Background Peritonitis is a major complication and the main cause of peritoneal dialysis (PD) failure. The aim of the present study was to evaluate peritonitis risk factors and its prevention with a new peritoneal educational program (NPEP). Methods We performed a retrospective analysis of a cohort of chronic PD patients, older than 16 years, who began PD in the period 1 January 1999 to 31 December 2015 at a Uruguayan PD center, with follow-up until 31 December 2016. Results The population included 222 cases (219 patients, 128 men), median age 59 (interquartile range [IQR] 47.0 – 72.0) years, median time on PD 17.5 (IQR 6.0 – 36.2) months. Ninety-five patients suffered 1 or more episodes of peritonitis, and they had been on PD for a longer period and had nasal-positive culture more frequently. A NPEP started in September 2008; patients who trained with it, as well as younger patients, had longer peritonitis-free survival. After the NPEP, global peritonitis rates decreased significantly (from 0.48 to 0.29 episodes/patient-year, respectively), particularly gram-positive bacteria and Staphylococcus aureus / coagulase-negative (CoNS) (from 0.26 to 0.12 and 0.21 to 0.07 episodes/patient-year, respectively). In the multivariate Cox analysis of peritonitis risk factors, survival to first peritonitis was significantly associated only with age (hazard ratio [HR] 1.024, 95% confidence interval [CI] 1.007 – 1.397, p = 0.007) and the NPEP (HR 0.600, 95% CI 0.394 – 0.913, p = 0.017). Conclusion A multidisciplinary peritoneal educational program may improve peritonitis rates, independently of other risk factors.

BackgroundThe serological test included in the classification for antiphospholipid syndrome are: IgG, IgM antibodies to cardiolipin (aCL), β2-glycoprotein (anti-β2GPI) and the lupus anticoagulant (LA). Among these antiphospholipid (aPL) antibodies, LA is considered the strongest risk factor for thromboembolic events and triple positivity of antiphospholipid antibodies (aPL)(Lupus anticoagulant /LA), aCL and antiβ2GPI) are at the highest risk for thrombosis recurrence and obstetric complications, even while on anticoagulant therapy.ObjectivesTo analyze the role of 4 antiphospholipid antibodies in thrombotic recurrence of patients with antiphospholipid syndrome (APS).MethodsIn a cross-sectional study, we included patients with established diagnosis of APS from 1996 to 2014. The clinical files were reviewed and we obtained demographic, clinical, and treatment data. Blood samples were taken to determine titers of aPL: aCL, anti anexin 5 (anti A5), antiβ2GPI IgG and IgM by ELISA method, and LA in plasma by the coagulation method.Results70 APS patients were studied, 56 females and 14 males, 67 with primary APS and 3 with associated APS. The mean age was 44±12.9 years (range 18-77 years) mean disease evolution 10.8±5.8 years, thrombosis recurrence was observed in 38 patients (53.5%) and 33 patients without thrombosis recurrence (46.5%); 67 patients treated with traditional oral anticoagulants, 47 (66%) had venous thrombosis,12 (17%) had arterial thrombosis and10 (14%) had venous and arterial thrombosis. Prevalence of aPL was: 35 for IgG aCL (49.3%), 21 for IgM aCL (29.6%), 36 for IgG antiβ2GPI (50.7%), 12 for IgM antiβ2GPI (15.5%), 3 for IgG antiA5 (4.2%), 5 for IgM anti A5 (7%) and 34 for LA (46.5%), 25 patients had triple positivity for aPL (35.2%.) and 16 patients had at time of study a negative aPL profile, even though some of them had thrombosis recurrence and aPL positive in the past. Regression analysis for all aPL and thrombosis recurrence showed an OR of 7.3 CI 95%=1.19-45.1) for LA (p=0.03)ConclusionsOur study confirm that LA seems to be the most important aPL, which presence confers a major risk of thrombosis recurrence. Careful follow-up of patients with persistence of LA should be recommended to avoid thrombosis recurrence. A negative “traditional” aPL profile seems to be not an indication for stop anticoagulation.ReferencesForastiero R. Multiple antiphospholipid antibodies positivity and antiphospholipid syndrome criteria re-evaluation. Lupus. 2014 Oct;23(12):1252-4.Hernández-Molina G, Espericueta-Arriola G, Cabral AR.The role of lupus anticoagulant and triple marker positivity as risk factors for rethrombosis in patients with primary antiphospholipid syndrome. Clin Exp Rheumatol. 2013 May-Jun;31(3):382-8.Disclosure of InterestNone declared