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Abstract: PO1294

Fatigue Predicts Higher Risk of Mortality in Peritoneal Dialysis Patients: A BRAZPD Analysis

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Guedes, Murilo Henrique, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil
  • Wallim, Liz Ribeiro, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil
  • Guetter, Camila R., Universidade Federal do Parana, Curitiba, PR, Brazil
  • Larkin, John W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Mysayphonh, Chance, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Jiao, Yue, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Pecoits-Filho, Roberto, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil
  • Moraes, Thyago Proença de, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil
Background

End-stage kidney disease (ESKD) patients are often burdened by fatigue. Fatigue is a core outcome to peritoneal dialysis (PD) patients and providers, but its associations with clinical outcomes are unknown. We analyzed a nationally representative cohort of PD patients to test the hypothesis that higher fatigue independently associates with higher mortality risk.

Methods

We analyzed data from adult patients in BRAZPD, a nationwide Brazilian cohort across 122 PD centers. Patients incident to PD with complete KDQOL-SF survey in the first 90 days of dialysis were included. Fatigue was defined by the vitality subscale in four subgroups: >50 (high vitality), ≥40 to ≤50 (moderate vitality), >35 to <40 (moderate fatigue), ≤35 (high fatigue). We built four distinct models to estimate the association between fatigue and 12-month mortality: (i) Cox-proportional hazard model; (ii) competitive risk model accounting for technique failure events; (iii) multilevel survival analysis modeling clinic-level clusters; (iv) Cox regression with smoothing splines treating vitality as a continuous measure. Analyses were adjusted for age, comorbidities, residual kidney function (RKF), daily prescribed PD volume, and PD modality.

Results

We included data from 1,388 PD patients (mean age 58.5±15.47 years, 64% had RKF). Proportions of patients with high vitality, moderate vitality, moderate fatigue and high fatigue were 21%, 38%, 15% and 26%, respectively. Hazard-ratios (95%CI) for mortality estimated for the high vitality group (compared to high fatigue) were 0.39 (0.23-0.65), 0.41 (0.24-0.68) and 0.39 (0.22-0.68) for Cox, competitive risk and multilevel models, respectively. Results from the smoothing spline regression are shown in the Figure (B).

Conclusion

Higher fatigue in the initial months of PD was independently associated with 12-month mortality risk. Potential interventions targeting ESKD fatigue in PD patients may not only yield benefits in patient-reported outcomes but possibly also improve survival.