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Ultrafiltration failure (UFF) and dyslipidemia are critical concerns in peritoneal dialysis (PD) associated with adverse clinical outcomes. Recent findings have linked a reduced apolipoprotein A to high-density lipoprotein cholesterol (HDL-C) ratio with a rapid decline in peritoneal function. The present study seeks to explore the potential association between dyslipidemia and UFF.
A bi-center cross-sectional study was conducted involving 114 PD patients with a minimum treatment duration of 3 months. Exclusion criteria encompassed anuria, recent hospitalization, peritonitis in the preceding month, prior hemodialysis, and the presence of neoplasms or severe comorbidities. All patients used Dianeal PD4 (Baxter Healthcare Corporation, USA). UFF was defined as a peritoneal ultrafiltration capacity of less than 400 mL (3.86% glucose/4.25% dextrose) over 24 hours. We assessed patient demographics, clinical and PD parameters, and lipid profiles.
Differences in frequencies between groups were assessed using Fisher's exact test (χ2). The correlation analysis was conducted using the Spearman rank correlation test. Receiver operating characteristic (ROC) analysis was employed to assess the predictive accuracy of the atherogenic index of plasma (AIP) in identifying UFF.
Among the 114 patients (mean age 55 (48-65) years, dialysis vintage of 31 (14-50) months), 76 (66.7%) had dyslipidemia. None of the patients had low transporter status, with 23 (20.2%) categorized as low-average transporters, 59 (51.8%) as high-average, and 32 (28.1%) as high transporters. Patients with dyslipidemia had a significantly lower proportion of low-average transporters and a higher percentage of high transporters compared to those without dyslipidemia (χ2 = 10.1,p = 0.006). Furthermore, 14 patients (12.3%) had peritoneal ultrafiltration of less than 400 mL per day, indicative of peritoneal membrane dysfunction. Among these individuals, 13 (17.1%) had dyslipidemia, while only 1 (2.63%) did not (p = 0.02).
As anticipated, we observed a negative correlation between the D/P creatinine ratio and daily peritoneal ultrafiltration rate (r = -0.27, p = 0.003) and diuresis (r = -0.31, p = 0.001). Surprisingly, an increase in the D/P creatinine ratio was associated with higher levels of total cholesterol (r = 0.39, p = 0.0005), low-density lipoprotein cholesterol (r = 0.26, p = 0.02), triglycerides (r = 0.33, p = 0.005), and the AIP (r = 0.27, p = 0.01). Peritoneal ultrafiltration displayed a positive correlation with HDL-C (r = 0.31, p = 0.003) and a negative correlation with AIP (r = -0.33, p = 0.004).
The ROC analysis, employing AIP as the comprehensive indicator of atherogenic dyslipidemia, revealed that an AIP value exceeding 4.3 could effectively predict UFF, with a sensitivity of 83.3% and a specificity of 73.4% (Fig. 1).
Fig. 1. The ROC curve for the cut-off value of AIP for predicting UFF in patients undergoing PD.
This study elucidates the association between dyslipidemia and UFF in patients undergoing PD. Recognizing this link could enhance the management of dyslipidemia and potentially mitigate the risk of UFF, ultimately improving clinical outcomes. Future longitudinal studies are needed to explore the causal mechanisms and assess the impact of dyslipidemia management on UFF prevention.