SHOULD WE UNDERGO PERITONEAL DIALYSIS IN MALNOURISHED CHRONIC KIDNEY DISEASE PATIENTS?

Abstract BACKGROUND AND AIMS The implementation of peritoneal dialysis (PD) in end-stage renal disease has been associated with various long-term pathophysiologic changes, which result in adverse consequences, such as malnutrition, occurring in 30–50% of patients. Specific factors to PD might be associated with poor oral intake as continuous absorption of glucose from PD solutions and abdominal fullness induced by the dialysate can suppress appetite. There are several accepted strategies for stratifying malnutrition in PD, such as laboratory markers [serum albumin and normalized protein catabolic ratio (nPCR)] and the recent use of bioimpedance spectroscopy (BIS) (with low lean tissue index). We aimed to evaluate if PD patients with a poor nutritional status at the beginning of the technique had worse outcomes (peritonitis, PD failure, hospitalizations, and death). METHOD We studied a cohort of incident patients from a single PD unit between 1 July 2011 and 31 August 2021, who had one BIS measurement and a peritoneal equilibration test in the first 3 months after the start of PD. We also collect laboratory data within 6 months from the BIS evaluation (serum albumin). Besides demographic parameters, we evaluated established endpoints (peritonitis, PD failure, hospitalizations and death). RESULTS There were included 91 PD patients. The mean age of patients was 65.40 $ \pm $ 13.88 years with a median dialysis vintage of 24 (IQR 14–31.61) months; 59.3% were male and 28% had diabetes. During the follow-up period, 5.5% of the cohort died, 56% were hospitalized and 47.3% had at least one episode of peritonitis. Furthermore, the transfer to hemodialysis occurred in 18 cases (19.8%) and 15 (16.5%) received a renal transplant. There was no difference in nutritional markers median in patients that had clinical endpoints versus those who had not (Table 1). In a multivariable analysis, neither nPCR, nor albumin nor lean tissue index were predictors of peritonitis, PD failure or hospital admissions. CONCLUSION In this study, we found that malnourished patients, prevalent in PD, did not have worse clinical endpoints (higher rate of infections, hospital admissions and PD failure). Although adequate nutrition has been deemed vital to the success of PD, this modality of renal replacement therapy did not result in worse outcomes, despite the malnutrition markers at the beginning of PD. Further studies are warranted to evaluate the positive impact of PD in nutrition status.