#6131 ANEMIA IN PERITONEAL DIALYSIS
Authors: Oltra Andrea Aledo , Manzano Diana , Martinez Adoración , Sarria Ines Llamas , Dolon Jose Luis Albero , Ortuño Pedro Pablo , Lanuza Manuel , Martínez Julian Navarro , Martínez Pablo Navarro , Cabezuelo-Romero Juan 
Published: June 2023

Background and Aims

Anemia is one of the most frequent complications of chronic kidney disease (CKD), affects quality of life and increases morbidity and mortality. Prevalence of anemia in patients on peritoneal dialysis (PD) is 83% according to the RIKAS study. Diagnosis of anemia in CKD is set at a hemoglobin (Hb) below 13 g/dL in men and less than 12 g/dL in women. These values serve to define the diagnosis, but not to indicate treatment. Treatment is based on the use of erythropoiesis stimulating agents (ESA) and iron therapy. Absolute iron deficiency (ferritin less than 100 ng/ml and transferrin saturation index (TSAT) less than 20%) and functional iron deficiency (TSAT less than 20% with normal ferritin), require correction with oral or intravenous iron before the use of ESA. Treatment with ESA is indicated when Hb is below 10g/dL despite adequate iron stores. The goal is to achieve Hb values between 10-12g/dL.

The aims are evaluating the situation of patients in our PD program with respect to anemia, its prevalence, treatment and its results.

Method

This is an observational, descriptive, cross-sectional and single-center study. Inclusion criteria were patients older than 18 years with at least 3 months of permanence in our PD program. We collected: age, sex, cause of CKD, type of PD, time on PD, origin (pre-dialysis, hemodialysis, kidney transplant), residual diuresis, diabetes mellitus (DM), high blood pressure (HBP), ischemic heart disease, bleeding, urea, creatinine, albumin, calcium, phosphorus, Hb, hematocrit, iron, ferritin, TSAT, C-reactive protein (CRP), transfusions and treatments (ESA and/or iron therapy).

Descriptive statistical analysis (mean, standard deviations, maximums and minimums) and comparative analysis between variables was performed using Chi-square test and ANOVA for qualitative and quantitative variables, respectively.

Results

N = 58 patients, 64% men and 36% women. The mean age was 61.3+/- 15.54 years. 31% of patients were CKD secondary to glomerulonephritis (predominant etiology). 5% had no cardiovascular risk factors (CVRF), 48% between one and two and 47% more than three. 74% on continuous ambulatory peritoneal dialysis (CAPD). Mean time on dialysis 28.74 +/- 25.05 months. Mean residual diuresis in 24 hours 1199.22 +/- 703.14 cc.

Prevalence of anemia 74%. Mean Hb of 10.97 +/-1.29 g/dL with 78% of patients with values between 10-12 g/dl. Mean ferritin of 356.79 +/-226.84 mg/dL with 79% of patients between 100-500 mg/dl.

83% received treatment with ESA, 33% with intravenous iron. No patient received oral iron. 4 patients needed of blood transfusion and 3 of them due to bleeding (2 gastrointestinal bleeding and 1 urinary bleeding).

We observed a statistically significant association between higher residual diuresis volume and adequate anemia control (P = .042) and between lower creatinine values and target Hb values (P = .0005). No statistically significant association was observed between adequate anemia control and type of dialysis (p= 0.106), time on dialysis (P = .28), sex (P = .224) and DM (p= 0.139).

Conclusion

The high prevalence of anemia continues to be a major problem in PD in our program, but similar to other series. Under treatment (ESA and iron therapy) is achieved an adequate control in most patients, although in approximately 20% of patients do not reach the established target. Higher residual diuresis and lower creatinine values (probably due to increased residual renal function) are associated with better anemia control.