Abstract: FR-PO462
Association of eGFR at Peritoneal Dialysis (PD) Catheter Insertion with PD-Related Complications
Session Information
- Home Dialysis - 1
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Dhoot, Arti, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Clarke, Alix, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Quinn, Robert R., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Oliver, Matthew J., Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Group or Team Name
- North American PD Catheter Registry.
Background
Guidelines now reflect a shift towards an intent to defer dialysis strategy, irrespective of modality. In peritoneal dialysis (PD), this may increase the risk of early complications. The objective of this study was to determine if early PD-related complications were associated with eGFR prior to PD catheter insertion.
Methods
We conducted a retrospective study using the North American PD catheter registry across 23 sites. Patients undergoing PD catheter insertions were initially grouped by pre-dialysis eGFR < 9 ml/min and >10 ml/min. The eGFR was then analyzed as a continuous variable. The primary outcome was the occurrence of PD related complications within 90 days of insertion. Adjusted risk between eGFR and outcomes was calculated using cause-specific Cox models.
Results
Of 1,537 patients with first PD catheter insertions, 1033 (67%) had a pre-dialysis eGFR < 9 versus 504 (33%) with ≥ 10. Patients with eGFR < 9 were more likely to be younger (median age 60 vs.63), female (44 vs 32%) and have fewer comorbidities. There was no significant difference in PD related complications between the eGFR < 9 and eGFR ≥ 10 groups (aHR 1.12 [0.86, 1.45]). However, in the lower GFR group, which represented two-thirds of the population, there was an increased risk for every 1ml/min eGFR decline below 9ml/min (aHR 1.18 [1.09, 1.28]) (Figure 1). The most common PD-related complications included; flow restriction (7%), leak (3%) and pain (3%).
Conclusion
PD-related complications were similar when comparing an insertion eGFR of <9 to >10 ml/min. However, when assessing eGFR as a continuum, there was an increased risk of complications by 18% for each 1ml/min drop in GFR below 9ml/min suggesting intent to defer start targets should account for modality.