P1187THE NUTRITIONAL STATUS IN PERITONEAL DIALYSIS PATIENTS: HOSPITALIZATION AND MORTALITY
Authors: Shifris Iryna , Shymova Anna , Dudar Iryna 
Published: June 2020

Background and Aims

The worldwide medical public attention focuses on the problems associated with decreasing morbidity frequency and improving of survival of patients with the end stage renal disease (ESRD). Peritoneal dialysis (PD), including continuous ambulatory peritoneal dialysis (CAPD), one of the known modality of renal replacement therapy (RRT). Several studies demonstrated that namely nutritional.

The aim of this study was to explore the relationship between the nutritional status in PD patients and their morbidity and mortality.

Method

This study was an observational, prospective, epidemiological tracking by clinical examination. The study included 105 patients with ESRD who started CAPD treated in single dialysis center of Ukraine (during 2012 - 2018). Fifty three (50.5%) patients were male, median age 60 (range 25–85 years) and the most common cause of ESRD was glomerulonephritis (63 patients, 60.0%). Median follow-up was 29 months (range 6- 132 months). Nutritional status (NS) indicators defined basing on the calculation of the subjective global assessment (SGA, points). Patients were classified into four groups according to their NS. Group 1 included 51 patients with normal NS, group 2- 30 patients with a light degree of malnutrition, group 3 (13 patients) and group 4 (11 patients) with moderate and severe degree of nutritional disorders, respectively. During follow-up, all hospital admissions and all causes of mortality were documented and compared for nutritional disorders versus normal NS.

Results

During follow up the 62 hospitalization cases (30 cardiovascular events, 15 PD-peritonitis, 13 other bacterial infections, 2 stroke and 2 - others) and 46 deaths among all patients were detected. The odds ratio for all-cause hospitalization in the group 3 (12/85.7% vs. 26/ 51.0%) were significantly higher than in the group 1 (OR = 5.7692, 95% CI: 1.1712 - 28.4178; р= 0.0312). A significant increasing of the hospitalization incidences both due infectious comorbidity (7/63.64% vs. 8/15.7%; χ²= 8.880, p = 0.003) among patients with severe degree of malnutrition compared with patients group 1. At the same time, cardiovascular (CVD) hospitalization rate was significantly higher in patients group 3 (8/57.1% vs. 10/ 19.6%; χ²= 5.968, p = 0.015) than in the group1.

Mortality rate was significantly higher in patients group with moderate (11/84.6% vs 16/31.37%, χ²= 12.041, p &lt;0.0001; OR =12.031; 95% CI: 2.3843 - 60.7105) and a light degree of nutritional disorders (11/84.6% vs 13/43.4%, χ²= 6.267, p= 0.013; OR = 7.1923; 95% CI: 1.352- 38.2367) than with normal NS. Similarly, patients with a severe degree of malnutrition (group 4) showed a higher mortality rate versus patients group1: 8/72.7%% vs. 16/31.37%,; χ²= 6.522, р= 0.011 (OR = 5.8333, 95% CI: 1.3645-24.9376). Cardiovascular disease was the leading cause of death (22/47.8%).

Conclusion

Thus, the obtained findings suggest that nutritional disorders at PD initiation have a significant negative effect on prognosis. The results of our study demonstrated the predictive role of assessing nutritional status in all-cause mortality and hospital admissions in ESRD population.