Abstract: TH-PO337
Peritoneal Dialysis Outcomes in Severely Obese Patients: Single-Center Experience
Session Information
- Home Dialysis - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Nyabera, Akwe, The University of Texas at San Antonio, San Antonio, Texas, United States
- Ayah, Omar A., The University of Texas at San Antonio, San Antonio, Texas, United States
- Dande, Gabriela, The University of Texas at San Antonio, San Antonio, Texas, United States
- Lorio, Alexis, The University of Texas at San Antonio, San Antonio, Texas, United States
- Bansal, Shweta, The University of Texas at San Antonio, San Antonio, Texas, United States
Background
Peritoneal dialysis (PD) has been increasingly performed in obese end stage kidney disease patients (ESKD) with the rising prevalence of obesity. However, PD is still viewed as a relative contraindication in severe obesity and experience in this group is sparse.
Methods
In a retrospective study, we identified patients with body mass index (BMI)>40 kg/m2 from patients who initiated PD between 2014 and 2020 (n=99) at the University Hospital Home Dialysis Center. Charts were reviewed for clinical and laboratory variables to assess PD adequacy, technique, and patient survival. Date of last evaluation was March 2023.
Results
A total of nine patients (9%) had severe obesity with mean BMI 43.2±2.9 kg/m2, age 47.8±12.6 years, and 44% were female. The cause of ESKD was Diabetes Mellitus in eight and IgA nephropathy in one patient. PD catheter was placed percutaneously in six and surgically in three patients. None of the patients had pericatheter leak or poor healing. PD training was initiated within 7.4±11.4 days after catheter placement. The initial prescription involved on average 4±0.5 cycles over 8.7±1.1 hr at night, total volume 9.0±1.2 lt and three patients had a last fill of 1.67±0.24 lt. Adequacy (both clinical and weekly kt/v>1.7 using actual/adjusted weight) was achieved in every patient using incremental PD. After an average of 17.7±6.8 months on PD, three patients transferred to hemodialysis (1 burnout, 1 prolonged hospitalization after cardiac surgery, 1 peritonitis with leak in the tunnel) and one moved to another PD facility. The remaining five patients continue to be on PD with a mean duration of 27.8±4.5 months. The latest prescription was 4.3±0.7 cycles over 9.2±1.2 hr at night, total volume of 11.1±2.6 lt and six had a last fill of 1.9±0.08 lt. Seven patients maintained the residual kidney function by the end of follow up. Peritonitis rate was 0.28 episode/pt-yr. Two patients had issues with slow drain and one with omental wrapping. Mean HbA1c was 7.8±2.3% and 7.1±1.3% at PD initiation and end of follow up, respectively.
Conclusion
Our experience demonstrates that PD is a viable option for long term therapy in patients with severe obesity. Further studies in a large population are needed to confirm our findings.