Peritoneal Protein Clearance and Lean Body Mass Index: Relationship in Peritoneal Dialysis Patients

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Background: An important feature of Peritoneal Dialysis (PD) is peritoneal protein loss (PPL) during dialysis. Peritoneal Protein Clearance (PPCl) is considered a better index as it reflects the individual differences of PPL and membrane function of both small and large pores. Higher PPCl has been reported to be associated with hypoalbuminemia and malnutrition, with some authors stating higher overall mortality. However, new studies failed to draw similar conclusions, arousing new insights on the peritoneal protein metabolism. Lean body mass index (LBMI) has been used as a useful marker of nutritional status in PD patients. The aim of this study was to evaluate the relationship between PPCl and LBMI. Methods: Prevalent PD patients with peritoneal equilibration test and multifrequency bioelectrical impedance analysis (BIA) were enrolled in the cross-sectional study in a single tertiary centre from January 2014 to December 2019. PPCl was calculated dividing 24h dialysate protein loss by serum total protein. LBM was assessed by BIA and LBMI was calculated dividing LBM by body height square. Spearman correlation test was performed to examine the association between body indexes and PPCl. Multiple regression linear model was used for exploring the associated factors of PPCl. Results: We included 67 PD patients (54.1±17.3 years, 59.7% male, 31.3% diabetic). The mean evaluated parameters were: total Kt/V 2.52±0.8, nGFR 6.7±4.1 ml/min/1.73m2 and D/P creatinine ratio 0.63±0.01. The median PPL and PPCl were 5.2(3.8-6.7) g/day and 78.35(54.81-97.19) ml/day, respectively. PPCl was significantly positively associated with LBMI (r=0.401, P 0.001) and BSA (r=0.327, P 0.007), but not with BMI (r=0.109, P 0.381). Compared with conventional body indexes, LBMI had better performance in predicting higher PPCl. Multiple linear regression model, when adjusted for gender, nGFR, kt/V and diabetes, showed that older age (β=0.288, P 0.018), higher D/P creatinine ratio (β=0.232, P 0.050) and higher LBMI (β=0.334, P 0.014) were independent predictors of PPCl. Conclusions: Higher LBMI is a marker of better nutritional state, which is associated with better survival in PD patients. In this study, higher LBMI was independently associated with higher PPCl, potentially explaining conflicting results on the impact of higher PPCl on mortality.

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