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Kidney Week

Abstract: SA-PO700

Are Peritoneal Protein Losses Related to Peritonitis Risk in Patients on Peritoneal Dialysis?

Session Information

  • Peritoneal Dialysis - II
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Rodrigues, Sara Sousa, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal
  • Santos, Clara, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal
  • Gomes, Ana Marta, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal
  • Fernandes, Joao Carlos, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal
Background

Peritoneal protein losses (PPL) are an inevitable process on peritoneal dialysis (PD). Few studies have supported a positive correlation between PPL and infections or general morbility and mortality. The aim of this study was to investigate whether baseline PPL (bPPL) was a risk factor of peritonitis in PD patients.

Methods

We retrospectively studied all incident PD patients in our center during the last 9 years. bPPL, serum hemoglobine (Hb) and albumin (alb) and other relevant analytic and clinical data were recorded at baseline. Number and timing of peritonitis episodes were registered. Patients were distributed by 3 groups of bPPL (group 1: <4,5 gr/day, group 2: 4,5-9gr/day and group 3: >9gr/day) in order to compare their peritonitis risk.

Results

104 patients were included, 54% male, median age: 57 years, median follow-up: 29 months. Group 3 patients had lower baseline hb and alb (p=0.03 and p 0.02). Higher bPPL patientes had a greater chance of having at least one peritonitis (group 3:72%, group 2:69%, group 1:39%, p=0.02) and removal of the PD catheter by PD related infection was higher (group 3:74%, group 2:47%, group 1:19%, p=0.01). bPPL was shown to be an independent predictor after adjustment for age, sex and diabetes (p=0.02). Time until the first peritonitis was shorter in higher bPPL groups (p=0.02) and, after adjustment for covariates, group 3 maintained a significant higher risk of peritonitis over group 1 (HR 2.38, p=0.04). bPPL and age significantly increased the absolute number of peritonitis during the follow-up (p=0.03 and p=0.02). No difference was observed in mortality as well as in the occurrence of severe non-PD related infections between groups.

Conclusion

Higher bPPL were able to independently predict risk for peritonitis, reflecting its impact on the morbidity of PD patients. The association between higher bPPL with lower basal serum alb and hb may highlights the hypothesis that bPPL can be a marker of disease severity at the onset of PD, possibly being related to a malnutrition and pro-inflammatory state. It would be useful to explore these effects prospectively and understand the underlying mechanisms in future. This could include a better characterization of the type of protein loss and its quantification of immunoglobulins, which could theoretically explain the higher infectious risk.