Dr Jenny Chen1,2, Prof DAVID JOHNSON3,4,5,6, A/Prof YEOUNGJEE CHO3,4,6, Dr MELISSA CHEETHAM7,8, A/Prof KAMAL SUD9,10, Dr ASHIK HAYAT4,15, Dr BELINDA STALLARD3,11, Dr PHILIP CLAYTON12,13,14, Ms MONIQUE BORLACE12, Prof NEIL BOUDVILLE16,17
1Wollongong Hospital, Wollongong, Australia, 2University of Wollongong, Wollongong, Australia, 3Princess Alexandra Hospital, Brisbane, Australia, 4University of Queensland, Brisbane, Australia, 5Translational Research Institute, Brisbane, Australia, 6Australasian Kidney Trials Network, Brisbane, Australia, 7Sunshine Coast Hospital, Sunshine Coast, Australia, 8University of Sunshine Coast, Sunshine Coast, Australia, 9Nepean Hospital, Penrith, Australia, 10University of Sydney, Sydney, Australia, 11Tweed Hospital, Tweed Heads, Australia, 12Royal Adelaide Hospital, Adelaide, Australia, 13Australia & New Zealand Dialysis and Transplant Registry, Adelaide, Australia, 14University of Adelaide, Adelaide, Australia, 15Taranaki Base Hospital, Westown, New Zealand, 16Sir Charles Gairdner Hospital, Perth, Australia, 17University of Wester Australia, Perth, Australia
AIM
To examine the associations between low glucose degradation products (GDP) peritoneal dialysis (PD) solutions with time to PD peritonitis, transfer to haemodialysis (TTH), all-cause mortality, and cause-specific mortality.
BACKGROUND
PD solutions containing low levels of GDP are associated with attenuation of peritoneal membrane injury. However, the associations between low GDP solutions and PD clinical outcomes remain unclear.
METHODS
Using data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the associations between low GDP solutions with PD peritonitis, TTH, all-cause mortality, and cause-specific mortality (cardiovascular and infection-related mortality) in incident adult PD patients in Australia and New Zealand between 2005 and 2020 using adjusted Cox regression analyses. Sensitivity analysis restricted to study period between 2016 and 2020 was also performed.
RESULTS
Of 13,363 incident PD patients, 2282 (17%) patients were commenced on low GDP solutions. The proportion of patients who commenced on low GDP solutions tripled over 16 years. 5736 (43%) patients experienced PD peritonitis, 5258 (39%) experienced TTH for ≥30 days, and 5929 (44%) died. Compared to patients on standard glucose solutions only, the adjusted hazard ratios (HRs) for patients on any form of low GDP solutions were 1.17 (95%CI 1.09-1.25), 0.94 (0.87-1.01), 0.75 (0.69-0.82), 0.64 (0.55-0.75), 0.69 (0.52-0.92) for PD peritonitis, TTH for ≥30 days, all-cause mortality, cardiovascular mortality, and infection-related mortality, respectively. Similar estimates were observed when restricted to 2016-2020 and after adjustment for cluster effect.
CONCLUSIONS
Patients who received low GDP solutions had decreased risks of all-cause and cause-specific mortality despite an increased risk of PD peritonitis. Future studies assessing for potential causality of these relationships are warranted to determine the clinical benefits of low GDP solutions.
Biography:
Dr Jenny Chen is a consultant nephrologist and the clinical lead for the home therapies program at Wollongong Hospital in NSW. Jenny completed her home therapies fellowship in Vancouver, Canada and is currently a member ANZDATA PD working group. Her research interests include peritoneal dialysis outcomes and kidney supportive care.