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Methods and Patients We evaluated gastric emptying time (GET) with a technetium (Tc) 99m-sulfur colloid gastric emptying scan in 11 patients on continuous ambulatory peritoneal dialysis (CAPO) (6 males, 5 females) and in 14 controls. We investigated the effect of dialysate dwell on GET by studying the subjects twice: once without dialysate in the abdomen (drained) and once with 2 L of dialysate in the abdomen (full). We also investigated the relationship between body surface area (BSA) and delayed gastric emptying. Results (1) The mean gastric emptying rate in 120 minutes in patients on CAPO when drained (67.8% ± 13.4%) was not different from that in controls (65.4% ± 8.6%). (2) The mean gastric emptying rate in 120 minutes in patients on CAPO when full was significantly slower than that when drained (55.6% ± 14.6% versus 67.8% ± 13.4%, p < 0.05). In four of the 11 patients (36.4%), gastric emptying was extremely delayed from normal to abnormal range when full. (3) The BSA of patients who had extremely delayed GET from normal to abnormal range was smaller than that of patients who had minimal delayed or unchanged GET when full (1.5 ± 0.11 m2 versus 1.74 ± 0.22 m2). Conclusion This study showed that patients on CAPO had normal gastric emptying when drained, and that gastric emptying was delayed by dialysate dwell, especially in patients who has less than 1.5 m2 of body surface area. Therefore, we suggest that, based on adequacy, intermittent nocturnal peritoneal dialysis or a small volume of dialysate be considered for patients with small body surface area.

Objective Elevated serum leptin can contribute to anorexia and poor nutrition in patients with chronic renal failure, because leptin is elevated in chronic renal failure patients with or without dialysis, especially in chronic ambulatory peritoneal dialysis (CAPO) patients. The aim of this study was to find whether leptin can be removed by peritoneal dialysis (PO) and to analyze factors that can affect serum leptin after start of CAPO by observing the change in serum leptin shortly after start of CAPO and its correlation with body mass index (BMI), with serum insulin, and with residual renal function. Design Twenty patients who started CAPO during the observation period were studied. Serum leptin was measured by radioimmunoassay before start of CAPO, 3 5 days after start of CAPO, and 1 month and 3 months after start of CAPO. Simultaneously, body weight, serum insulin, and residual renal function were measured. To compensate for the circardian rhythm of leptin, removal of leptin was assessed by measuring dialysate leptin divided by average serum leptin before and after a peritoneal equilibration test (PET). Results Leptin was eliminated by PO with a dialysateto-serum ratio of 0.16 ± 0.07, which was comparable to removal of β2-microglobulin (0.14 ± 0.06). The mean serum leptin concentrations did not decrease after 3 5 days of CAPO (8.4 ± 13.1 ng/mL → 11.9 ± 18.0 ng/mL) despite its removal by PO, and levels increased markedly to 189% of basal serum leptin 1 month after start of PO and to 260% of basal serum leptin 3 months after start of PO. Correlation coefficients (Spearman's p) between change of serum leptin and change of BMI, of serum insulin, of glomerular filtration rate (average of urine creatinine clearance and urine urea clearance) were 0.267 (p > 0.05, n = 20),0.441 (p > 0.05, n = 16),0.706 (p > 0.05, n = 8) respectively. Conclusion Leptin is removed by peritoneal dialysis. Serum leptin did not decrease in 5 days after the start of PO despite its removal by PO, but increased markedly thereafter, within 3 months after start of PO. We could not find a significant correlation between the change in leptin and the change in BMI. Factors other than fat-mass gain can stimulate leptin increase shortly after start of PO.