Abstract: FR-PO516
Effect of Switching Dialysis Modalities on Metabolic and Nutritional Parameters: Analysis from USRDS
Session Information
- Peritoneal Dialysis: Modality, Catheter, Infections
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Peritoneal Dialysis
Authors
- Abifaraj, Farah, University of Texas Medical Branch , Galveston, Texas, United States
- Aleter, Omar A., University of Texas Medical Branch , Galveston, Texas, United States
- Hsu, Enshuo, University of Texas Medical Branch , Galveston, Texas, United States
- Badalamenti, John, University of Texas Medical Branch, Dickinson, Texas, United States
- Kassem, Hania, University of Texas Medical Branch , Galveston, Texas, United States
Background
The effect of renal disease and the two dialysis modalities (hemodialysis (HD), and peritoneal dialysis (PD)) on metabolic and nutritional parameters has been well-studied. Compared to HD, PD is associated with low parathyroid hormone and calcium (Ca) levels, low albumin (alb) and increased BMI. In 2011, the prospective payment system dialysis bundle provided incentive for providers to place patients (pts) on PD, leading to more pts switching from HD to PD. To our knowledge, the impact of switching modalities on these parameters has not been described. We aim to elucidate the effect of switching dialysis modalities and the direction of the switch on metabolic and nutritional parameters in end-stage renal disease (ESRD) pts.
Methods
Using USRDS data, we reviewed 2,955,601 pts and analyzed 16,203 pts who switched modalities from 2012 to 2016. Pts were included if they were age >18, were switched from HD to PD or PD to HD after being on the first modality for at least 2 months, and had data available in Crownweb records before and after switch. Transplant pts and pts who switched modalities more than once during the research period were excluded. After excluding data for the last 3 months of the first modality and the first 3 months of the second, we used t-test to compare average Ca, phos, alb, BMI, and normalized protein catabolic rate (NPCR). We further used linear models to show differences between the two groups, adjusting for demographics and time on first modality.
Results
In both groups, phos and Ca increased after switch.
In the HD to PD group, alb decreased (0.25mg/dL) and BMI increased (0.42kg/m2); NPCR did not change significantly.
In the PD to HD group, alb (0.26) and NPCR (0.06) increased, though BMI decreased (2.1kg/m2).
Compared to HD to PD switch patients and after adjusting for demographics and time on initial dialysis modality, PD to HD pts had higher phos (0.15mg/dL), Ca (0.09mg/dL), alb (0.41mg/dL), and NPCR (0.07g/kg/d), and lower BMI (2.23 kg/m2). All results were significant (p<0.0001).
Conclusion
Regardless of the direction of the switch, HD was associated with a higher alb and lower BMI. After adjusting for demographic variables and time on initial dialysis, switching from HD to PD results in lower phos, Ca, alb, but higher BMI than PD to HD pts.