Background and Aims Peritoneal dialysis (PD) catheter insertion technique has an impact on the health outcomes and technical success in PD. The percutaneous technique allows for a bedside, minimally invasive and faster insertion without the need of using an operating room and general anesthesia. In 2021, Agarwal et. al reported that percutaneous insertion was associated with a 64% relative risk reduction (RRR) of early exit site infection and a 48% RRR of early peritonitis with no difference in terms of mechanical complications compared to the surgical technique [1]. The aim of our study was to describe the frequency of mechanical and infectious complications within the first 30 days of PD catheter insertion between the percutaneous and surgical technique. Method We conducted a descriptive and prospective study in our Hospital from January 1st to December 31st, 2022. Patients who were candidates for renal replacement therapy with PD and who had no previous history of abdominal surgery or only minor abdominal surgery, underwent percutaneous insertion of PD catheter by a nephrologist with a bedside blind technique, whereas patients with previous abdominal surgery underwent surgical insertion with a mini laparotomy. Informed consent and preoperative blood tests were obtained before the procedure in both techniques. Patient preparation for the percutaneous insertion included fasting the night before, colonic enema and the placement of a urinary catheter, patients received antimicrobial prophylaxis as well as analgesia and light sedation. Mechanical and infectious complications within the first 30 days after insertion of double cuff Tenckhoff catheters were registered. Results During the study period, 155 PD catheter insertions took place in our hospital, the majority of insertions were surgical (53.5% versus 46.4%) and happened in women (60.6%). The mean age of the population was 51.5 years and 70.3% of the participants were diabetic. Exit-site infection was significantly more frequent in the surgically placed PD catheters (10% versus 1%, p = 0.02), there was a tendency for more mechanical dysfunction in the surgical technique versus the percutaneous technique (14.4% versus 5.5%, p = 0.07) and transfer to hemodialysis was more frequent in the surgical insertion group (10.8% versus 1.3%, p = 0.01). There was no difference between peritonitis in both groups and the frequency of uncomplicated PD catheters (catheter survival without any complication) was similar in both techniques. Conclusion Bedside PD catheter insertion by the nephrologist using a percutaneous technique can be an easy, timely, safe and adequate procedure with comparable success to the surgical insertion. It may have the advantage of more efficient control of infectious and mechanical complications and what is more, this approach could reduce the cost of kidney failure treatment as it allows for the use of minimal material and human resources.

Background and Aims There is scarcity in epidemiological data regarding chronic kidney (CKD) disease in low- and medium-income countries, and information about vascular access infectious complications is limited. In Mexico, access to renal replacement therapy (RRT) is burdensome for the uninsured patients. The General Hospital Agustin O'Horán, is a secondary care level unit in Yucatan, which receives uninsured patients from southeast Mexico. In our hospital, patients who are not candidates for peritoneal dialysis start hemodialysis with non-tunneled hemodialysis central venous catheters (NTHC), mainly due to the late nephrology referral and the shortage of vascular access specialists in our unit which prevents for the timely creation of an arteriovenous fistula or the placement of a tunneled hemodialysis catheter (THC). Permanence of NTHC is the main risk factor for catheter related bloodstream infection (CRBI) and according to the literature, Gram positive microorganisms are the most common isolated microbes. The aim of our study was to describe the incidence and risk factors for CRBSI in our hospital, from January to December 2022. Method We conducted a prospective and observational study in patients older than 18 years with CKD who were candidates to start hemodialysis and who had a NTHC inserted in our hospital from January to December 2022. We evaluated the incidence, organisms and risk factors related to CRBSI. Results During the study period, 94 NTHC were placed, 63.8% of them were inserted in women. Median age of the population was 49.4 years, and the most frequent comorbidities were diabetes mellitus (63.8%), hypertension (86.2%) and renal lithiasis (27.7%). 73.4% of the NTHC were Mahurkar® catheters and most of the insertions (73.4%) were not ultrasound guided. The right jugular vein was the most common insertion site (72.3%), followed by the left jugular vein. Mean catheter use duration was 71 ± 66 days. 27 patients had evidence of CRBI, the incidence rate was 0.78 per 1000 catheters-day. CRBI was more frequent in patients with prolonged catheter use (more than 30 days) (p<0.001) (Table 1). In respect to blood cultures reports, 51.83% were Gram positive organisms and 48.12% were Gram negative (Table 2). Conclusion Vascular access survival without infectious complications is of paramount importance in hemodialysis patients. The prolonged used of NTHC with the associated risk for developing CRBI negatively impacts the health outcomes in our population. In accordance to previously published literature, the main isolated microbes in our hospital comprise Gram positive bacteria. One of the biggest challenges in our country is to provide our CKD population with better vascular access options like THC or arteriovenous fistula to improve the outcomes and reduce infectious complications.

<b><i>Introduction:</i></b> Constipation is prevalent in patients with kidney failure partly due to the use of medication, such as phosphate binders. We hypothesized that serum levels of gut microbiome-derived uremic toxins (UTOX) may be affected by the choice of phosphate binder putatively through its impact on colonic transit time. We investigated two commonly prescribed phosphate binders, sevelamer carbonate (SEV) and sucroferric oxyhydroxide (SFO), and their association with gut microbiome-derived UTOX levels in hemodialysis (HD) patients. <b><i>Methods:</i></b> Weekly blood samples were collected from 16 anuric HD participants during the 5-week observational period. All participants were on active phosphate binder monotherapy with either SFO or SEV for at least 4 weeks prior to enrollment. Eight UTOX (7 gut microbiome-derived) and tryptophan were quantified using liquid chromatography-mass spectrometry. Serum phosphorus, nutritional, and liver function markers were also measured. For each substance, weekly individual levels, the median concentration per participant, and differences between SFO and SEV groups were reported. Patient-reported bowel movements, by the Bristol Stool Scale (BSS), and pill usage were assessed weekly. <b><i>Results:</i></b> The SEV group reported a 3.3-fold higher frequency of BSS stool types 1 and 2 (more likely constipated, <i>p</i> &#x3c; 0.05), whereas the SFO group reported a 1.5-fold higher frequency of BSS stool types 5–7 (more likely loose stool and diarrhea, not significant). Participants in the SFO group showed a trend toward better adherence to phosphate binder therapy (SFO: 87.6% vs. SEV: 66.6%, not significant). UTOX, serum phosphorus, nutritional and liver function markers, and tryptophan were not different between the two groups. <b><i>Conclusion:</i></b> There was no difference in the gut microbiome-derived UTOX levels between phosphate binders (SFO vs. SEV), despite SFO therapy resulting in fewer constipated participants. This pilot study may inform study design of future clinical trials and highlights the importance of including factors beyond bowel habits and their association with UTOX levels.

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Background and Aims Pervasive sensing technologies allow healthcare providers to gain additional insights into patient’s status outside the clinical setting. In order to adopt widespread use of remote monitoring devices we must first study the feasibility of their use. We aim to quantify how long patients will use a wearable device before requiring an intervention to maintain the use of the device. Method In-center hemodialysis (HD) patients were enrolled from 4 clinics in New York City starting in May 2018 and followed for a period of up to 1 year. Patients ≥18 years, on HD ≥3 months, able to walk, owning a smartphone, mobile tablet or PC were enrolled. They were provided with a wrist-based monitoring device (Fitbit Charge 2). Participants were instructed on how to use the device, and sync data to their smartphone, mobile tablet, or PC. If a patient failed to sync data for 7 consecutive days, a text message or email reminder was sent from the research staff. We evaluated time to first notification using Kaplan Meier time-to-event analysis. Predictors of time to first intervention was assessed via univariate Cox Regression. Patients were censored at the end of the observation period (January 6, 2020). Socio-economic parameters such as living situation, marriage status, employment status, race, and education level were collected at the beginning of the study. Results 125 patients were enrolled into our study. 7 patients were screen-failed after enrollment. At enrollment patients were 54±12 years old with a dialysis vintage of 5.6±5.8 years. 37% lived alone, 56% were single, 59% unemployed, 64% were African-American, and 42% had an education level of some college or higher. 82% of the patients required a text message reminder to continue wearing/syncing the device. Mean and median time to first reminder were 101 days (95% CI 80 to 123) and 50 days (95% CI 35 to 70 days), respectively. The probability of being on the study without intervention is shown in Figure 1. Predictors of time to first intervention were chosen a priori and included gender, age, living situation, and education level. None of these parameters were significant predictors of time to first intervention. Conclusion We found that most patients will require at least some intervention or counseling to maintain the use of a wrist-based wearable device for remote patient monitoring. While most patients require an intervention before approximately 2 months into wear, the patients who can maintain use independently after that point are likely to do so for longer.