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Abstract: FR-OR27

Fluid-Related Risk Factors of Peritoneal Dialysis Technique Failure

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Flythe, Jennifer E., University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Ficociello, Linda, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Parameswaran, Vidhya, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Kraus, Michael A., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Chatoth, Dinesh K., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Mullon, Claudy, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Anger, Michael S., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Kossmann, Robert J., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
Background

Inadequate fluid management in peritoneal dialysis (PD) patients is associated with a higher risk of cardiovascular morbidity and mortality and may result in shortened PD technique survival (Van Biesen et al, 2019). In this analysis, we evaluated the associations between fluid-related clinical factors and PD technique failure within 1 year of treatment initiation.

Methods

Adult, ESKD patients who were newly prescribed PD for ≥ 120 days at Fresenius Kidney Care (FKC) facilities between 2017-2019 were included. Deidentified data were extracted from the FKC clinical data warehouse and evaluated within 120 days of treatment initiation. Crude and case-mix adjusted Cox regression models with competing risks (patient transfer to HD, death, and loss to follow-up) were used to evaluate the associations between fluid-related risk factors and PD technique failure.

Results

15,854 automated PD patients (APD; age: 58 years; KRU: 4.5 mL/min) and 1,547 manual PD patients (CAPD; age: 58 years; KRU: 4.8 mL/min) were included. 53% of APD patients and 56% of CAPD patients had a PD technique survival ≥ 1 year, and all patients with urine volume ≤ 100 mL, systolic BP > 160 mmHg, history of cardiovascular events and hospitalizations, or weight change ≥ 2 kg between day 1 and day 120 of PD treatment had a higher risk of 1-year PD technique failure (Figure 1). Significant patient-reported risk factors included shortness of breath (APD only) and edema (APD and CAPD). Patients with a weekly Kt/V > 2 had half the risk of PD attrition at 1 year.

Conclusion

APD and CAPD patients with fluid-related complaints (shortness of breath and edema), history of cardiovascular morbidity and hospitalizations, hypertension, or weight change ≥ 2 kg within 120 days of PD initiation had a higher risk of technique failure within 1 year of PD initiation.

Figure 1

Funding

  • Commercial Support – Fresenius Medical Care North America