#2448 Peritoneal protein loss: how does it relate to fluid overload, sarcopenia and nutrition on renal disease

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Abstract Background and Aims Peritoneal protein loss (PPL) through peritoneal effluent is a well-established complication of peritoneal dialysis (PD) and has been linked with malnutrition and mortality. However, the perspective is changing. The association of PPL with malnutrition and sarcopenia has been refuted in recent studies. Moreover, recently, fluid overload and venous congestion have been associated with PPL uncovering the importance of hydrostatic convection in protein transport. The aim of this study was to explore the relation of PPL with fluid overload, sarcopenia and nutritional markers in prevalent PD patients. Method We performed a single-center cross-sectional study that included all PD patients of our unit submitted to a modified peritoneal equilibration test (PET) during the year 2024. Demographic and clinical data were collected from clinical records. Biochemical data, evaluation of sarcopenia and bioelectrical impedance assessment (BIA) were evaluated at the same time as PET. PPL was measured in a 24h dialysate effluent collection and the PET’s dialysate effluent (4 h). NTproBNP, CA 125 and extracellular water excess in BIA were used as fluid overload markers, and albumin, total proteins, handgrip strength, ultrasound evaluation of rectus femoris and BIA parameters as nutritional and sarcopenia markers. Statistical analyses were done in SPSS. Univariable analysis were performed with linear regression model and a p value ≤ 0.05 was considered significant. Results Our study included 61 patients, 39 (64%) male, with a mean age of 59 ± 13 years, and 20 (33%) were diabetic. Cause of renal failure was diabetes in 15 patients (24.6%), ADPKD in 7 (11.5%), hypertension in 6 (9.8%), IgA nephropathy in 5 (8.2%) and cardiorenal syndrome in 4 (6.5%), other causes were less frequent. Most patients (73%) were on continuous ambulatory peritoneal dialysis (CAPD). Median PPL was 0.081g/dL (0.055–0.099) in the 24h dialysate and 0.046 g/dL (0.039–0.063) in the 4 h dialysate. Regarding fluid overload, median NTproBNP was 1260 pg/mL (517–3702), median CA125 was 13 U/mL (9–23) and mean extracellular water excess was 1.5 L ± 1.6. Average handgrip strength was 28 and 26kg, right and left arm, respectively, with a mean rectus femoris muscle thickness of 13.7 mm ± 4.4. Remaining data, including PET parameters, are detailed in Table 1. Univariable analysis showed a positive association between 4h PPL and NTproBNP (P = 0.001), extracellular water excess (P = 0.018) and lean tissue mass (LTM) (P = 0.006). A negative association was found between 4h PPL and fat mass in BIA (P = 0.015). Albumin, total proteins, handgrip strength, muscle thickness and other BIA parameters did not correlate with PPL. Conclusion Our study coincides with recent data reinforcing an absence of causality and relationship between PPL sarcopenia and malnutrition markers. A positive correlation between LTM and 4 h PPL might be justified by a higher metabolic rate and more significant protein turnover in patients with more lean tissue mass. The same rationale explains a negative association between fat mass and 4 h PPL, as these patients tend to have lower protein turnover. On the other hand, a fluid overload status appears to play a role in PPL as evidenced by a significant relationship between 4 h PPL and NTproBNP and extracellular water excess.

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