MO711COMPARISON OF PERITONEAL DIALYSIS EFFICACY MARKERS IN DIABETIC AND NON-DIABETIC PATIENTS
Authors: Carvão João , Fernandes Adriana Paixão , Veríssimo Rita , Calça Rita , Martins Ana Rita , Matias Patricia , Branco Patricia 
Published: May 2021

Abstract

Background and Aims
Diabetes mellitus (DM) is the leading cause of end-stage kidney disease. Peritoneal dialysis (PD) is an effective and convenient modality of renal replacement therapy, however in diabetic patients, higher technique failure is feared. This cross sectional study aimed to investigate if diabetic patients are good candidates for peritoneal dialysis in terms of dialysis efficacy and volume overload management when compared with non-diabetic patients.

Method
We conducted a cross-sectional study including 60 patients with end-stage kidney disease currently in peritoneal dialysis. Echocardiography was performed using HDI 5000, allowing M-mode, two-dimensional measurement. Peritoneal equilibration test exam was used to evaluate transport rate and dialysis efficacy. A multifrequency bioimpedance (BIA) analyzer was used. Overhydration (OH) was defined as an extra-cellular water (ECW)/total body water (TBW) over 15%. Clinical and biochemical variables were also explored.

Results
A total of 60 patients completed evaluation. Overall, 60% (n=36) were males with a mean age of 55,8 ± 15,3 years, BMI 25.9 ± 3.9 kg/m2, 31,7% (n=19) had DM. Median PD vintage was 21 months, automated PD 30%, 8.3% (n=5) were anuric and 10% (n=6) were overhydrated. The median serum N-terminal pro b-type natriuretic peptide (NT-proBNP) level was 1071 pg/mL. Left ventricule (LV) mass index and LV ejection fraction were 129.0 ± 51.1 g/m2 and 62.8 ± 13.0%, respectively. The median excess volume overload was 0.9L.
Patients were divided in 2 groups (diabetic and non-diabetic). No differences were found between the 2 groups in terms of time in PD, peritoneal transportation, dialysis efficacy, diuresis, hemoglobin, albumin, normalized protein catabolic rate, hydration status, weight, body mass index, arterial hypertension, chronic heart failure, LV ejection fraction, LV mass index, CA-125 value, clinical signs of fluid overload, systolic and diastolic blood pressure. However, diabetic patients were younger (51,6 versus 58,0; p=0,02), more likely to have peripheral arterial disease (42,1 versus 7,3%, p=0,03), ischemic heart disease (52,6 versus 7,3%, p&lt;0,001) and had higher levels of NT-proBNP (5932 versus 4216 pg/mL, p=0.04).
However, when using a multivariable analysis, in a model adjusted to age, residual dialysis, efficacy of dialysis, diabetic patients did not have a significant difference in volume overload, dialysis efficacy and markers of cardiac dysfunction when compared with non-diabetic patients.

Conclusion
In this population, diabetes was associated with higher levels of NT-proBNP, however it did not translate in higher fluid overload, lower dialysis efficacy or worst cardiac dysfunction, when compared with non-diabetic patients. We conclude that PD is able to control hydration status, dialysis efficacy and cardiac dysfunction in diabetic patients with similar efficiency as in non-diabetic patients.