Kidney Week

Abstract: FR-PO474

Effect of Protein Supplement in Patients With Peritoneal Dialysis-Associated Peritonitis on Clinical Outcomes: A Multicenter, Randomized-Controlled Trial

Session Information

• Peritoneal Dialysis: Current Topics
  November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Faisatjatham, Surasak, Chulalongkorn University Faculty of Medicine, Bangkok, Bangkok, Thailand

Surasak Faisatjatham,

• Chuengsaman, Piyatida, Banphaeo-Charoenkrung Peritoneal Dialysis Center, Bangkok, Thailand

Piyatida Chuengsaman,

• Pisutpaisan, Chaiwat, Samut Prakan Hospital, Samut Prakan, Thailand

Chaiwat Pisutpaisan,

• Lawsuwanakul, Rhonachai, Chonburi Hospital, Chonburi, Chonburi, Thailand

Rhonachai Lawsuwanakul,

• Boonyakrai, Chanchana, Taksin Hospital, Bangkok, Bangkok, Thailand

Chanchana Boonyakrai,

• Kananuraks, Sarassawan, Khon Kaen Hospital, Khon Kaen, Khon Kaen, Thailand

Sarassawan Kananuraks,

• Chieochanthanakij, Rutchanee, Sawanpracharak Hospital, Pak Nam Pho, Nakhon Sawan, Thailand

Rutchanee Chieochanthanakij,

• Khositrangsikun, Kamol, Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat, Nakhon Si Thammarat, Thailand

Kamol Khositrangsikun,

• Phannajit, Jeerath, Chulalongkorn University Faculty of Medicine, Bangkok, Bangkok, Thailand

Jeerath Phannajit,

• Tungsanga, Somkanya, Chulalongkorn University Faculty of Medicine, Bangkok, Bangkok, Thailand

Somkanya Tungsanga,

• Eiam-Ong, Somchai, Chulalongkorn University Faculty of Medicine, Bangkok, Bangkok, Thailand

Somchai Eiam-Ong,

• Kanjanabuch, Talerngsak, Chulalongkorn University Faculty of Medicine, Bangkok, Bangkok, Thailand

Talerngsak Kanjanabuch,

Background

Malnutrition is associated with increased mortality in peritoneal dialysis (PD) patients with peritonitis. Data on protein supplementation during peritonitis episodes are limited.

Methods

A multicenter, open-label, randomized trial across 9 PD centers in Thailand was conducted. Adult PD patients above 18 years, diagnosed with peritonitis with serum albumin below 3.5 g/dL were randomly assigned to receive protein supplementation (intervention group) or none (control group). Participants with tuberculous/fungal/secondary peritonitis or septic shock were excluded. Whey protein of 30 g/day was given to the intervention group for 30 days. Participants in both groups received nutritional counseling according to SPENT guideline (dietary energy intake of 30 kcal/kg/day and dietary protein intake of 1.5 g/kg/day). The primary outcome was a composite outcome of peritonitis-related death or relapsing/repeat peritonitis. The secondary outcome was serum albumin levels across study period between groups. Outcomes were monitored for 120 days.

Results

From June 2021 to February 2022, 74 participants were randomized to the intervention group (N=37) and control group (N=37). Both groups had comparable demographics and baseline serum albumin. Dietary protein intake on the 30^th day was 1.4±0.4 g/kg/day in the intervention group and 1.0±0.2 g/kg/day in the control group (p=0.07). Primary outcome events were reported in 15 (41%) and 19 (51%) participants in the intervention and control groups, respectively (hazard ratio 0.84; 95% confidence interval [CI] 0.43-1.67). Serum albumin concentrations were significantly higher in the intervention group across study period (linear mixed-effects model, p<0.001), with a mean difference on the 120^th day of 0.35 g/dL (95% CI 0.06-0.64) (p=0.02).

Conclusion

Serum albumin concentrations in patients with PD-associated peritonitis were higher with protein supplementation compared with nutritional counseling alone, although death or relapsing/repeat peritonitis were not affected. Further studies with a longer follow-up period and a larger number of participants are warranted.

Funding

• Private Foundation Support