Clinical Outcomes of Peritoneal Dialysis in Patients with Chronic Liver and Kidney Failure: A Single-Center Experience
Home Dialysis - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
802 Dialysis: Home Dialysis and Peritoneal Dialysis
Tedunjaiye, Oluwatitomi A., The University of Texas Southwestern Medical Center Department of Internal Medicine, Dallas, Texas, United States
Khan, Sefia, The University of Texas Southwestern Medical Center Department of Internal Medicine, Dallas, Texas, United States
Thomas, Litty, The University of Texas Southwestern Medical Center Department of Internal Medicine, Dallas, Texas, United States
Saxena, Ramesh, The University of Texas Southwestern Medical Center Department of Internal Medicine, Dallas, Texas, United States
Patients with Chronic Liver and Kidney Failure (CLKF) face severe complications and high mortality. Simultaneous Liver-Kidney Transplant (SLKT) is the ideal therapeutic option, but the dearth of organs leaves most patients dialysis-dependent. PD is often overlooked due to concern for elevated peritonitis risk, hypoalbuminemia, and poor transplant candidacy. However, HD is often poorly tolerated due to exacerbation of pre-existing hemodynamic problems. We present a single-center experience to provide evidence that PD should be recommended in CLKF patients.
In this retrospective observational study, we included all patients with CLKF who initiated PD from 01/2006 to 03/2023. Medical charts were reviewed, and demographic/clinical data was retrieved. The primary clinical outcomes included mortality, PD complications, hospitalization rates, change in serum albumin from baseline, and SLKT candidacy. Censoring events were study period end, death, transfer to HD or to a different PD center, and SLKT.
Twenty-six patients with CLKF and mean age of 58 years initiated PD during the study period. The mean time on PD was 38.3 months. There were 18 episodes of peritonitis with a rate of 0.2 episodes per year. Nine patients died with annualized mortality of 10.9%. Hospitalization rate was 0.95 per patient per year. Six patients received SLKT, 5 remain active on the waitlist. Four patients had technique failure with a permanent switch to HD. Mean serum albumin at the end of the observation period was 2.8g/dL, a 12% decline from baseline (p=0.06). No patient needed therapeutic paracentesis for ascites while on PD.
To our knowledge, this is the largest single-center study on PD with CLKF patients. Our patients had mortality, hospitalization, and peritonitis rates lower than the general PD population. Peritonitis episodes were more commonly from non-enteric pathogens suggesting a failure of aseptic PD technique rather than cirrhosis-related spontaneous bacterial peritonitis. The decline in serum albumin from baseline was not statistically significant. Six patients received SLKT and 5 are active on the list, demonstrating PD can be a successful bridge to SLKT. Given excellent outcomes and effectiveness in ascites management, we propose PD as a first-line kidney replacement therapy option in patients with CLKF.