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Kidney Week

Abstract: SA-PO727

Carbamylated Albumin Predicts Mortality in Peritoneal Dialysis (PD) Patients

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

  • Li, Yang, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
  • Liu, Dongyang, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
  • Jiang, Lanping, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
  • Liu, Jie, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
  • Zhou, Zijuan, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
  • Wang, Haiyun, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
  • Wang, Ying, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
  • Li, Xuemei, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
  • Hu, Pei, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
  • Kalim, Sahir, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Chen, Limeng, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
Background

Carbamylation is a posttranslational protein modification mediated by cyanate, the dissociation product of urea, which increases in patients with kidney dysfunction. Recently, carbamylated albumin (C-Alb) was reported to be independently associated with mortality in maintenance hemodialysis patients, but its value in peritoneal dialysis populations has not been studied yet. We employed high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) to measure C-Alb levels and analyze its association with mortality in PD patients.

Methods

We collected serum samples from 114 maintenance adult PD patients at a single university medical center between July 2010 and January 2011, following them until December 2016 (mean length of follow up was 39.6 ± 25.6 months). C-Alb levels were natural log-transformed, and then divided into two groups (high and low levels) according to the cut-off value with highest Youden Index in ROC curve for death. Multifactor Cox regression models were used to analyze the association between C-Alb and death.

Results

The average age of the PD cohort was 63.6±13.3 years, 51% were female, and the average dialysis vintage at baseline was 37.4±29.8 months. The primary causes of ESRD were diabetic nephropathy (DN, 31.6%), hypertensive nephrosclerosis (30.7%) and chronic glomerulonephritis (20.2%). After 6 years follow up, 66 patients died (57.9%), mainly due to cardiovascular events (50.0%). Those who died were older (69.6±10.3 vs. 55.3±12.6, P<0.001), had a higher proportion of DN (40.9% vs. 18.8%, P=0.012), cardiovasular comorbidities (27.3% vs. 6.2%, P=0.004) and hypoalbuminema (Alb<35g/L) rate (63.6% vs. 43.8%, P=0.035). The Kaplan-Meier analysis showed a worse survival rate for PD patients with higher C-Alb level (Log-Rank Test: P=0.017). The univariate Cox regression analysis showed that higher C-Alb levels were associated with death. After adjusting for other important or significant mortality predictors in this cohort including age, gender, DN and cardiovasular comorbidities, higher C-Alb levels (HR=1.763, 95% CI 1.032-3.014, P=0.038) remained an independent risk factor for death in PD patients.

Conclusion

For the first time, we report higher C-Alb level was an independent risk factor for mortality in PD patients confirming similar observations in hemodialysis cohorts.