SPC365

Fluid overload at the beginning of peritoneal dialysis and its association with serum NT-proBNP and CA-125

Session: Sessão de Posters 15 - Patologias diversas em Cardiologia
Speaker: Gonçalo Félix Pimenta

Congress: CPC 2024
Topic: P. Other
Theme: 37. Miscellanea
Subtheme: 30.9 Renal Failure and Cardiovascular Disease
Session Type: Cartazes
FP Number: ---
Authors: Gonçalo Félix Pimenta; Rita Afonso; Carlota Vida; Sérgio Maltês; Patrícia Matias; Carlos Aguiar; Cândida Fonseca; Patrícia Branco; Rita Calça
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="background-color:white"><span style="font-family:Tahoma,sans-serif"><span style="color:black">G.Pimenta and R.Afonso contributed equally.</span></span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="background-color:white"><strong><span style="font-family:Tahoma,sans-serif"><span style="color:black">Background and Aims: </span></span></strong><span style="font-family:Tahoma,sans-serif"><span style="color:black">Volume management in patients undergoing peritoneal dialysis (PD) is of major importance, as fluid overload has been associated with cardiovascular (CV)&nbsp;morbidity and mortality. Clinical examination has poor diagnostic accuracy for minor deviations from normohydration, highlighting the need for additional tools. This study aimed to evaluate the association between serum biomarkers (NT-proBNP and CA-125) and volume status, assessed by clinical and bioimpedance analysis, at the initiation of PD.</span></span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="background-color:white"><strong><span style="font-family:Tahoma,sans-serif"><span style="color:black">Method: </span></span></strong><span style="font-family:Tahoma,sans-serif"><span style="color:black">This single-center cross-sectional study included patients who started PD between 2017 and 2022. Demographic and clinical data were collected from electronic records. The parameters evaluated included clinical examination, serum biomarkers, bioimpedance, and dialysis adequacy.</span></span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="background-color:white"><strong><span style="font-family:Tahoma,sans-serif"><span style="color:black">Results:</span></span></strong> <span style="font-family:Tahoma,sans-serif"><span style="color:black">A total of 79 patients (64.6% male) with a mean age of 57 &plusmn; 15 years were included. All patients started with continuous ambulatory PD, and 51.9% were treated with&nbsp;icodextrin. Hypertension, CV disease, and diabetes were present in 93.7%, 50.6%, and 34.2% of the patients, respectively. The majority were under renin-angiotensin-aldosterone system inhibitors (91.1%), beta-blockers (48.1%) and diuretic therapy (93.7%). According to the baseline peritoneal equilibration test, 77.2% were high or high-average transporters. Mean weekly Kt/V was 2.4&plusmn;15. Mean residual renal function (RRF) and residual diuresis were 6.7&plusmn;15 mL/min/1.73 m<sup>2</sup> and 1.6&plusmn;0.8 L (3.8% anuric), respectively, and 11.4% had ultrafiltration (UF) failure (UF test &lt; 400 mL). Median nPCR was 0.9 g/Kg/day (0.8-1.1). Median NT-proBNP and CA-125 were 1337 pg/mL (541.5-3942.5) and 14.6 U/mL (10.3-27.1), respectively.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="background-color:white"><span style="font-family:Tahoma,sans-serif"><span style="color:black">Bivariate analysis showed a positive association between NT-proBNP and CA-125 levels (r=0.27, p=0.024). Overhydration (OH &gt; 2 L), UF failure, and icodextrin use were associated with significantly higher NT-proBNP&nbsp;levels (p=0.022, p=0.018, and p=0.002, respectively). NT-proBNP was negatively associated with weekly Kt/V (r=-0.35; p=0.003), RRF (r=-0.36; p=0.002), and nPCR (r=-0.28; p=0.001). CA-125 was negatively associated with weekly Kt/V (r=-0.3; p=0.01), UF test (r=-0.25; p=0.03), and nPCR (r=-0.23; p=0.04). Patients treated with icodextrin had higher CA-125 levels (p=0.001). Multivariate analysis showed that each 1 UI/mL increase in CA-125 was associated with a 10% increase in the odds of using icodextrin in patients with CV disease and diabetes (adjusted OR=1.102; 95% CI 1.036-1.172).</span></span></span></span></span></span></p>

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<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="background-color:white"><strong><span style="font-family:Tahoma,sans-serif"><span style="color:black">Conclusion:</span></span></strong><span style="font-family:Tahoma,sans-serif"><span style="color:black"> Serum NT-proBNP and CA-125 were associated with worse dialytic efficacy, UF and poorer nutritional status at the beginning of PD. Further multicentric studies are warranted to validate the usefulness of these biomarkers in the early management of hydration in PD patients, thus improving personalized dialysis prescription and nutritional support. </span></span></span></span></span></span></p>