Impact of peritoneal dialysis strategy on technique and patient survival.

Background: The aim of this study was to evaluate the impact of peritoneal dialysis (PD) strategy on technique and patient survival. Methods: This was a retrospective, single-center study conducted on consecutive patients with chronic kidney disease who underwent PD between January 2009 and December 2019. The study sample was stratified into four different groups according to PD technique [automated (APD) or manual (CAPD)] and icodextrin use (yes versus no). The primary endpoints were survival of both technique and patient. Results: A total of 531 patients were included in the analysis. Mean ± standard deviation age was 60.6 ± 14.6 years, 68.4% (363) were men and 34.8% (185) had diabetes. The median technique survival time was 19 (15) months. A total of 185 (34.8%), 96 (18.1%), 99 (18.7%) and 151 (28.4%) patients were included in the CAPD/No-Icodextrin, CAPD/Icodextrin, APD/No-Icodextrin and APD/Icodextrin study groups, respectively. Throughout the study, 180 (33.9%) patients underwent renal transplant, 71 (13.4%) were changed to hemodialysis and 151 (28.4%) died. Age [hazard ratio (HR) 0.975, 95% confidence interval (CI) 0.960-0.990, P = .001] and incidence of early peritoneal infection (HR 2.440, 95% CI 1.453-4.098, P = .001) were associated with technique survival, while age (HR 1.029, 95% CI 1.013-1.045, P < .001), Charlson Index (HR 1.192, 95% CI 1.097-1.295, P < 0.001), use of icodextrin (HR 0.421, 95% CI 0.247-0.710, P < .001) and APD/Icodextrin (HR 0.499, 95% CI 0.322-0.803, P = .005) were associated with patient survival. Conclusions: Icodextrin use and APD/Icodextrin had a positive impact on patient survival, while older age and higher Charlson Index had a negative one. Age and incidence of early peritoneal infection significantly impacted on technique survival.

Novel Immune Cell Subsets Exhibit Different Associations With Vascular Outcomes in Chronic Kidney Disease Patients-Identifying Potential Biomarkers.

Background and Aims: Alterations in novel immune cell subsets, such as angiogenic T cells (Tang), senescent T cells (CD4+CD28null), and monocyte subsets are associated with impaired vascular homeostasis in several inflammatory conditions. However, mediators underlying vascular deterioration in chronic kidney disease (CKD) are poorly characterized. This study assessed their role in the vascular deterioration of CKD using a broad spectrum of surrogate markers ranging from altered functionality to overt calcification. Methods: Tang (CD3+CD31+CXCR4+), CD4+CD28null cells, and monocytes [CD14/CD16 subsets and angiotensin-converting enzyme (ACE) expression] were measured in peripheral blood by flow cytometry in 33 CKD stage 5 patients undergoing peritoneal dialysis (CKD5-PD) and 15 healthy controls (HCs). Analyses were replicated in a hemodialysis cohort. Vascular surrogate markers (including adventitial vasa vasorum, pulse wave velocity, intima-media thickness, and vascular calcification) were assessed by appropriate imaging methods. Results: In CKD5-PD, decreased Tang levels (p < 0.001) were unrelated to clinical features or traditional cardiovascular (CV) risk factors but correlated negatively with troponin T levels (r = -0.550, p = 0.003). Instead, CD4+CD28null frequency was increased (p < 0.001), especially in those with vascular calcifications. Quantitative and qualitative differences were also observed within the monocyte pool, a shift toward CD16+ subsets and ACE expression being found in CKD. Equivalent results were observed in the replication cohort. Each subset associated distinctly with adverse vascular outcomes in univariate and multivariate analyses: while Tang depletion was linked to poor vascular function and subclinical atherosclerosis, increases in CD4+CD28null were associated with overt vascular thickening and calcification. Monocytes were not independently associated with vascular outcomes in CKD patients. Conclusions: Novel T cell and monocyte subsets are altered in CKD. Altered T-cell subpopulations, but not monocytes, exhibited distinct associations with different vascular outcomes in CKD. Tang are emerging biomarkers of subclinical vascular deterioration in CKD.

Eficacia y seguridad de oxihidróxido sucroférrico en el tratamiento de la hiperfosforemia en la enfermedad renal crónica. Estudio FOSFASTUR / Efficacy and safety of sucroferric oxyhydroxide in the treatment of hyperphosphataemia in chronic kidney disease. FOSFASTUR study

INTRODUCCIÓN: Las alteraciones del metabolismo óseo y mineral son muy frecuentes en la enfermedad renal crónica (ERC). El aumento en los niveles de fósforo condiciona enfermedad ósea, riego de calcificación y mayor mortalidad, por lo que cualquier estrategia encaminada a su reducción debe ser bienvenida. El último fármaco incorporado al arsenal terapéutico para tratar la hiperfosforemia en la ERC es el oxihidróxido sucroférrico (OSF). OBJETIVO: Analizar la eficacia y seguridad de OSF en 3 cohortes de pacientes, una con ERC avanzada no en diálisis, otra en diálisis peritoneal y finalmente otra en hemodiálisis, seguidas durante 6 meses. MÉTODOS: Estudio observacional multicéntrico, prospectivo, de práctica clínica. Se analizaron variables clínicas y epidemiológicas. Se valoró la evolución de parámetros relacionados con las alteraciones del metabolismo óseo y mineral y la anemia. RESULTADOS: Se incluyeron en el estudio 85 pacientes (62 ± 12 años, 64% varones, 34% diabéticos), 25 con ERC avanzada no en diálisis, 25 en diálisis peritoneal y finalmente 35 en hemodiálisis. En 66 pacientes (78%) OSF fue el primer captor del fósforo; en los otros 19 se sustituyó un captor previo por OSF, por falta de tolerancia o eficacia. La dosis inicial de OSF fue 964 ± 323 mg/día. Globalmente los niveles séricos de fósforo experimentaron un descenso significativo a los 3 meses de tratamiento (19,6%; p < 0,001). No hubo diferencias en la eficacia del fármaco al comparar las distintas poblaciones analizadas. A lo largo del estudio no se modificaron los niveles de calcio, PTHi, ferritina, índice de saturación de la transferrina ni hemoglobina, aunque se manifestó una tendencia al aumento de los 2 últimos. Doce pacientes (14%) abandonaron el seguimiento, 10 por efectos adversos gastrointestinales (diarrea fundamentalmente) y 2 por pérdida de seguimiento (trasplante renal). La dosis media del fármaco que recibieron los pacientes se incrementó a lo largo del tiempo hasta alcanzar los 1.147 ± 371 mg/día. CONCLUSIONES: OSF es una opción eficaz para el tratamiento de la hiperfosforemia en pacientes con ERC tanto en fases avanzadas de la enfermedad como en diálisis. Encontramos una eficacia similar en los 3 grupos analizados. A mayor nivel basal de fósforo, mayor descenso de sus niveles séricos. Con dosis de alrededor de 1.000 g/día se puede conseguir un notable descenso de los niveles de fósforo. La diarrea fue el efecto secundario más frecuente, aunque tuvo poca importancia generalmente

INTRODUCTION: Alterations in bone and mineral metabolism are very common in chronic kidney disease (CKD). The increase in phosphate levels leads to bone disease, risk of calcification and greater mortality, so any strategy aimed at reducing them should be welcomed. The latest drug incorporated into the therapeutic arsenal to treat hyperphosphataemia in CKD is sucroferric oxyhydroxide (SFO). OBJECTIVE: To analyse the efficacy and safety of SFO in 3 cohorts of patients, one with advanced CKD not on dialysis, another on peritoneal dialysis and the last on haemodialysis, followed for 6 months. METHODS: A prospective, observational, multicentre study in clinical practice. Clinical and epidemiological variables were analysed. The evolution of parameters relating to alterations in bone and mineral metabolism and anaemia was analysed. RESULTS: Eighty-five patients were included in the study (62 ± 12 years, 64% male, 34% diabetic), 25 with advanced CKD not on dialysis, 25 on peritoneal dialysis and lastly, 35 on haemodialysis. In 66 patients (78%), SFO was the first phosphate binder; in the other 19, SFO replaced a previous phosphate binder due to poor tolerance or efficacy. The initial dose of SFO was 964 ± 323 mg/day. Overall, serum phosphate levels saw a significant reduction at 3 months of treatment (19.6%; P < .001). There were no differences in the efficacy of the drug when the different populations analysed were compared. Over the course of the study, there were no changes to levels of calcium, PTHi, ferritin, transferrin saturation index or haemoglobin, although there was a tendency for the last 2 to increase. Twelve patients (14%) withdrew from follow-up, 10 due to gastrointestinal adverse effects (primarily diarrhoea) and 2 were lost to follow-up (kidney transplant). The mean dose of the drug that the patients received increased over time, up to 1,147 ± 371 mg/day. CONCLUSIONS: SFO is an effective option for the treatment of hyperphosphataemia in patients with CKD both in the advanced phases of the disease and on dialysis. We found similar efficacy across the 3 groups analysed. The higher their baseline phosphate level, the greater the reduction in the serum levels. A notable reduction in phosphate levels can be achieved with doses of around 1,000 mg/day. Diarrhoea was the most common side effect, although it generally was not significant

Efficacy and safety of sucroferric oxyhydroxide in the treatment of hyperphosphataemia in chronic kidney disease in Asturias. FOSFASTUR study.

Alterations in bone and mineral metabolism are very common in chronic kidney disease (CKD). The increase in phosphate levels leads to bone disease, risk of calcification and greater mortality, so any strategy aimed at reducing them should be welcomed. The latest drug incorporated into the therapeutic arsenal to treat hyperphosphataemia in CKD is Sucroferric Oxyhydroxide (SFO). OBJECTIVE: To analyse the efficacy and safety of OSF in three cohorts of patients, one with advanced chronic kidney disease not on dialysis (CKD-NoD), another on peritoneal dialysis (PD) and the last on haemodialysis (HD), followed for six months. METHODS: A prospective, observational, multicentre study in clinical practice. Clinical and epidemiological variables were analysed. The evolution of parameters relating to alterations in bone and mineral metabolism and anaemia was analysed. RESULTS: Eighty-five patients were included in the study (62 ±â€¯12 years, 64% male, 34% diabetic), 25 with CKD-NoD, 25 on PD and lastly, 35 on HD. In 66 patients (78%), SFO was the first phosphate binder; in the other 19, SFO replaced a previous phosphate binder due to poor tolerance or efficacy. The initial dose of SFO was 964 ±â€¯323 mg/day. Overall, serum phosphate levels saw a significant reduction at three months of treatment (19.6%, P < 0.001). There were no differences in the efficacy of the drug when the different populations analysed were compared. Over the course of the study, there were no changes to levels of calcium, PTHi, ferritin, or the transferrin and haemoglobin saturation indices, although there was a tendency for the last two to increase. Twelve patients (14%) withdrew from follow-up, ten due to gastrointestinal adverse effects (primarily diarrhoea) and two were lost to follow-up (kidney transplant). The mean dose of the drug that the patients received increased over time, up to 1147 ±â€¯371 mg/day. CONCLUSIONS: SFO is an effective option for the treatment of hyperphosphataemia in patients with CKD both in the advanced phases of the disease and on dialysis. We found similar efficacy across the three groups analysed. The higher their baseline phosphate level, the greater the reduction in the serum levels. A notable reduction in phosphate levels can be achieved with doses of around 1000 mg/day. Diarrhoea was the most common side effect, although it generally was not significant.

Efficacy and safety of sucroferric oxyhydroxide in the treatment of hyperphosphataemia in chronic kidney disease. FOSFASTUR study. / Eficacia y seguridad de oxihidróxido sucroférrico en el tratamiento de la hiperfosforemia en la enfermedad renal crónica. Estudio FOSFASTUR.

INTRODUCTION: Alterations in bone and mineral metabolism are very common in chronic kidney disease (CKD). The increase in phosphate levels leads to bone disease, risk of calcification and greater mortality, so any strategy aimed at reducing them should be welcomed. The latest drug incorporated into the therapeutic arsenal to treat hyperphosphataemia in CKD is sucroferric oxyhydroxide (SFO). OBJECTIVE: To analyse the efficacy and safety of SFO in 3 cohorts of patients, one with advanced CKD not on dialysis, another on peritoneal dialysis and the last on haemodialysis, followed for 6 months. METHODS: A prospective, observational, multicentre study in clinical practice. Clinical and epidemiological variables were analysed. The evolution of parameters relating to alterations in bone and mineral metabolism and anaemia was analysed. RESULTS: Eighty-five patients were included in the study (62±12 years, 64% male, 34% diabetic), 25 with advanced CKD not on dialysis, 25 on peritoneal dialysis and lastly, 35 on haemodialysis. In 66 patients (78%), SFO was the first phosphate binder; in the other 19, SFO replaced a previous phosphate binder due to poor tolerance or efficacy. The initial dose of SFO was 964±323mg/day. Overall, serum phosphate levels saw a significant reduction at 3 months of treatment (19.6%; P<.001). There were no differences in the efficacy of the drug when the different populations analysed were compared. Over the course of the study, there were no changes to levels of calcium, PTHi, ferritin, transferrin saturation index or haemoglobin, although there was a tendency for the last 2 to increase. Twelve patients (14%) withdrew from follow-up, 10 due to gastrointestinal adverse effects (primarily diarrhoea) and 2 were lost to follow-up (kidney transplant). The mean dose of the drug that the patients received increased over time, up to 1,147±371mg/day. CONCLUSIONS: SFO is an effective option for the treatment of hyperphosphataemia in patients with CKD both in the advanced phases of the disease and on dialysis. We found similar efficacy across the 3 groups analysed. The higher their baseline phosphate level, the greater the reduction in the serum levels. A notable reduction in phosphate levels can be achieved with doses of around 1,000mg/day. Diarrhoea was the most common side effect, although it generally was not significant.

Utilidad de la maniobra alfa en la malposición del catéter peritoneal: revisión y experiencia / Usefulness of the alpha maneuver in the peritoneal catheter displacement: review and experience

INTRODUCCIÓN Y OBJETIVOS: La malposición del catéter peritoneal es una de las complicaciones más frecuentes de la diálisis peritoneal. Para recolocarlo se ha propuesto realizar la maniobra alfa, que consiste en devolver al catéter a su correcta posición a través de unas guías rígidas bajo control fluoroscópico. El objetivo del presente estudio es analizar los 107 procedimientos realizados en nuestro Centro tratando de determinar factores que puedan predecir el éxito de la técnica. MATERIAL Y MÉTODOS: El método de la maniobra alfa fue utilizado en 86 pacientes con un total de 107 procedimientos (en 70 pacientes solo una maniobra, en 16 pacientes dos maniobras o más). RESULTADOS: El éxito global de la técnica fue de un 60%. La tasa de éxito no mostró diferencias en cuanto al sexo (60% en varones frente a 40% mujeres, p = 0,104), tiempo de fallo del catéter (fallos precoces 60% frente a fallos tardíos 62%, p = 0,849), tipo de catéter (75% en autoposicionantes frente a 58% en espirales, p = 0,633), ni en cuanto a la posición inicial del catéter. Sólo hubo un caso de peritonitis secundaria al procedimiento. CONCLUSIONES: La maniobra alfa es un método eficaz y seguro en la corrección de la malposición del catéter peritoneal

INTRODUCTION AND OBJECTIVES: Peritoneal catheter displacement is one of the most common complications of peritoneal dialysis. The alpha manoeuvre has been proposed as a repositioning technique, which involves returning the catheter to its correct position using rigid guidewires under fluoroscopic guidance. The aim of this study is to analyse the 107 procedures performed at our Centre to identify factors that may predict the success of the technique. MATERIAL AND METHODS: The alpha manoeuvre method was used in 86 patients, with a total of 107 procedures (70 patients underwent one manoeuvre only, 16 patients underwent two or more manoeuvres). RESULTS: The overall success rate of the technique was 60%. There were no differences in success rate in terms of gender (60% male vs. 40% female, p = 0.104), time of catheter failure (early 60% vs. late 62%, p = 0.849), type of catheter (75% self-locating vs. 58% spiral, p = 0.633) or the initial position of the catheter. There was only one case of peritonitis related to the procedure. CONCLUSIONS: The alpha manoeuvre is an effective and safe method for correcting peritoneal catheter displacement

Usefulness of the alpha maneuver in the peritoneal catheter displacement: review and experience. / Utilidad de la maniobra alfa en la malposición del catéter peritoneal: revisión y experiencia.

INTRODUCTION AND OBJECTIVES: Peritoneal catheter displacement is one of the most common complications of peritoneal dialysis. The alpha manoeuvre has been proposed as a repositioning technique, which involves returning the catheter to its correct position using rigid guidewires under fluoroscopic guidance. The aim of this study is to analyse the 107 procedures performed at our Centre to identify factors that may predict the success of the technique. MATERIAL AND METHODS: The alpha manoeuvre method was used in 86 patients, with a total of 107 procedures (70 patients underwent one manoeuvre only, 16 patients underwent two or more manoeuvres). RESULTS: The overall success rate of the technique was 60%. There were no differences in success rate in terms of gender (60% male vs. 40% female, p = 0.104), time of catheter failure (early 60% vs. late 62%, p = 0.849), type of catheter (75% self-locating vs. 58% spiral, p = 0.633) or the initial position of the catheter. There was only one case of peritonitis related to the procedure. CONCLUSIONS: The alpha manoeuvre is an effective and safe method for correcting peritoneal catheter displacement.

Aureimonas altamirensis: primer caso de peritonitis en diálisis peritoneal / Aureimonas altamirensis: The first case of peritonitis on peritoneal dialysis

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Barley-ß-glucans reduce systemic inflammation, renal injury and aortic calcification through ADAM17 and neutral-sphingomyelinase2 inhibition.

In chronic kidney disease (CKD), hyperphosphatemia-induced inflammation aggravates vascular calcification (VC) by increasing vascular smooth muscle cell (VSMC) osteogenic differentiation, ADAM17-induced renal and vascular injury, and TNFα-induction of neutral-sphingomyelinase2 (nSMase2) to release pro-calcifying exosomes. This study examined anti-inflammatory ß-glucans efficacy at attenuating systemic inflammation in health, and renal and vascular injury favoring VC in hyperphosphatemic CKD. In healthy adults, dietary barley ß-glucans (Bßglucans) reduced leukocyte superoxide production, inflammatory ADAM17, TNFα, nSMase2, and pro-aging/pro-inflammatory STING (Stimulator of interferon genes) gene expression without decreasing circulating inflammatory cytokines, except for γ-interferon. In hyperphosphatemic rat CKD, dietary Bßglucans reduced renal and aortic ADAM17-driven inflammation attenuating CKD-progression (higher GFR and lower serum creatinine, proteinuria, kidney inflammatory infiltration and nSMase2), and TNFα-driven increases in aortic nSMase2 and calcium deposition without improving mineral homeostasis. In VSMC, Bßglucans prevented LPS- or uremic serum-induced rapid increases in ADAM17, TNFα and nSMase2, and reduced the 13-fold higher calcium deposition induced by prolonged calcifying conditions by inhibiting osteogenic differentiation and increases in nSMase2 through Dectin1-independent actions involving Bßglucans internalization. Thus, dietary Bßglucans inhibit leukocyte superoxide production and leukocyte, renal and aortic ADAM17- and nSMase2 gene expression attenuating systemic inflammation in health, and renal injury and aortic calcification despite hyperphosphatemia in CKD.

A subset of low density granulocytes is associated with vascular calcification in chronic kidney disease patients.

Inflammation is central to chronic kidney disease (CKD) pathogenesis and vascular outcomes, but the exact players remain unidentified. Since low density granulocytes (LDGs) are emerging mediators in inflammatory conditions, we aimed to evaluate whether LDGs may be altered in CKD and related to clinical outcomes as biomarkers. To his end, LDGs subsets were measured in peripheral blood by flow cytometry and confocal microscopy in 33 CKD patients undergoing peritoneal dialysis and 15 healthy controls (HC). Analyses were replicated in an additional cohort. DEF3 (marker of early granulopoiesis) gene expression on PBMCs was quantified by qPCR. Total CD15+ LDGs and both CD14lowCD16+ and CD14-CD16- subsets were expanded in CKD. The relative frequency of the CD14-CD16- subpopulation was higher among the CD15+ pool in CKD. This alteration was stable over-time. The increased CD14-CD16-CD15+ paralleled Kauppila scores and DEF3 expression, whereas no association was found with CD14lowCD16+ CD15+. Both subsets differed in their CD11b, CD10, CD35, CD31, CD62L, IFNAR1 and CD68 expression, FSC/SSC features and nuclear morphology, pointing to different origins and maturation status. In conclusion, LDGs were expanded in CKD showing a skewed distribution towards a CD14-CD16-CD15+ enrichment, in association with vascular calcification. DEF3 expression in PBMC can be a marker of LDG expansion.

MUL+DO: índice multicomponente para el diagnóstico rápido de peritonitis en pacientes de diálisis peritoneal / MUL+DO: a multicomponent index for the quick diagnosis of peritonitis in peritoneal dialysis patients

La infección peritoneal es un problema frecuente que afecta negativamente a la supervivencia del paciente y de la técnica. El inicio rápido del tratamiento de la infección peritoneal reduce las complicaciones. Se busca diseñar un índice multicomponente (MUL+DO) para el diagnóstico rápido y eficiente de infección peritoneal. Con ese objetivo, se crea una cohorte de construcción con muestras de efluente peritoneal que se analizaron con tiras Multistix (R) 10 SG Siemens para la detección de leucocitos. Después, se examinó cada muestra según el patrón oro: número de leucocitos, porcentaje de polimorfonucleares y cultivo microbiológico. Se construyó MUL+DO sumándole un punto a la escala cromática modificada MULTISTIX [0-1-2-3] si el paciente reporta dolor. MUL+DO toma valores de 0 a 4. Posteriormente, se creó una cohorte de validación del modelo. MUL+DO se aplicó a cada muestra, determinándose también leucocitos y porcentaje de polimorfonucleares. La cohorte de construcción incluyó 134 muestras, 34 tenían infección (25,4% [17,6-33,1]). Las muestras con un valor MUL+DO >1, presentaron una sensibilidad y especificidad del 100%. La cohorte de validación incluyó 100 muestras con 16 infecciones (16% [8,3-23,7]). En la cohorte de validación asumiendo como positiva una muestra con un valor MUL+DO > 1, se obtuvo una sensibilidad del 100% y una especificidad del 95,2%. MUL+DO aplicado en la cohorte de construcción, mostró una separación perfecta de las poblaciones positiva y negativa. Todos los pacientes positivos presentaron una puntuación ≥2. En la cohorte de validación, el índice MUL+DO presentó una sensibilidad del 100% y una especificidad del 95,2%

Peritoneal infection is a common problem that has a negative impact on the survival of patients and the technique. The early administration of peritoneal infection treatment reduces complications. The goal of this study is to propose a multicomponent index (MUL+DO) for the quick and efficient diagnosis of peritoneal infection. We selected a training cohort of peritoneal effluent samples which were analysed by Multistix (R) 10 SG Siemens test strips for leukocyte detection. Then, each sample was examined according to the gold standard: number of leukocytes, polymorphonuclear percentage and microbiological culture. We constructed the MUL+DO index by adding one point to the MULTISTIX [0-1-2-3] modified chromatic scale if the patient reported pain. The MUL+DO index ranged from 0 to 4. A model validation cohort was then created. MUL+DO was applied to each sample and leukocytes and polymorphonuclear percentage were also assessed. The training cohort ultimately included 134 samples, 34 of which with infection (25.4% [17.6-33.1]). Samples with a MUL+DO value greater than 1 presented a sensitivity and specificity of 100%. The validation cohort included 100 samples with 16 infections (16% [8.3-23.7]). Assuming a sample with a MUL+DO value greater than 1 to be positive, we obtained a sensitivity of 100% and a specificity of 95.2%. The MUL+DO index applied to the training cohort showed a perfect separation of the positive and negative populations. All positive patients presented a score ≥2. In the validation cohort, the MUL+DO reported a sensitivity of 100% and a specificity of 95.2%

MUL+DO: a multicomponent index for the quick diagnosis of peritonitis in peritoneal dialysis patients. / MUL+DO: índice multicomponente para el diagnóstico rápido de peritonitis en pacientes de diálisis peritoneal.

Peritoneal infection is a common problem that has a negative impact on the survival of patients and the technique. The early administration of peritoneal infection treatment reduces complications. The goal of this study is to propose a multicomponent index (MUL+DO) for the quick and efficient diagnosis of peritoneal infection. We selected a training cohort of peritoneal effluent samples which were analysed by Multistix ® 10 SG Siemens test strips for leukocyte detection. Then, each sample was examined according to the gold standard: number of leukocytes, polymorphonuclear percentage and microbiological culture. We constructed the MUL+DO index by adding one point to the MULTISTIX [0-1-2-3] modified chromatic scale if the patient reported pain. The MUL+DO index ranged from 0 to 4. A model validation cohort was then created. MUL+DO was applied to each sample and leukocytes and polymorphonuclear percentage were also assessed. The training cohort ultimately included 134 samples, 34 of which with infection (25.4% [17.6-33.1]). Samples with a MUL+DO value greater than 1 presented a sensitivity and specificity of 100%. The validation cohort included 100 samples with 16 infections (16% [8.3-23.7]). Assuming a sample with a MUL+DO value greater than 1 to be positive, we obtained a sensitivity of 100% and a specificity of 95.2%. The MUL+DO index applied to the training cohort showed a perfect separation of the positive and negative populations. All positive patients presented a score ≥2. In the validation cohort, the MUL+DO reported a sensitivity of 100% and a specificity of 95.2%.

Baseline Residual Kidney Function and Its Ensuing Rate of Decline Interact to Predict Mortality of Peritoneal Dialysis Patients.

BACKGROUND: Baseline residual kidney function (RKF) and its rate of decline during follow-up are purported to be reliable outcome predictors of patients undergoing Peritoneal Dialysis (PD). The independent contribution of each of these factors has not been elucidated. METHOD: We report a multicenter, longitudinal study of 493 patients incident on PD and satisfying two conditions: a glomerular filtration rate (GFR) ≥1 mL/minute and a daily diuresis ≥300 mL. The main variables were the GFR (mean of urea and creatinine clearances) at PD inception and the GFR rate of decline during follow-up. The main outcome variable was patient mortality. The secondary outcome variables were: PD technique failure and risk of peritoneal infection. The statistical analysis was based on a multivariate approach, placing an emphasis on the interactions between the two main study variables. MAIN RESULTS: Baseline GFR and its rate of decline performed well as independent predictors of both patient mortality and risk of peritoneal infection. These two main study variables maintained a moderate correlation with each other (r2 = 0.12, p<0.0005), and interacted clearly, as predictors of patient mortality. A low baseline GFR followed by a fast decline portended the worst survival outcome (adjusted HR 3.84, 95%CI 1.81-8.14, p<0.0005)(Ref. baseline GFR above median plus rate of decline below median). In general, the rate of decline of RKF had a greater effect on mortality than baseline GFR, which had no detectable effect on survival when the decline of RKF was slow (HR 1.17, 95% CI 0.81-2.22, p = 0.22). Conversely, a relatively high GFR at the start of PD still carried a significant risk of mortality, when RKF declined rapidly (HR 1.89, 95% CI 1.05-3.72, p = 0.028). CONCLUSION: The risk-benefit balance of an early versus late start of PD cannot be evaluated without taking into consideration the rate of decline of RKF. This circumstance may contribute to explain the controversial results observed at the time of evaluating the potential benefits of an early initiation of PD.

Efluente peritoneal turbio sin peritonitis en pacientes con insuficiencia cardiaca refractaria en programa de ultrafiltración peritoneal / Cloudy peritoneal effluent without peritonitis in patients with refractory heart failure undergoing peritoneal ultrafiltration

En los pacientes con insuficiencia cardiaca refractaria en programa de ultrafiltración peritoneal no es infrecuente la presencia de líquido turbio en ausencia de otros criterios de infección peritoneal. El objetivo del estudio fue analizar si la presencia de drenado peritoneal turbio se corresponde con la presencia de infección peritoneal. Se realizó un estudio observacional prospectivo entre Diciembre de 2014 y Marzo de 2015, en el que se incluyeron pacientes con insuficiencia cardiaca refractaria. Se analizaron 4 muestras de cada paciente, separadas por 15 días, de forma programada. Los cultivos bacteriológicos se realizaron en las muestras que presentaban un recuento leucocitario superior a 100 leucocitos/μl. Se recogieron datos epidemiológicos y clínicos de los pacientes, como la patología de base responsable de la insuficiencia cardiaca y las proteínas presentes en el efluente peritoneal. Se evaluaron 13 pacientes, 77% varones, edad media de 71±8 años. Se recogieron un total de 51 muestras; de ellas, en 5 muestras (9.8%) procedentes de 4 pacientes (31% del total de pacientes), el efluente peritoneal era turbio. En 2 de ellos el recuento leucocitario fue inferior a 100 leucocitos/μl mientras que en los otros 2 pacientes el recuento fue superior, con polimorfonucleares por debajo del 50% y cultivos sin crecimiento bacteriano. No hubo relación entre la celularidad y las enfermedades de base. Consideramos que la presencia de turbidez en el efluente peritoneal de los pacientes con Insuficiencia Cardiaca no siempre se corresponde con la existencia de infección peritoneal (AU)

In patients with refractory heart failure undergoing peritoneal ultrafiltration it is not uncommon for the presence of turbid liquid in the absence of other criteria of peritoneal infection. The aim of the study was to analyze whether the presence of peritoneal drainage cloudy corresponds to the presence of peritoneal infection. A prospective observational study between December 2014 and March 2015 was performed, which included patients with refractory heart failure. They analyzed 4 samples of each patient, separated by 15 days, programmatically. Bacterial cultures were performed on samples that had a white blood cell count above 100 cells/μl. Epidemiological and clinical data of patients, as the pathology of heart failure responsible base and the proteins present in the peritoneal effluent were collected. 13 patients, 77 % male, mean age 71 ± 8 years were evaluated. A total of 51 samples were collected; of then, 5 samples (9.8 %) from 4 patients (31 % of all patients), peritoneal effluent was cloudy. In 2 of then the white blood cell count was less than 100 cells/μl. whereas in the other 2 patients the count was higher, with polymorfonuclear below 50% and no growth crops. There was no relationship between the cellularity and the underlying diseases. We believe that the presence of turbidity in the peritoneal effluent of patients with heart failure not correspond to the existence of peritoneal infection (AU)

Una causa infrecuente de hemoperitoneo espontáneo en un paciente en diálisis peritoneal / An uncommon cause of spontaneous hemoperitoneum in a peritoneal dialysis patient

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