INTRODUCTION: Our PD unit is one of the biggest units in Saudi Arabia wheremore than 200 PD patients are taken care of; the clear majority ofthem are on APD. Our protocol includes colonoscopy for those withunexplained anaemia, weight loss, positive occult blood and chronic constipation or diarrhoea and as part of the prerenal transplantation protocol. The fear of developing peritonitis after colonoscopy isunjustified as few cases have been reported in the literature on postcolonoscopy peritonitis in PD patients [17-21]. A retrospective study[22] found that the risk of peritonitis after colonoscopy without antibiotic prophylaxis was 6.3%; colonic biopsy or polypectomy did notappear to further increase the risk and no peritonitis was observed inpatients that received prophylactic antibiotics although the differencewas not statistically significant. Few cases have been reported on theincidence of peritonitis following colonoscopy in Continuous Ambulatory Peritoneal Dialysis (CAPD) patients. Those reports claimedthat instrumental diagnostic procedures such as colonoscopy mayplay a significant role in the development of gram negative peritonitisin CAPD patients [23,24]. Similar results were reported by Yip etal., [25]. METHODS: Patients and Methods:A total of 103 patients out of 144 patientson Automated Peritoneal Dialysis (APD) undergoing diagnosticcolonoscopy were enrolled in a prospective randomized study. Thestudy was extended from January 2012 until January 2018. Patientswere randomized into two age and sex matched groups; group A(51 patients) who had prophylaxis ceftazidime prior to colonoscopyand group B (52 patients) who had colonoscopy without prophylactic antibiotics. The following parameters: age, gender, duration ondialysis, duration on APD, diabetic status, use of antibiotics beforethe procedure, and indications for and findings of colonoscopy werestudied. Prophylactic antibiotics were given for prevention of peritonitis according to the 2016 ISPD (International Society of PeritonealDialysis) guidelines recommendation which is a class C weak suggestion. RESULTS: Results: Of all colonoscopies 63.1% showed normal findings, 17.2%with colonic polyps at different sites, 12.9% with angiodysplastic-likelesions, 5.4% with colonic ulcer (s), 3.2% with diverticulae withoutdiverticulitis and 1.1% had transverse colon stricture. Post-colonoscopy peritonitis was documented in 4 (7.8%) and 5 (5.8%) patientsin groups A and B respectively (p> 0.05); the causative organismswere mainly gram-negative bacteria. All peritonitis cases resolvedwith treatment and one of the patients in group A required catheter removal because of fungal peritonitis. Complications other thanperitonitis were 0.0% in both groups.By multiple logistic regressionanalysis, diabetes mellitus was the only independent variable thatentered into the best predictive equation over the development ofpost-colonoscopy peritonitis but not antibiotic use. CONCLUSIONS: Conclusion: The overall risk of peritonitis in the studied populationis 8.7%. It seems that there is no correlation between the groupwho received intraperitoneal prophylactic ceftazidime before theprocedure of colonoscopy and the group who had not received itin terms of protection against peritonitis post colonoscopy. Only oldage, diabetes mellitus and low serum albumin appear to be of significance. Polypectomy; partial or complete did not increase peritonitisepisodes in our study population. FP560 PROACTIVE PD+HD COMBINATION INTRODUCTION: A PRELIMINARY REPORT ON A NOVEL HIGHLY EFFICIENT STRATEGY FOR RENAL REPLACEMENT THERAPY Atsushi Ueda 1 , Aki Hirayama 2 , Kei Nagai 3 , Kunihiro Yamagata 3 1 University of Tsukuba Hospital Hitachi Society Collaborative Education Research Center, Hitachi, Japan, 2 Tsukuba University of Technology, Tsukuba, Ibaraki Prefecture, Japan, Japan and 3 University of Tsukuba, Tsukuba, Ibaraki Prefecture, Japan, Japan INTRODUCTION: Conventional peritoneal dialysis (PD) + hemodialysis (HD) therapy as a rescue option, introduced in PD patients with reduced residual renal function (RRF), has provided a lot of benefits to patients in comparison to PD-only therapy. However, the disadvantage of conventional PD+HD therapy is that the RRF rapidly and completely diminishes and the therapy has to be shifted to HD only. We performed PD+HD therapy at the beginning of renal replacement therapy as a proactive (Px) option. In order to clarify the significance of Px PD+HD combination introduction, RRF, several laboratory findings, and PD technical survival were examined and compared with PD introduction. METHODS: Twelve PD-introduced patients (PD group) and nine Px PD+HD- introduced patients (Px PD+HD group) were included in the study. The observation period was 6 months before and 12 months after the start of dialysis treatment. Evaluation items were urine volume, creatinine clearance, serum albumin, serum b 2 microglobulin (MG), serum phosphate, and PD technical survival. Patients with treatment duration of less than 6 months were excluded. RESULTS: The urine volume in the PD group decreased 12 months after the start of dialysis; on the contrary, urine volume in Px PD+HD group remained stable until 12 months later. The creatinine clearance in both groups declined gradually over 12 months; however, the decline in the Px PD+HD group maintained a much slower pace compared with the PD group. Serum albumin in the PD group reduced rapidly, but that in the Px PD+HD group showed no significant change. After examining the PD technical survival, the Px PD+HD therapy was effective for a longer period of time in comparison to PD-only therapy. CONCLUSIONS: Even in this short-term study of one year, the Px PD+HD has been proved to be superior in urine volume preservation and PD technical survival when compared with PD introduction group. The Px PD+HD therapy is a novel treatment that overcomes the reduction of RRF, which is a disadvantage of conventional PD+HD combination therapy. Therefore, Px PD + HD therapy should be considered as the initial renal replacement therapy. FP561 INFLUENCE OF DIALYSATE TEMPERATURE ON CREATININE PERITONEAL CLEARANCE IN PERITONEAL DIALYSIS PATIENTS Francesco Fontana 1 , Chiara Torelli 1 , Silvia Giovanella 1 , Giulia Ligabue 1 , Gaetano Alfano 1 , Gianni Cappelli 1 1 University of Modena and Reggio Emilia, Modena, Italy INTRODUCTION: It is common practice to encourage patients on continuous ambulatory peritoneal dialysis (PD) to warm dialysate to 37  C before peritoneal infusion; main international PD guidelines do not provide specific recommendation on this topic. Patients generally warm dialysate batches partially or do not warm them at all; at our center, mean measured infusion temperature was 31  C. Warming of dialysate is a time-consuming procedure, not free from potential risks (i.e. degradation of glucose), and should be justified by a clear clinical benefit. METHODS: We designed a single blind randomized controlled trial where 18 stable PD patients were randomized to receive a peritoneal equilibration test either with dialysate at a controlled temperature of 37  C (intervention group) or with dialysate warmed with conventional methods (control group). Primary end-point was a higher peritoneal creatinine clearance in patients in the intervention group. Secondary end- points were: higher urea clearance, higher creatinine and urea mass transfer area coefficient (MTAC), lower abdominal discomfort in the intervention group, differences in blood pressure and body temperature between groups. Dialysate temperature was checked before infusion; blood pressure and body temperature were monitored during the exchange; abdominal discomfort was assessed through a specific questionnaire. RESULTS: As expected, there was a statistically significant difference in dialysate temperature between the intervention and control group; other relevant patients’ characteristics were not significantly different between groups. Patients in the intervention group did not show a significantly higher peritoneal creatinine clearance when compared to the control group (6.38 6 0.52 ml/min vs 5.65 6 0.37 ml/min, p=0.2682). Similar results were obtained for urea peritoneal clearance (8.28 6 0.31 ml/ min in the intervention group and 8.92 6 0.45 ml/min in the control group, p=0.2561), MTAC creatinine (22.05 6 1.69 ml/min in the intervention group and 22.66 6 2.03 ml/min in the control group, p=0.8199) and MTAC urea (10.66 6 1.77 ml/min in the intervention group and 8.82 6 1.08 ml/min in the control group, p=0.3781). There were no significant differences in total abdominal discomfort questionnaire score, blood pressure and body temperature between the two groups. CONCLUSIONS: An increase in temperature in the peritoneal cavity could theoretically lead to local microcirculatory vasodilation, increasing the total pore area and eventually solute transport. In our randomized study treatment with dialysate at 37  C failed to meet the primary end-point of superior peritoneal creatinine clearance compared to current clinical practice. Urea peritoneal clearance and peritoneal MTACs for urea and creatinine were also not different between intervention and control groups. These relatively unexpected results could be related to the shortness of temperature effects on microcirculation and to the influence of factors other than blood flow transport in small solutes peritoneal clearances (i.e., the action of peritoneal interstitium). No significant difference in blood pressure, body temperature and scores of the abdominal discomfort questionnaire were detected between groups. Using peritoneal dialysate at different temperatures without causing significant side effects or discomfort to patients appears feasible. We report a lack of benefit of warming peritoneal dialysate to 37  C; future PD guidelines should not reinforce this recommendation. FP562 PERITONITIS IN THE FIRST TWO YEARS ON PERITONEAL DIALYSIS: ARE THERE ANY PREDISPOSING FACTORS? Filipe Mira 1 , Margarida Marques 2 , Maria Teresa Mendes 1 , Ana Galv~ ao 3 , Pedro Maia 1 , Rui Alves 3 1 Centro Hospitalar E Universitario De Coimbra, E.P.E., Coimbra, Portugal, 2 Coimbra University Hospital, Coimbra, Portugal and 3 Coimbra University, Coimbra, Portugal INTRODUCTION: Peritoneal dialysis (PD) is a renal substitution therapy with a prevalence of 5.8% in Portugal. It has clear advantages in the patient’s quality of life, preserving vascular access, renal residual function and reducing the economic weight upon our Health System. Peritonitis is one of the most common complications of this technique and is associated with technique failure and hospitalization to undergo intra-abdominal treatment. Identifying predictors of susceptibility to peritonitis is crucial to reduce the risk and allow for faster action. Intra-peritoneal cancer antigen 125 (CA 125) is used as a biomarker that represents the mass of mesothelial cells in a patient on PD which are thought to be involved in local host defense. Objectives: Find the relationship between intra-peritoneal CA 125, peritoneal protein excretion (PPE) and transporter type with peritonitis in the first 2 years on PD. doi:10.1093/ndt/gfz106 | i233 Nephrology Dialysis Transplantation Abstracts Downloaded from https://academic.oup.com/ndt/article/34/Supplement_1/gfz106.FP562/5515616 by guest on 22 February 2023