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Abstract: TH-PO382

Baseline Echocardiographic Parameters Predict Mortality in Peritoneal Dialysis Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Orihuela, Rodolfo Mario, Hospital Central Militar, Ciudad de México, Ciudad de México, Mexico
  • Bahena, Lucino, Hospital central militar, México, DF, Mexico
  • Cruz, Rocio Blazquez, Hospital Central Militar, Mexico City, Mexico
  • Correa-Rotter, Ricardo, Institutor Nacional de la Nutricion, Mexico City, Mexico
  • Morales-Buenrostro, Luis E., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CIUDAD DE MEXICO, Mexico
  • Cohen-Bucay, Abraham, Boston University Medical Center, Boston, Massachusetts, United States

Group or Team Name

  • Departamento de Nefrología Hospital Central Militar
Background

Patients with end-stage renal disease (ESRD) have high mortality rates and the leading cause of death is CV disease. Multiple baseline factors including age, comorbidities and frailty, have been associated with higher mortality risk. Here we evaluate the prognostic value of baseline echocardiographic structural and functional cardiac abnormalities in incident peritoneal dialysis (PD) patients.

Methods

Prospective cohort study of patients with CKD5 that started PD between 2014 and 2016 at Hospital Central Militar in Mexico City, Mexico. A bi-dimensional transthoracic echocardiogram was performed within 7-14 days before starting PD. The primary objective was to correlate structural and functional echocardiographic parameters with the primary outcome of death by any cause.

Results

We included 138 patients, 44.9% were male, median age 52.3 +/- 15.3, the cause of ESRD was DM in 71%. During a median follow up of 26.8 months 73 patients (52%) died, with a median survival of 30.8 months. In univariate analysis we identified age (p=0.001), DM (p=0.001), residual urine volume (RUV) (p,0.001), serum albumin (p<0.001) and B-type natriuretic peptide (BNP) (p=0.001) as risk factors for mortality. By Kaplan-Meier method we identified the following echocardiographic parameters to be correlated with higher mortality: left atrium volume >20 (p=0.007), mitral insufficiency (p=0.001), LV ejection fraction (EF) <53% (p=0.017), LV hypokinesis (p=0.001) and diastolic dysfunction with a restrictive pattern (p<0.001). Multivariate analysis identified age >50y (OR=2.05, p=0.046), gender (OR=0.53, p=0.010), RUV (OR=0.99, p=0.002), LV EF (OR=0.97, p=0.042), and diastolic dysfunction with a restrictive pattern (OR=3.08, p=0.003) as independent risk factors for mortality.

Conclusion

Baseline echochardiogram (lower LV EF and diastolic dysfunction) at dialysis initiation is a strong predictor of mortality in PD patients, in particular in those with DM. We hereby confirm high mortality rate in patients that start PD, and the previously reported correlation of age, gender, and RUV with mortality.