Kidney Week

Abstract: TH-PO166

Associations Between Serum Phosphate, Kt/V, and Creatinine Clearance Among Peritoneal Dialysis Patients: Preliminary Analysis From the PD-MONDO Initiative

Session Information

• CKD-MBD: Targets and Outcomes
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 402 Bone and Mineral Metabolism: Clinical

Authors

• Guedes, Murilo Henrique, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil

Murilo Henrique Guedes,

• Diaz Bessone, Maria Ines, Fresenius Medical Care, Buenos Aires, Argentina

Maria Ines Diaz Bessone,

• Chan, Lili, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Lili Chan,

• Mermelstein, Ariella E., Renal Research Institute, New York, New York, United States

Ariella E. Mermelstein,

• De la torre quiroga, Andres E., Hospital Civil de Guadalajara, Guadalajara, Jalisco, Mexico

Andres E. De la torre quiroga,

• Farrell, Douglas R., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Douglas R. Farrell,

• Peters, Vincent, Catharina Hospital Eindhoven, Eindhoven, Netherlands

Vincent Peters,

• Konings, Constantijn, Catharina Hospital Eindhoven, Eindhoven, Netherlands

Constantijn Konings,

• Garcia-Garcia, Guillermo, Hospital Civil de Guadalajara, Guadalajara, Jalisco, Mexico

Guillermo Garcia-Garcia,

• Raimann, Jochen G., Renal Research Institute, New York, New York, United States

Jochen G. Raimann,

• Guinsburg, Adrian M., Fresenius Medical Care, Buenos Aires, Argentina

Adrian M. Guinsburg,

• Moraes, Thyago Proença de, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil

Thyago Proença de Moraes,

• Kotanko, Peter, Renal Research Institute, New York, New York, United States

Peter Kotanko,

• Uribarri, Jaime, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Jaime Uribarri,

Background

Serum phosphate (PO) control requires adequate dialysis, yet commonly used biomarkers of dialysis adequacy (Kt/V) may underestimate PO removal in peritoneal dialysis (PD) patients. We sought to explore if creatinine clearance (CrCl), in addition to Kt/V, yields a better prediction of PO in PD patients.

Methods

We performed a cross-sectional analysis of multiple cohorts of incident PD patients – Fresenius Medical Care Latin America (FMC-LATAM), Renal Research Institute (RRI), Mount Sinai Hospital, Hospital Civil Guadalajara, and the BRAZPD cohort. We extracted the first available PO, Kt/V, and CrCl after 90 days of PD start. We fit separate linear regression models between PO, CrCl, and Kt/V, adjusting for predictors of PO. We computed log-likelihood ratio tests (LRT) for the models with and without CrCl. Pooled estimates between datasets were summarized by conducting a meta-analysis using random effects.

Results

16.814 patients were included. Across data sets, median age (max,min) was 56 (60,45), 55% male (50,62); Kt/V and CrCl were 2.1 (1.7,2.5) and 77 (57,96) L/week, respectively. Phosphate binder use was 70% across datasets. In most datasets, Kt/V and CrCl were inversely associated with PO in the models adjusted for age, sex, PO binder use, and normalized protein catabolic rate (nPCR) (Figure) The pooled results confirmed the findings, despite high heterogeneity. Adding CrCl to the Kt/V provided additional information for PO prediction in the largest datasets (LRT p<0.01 for FMC-LATAM and RRI).

Conclusion

In this international study of incident PD patients, Kt/V and CrCl were inversely associated with PO. CrCl provided extra information for PO prediction, suggesting that both CrCL and Kt/V could be used to monitor dialysis adequacy in PD patients.

Random effects meta-analysis of the associations between PO, CrCl, and Kt/V. Models adjusted for age, sex, PO binder use, and nPCR.