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Starting peritoneal dialysis (PD) without prior planning is feasible and usually safe but may potentially be associated with increased risk for complications. However, it is not known if nutritional markers differ between planned and unplanned start of PD. Here we compared the evolution of nutritional parameters and clinical outcomes between incident PD patients with planned and unplanned dialysis start.
This study included adult incident PD patients with unplanned (starting PD within 72 hours after catheter implantation) and planned (pre-dialysis follow-up ≥ 90 days) modes. Clinical data, level of physical activity, physical performance, inflammatory markers, appetite assessment, anthropometric measurements, bioelectrical bioimpedance analysis (BIA), food intake, protein equivalent of nitrogen appearance (PNA), handgrip strength and Malnutrition Inflammation Score (MIS) were evaluated. The assessments were carried out within 30 days after the start of PD (T0), after 6 (T1) and 12 months (T2). The outcomes (technique failure, hospitalization, infection related and non-related to PD and death) were observed during the 12 months follow-up. Comparisons between visits and groups were performed using a generalized linear model of repeated measures with Bonferroni as a post hoc test. Survival analysis was performed by Kaplan Meier and using log-rank test.
Among 47 incident patients, 61.7% (n=29) started unplanned PD. At T0, unplanned PD patients had significantly lower albumin levels, lower calf circumference (CC) and higher MIS (indicating worse nutritional status), higher PNA (possibly reflecting catabolism), and longer time to complete the gait test (indicating lower physical performance). For the 12 months follow-up, the unplanned PD group showed an increase in anthropometric measurements (body mass index (BMI), waist circumference (WC), arm circumference, and triceps skinfold), a decrease in MIS, an increase in fat mass index by BIA indicating amelioration in nutritional status. In comparisons between visits and groups, significant changes occurred in BMI, WC, CC, appetite, MIS, and PNA over the 12 months. There was no difference between the groups in relation to the occurrence of adverse clinical outcomes.
Worse results in nutritional parameters were found in incident PD patients with unplanned as compared to planned start at baseline; however, during the 12 months of follow-up, the groups became similar as regards nutritional variables.
The content presented in this abstract was submitted for other meeting (Congresso Paulista de Nefrologia, 2023).