Kidney Week

Abstract: TH-PO383

A Fast Decline of Residual Renal Function in the First Year Is a Predictor for Early Withdrawal from Peritoneal Dialysis in Non-Diabetic Patients

Session Information

• Dialysis: Peritoneal Dialysis - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 703 Dialysis: Peritoneal Dialysis

Author

• Han, Fei, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, ZheJiang, China

Fei Han,

Background

Little is known about the relationship of residual renal function (RRF) decline in early period with survival in peritoneal dialysis (PD).

Methods

Total of 567 patients who began PD between January 1, 2005, and June 30, 2013 was investigated. The rate of decline of RRF was determined by the “slope of the trend equation” of serial RRFs. A composite end-point of all-cause mortality and transfer to hemodialysis was used, survival status was censored on June 30, 2016.

Results

The median of “the slope of RRF decline equation” was 0.308 (0.001-2.111) mL/min/1.73 m²/month. In the median follow-up period of 43 months (12 to 120 months), 65 patients died, 90 patients transferred to HD, and 171 patients underwent kidney transplantation. Male, high baseline RRF, high baseline peritoneal Kt/V urea, low serum albumin and low uric acid were independently associated with the rate of RRF in the first year of PD. RRF decline in the first year remained a predictor of composite end-point (HR, 2.74, P =0.001). When the patients were divided into high RRF decline group (>0.308 mL/min/1.73m²/month) and low RRF decline group (≤0.308 mL/min/1.73m²/month) at the first three years of PD period, end-point events incidence was higher in high RRF decline group (23.2%) than in low RRF decline group (11.0%) (log-rank test P < 0.001). There were 189 patients in low RRF decline group and 171 patients in high RRF decline group maintaining PD for more than 3 years, in a median follow-up of 54 months (range 37 to 120 months), no significant difference of survival was observed (30.9% in high group vs 46.4% in low group, log-rank test P=0.883). In high RRF decline group, there were 92 patients reaching composited end-point and 112 patients maintaining PD; multivariate Cox regression model showed high peritoneal Kt/V urea after 1 year of PD period and high albumin level were the protective factor for composite end-point (HR, 0.29, P = 0.001; HR, 0.94, P=0.022, respectively), while fast RRF decline remained the risk factor for composite end-point (HR, 3.28, P=0.004 ).

Conclusion

A faster RRF decline in the first year was a predictor for all-cause mortality and transfer to hemodialysis in non-diabetic PD patients, mainly in the first three year. For patients with faster RRF decline, increase the PD dose was effective to improve survival.