Abstract: TH-PO851

Fat Mass Monitoring in the Follow-Up of Peritoneal Dialysis Patients: Prognostic Value of Excessive Fat Gain

Session Information

  • Peritoneal Dialysis - I
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Kim, Jwa-kyung, Hallym University, Seoul, Korea (the Republic of)
  • Kim, Hyung jik, Hallym Univ. Sacred Heart Hospital, Anyang, Korea (the Republic of)
Background

Visceral obesity caused by fat accumulation is an important change in body composition among patients undergoing peritoneal dialysis (PD). Although a significant portion of patients become obese, its long-term effect is not clear and associated changes in peritoneal characteristics are also unknown.

Methods

In this prospective observational study, the prognostic value of excessive fat accumulation on technical failure rate and death was tested. Body composition monitoring was performed twice, 18.0 ± 6.0 months apart, and increment of percentage of body fat (delta_PBF, %) were used to predict long-term outcomes during the following 28.1 ± 8.5 months. Also, accompanying changes of peritoneal characterises with fat accumulation were evaluated by modified peritoneal equilibration test. Technical failure was defined as a transfer from PD to haemodialysis (HD).

Results

Among the 205 patients, 66.8% (N=137) and 59.5% (N=122) experienced BMI increase and PBF gain during the 18 months. The mean PBF was 24.5% and 35.3% at first test, and 25.9% and 37.0% at second test in men and women respectively. Excessive fat gain was defined as a delta_PBF over the gender-specific highest quartile (4.8% for men and 5.7% for women). However, lean mass was not significantly changed. Patients with excessive fat gain was more diabetic and had higher systolic blood pressure. Interestingly, they exprienced significantly higher rate of technical failure than those without excessive fat accumulation (90.5 cases vs. 22.4 cases per 1000 patient-year, p=0.002), but mortality was not affected. Even after adjusting the volume status and other comorbidities, excessive fat gain increased the risk of technical failure by 4.86-fold. Furthermore, with excessive fat gain, the peritoneal characteristics showed a tendency to change to a low transporter (p=0.013). However, mortality was not affected by the excessive fat gain.

Conclusion

Excessive fat gain during PD have an independent prognostic value for technical failure. Concomitant peritoneal membrane changes, decreased solute clearance in low transporter, may affect the higher rate of technical failure.

Funding

  • Private Foundation Support