Abstract: TH-PO874
Peritoneal Dialysis Is Associated with Lower Mortality Compared to Hemodialysis in Patients with Low Serum Albumin
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
- Waheed, Sana, University of Wisconsin School Of Medicine and Public Health, Madison, Wisconsin, United States
- Astor, Brad C., University of Wisconsin, Madison, Wisconsin, United States
- Singh, Tripti, None, Madison, Wisconsin, United States
Background
Low serum albumin is associated with high mortality in patients on chronic dialysis. Clinicians are reluctant to offer peritoneal dialysis (PD) as an option for dialysis for patients with low serum albumin due to concerns of loss of albumin with PD. We evaluated mortality based on dialysis modality in patients with low serum albumin (<2.5 gm/dL)
Methods
We analyzed USRDS data from 2010-2015 to assess mortality by modality type adjusted for age, sex, race, employment, comorbidities and the year of dialysis initiation.
Results
Low serum albumin (<2.5 gm/dL) was present in 78,625 (19.9%) of 395,656 patients. Those with low serum albumin were less likely to use PD as their first modality than those with higher albumin (3.1% vs. 10.9%; p<0.001). Use of PD was associated with lower mortality compared to HD (hazard ratio [HR]= 0.86, 95% CI 0.80-0.93, p< 0.05) in patients with low serum albumin. This difference was more pronounced in patients who had glomerulonephritis (HR= 0.70) or hypertension (HR=0.79) than in those with end-stage renal disease (ESRD) due to diabetes mellitus or other causes [Table 1].
Conclusion
PD is associated with lower mortality than HD in patients with low serum albumin. Therefore, it is of concern that the rate of PD utilization is lower in these patients. We recommend advocating the use of PD in patients with low serum albumin as is associated with a lower mortality rate.
Table 1: Hazard ratio for mortality associated with PD compared to HD in patients with low serum albumin, by cause of ESRD
| Cause of ESRD | HR (PD/HD) | CI (95%) | P-interaction |
| Glomerulonephritis | 0.70 | 0.54-0.92 | Reference |
| Hypertension | 0.79 | 0.64-0.97 | 0.53 |
| Diabetes Mellitus | 0.92 | 0.83-1.02 | 0.04 |
| Others | 1.03 | 0.85-1.25 | 0.01 |
| Overall | 0.86 | 0.8-0.93 |