Uribarri, Jaime

Measuring intraperitoneal pressure (IPP) has been proposed as a means to help maintain optimal ultrafiltration and prevent complications such as hernias, peritoneal leaks, and gastroesophageal reflux, which are linked with high IPP levels. The Durand method is a commonly accepted method for measuring IPP; however, it is cumbersome and not routinely used in clinics due to its complexity. Here we report the outcome of a pilot study that evaluated the agreement between IPP measured using an in-line pressure transducer and IPP measured using the Durand method during in-clinic automated peritoneal dialysis (APD) therapy. This was an exploratory, descriptive, early feasibility study conducted among patients with a diagnosis of kidney failure who were on APD therapy. IPP was continuously measured using an investigational device (x-MIP transducer) and at fixed timepoints using the Durand method. The study included 10 patients with a median age of 47.0 years and a median body mass index of 28.1 kg/m 2 . The study population was predominantly female, comprising 70% of the participants. The transducer IPP showed a moderate agreement with manual IPP, as most differences in measurements were within ±3 cmH 2 O. Overall, IPP did not correlate with fill-volume. However, when examined on a per-patient level, six patients showed stronger correlations ( ρ > 0.7) between IPP and fill-volume, while the remaining four patients had weaker correlations ( ρ < 0.5). No safety concerns were identified in the study. In summary, this study indicates that a transducer-based IPP measurement device could serve as an alternative to the Durand method.

Background: Dietary advanced glycation end-products (AGEs) are linked to cognitive decline. However, clinical trials have not tested the effect of AGEs on cognition in older adults. Objective: The aim of the current pilot trial was to examine the feasibility of an intervention to reduce dietary AGEs on cognition and on cerebral blood flow (CBF). Methods: The design is a pilot randomized controlled trial of dietary AGEs reduction in older adults with type 2 diabetes. Seventy-five participants were randomized to two arms. The control arm received standard of care (SOC) guidelines for good glycemic control; the intervention arm, in addition to SOC guidelines, were instructed to reduce their dietary AGEs intake. Global cognition and CBF were assessed at baseline and after 6 months of intervention. Results: At baseline, we found a reverse association between AGEs and cognitive functioning, possibly reflecting the long-term toxicity of AGEs on the brain. There was a significant improvement in global cognition at 6 months in both the intervention and SOC groups which was more prominent in participants with mild cognitive impairment. We also found that at baseline, higher AGEs were associated with increased CBF in the left inferior parietal cortex; however, 6 months of the AGEs lowering intervention did not affect CBF levels, despite lowering AGEs exposure in blood. Conclusion: The current pilot trial focused on the feasibility and methodology of intervening through diet to reduce AGEs in older adults with type 2 diabetes. Our results suggest that participants with mild cognitive impairment may benefit from an intensive dietary intervention.

Introduction: High serum concentrations of advanced glycation end-products (AGEs) in older adults and diabetics are associated with an increased risk of cognitive impairment. The aim of this pilot study was to assess the feasibility of long-term adherence to a dietary intervention designed to decrease intake and exposure to circulating AGEs among older adults with type 2 diabetes. Methods: Herein, 75 participants were randomized to either a standard of care (SOC) control arm or to an intervention arm receiving instruction on reducing dietary AGEs intake. The primary outcome was a change in serum AGEs at the end of the intervention. Secondary and exploratory outcomes included adherence to diet and its association with circulating AGEs. Cognitive function and brain imaging were also assessed but were out of the scope of this article (ClinicalTrials.gov Identifier: NCT02739971). Results: The intervention resulted in a significant change over time in several serum AGEs compared to the SOC guidelines. Very high adherence (above 80%) to the AGE-lowering diet was associated with a greater reduction in serum AGEs levels. There were no significant differences between the two arms in any other metabolic markers. Conclusions: A long-term dietary intervention to reduce circulating AGEs is feasible in older adults with type 2 diabetes, especially in those who are highly adherent to the AGE-lowering diet.