Abstract: TH-OR097

New Overhydration Definition and Mortality Risk Assessment in Automated Peritoneal Dialysis Mexican Patients

Session Information

  • Peritoneal Dialysis
    November 02, 2017 | Location: Room 290, Morial Convention Center
    Abstract Time: 06:18 PM - 06:30 PM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Arriaga, Julio Cesar, Instituto Nacional de Cardiologia Ignacio Chavez, Tlalpan, Distrito Federal, Mexico
  • Leal, Gabriela, Instituto Nacional de Cardiología, México, Mexico
  • Moguel, Bernardo, Instituto Nacional de Cardiologia, Mexico City, Coyoacan, Mexico
Background

CKD prevalence in Mexico is about 33% and peritoneal dialysis (PD) represents 66% of renal replacement therapy. Overhydration assessment with bioimpedance in APD patients may be a key point predictor for mortality.

Methods

We analyze an APD cohort of 64 Mexican patients. Anthropometric, blood and nutritional profiles, time in APD, dialysis prescription, use of medication and bioimpedance analysis was assessed and reported as the average of 3 repeated samples during the last 6 months. Inclusion criteria were age ≧18 years, clinical and biochemical stability and adherence to dialytic therapy. Patients with other systemic comorbidities were excluded. Edema index (Ei) was defined as ECW/TBW (extracellular water/ total body water) ≧0.385 and phase angle (Pa)〈4.8. Euvolemic and overhydrated groups were compared in mortality, regression, correlation and risk factor analysis.

Results

Mean age was 38.9 ±15 years. BMI was normal in half of the patients; 43 patients were overhydrated and 21 euvolemic, we observed significant differences between groups (p〈0.05) for Ei, Pa, albumin, residual urine volume and RDW. Survival analysis at 48 months was 100% for euvolemic arm and 79.1% for overhydrated patients (p=0.05). Regression model showed an r2= 0.6. Correlation coefficient analysis for overhydration was 0.85 for Pa and 0.52 for low albumin both with p〈0.05. Risk factors for mortality were Ei OR=1.26 (IC 1.08-1.47), Pa〈4.8 OR=6.13 (IC 1.16-32.3), albumin 〈3.5 OR=5.8 (IC 1.29-26.5), Age ≧50 years OR=5.0 (IC 1.15-21.7) and RDW ≧14.5% OR=1.38 (1.12-1.69).

Conclusion

Bioimpedance analysis is a practical, useful, cheap, easy and relevant evaluation that impacts on mortality. Cut point values for Mexican PD population (Ei=0.385 and Pa=4.8) are proposed as a new overhydration definition in stable normotensive and non-clinical edema patients. Overhydration, albumin and RDW model predicts 60% of mortality risk in this population.