Adipose expression of miR-130b and miR-17-5p with wasting, cardiovascular event and mortality in advanced chronic kidney disease patients

Background There were limited data on the association of adipose microRNA expression with body composition and adverse clinical outcomes in patients with advanced chronic kidney disease (CKD). We aimed to evaluate the association of adipose miR-130b and miR-17–5p expressions with body composition, functional state, cardiovascular outcome and mortality in incident dialysis patients. Methods We performed a single-centre prospective cohort study. Patients who were planned for peritoneal dialysis were recruited. MiR-130b and miR-17–5p expressions were measured from subcutaneous and pre-peritoneal fat tissue obtained during peritoneal dialysis catheter insertion. Body composition and physical function were assessed by bioimpedance spectroscopy and Clinical Frailty Scale. Primary outcome was 2-year survival. Secondary outcomes were 2-year technique survival and major adverse cardiovascular event (MACE) rate. Results Adipose expression of miR-130b and miR-17–5p correlated with parameters of muscle mass including intracellular water (miR-130b: r = 0.191, P = 0.02; miR-17–5p: r = 0.211, P = 0.013) and lean tissue mass (miR-130b: r = 0.180, P = 0.03; miR-17–5p: r = 0.176, P = 0.004). miR-130b expression predicted frailty significantly (P = 0.016). Adipose miR-17–5p expression predicted 2-year all-cause survival (P = 0.020) and technique survival (P = 0.036), while miR-130b expression predicted incidence of major adverse cardiovascular events (P = 0.015). Conclusions Adipose miR-130b and miR-17–5p expressions correlated with body composition parameters, frailty, and predicted cardiovascular events and mortality in advanced CKD patients.

P05.04 Reradiation by reccurent gliomas with VMAT (Volumetric Modulated Arc Therapy) technique- survival benefit

BACKGROUND Patients who have been treated with reirradiation for recurrent glioma reported survival benefits. Limited data are available for the outcomes after fractionated re-irradiation. This study aims to investigate whether re-irradiation of recurrent glioma with 45Gy dose can increase the overall survival of patients. MATERIAL AND METHODS A retrospective analysis of 35 patients re-irradiated for high-grade glioma recurrence between 2012 and 2020 was performed. All included patients met the following criteria: a) histopathological confirmation of primary brain cancer at initial diagnosis; b) a history of initial primary radiation; c) histological and/or imaging modality confirmation of recurrence. Outcome metrics included overall survival, prognostic factors for survival, and treatment-related toxicity. RESULTS After the end of re-irradiation the median overall survival was 11 months (95% confidence interval, 7–14 months). From the patients evaluated in the current study after the end of re-irradiation the progression free survival was 6 months (3.8 - 8 months) while after the end of first radiation was 13 months (8 - 17.9 months). Our findings suggest that re-irradiation might prolong survival rates. CONCLUSION Recurrent Glioblastoma WHO IV is associated with a median overall survival of less than a year and the majority of patients have profound tumor-related symptoms.The results of this study suggest that re-irradiation may prolong the overall survival.

Valvular Calcific Deposits and Mortality in Peritoneal Dialysis Patients: A Propensity Score-Matched Cohort Analysis

<b><i>Objective:</i></b> This study aimed to compare mortality between peritoneal dialysis (PD) patients with and without cardiac valve calcification (CVC). <b><i>Methods:</i></b> Patients undergoing PD at the dialysis center of the Second Affiliated Hospital of Soochow University from January 1, 2009, to June 31, 2016, were included and followed through December 31, 2018. The inclusion criteria were (1) age ≥18 years and (2) PD vintage ≥1 month. The exclusion criteria were (1) a history of hemodialysis or renal transplantation before PD; (2) diagnosed congenital heart disease, rheumatic heart disease, or hyperthyroid heart disease; and (3) loss to follow-up. Differences in mortality rates were compared using a Fine-Gray proportional hazards model. <b><i>Results:</i></b> A total of 310 patient cases were included in this study, including 237 cases without CVC (non-CVC group). The CVC group included 59 cases with aortic valve calcification (AVC), 6 cases with mitral valve calcification (MVC), and 8 cases of AVC associated with MVC. After propensity score matching, 68 pairs were selected. The multivariate competing risk regression analysis revealed that age (hazard ratio [HR]: 1.06, 95% confidence interval [95% CI]: 1.03–1.10, <i>p</i> &#x3c; 0.001) and CVC group (HR: 1.83, 95% CI: 1.04–3.20, <i>p</i> &#x3c; 0.05) were independent risk factors associated with mortality. No significant difference was observed in technique survival between the 2 groups. <b><i>Conclusion:</i></b> CVC is an independent risk factor for mortality in PD patients.

Eosinophilic Reaction at the Time of Catheter Insertion Predicts Survival in Patients Initiating Peritoneal Dialysis

<b><i>Introduction:</i></b> Despite excellent biocompatibility, insertion of silicone peritoneal dialysis (PD) catheters can induce minor foreign body reaction, affecting long-term patient outcomes. We evaluated the effect of eosinophilic reaction associated with PD catheter insertion on outcomes of patients initiating PD. <b><i>Methods:</i></b> Eosinophilic reaction to PD catheter insertion was defined as the ratio of peripheral blood eosinophil count at 1 week after insertion (E1W) to pre-insertion eosinophil count (E0), and the association of E1W/E0 with technique survival, peritonitis-free survival, and heart failure (HF)-related hospitalization-free survival was analyzed. <b><i>Results:</i></b> This retrospective cohort study included 116 patients (89 male patients) who underwent PD catheter insertion between January 2008 and June 2018 (61.3 ± 12.9 years). The follow-up duration was 46.2 (23.8–75.3) months. E1W was significantly higher than E0 (median, 333 vs. 234/μL, <i>p</i> &#x3c; 0.001), with a median E1W/E0 of 1.54. The log-rank test showed that technique survival, peritonitis-free survival, and HF-related hospitalization-free survival were significantly better in patients with E1W/E0 &#x3c; 1.54 than in those with E1W/E0 ≥ 1.54 (<i>p</i> = 0.002, &#x3c;0.001, and &#x3c;0.001, respectively). By the Cox regression analysis adjusted for age, sex, the Charlson comorbidity index, the estimated glomerular filtration rate, and the geriatric nutritional risk index, E1W/E0 remained a significant risk factor for technique failure, peritonitis, and hospitalization for HF (hazard ratio (HR) 1.68, <i>p</i> = 0.01; HR 2.19, <i>p</i> &#x3c; 0.001; HR 2.15, <i>p</i> &#x3c; 0.001, respectively). <b><i>Conclusion:</i></b> Eosinophilic reaction at the time of PD catheter insertion is a novel marker that may predict outcomes in patients initiating PD.

Home-to-home dialysis transition: A 24-year single-centre experience

Home dialysis (peritoneal dialysis (PD) and home haemodialysis (HHD)) are ideal options for kidney replacement therapy (KRT). Occasionally, because of technique failure, patients are required to transition out of home dialysis, and the most common option tends to be to in-centre HD. There are few published studies on home-to-home transition (PD to HHD or HHD to PD) and dynamics during the transition period. We present a retrospective review of 28 patients who transitioned from a home-to-home dialysis modality at our centre over a 24-year period. We observed a total of 911 home dialysis patients with technique failure (826 PD patients and 85 HHD patients) with only 28 patients (3% of the total with technique failure) having successful home-to-home transition. During the transition period, 11 patients (39%) were hospitalized and 13 patients (46%) required variable periods of in-centre HD. After a median follow-up of 48 months following dialysis modality transition, four patients switched to in-centre HD permanently (home dialysis technique survival of 86% censored for death and kidney transplantation) and four patients died resulting in a patient survival of 86% (censored for switch to in-centre HD and transplantation). In our centre, home-to-home transition is a feasible strategy with comparable patient and technique survival. A significant proportion of patients switching from a home-to-home dialysis modality required variable intervals of hospitalization and in-centre HD during transitions. Future efforts should be directed towards assessment and home dialysis education during the entire process of dialysis transition.

Risk Factors and Clinical Outcomes of Cognitive Impairment in Diabetic Patients Undergoing Peritoneal Dialysis

<b><i>Introduction:</i></b> Cognitive impairment (CI) is common in patients with CKD or diabetes mellitus (DM). However, the relevance between DM and CI in diabetic patients undergoing peritoneal dialysis (PD) has not been clearly established. This study aimed to explore the role of DM in CI, the association of glycemic control with CI, and clinical outcomes of CI in diabetic PD patients. <b><i>Methods:</i></b> Continuous ambulatory PD (CAPD) patients followed up in our PD center between 2014 and 2016 were enrolled. The participants were followed until an endpoint was reached or December 2017. Demographic data and clinical characteristics were collected, and laboratory parameters were measured. The Montreal Cognitive Assessment (MoCA) was used to evaluate global cognitive function, and a score of &#x3c;26 was considered to indicate CI. A propensity score matching according to age, gender, and mean arterial pressure was conducted between the DM and non-DM groups. <b><i>Results:</i></b> A total of 913 CAPD patients were enrolled, of whom 186 (20.4%) had diabetes. After appropriate matching, 175 patients in the DM group and 270 patients in the non-DM group were included. Patients with diabetes had a higher prevalence of CI and lower scores for visuospatial/executive function, naming, language, delayed recall, and orientation. Higher HbA1c (odds ratio [OR], 1.547; 95% confidence interval [95% CI], 1.013–2.362) and cardiovascular disease (CVD; OR, 2.926; 95% CI, 1.139–7.516) significantly correlated with a risk of CI in diabetic patients. During a median of 26.0 (interquartile range 13.5–35.6) months of follow-up, diabetic patients with CI demonstrated a significantly lower survival rate than those without CI, and CI was an independent risk factor for mortality after adjustment (hazard ratio, 7.224; 95% CI, 1.694–30.806). However, they did not show worse technique survival or higher peritonitis rate than patients without CI. <b><i>Conclusions:</i></b> HbA1c and CVD are independent risk factors for CI in diabetic patients undergoing CAPD, and CI is independently associated with a higher risk of mortality.

MO704THE PROGNOSTIC IMPACT OF WEIGHT GAIN AFTER PERITONEAL DIALYSIS

Background and Aims The prevalence of obesity has increased over the past decade in patients with End Stage Kidney Disease (ESKD). Obesity at the initiation of peritoneal dialysis (PD) was reported to adversely affect clinical outcomes. However, there are few studies on the prognostic relevance of weight gain after PD. Method We reviewed the change in body weight of 954 consecutive PD patients from the initiation of dialysis to 2 years after they remained on PD. Clinical outcomes including patient survival, technique survival, and peritonitis rate in the subsequent two years were reviewed. Results The mean age was 60.3 ± 12.2 years; 535 patients (56.1%) were men and 504 (52.8%) had diabetes. After the first 2 years on PD, the average change in body weight was 1.2± 5.1 kg; their body weight was 63.0 ± 13.3 kg; body mass index (BMI) 24.4 ± 4.4 kg/m2. The patient survival rates in the subsequent two years were 64.9%, 75.0%, and 78.9% (log rank test, p = 0.008) for patients with weight loss ≥3 kg during the first 2 years of PD weight change between -3 and +3 kg, and weight gain ≥3 kg, respectively. The corresponding technique survival rates in the subsequent two years were 93.1%, 90.1%, 91.3%, respectively (p = 0.110), and the peritonitis rates were 0.7±1.5, 0.6±1.7, and 0.6±1.1 episodes per patient-year, respectively (p = 0.3). When the actual BMI after the first 2 years of PD was categorized into underweight, normal weight, marginal overweight, overweight, and obesity groups, the patient survival rates in the subsequent two years were 77.3%, 75.2%, 73.3%, 74.3%, and 75.9%, respectively (p= 0.005), and technique survival 98.0%, 91.9%, 88.0%, 92.8%, and 81.0%, respectively (p= 0.001). After adjusting for confounding clinical factors by multivariate Cox regression models, weight gain ≥ 3kg during the first 2 years of PD was an independent protective factor for technique failure (adjusted hazard ratio [AHR] 0.049; 95% confidence interval [CI] 0.004-0.554, p = 0.015), but was an adverse predictor of patient survival (AHR 2.338, 95%CI 1.149-4.757, p = 0.019). In contrast, weight loss ≥ 3kg during the first 2 years of PD did not predict subsequent patient or technique survival. Conclusion Weight gain during the first 2 years of PD confers a significant risk of subsequent mortality but appears to be associated with a lower risk of technique failure. The mechanism of this discordant risk prediction deserves further study.

MO698IS PERITONEAL DIALYSIS SUITABLE METHOD FOR OBESE PATIENTS?

Background and Aims In recent years, obesity has reached epidemic proportions, and it's a great challenge to choose an adequate treatment for obese ESRD patients. The aim of the study was to analyze the outcome in patients with peritoneal dialysis with different degrees of nutrition expressed through body mass index at the beginning of treatment. Method The prospective clinical study included 53 incidental patients, who started peritoneal dialysis between June 2006 and August 2015. According to BMI on the beginning of treatment, patients were divided into three groups: normal weight: BMI of 18.5 - 24.9 kg/m2, n=17, overweight: BMI of 25 - 29.9 kg/m2, n=25, obese: BMI&gt; 30.0 kg/m2. n=11. Mechanical and infective complications, technique survival and patients survival were analyzed over 48 - months period. Results In terms of mechanical complications, there was no difference between the groups- malposition of the catheter (p = 0.769), leakage of dialysate (p = 0.462), hernia (p = 0.381). Exit sitе infection were most prevalent in group 3 - 1 episode/22 patient months vs 1 episode/30 patient months in groups 1 and 2, but without statistical significance (p = 0.272). However, the lowest incidence of peritonitis was in the group 3 - 1 episode/40 patient months vs 1 episode/30 patient months in group 2, and 1 episode/33 patient months in group 1, but even here the difference did not reach statistical significance (p = 0.624). Cardiovascular events – myocardial infarction, stroke and peripheral vascular disease were rare in all groups, with no statistical significance between groups. The incidence of hospitalizations was highest in the obese group – 1 episode/22 patient months vs 1 episode/27 patient months in group 2, and 1 episode/25 patient months in group 1 (p = 0.735). Kaplan Meier's analysis showed the worst, but not significant, survival of the technique in a group of obese patients (group 1 vs. group 2; p = 0.536; group 1 vs. group 3 - p= 0.662; group 2 vs. group 3 - p = 0.357). Also, overall patient survival was not differed between the groups (group 1 vs group 2 - p = 0.387; group 1 vs group 3 - p= 0.885; group 2 vs group 3 - p = 0.375). According to Cox's analysis, only values of total cholesterol at the end of the follow-up period (p = 0.027) and diastolic blood pressure (p = 0.013) were significantly associated with overall survival obese patients. Conclusion In the present study the degree of nutrition at the beginning of treatment had no significant effect on the outcome of peritoneal dialysis treatment. Therefore, patients should not be discouraged for peritoneal dialysis on the basis of BMI.

Trends in Peritoneal Dialysis Technique Survival, Death, and Transfer to Hemodialysis: A Decade of Data from the RDPLF

<b><i>Introduction:</i></b> There is limited information on the trends of peritoneal dialysis (PD) technique survival over time. This study aimed to estimate the effect of calendar time on technique survival, transfer to hemodialysis (HD) (and the individual causes of transfer), and patient survival. <b><i>Methods:</i></b> This retrospective, multicenter study, based on data from the French Language Peritoneal Dialysis Registry, analyzed 14,673 patients who initiated PD in France between January 1, 2005, and December 31, 2016. Adjusted Cox regressions with robust variance were used to examine the probability of a composite end point of either death or transfer to HD, death, and transfer to HD, accounting for the nonlinear impact of PD start time. <b><i>Results:</i></b> There were 10,201 (69.5%) cases of PD cessation over the study period: 5,495 (37.4%) deaths and 4,706 (32.1%) transfers to HD. The rate of PD cessation due to death or transfer to HD decreased over time (PR 0.96, 95% CI: 0.95–0.97). Compared to 2009–2010, starting PD between 2005 and 2008 or 2011 and 2016 was strongly associated with a lower rate of transfer to HD (PR 0.88, 95% CI: 0.81–0.96, and PR 0.91, 95% CI: 0.84–0.99, respectively), mostly due to a decline in the rate of infection-related transfers to HD (PR 0.96, 95% CI: 0.94–0.98). <b><i>Conclusions:</i></b> Rates of the composite end point of either death or transfer to HD, death, and transfer to HD have decreased in recent decades. The decline in transfers to HD rates, observed since 2011, is mainly the result of a significant decline in infection-related transfers.

Outcome measures for technique survival reported in peritoneal dialysis: A systematic review

Background: Peritoneal dialysis (PD) technique survival is an important outcome for patients, caregivers and health professionals, however, the definition and measures used for technique survival vary. We aimed to assess the scope and consistency of definitions and measures used for technique survival in studies of patients receiving PD. Method: MEDLINE, EMBASE and CENTRAL databases were searched for randomised controlled studies (RCTs) conducted in patients receiving PD reporting technique survival as an outcome between database inception and December 2019. The definition and measures used were extracted and independently assessed by two reviewers. Results: We included 25 RCTs with a total of 3645 participants (41–371 per trial) and follow up ranging from 6 weeks to 4 years. Terminology used included ‘technique survival’ (10 studies), ‘transfer to haemodialysis (HD)’ (8 studies) and ‘technique failure’ (7 studies) with 17 different definitions. In seven studies, it was unclear whether the definition included transfer to HD, death or transplantation and eight studies reported ‘transfer to HD’ without further definition regarding duration or other events. Of those remaining, five studies included death in their definition of a technique event, whereas death was censored in the other five. The duration of HD necessary to qualify as an event was reported in only four (16%) studies. Of the 14 studies reporting causes of an event, all used a different list of causes. Conclusion: There is substantial heterogeneity in how PD technique survival is defined and measured, likely contributing to considerable variability in reported rates. Standardised measures for reporting technique survival in PD studies are required to improve comparability.