No abstract

For both hemodialysis and CAPD patients nutrition has been linked to mortality. Protein calorie malnutrition is present in 20 to 40% of CAPD patients. The normalized protein catabolic rate (NPCR), has been proposed as a useful measure of dietary protein intake and ultimately nutrition. However, the NPCR value has not been consistently predictive of outcome in CAPD patients. We have performed a cross sectional study on 147 clinically stable CAPD patients, who had a mean dialysis duration 22 months, to evaluate the relationship between the NPCR and conventional markers of nutrition. The NPCR was significantly correlated with normalized models of dialysis adequacy including KT/V (urea), total weekly creatinine clearance and the dialysis index. A significant negative correlation was found between individual anthropometric measures and the NPCR. Using a composite nutritional index to nutritionally categorize our population we found a significantly higher NPCR value in the severely malnourished group. The unadjusted protein catabolic rate (PCR) was significantly correlated with individual nutritional measures and was significantly greater in the well-nourished group. The NPCR, obtained by dividing the PCR by body weight (itself a nutritional measure), is lowest in well-nourished or obese patients, and thus as a marker of nutrition may be flawed. The PCR has nutritional relevance, however, adjusting its value to take into account patient size will require prospective evaluation of the influence of small solute removal on body composition.

Background Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD). Gastrointestinal (GI) symptoms affect appetite and dietary intake. Adequate nutrition is especially important if surgical interventions are required. Aim To investigate the nutritional management of 23 EPS patients that underwent surgical intervention between 1999 and 2005 at Manchester Royal Infirmary, United Kingdom. Methods EPS was recognized by GI symptoms and diagnostically confirmed by laparotomy, computed tomographic scanning, or biopsy. Results Mean time on PD was 74 months (interquartile range 42 – 89 months). During the 12 months pre-diagnosis, 65% of the group showed significant weight loss ( p = 0.0001), with 8 patients losing >10% of body weight; 74% of patients experienced significant albumin decrease ( p = 0.001); and 56% of patients experienced GI symptoms during the 6 months pre-diagnosis. Nasogastric (NG) feeding was recommended for 8 patients but continued in only 1. 15 patients (mean albumin 27 g/L) commenced parenteral nutrition (PN); 9 patients recovered, with albumin increasing over the 6-month follow-up. Mean hospital time was 62 days for the group receiving neither NG nor PN, compared with 124.3 for the PN/NG group ( p = 0.04). In patients that died of EPS, albumin continued to fall at 3 months post-diagnosis. Conclusion There is currently little guidance for nutritional management of EPS. From this study we recommend ( 1 ) a high level of clinical suspicion for EPS, especially if PD patients have weight loss; ( 2 ) PN may be better than NG feeding but further studies into dual enteral nutrition and PN are needed; ( 3 ) aggressive nutritional supplementation pre- and postoperatively; and ( 4 ) dietitians need to recognize the high risk of refeeding syndrome.

Summary Decline in residual renal function in CAPD patients often leads to reduced overall solute clearances. Inadequate dialysis has been linked to malnutrition and increased morbidity and mortality rates. Achieving dialysis adequacy targets is often difficult by the conventional method of increasing CAPD exchange volumes. In comparison, substantial increases in solute clearances can be achieved with the use of automated peritoneal dialysis with large fill volumes and an extra daytime exchange.