Kidney Week

Abstract: FR-PO0593

Relationship of Serum Chloride Levels with All-Cause Mortality in Patients Undergoing Peritoneal Dialysis: The Fukuoka Peritoneal Dialysis Registry (F-PDR)

Session Information

• Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 2
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Fluid, Electrolytes, and Acid-Base Disorders

• 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

• Hamashoji, Tomoya, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Tomoya Hamashoji, MD

• Tsuneyoshi, Shoji, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Shoji Tsuneyoshi, MD

• Okamura, Kazuhiro, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Kazuhiro Okamura, MD

• Yamada, Shunsuke, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Shunsuke Yamada, MD, PhD

• Tsuruya, Kazuhiko, Department of Nephrology, Nara Medical University, Nara, Japan

Kazuhiko Tsuruya, MD, PhD

• Ago, Tetsuro, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Tetsuro Ago, MD, PhD

• Nakano, Toshiaki, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Toshiaki Nakano, MD, PhD

Background

It has been reported that lower serum chloride levels are associated with higher mortality, independent of serum sodium levels, in patients with chronic kidney disease and those undergoing dialysis. However, a study of peritoneal dialysis (PD) patients reported that higher Cl levels were linked to increased mortality, suggesting inconsistent findings.

Methods

We analyzed data from 991 patients enrolled in the multicenter cohort study, the F-PDR. Patients were divided into tertiles by baseline serum chloride levels: T1 (<96 mmol/L), T2 (96–99 mmol/L), and T3 (>99 mmol/L). Associations between serum chloride tertiles and all-cause mortality were assessed using Cox proportional hazards and Fine–Gray competing risk models, adjusting for covariates including age, sex, diabetes, cardiovascular disease (CVD), duration of PD, body mass index (BMI), residual renal Kt/V, serum sodium levels, and diuretic use.Missing data were addressed using multiple imputation.

Results

Over a median follow-up of 731 days, 159 deaths were recorded. Compared with T3, the adjusted hazard ratio for all-cause mortality in T1 was 2.31 (95% confidence interval [CI]: 1.34–3.97), as estimated using the Cox proportional hazards model. The corresponding subdistribution hazard ratio from the Fine–Gray competing risk model was 2.21 (95% CI: 1.28–3.83). Subgroup analyses stratified by baseline characteristics including age, sex, diabetes, CVD, duration of PD, BMI, residual renal Kt/V, serum sodium levels, and diuretic use revealed no significant interactions.

Conclusion

Lower serum chloride levels were independently associated with higher all-cause mortality in patients undergoing PD.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025qqfdsbrh