ang-2) as well as residual renal function were assessed after 3,6,9 and 12 months. Results: Patients assigend to lower glucose dialysis solution showed less gain of weight over time. Furthermore, this group also showed less decrease of residual renal function compared to the normal glucose group. No difference in blood glucose levels and HbA1c, serum lipids, red and white blood cell count and liver function parameters were observed. Tie-2, Ang-2 and ADMA levels did not show significant differences. Conclusions: Our study shoes that reduced glucose content in dialysis solutions preservers residual renal function in PD patients. Furthermore, less glucose dialysate contributes to more stable body weight. MP444 EDUCATIONAL SIMULATOR DESIGNED FOR PD ACCESS SURGICAL PROCEDURE EDUCATION - HYBRID PERITONEAL DIALYSIS ACCESS MODEL Mizuya Fukasawa Mizuya Fukasawa 1Blood Purification Unit, University of Yamanashi, Chuo, Yamanashi, Japan Tomoko Manabe Tomoko Manabe 2Medical Pranex, Terumo Co. Ltd, Kanagawa, Japan Abstract Introduction and Aims: Although many Japanese receive dialysis, those on PD account for only 3.2 percent, a percentage that has not increased the past few years. A variety of factors are involved in this leveling-off; however, two in particular can be attributed to the medical profession. One is the limited number of physicians who can perform catheter insertion surgery and the other is the absence of an effective training system for teaching. At Terumo Medical Pranex™, a Terumo medical training facility, we collaborated to create an improved training model for teaching PD access procedures. Methods: This PD access training model was developed as a hybrid model [Figure 1], with a mannequin remodeled in the following manner.4 View largeDownload slide View largeDownload slideThe lower abdominal section is replaced by a piece of porcine tissue, including the skin. The abdominal wall and pelvic cavity are reproduced by filling the cavity with artificial organs made of silicone. The peritoneum is attached to the abdominal wall “skin.” The organs are accurately arranged in the mannequin and Douglas' pouch also reproduced in the pelvic cavity. Using this model, trainees can learn a series of procedures as if they are practicing in a clinical setting. Results: We conducted a series of PD catheter placement procedures using this model. Because the anatomy of a pig's abdominal wall so closely resembles that of a human, a trainee can gain nearly the same clinical experience. Trainees can also use surgical tools such as an electrosurgical knife. Thus, this model enables the practical reproduction of performing a clinical procedure. A trainee can review his/her attempts, check the catheter placement site/angle, and determine whether the catheter was placed correctly or erroneously. These results suggest the model could be remarkably efficient in teaching PD catheter placement procedures. The difference between the volume and shape of the mannequin's pelvic cavity and a human pelvic cavity, however, made it difficult to confirm whether a catheter was inserted into the correct site. So, we then referred to computed tomography (CT) images of an adult male pelvis and attempted to reproduce the protrusion of the bladder and the narrowness of Douglas' pouch. In this manner, we jointly developed this model. Conclusions: Animal welfare can be sufficiently assured, as no living animals were used in the development of this training system. Its use enabled us to establish a training system for PD catheter insertion that fully simulates a clinical procedure. We could create an excellent training model. If this model could be used to teach physicians how to perform PD access procedures correctly, the number of PD access specialists could increase as a result, and further promote the widespread introduction of PD throughout the country as well. MP445 LONG-CHAIN FATTY ACIDS: A RARE CAUSE OF CHYLOUS ASCITES IN ADULT CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS? Qijun Wan Qijun Wan 1Nephrology, Shenzhen Second People's, Hospital Shenzhen, Guangdong, Province China Yongcheng He Yongcheng He 1Nephrology, Shenzhen Second People's, Hospital Shenzhen, Guangdong, Province China Dan Zhu Dan Zhu 1Nephrology, Shenzhen Second People's, Hospital Shenzhen, Guangdong, Province China Jing Li Jing Li 1Nephrology, Shenzhen Second People's, Hospital Shenzhen, Guangdong, Province China Huili Xu Huili Xu 1Nephrology, Shenzhen Second People's, Hospital Shenzhen, Guangdong, Province China Abstract Introduction and Aims: Continuous chyle leak can cause a decrease in immunity and loss of fat, resulting in recurrent infections, malnutrition and even obstruction of the peritoneal catheter among peritoneal dialysis patients. Chylous ascites typically occurs due to congenital anomalies of the lymphatic system or secondary to abdominal trauma or surgery in a child. However, is Long-Chain Fatty Acids a rare cause of chylous ascites in adult continuous ambulatory peritoneal dialysis (CAPD) patients? The literature has not been seen. Methods: A 63-year-old female was treated with CAPD for end-stage renal disease 4 weeks due to chronic glomerulonephritis. Four weeks after catheter insertion via an abdominal operation, she was initiated on an intravenous infusion of 10 % Medium and Long chain Fat Emulsion Injection (produced by Baxter, 250 ml containing long-chain fatty acids 12.5 g IV) and oral administration of Enteral Nutritional Emulsion (TP-HE, 500 ml containing long-chain fatty acids 8 g, orally) once daily. The indication for this was poor nutritional intake. Three days later, the peritoneal effluent became “milky”. The milky effluent was most apparent on the first drain of each day. She had not been prescribed calcium channel blockers and she had no history of liver disease, portal hypertension, nephrotic syndrome or pancreatitis. Results: Peritoneal effluent cell counts were normal and cultures were negative. Peritoneal effluent triglyceride levels were 220 mg/dl which was higher than the diagnosis criterion of chyloperitoneum (defined as triglyceride levels > 110 mg/dl). Investigations to detect a cause of chyloperitoneum were negative.The intravenous infusion of Long-chain fatty acids and the oral administration of Enteral Nutritional Emulsion were stopped and the chyloperitoneum rapidly resolved. It was decided to transfer the patient from peritoneal dialysis to hemodialysis for two weeks to allow her peritoneum to rest. She subsequently resumed peritoneal dialysis with no recurrence of her chylous ascites. Because of the poor nutritional status of the patient, the two fatty acid products were reused. Then the chyloperitoneum appeared again. From then on, the two fatty acid agents were not used any more for the patient. The patient did not suffer any side-effects from this and, in particular, did not develop peritonitis, lymphopenia or worsening malnutrition. Conclusions: We highlight a new cause of chyloperitoneum in adult CAPD patients. In this case, the etiology was high doses of Long-chain fatty acids. This is supported by the fact that the chyloperitoneum disappeared after these agents were stopped and recurred when they were reused because of the poor nutritional status of the patient. To our knowledge, this is the first report of such an occurrence. The conservative treatment is effective enough in chylous ascites in our patient. MP446 ELEVATED PLASMA S100A12 LEVELS IN PERITONEAL DIALYSIS PATIENTS WITH ATHEROSCLEROSIS Ozlem Yayar Ozlem Yayar 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Baris Eser Baris Eser 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Mehmet Buyukbakkal Mehmet Buyukbakkal 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Zafer Ercan Zafer Ercan 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Bulent Erdogan Bulent Erdogan 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Ozgur Merhametsiz Ozgur Merhametsiz 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Tolga Yildirim Tolga Yildirim 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Alaattin Kali Alaattin Kali 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Ayhan Haspulat Ayhan Haspulat 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Aysegul Oztemel Aysegul Oztemel 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Ibrahim Akdag Ibrahim Akdag 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Mehmet Deniz Ayli Mehmet Deniz Ayli 1Nephrology Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey Abstract Introduction and Aims: Atherosclerotic cardiovascular disease is one of the major causes of mortality and morbidity in peritoneal dialysis (PD) patients. S100A12 is an endogenous receptor ligand of advanced glycation end products. It has been shown that S100A12 induces expression of adhesion molecules and mediates activation and migration of monocyes/macrophages. It contributes to the development of atherosclerosis in animal models. The aim of this study was to evaluate the relation between S100A12 levels and carotid atherosclerosis in patients under peritoneal dialysis treatment. Methods: A cross-sectional study was performed in 56 PD patients and 20 control subjects with similar demographic characteristics. Plasma S100A12 levels were measured from all participants beside routine laboratory evaluation. All subjects underwent high-resolution B-mode ultrasonography to determine carotid intima media thickness (CIMT). S100A12 levels were compared between patient and control groups. Correlation analyses of S100A12 with other laboratory values and CIMT were also performed. Results: Plasma S100A12 were higher in PD patients compared to control subjects (129.5±167.2ng/ml vs. 48.5±30.3ng/ml respectively, P<0,001). S100A12 showed a strong positive correlation with serum C-reactive protein (CRP) (r=0,585, p<0.001), white blood count (WBC) (r=0,488, p<0.001) and CIMT (r=0,265, p=0.04). Multivariate logistic analysis confirmed the relation of CRP with S100A12. Conclusions: This study indicates that elevated plasma S100A12 level may be one of the factors that play in systemic inflammation and atherosclerosis in PD patients. MP447 MICROBIOLOGICAL PROFILE OF CAPD PERITONITIS IN OUR CENTRE - OUR WAY TO EMPIRICAL THERAPY Dejan Pilcevic Dejan Pilcevic 1Nephrology, Military Medical Academy, Belgrade, Serbia and Montenegro Zoran Kovacevic Zoran Kovacevic 1Nephrology, Military Medical Academy, Belgrade, Serbia and Montenegro Djoko Maksic Djoko Maksic 1Nephrology, Military Medical Academy, Belgrade, Serbia and Montenegro Zoran Paunic Zoran Paunic 1Nephrology, Military Medical Academy, Belgrade, Serbia and Montenegro Jelena Tadic-Pilcevic Jelena Tadic-Pilcevic 1Nephrology, Military Medical Academy, Belgrade, Serbia and Montenegro Mirjana Mijuskovic Mirjana Mijuskovic 1Nephrology, Military Medical Academy, Belgrade, Serbia and Montenegro Marijana Petrovic Marijana Petrovic 1Nephrology, Military Medical Academy, Belgrade, Serbia and Montenegro Katarina Obrencevic Katarina Obrencevic 1Nephrology, Military Medical Academy, Belgrade, Serbia and Montenegro Violeta Rabrenovic Violeta Rabrenovic 1Nephrology, Military Medical Academy, Belgrade, Serbia and Montenegro Ljiljana Ignjatovic Ljiljana Ignjatovic 1Nephrology, Military Medical Academy, Belgrade, Serbia and Montenegro Brankica Terzic Brankica Terzic 1Nephrology, Military Medical Academy, Belgrade, Serbia and Montenegro Dragan Jovanovic Dragan Jovanovic 1Nephrology, Military Medical Academy, Belgrade, Serbia and Montenegro Abstract Introduction and Aims: To identify the most common infecting organism in PD –associated peritonitis, their antibiotic susseptibility to empirical teratment, evaluates the clinical outcomes, the survival of the technique and of patients presenting peritonitis. Methods: Clinical records and reports reliable evaluated from the patients who attended the PD program in Military Medical Academy since 2001 to 2010. We analyzed 186 patients (98 male, 88 female); mean age were 58,4 +/- 12,4 years(range 18-85 years). A total of 147 peritonitis episodes were identified. Diagnosis of peritonitis was made based on clinical signs of inflamation, number of white blood cells and culture from the PD fluid. Dyalisate specimens were obtained from all cases and were examined for microbilogic culture and resistance. Results: The incidence of peritonitis in our centre was 1 episode / 29,86 patient months. Culture revealed: A possitive culture in the peritoneal fluid was found in 87,07 % of the peritonitis episodes. A single gram (+) organism was found in 71,88 % of the positive culture cases: Staphylococus coag. negative 55/92 (59,78%), Staphylococcus aureus 11/92 (11,96%), Streptococcus spp 10/92 (10,87%), Enterococcus 8/92(8,69%), Coryneform 8/92 (8,69%).There was 2 cases vankomycin resistence staphylococcus aureus and 2 cases vankomycin resistence enterococcus. A single gram (-) organism was found in 21,88 % of the positive culture cases:E.colli 10/28 (35,71%), Acinetobacter 6/28 (21,43%), Klebsiella 4/28 (14,28%), Proteus 4/28(14,28%), Pseudomonas aeruginosa 3/28 (10,71%), Stenotrophomonas 1/28(3,59%). Polymicrobial peritonitis occured in 6 cases (4,67%) and fungal peritonitis in 2 cases (1,57%) . The overall cure rate was 87.4 %, relapsing peritonitis occured in 8 patients, 10 patients required transfer to hemodialysis. There were 3 peritonitis –related deaths. Conclusions: Gram positive microorganisms are the most common finding in a CAPD peritonitis in our hospital. There was a significant rate of resistance to vancomycin. Based on the foregoing, we implemented our center specific protocol for the treatment of CAPD peritonitis- cephalosporins of the first and third generations in patients with RRF and aminoglycosides in combination with cephalosporins of the first generations in anuric patients. Vankomycin is part of the second line therapy because of the high rate resistance to this drug in our center. MP448 INCREASED CANCER RISK IN UREMIC PATIENTS INITIALLY RECEIVING MAINTENANCE PERITONEAL DIALYSIS IN TAIWAN Chung-Hsin Chang Chung-Hsin Chang 1Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan Republic of China Ya-Shen Chang Ya-Shen Chang 1Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan Republic of China Abstract Introduction and Aims: Previous studies have suggested that the incidence of cancer is increased in patients with end-stage renal disease (ESRD). The cancer risk in patients who received chronic hemodialysis or renal transplantation is well documented. However, such data in patients receiving maintenance peritoneal dialysis (PD) is undetermined. The aim of this study was to examine the risk of malignancy in PD patients of Taiwan. Methods: We retrospectively reviewed the clinical data and outcome of 445 uremic patients who initially received PD for more than 3 months from 1993 to 2006 in our hospital. The incidence of malignancies was computed. The standardized incidence ratio (SIR) was calculated by the ratio of observed to expected numbers of cancer cases (observed/expected). Results: After the cumulative observed periods of 1444 patient-years, 15 patients (3.4%) with 16 malignancies (one patient had double cancer) were diagnosed, including 6 cases (37.5%) of urinary tract transitional cell carcinoma (TCC), 3 cases (18.75%) of colon cancer, 2 cases of hepatoma (12.5%), 2 cases (12.5%) of breast cancer, 1 case (6.25%) of gastric cancer, and 2 cases of other malignancies ( 1 adenocarcinoma of unknown primary and 1 tongue base cancer). The SIR of all malignancies as compared with the general population was 4.18 (p < 0.01). High risks were observed for TCC (SIR 41.2, p < 0.01), cancers of digestive system (SIR 4.3, p < 0.01), colon cancer (SIR 11.7, p < 0.05), and hepatoma (SIR 3.8, p < 0.05) respectively. Conclusions: We conclude that PD patients are at higher risk of developing malignancy, especially urologic cancer and cancers of digestive system. MP449 REDUCTION IN THE INCIDENCE OF PERITONITIS - COMPARISON OF THE COLLECTED DATA Mihaela Busuioc Mihaela Busuioc 1CALYDIAL, Lyon, France Abdallah Guerraoui Abdallah Guerraoui 1CALYDIAL, Lyon, France Agnes Caillette-Beaudoin Agnes Caillette-Beaudoin 1CALYDIAL, Lyon, France Abstract Introduction and Aims: For 25 years, our association Lyonnais (Calydial) specializing in the treatment of all stages chronic renal failure patients, treats 25% of its patients by peritoneal dialysis (PD), this allowing us to achieve quantitative regional goals. Peritonitis is one of the most common complications of PD. To improve the quality and safety of PD home treatment, our institution has since 2006 initiated a mortality and morbidity review in PD (MMR PD). Calydial adhered to “Registre de Dyalise Peritoneale de Langue Francaise” (RDPLF) for a global surveillance. Methods: From January 2006 we analyzed the incidence of peritonitis in a cohort represented by the PD patients in our association. We calculated as rates (for all infections and each organism): months of peritoneal dialysis at risk, divided by number of episodes, and expressed as interval in months between episodes and the number of infections by organism for a time period, divided by dialysis-years' time at risk, and expressed as episodes per year. We also locked for the percentage of patients who are peritonitis free per period of time and the median peritonitis rate for the program (calculate peritonitis rate for each patient and then obtain the median of these rates). We reported our results to the RDPLF. Results: The peritonitis occurrence in our institution decreased from 1/ 26 months in 2007 and 1/39.75 months in 2009 to 1/45.75 months in 2011. Moreover, our results are well above the national average, in 2007 the peritonitis occurrence in France was of 1/33 months vs. 1/41 months in 2011 (source RDPLF). Conclusions: Considering those results some specific treatment recommendations can be made: 1) take energetic actions after each incidence; 2) careful analyzing the indicators; 3) education of patients and aids by a specialized team (doctor and nurse). The research of problems encountered during the treatment of patients on PD or the answer to the question 'how did this happen?' conducted to the following conclusion: lack of traceability and analysis of systematic treatment problems encountered. This conclusion has helped to re-write and validate by involved professionals the peritonitis management protocol. Therefore the necessary element collection for root cause analysis has been implemented. MP450 ACCUMULATION OF LEVETIRACEPAM IN PERITONEAL DIALYSIS LEADING TO LOSS OF CONSCIOUSNESS AND TRAUMA - A PHARMACOKINETIC ANALYSIS Svenja K. Bahte Svenja K. Bahte 1Nephrology and Hypertension, Medical School Hanover, Hanover, Germany Marcus Hiss Marcus Hiss 1Nephrology and Hypertension, Medical School Hanover, Hanover, Germany Jan T. Kielstein Jan T. Kielstein 1Nephrology and Hypertension, Medical School Hanover, Hanover, Germany Abstract Introduction and Aims: Levetiracetam is a frequently used drug in the therapy of partial onset, myoclonic and generalized tonic-clonic seizures. Levetiracetam (molecular weight (170.2 Da) is rapidly absorbed after oral ingestion with bioavailability af close to 100%. The elimination half-life in adults is 7 ± 1 hour. The cumulated renal excretion rate of levetiracetam is 66% in the first 48 hours (1). For on “dialysis” the package insert suggests a dose of 500-1000 mg once a day. As the small unbound molecule is easily removed by “dialysis” an supplemental dose of 250-500 mg after is suggested (1). Despite the fact that levetiracetam was approved 13 years ago, there are no data for dosing in peritoneal dialysis patients. We therefore analysed pharmacokinetical data of Levetiracetam in a patient on peritoneal dialysis for treatment of partial seizures. Methods: Samples were centrifuged at 2800xg for 5 min at 4°C and stored at -80°C until analysis. Levetiracetam levels were measured using an HPLC method. Results: A 73-y-old Caucasian male was admitted to our tertiary care hospital to undergo elective angioplasty due to peripheral artery disease Fontaine's stage IV. Due to diabetic and hypertensive nephropathy he suffered from chronic kidney disease stage 5 and had been undergoing peritoneal dialysis treatment for two years. On admission the patient complained about fatigue and stupor. A thorough history revealed that this coincided with the start of levetiracetam treatment. The patient received a dose of 500 mg bid due to suspected partial seizures with secondary generalization eight weeks to the recent admission. Due to the severe fatigue fractured his metatarsal bone of digitus V a week prior to admission. As fatigue and drowsiness did not improve over time, we assumed an overdosing of antiepileptic drug Levetiracetam. We found Levetiracetam-levels in serum increased at about 29.8 mg/l, though being in therapeutic range of 20 – 65 mg/l. After discontinuing Levetiracetam fatigue and stupor disappeared within 24 hours. In order to establish the assumed accumulation /overdose of levetiracetam we reexposed the patient to the drug.After discontinuing Levetiracetam for 7 days, a single dose of 500 mg Levetiracetam was administered after end of automated peritoneal dialysis (APD). This was the treatment of choice due to a high transporter status in peritoneal equilibration test according to the classification of Twardowski (3). Blood was taken before ingestion and 2.5 h, 5 h, 6 h, 8.5 h, 10.5 h, 20 h and 24 h after ingestion as well as peritoneal fluid before ingestion and 7.5 h and 20 h after ingestion in order to study pharmacokinetics in peritoneal dialysis. Levetiracetamserum levels were found to be considerably elevated in serum for more than 20 hours after ingestion. Serum levels and peritoneal fluid levels were nearly equivalent over the whole time period. Conclusions: This case suggests that treatment with levetiracepam in patients undergoing dialysis should be regularly monitored to avoid supratherapeutic levels that could lead to severe sequelae. MP450bis HIGH FALL INCIDENCE AND FRACTURE RATE IN ELDERLY HAEMODIALYSIS AND PERITONEAL DIALYSIS POPULATION. IS BLOOD PRESSURE THE KEY TO PREVENTION? Harmke Polinder-Bos Harmke Polinder-Bos 1Geriatrics, UMC Utrecht, Utrecht, The Netherlands 2Nephrology, Meander Medical Center, Amersfoort, The Netherlands Marielle Emmelot-Vonk Marielle Emmelot-Vonk 1Geriatrics, UMC Utrecht, Utrecht, The Netherlands Carlo Gaillard Carlo Gaillard 2Nephrology, Meander Medical Center, Amersfoort, The Netherlands Abstract Introduction and Aims: The dialysis population is aging and the percentage of patients > 75 year that started dialysis therapy doubled the last decade. Geriatric conditions are increasingly present in this population. Dialysis patients have many risk factors for falls like polyfarmacy, comorbidity and functional decline. However, few studies have been performed and in haemodialysis patients only. Aim of this study was to determine the incidence and complications of falls in an elderly haemodialysis (HD) and peritoneal dialysis (PD) population. Methods: In a prospective observational study Dutch chronic HD and PD patients of 70 years and older were included and followed for 1 year. Demografic, medical and functional characteristics were recorded at start of the study, vital parameters and laboratory values were recorded monthly during follow up. Weekly, and monthly in PD patients, patients were asked about falls, fall circumstances en consequences using a pre-specified form by trained dialysis nurses. Results: At two dialysis units, a total of 49 patients were included, median age 79.4 year (70.5 – 89.6 yr; 86% HD patients; 71% male). 40 fall accidents occurred in 28 (55%) patients. PD patients fell more frequent than HD patients (fall incidence 1.8 vs 1.4/ personyear). The falls resulted in small injuries in 53%, fractures in 15% and hospital admission in total in 15%. In multivariate regression analysis mean systolic blood pressure before and after dialysis in HD patients were the main independent determinants of falls. For every 1 mmHg rise in systolic blood pressure before or after dialysis, the risk of falling decreased by 6 or 7% respectively (p 0,009, OR 0.94, 95% CI 0.89-0.98). Conclusions: Elderly haemodialysis and peritoneal dialysis patients have an extreme high incidence of falls accompanied by a high fracture rate. A higher systolic blood pressure before and after dialysis decreased the risk of falling. In this vulnerable population, falls should be recognized as an important signal and prevention of falls needs more attention. Especially more study of the optimal blood pressure in relation to falls is needed. © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com
TI - Peritoneal dialysis II
JF - Nephrology Dialysis Transplantation
DO - 10.1093/ndt/gft145
DA - 2013-05-01
UR - https://www.deepdyve.com/lp/oxford-university-press/peritoneal-dialysis-ii-6QDnr5Li07
SP - i428
EP - i439
VL - 28
IS - suppl_1
DP - DeepDyve
ER -