Association between Gastric Emptying Rate and Nutritional Status in Patients Treated with Continuous Ambulatory Peritoneal Dialysis

Abstract

♦ Objective To estimate gastric emptying rate in continuous ambulatory peritoneal dialysis (CAPD) patients, with or without indwelling dialysate, and to evaluate if there is an association between gastric motility and nutritional status. ♦ Design Single-center cross-sectional study. ♦ Setting Peritoneal Dialysis Unit, Medical Faculty, Jagiellonian University Hospital, Krakow, Poland. ♦ Patients and Methods 20 end-stage renal disease patients [11 F, 9 M; mean age 50.1 ± 11 years; treated with CAPD for median 13.5 (2 – 61) months] were studied. All patients were nondiabetic and had no comorbidity that might influence gastric motility; nor were they receiving any prokinetic drugs. Gastric emptying rate was estimated with dynamic abdominal scintigraphy, started immediately after complete ingestion of a standard 200-kcal solid meal injected with 99mTc-labeled colloid, activity 40 MBq. Scintigraphy was performed at the rate of 23 images in 4-minute intervals for 92 minutes. Two consecutive procedures — with and without PD fluid — were performed at weekly intervals. As nutritional parameters, protein catabolic rate (PCR) and lean body mass (LBM) (based on urea and creatinine kinetics, respectively), body mass index (BMI), and serum albumin were measured. ♦ Results All analyzed gastric emptying parameters, measured with or without dialysis fluid, were markedly prolonged in patients compared to values accepted as normal in the local scintigraphy unit. Gastric emptying half-time (T1/2) and percent of initial activity in minute 46 and in minute 92 were 60.5 ± 25.0 minutes, 57.19% ± 17.5%, and 33.8% ± 20.9% with a full peritoneal cavity, and 63.9 ± 28.2 minutes, 59.1% ± 23.9%, and 33.9% ± 24.3% with an empty peritoneal cavity. The T1/2 and percent of initial activity after 46 and 92 minutes for healthy subjects were 39 ± 9 minutes, 45% ± 11%, and 15% ± 6%, respectively. T1/2 without dialysis fluid revealed a negative correlation with LBM and BMI values ( r = –0.5, p < 0.05, and r = –0.56, p < 0.01; respectively). Patients with dialysate-free T1/2 > 40 minutes were characterized by significantly lower serum albumin level compared to subjects with T1/2 < 40 minutes (39.2 ± 2.9 vs 42.9 ± 3.6 g/L, p < 0.05). The values of all gastric emptying parameters measured for an empty abdomen were prolonged in subjects with BMI < 25 kg/m2. No difference was found between patients with and without PD fluid. ♦ Conclusions Gastric emptying is markedly impaired in CAPD patients compared to healthy subjects. However, the presence of dialysate does not influence it significantly. Gastric emptying rate was negatively associated with the nutritional status of treated subjects. This association can be demonstrated when gastric motility is measured with an empty peritoneal cavity.

Diminished Appetite Predicts Mortality of Chinese Peritoneal Dialysis Patients

“…Specific factors that might be associated with poor appetite include absorption of glucose from PD solutions and abdominal fullness induced by the dialysate (Chung, Carrero, & Lindholm, 2011). Stompor et al (2002) also reported delay of gastric emptying as another explanation for anorexia in PD patients. We also found an association between underlying cardiovascular disease and diminished appetite among PD patients in the current study, which did not emerge in previous studies conducted in hemodialysis patients (Carrero et al, 2007;Kalantar-Zadeh et al, 2004).…”

Malnutrition in Chronic Kidney Disease

“…Gastroparesis is associated with gastrointestinal symptoms such as dyspepsia, early satiety, bloating, vomiting, and gastroesophageal reflux. These symptoms contribute to decreased nutritional intake in no small measure and are an important cause of malnutrition in patients with chronic kidney disease ( 71 ). Dialysis therapy and the use of prokinetic agents such as erythromycin or metoclopramide have been shown to improve gastrointestinal motor function in these patients ( 70 , 74 ).…”

Delayed gastric emptying among Indian patients with non-diabetic chronic kidney disease

“…[ 18 ] A Swedish study,[ 6 ] employing fluoroscopic evaluation of GE of spherical radiopaque markers, has reported a 36% prevalence of delayed GE among CKD patients. Barring a Brazilian study,[ 21 ] several previous studies[ 5 6 9 11 12 22 ] have reported an increased prevalence of delayed GE among CKD patients. Delayed GE was more frequent in male CKD patients in the Swedish study,[ 6 ] similar to findings in the present study.…”

“…Although few studies have evaluated GE in patients with CKD, most of them have involved end-stage kidney disease patients on either maintenance hemodialysis[ 3 6 7 8 10 ] or peritoneal dialysis. [ 6 7 8 11 ] To the best of our knowledge, only one small Indian study has evaluated GE in non-diabetic CKD patients so far. [ 5 ] However, the prevalence of upper gastrointestinal symptoms and abnormalities of GE have not been studied systematically in different stages of non-diabetic CKD, among Indian patients.…”