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Differences in assessment of patients with satisfactory or complicated continuous ambulatory peritoneal dialysis
A E Grzegorzewska1, I Mariak, A Dobrowolska-Zachwieja
1Department of Nephrology, Karol Marcinkowski University of Medical Sciences, Poznan, Poland.
Abstract:
The aim of our study was a comparison of comorbid scores, peritonitis rates, dialysis adequacy, and nutritional parameters in continuous ambulatory peritoneal dialysis (CAPD) patients. Patients were separated into two groups: those who, in the course of CAPD, were ingood clinical condition and underwent renal transplantation (group I, n = 11), and those who had to discontinue CAPD treatment (group II, n = 16) owing to death caused by comorbid disease or owing to transfer to hemodialysis for technique failure related mainly to recurrent peritonitis. Clinical scores were lower in group II, showing significantly more insomnia, weakness, and anorexia. The PET D/P creatinine, mean adequacy parameter, and urine output were similar in groups I and II. Daily protein intake (DPI) and daily energy intake (DEI) showed higher values in group I than in group II when expressed in g/kg and kcal/kg total body mass (TBM) respectively (DPI 1.09 +/- 0.15 g/kg TBM vs 0.92 +/- 0.31 g/kg TBM, p = 0.036; DEI 36.3 +/- 4.3 kcal/kg TBM vs 31.0 +/- 9.0 kcal/kg TBM, p = 0.048), but the intakes were not significantly different when calculated per kilogram ideal body mass (IBM). Lean body mass as a percent of total mass was 77.7% +/- 7.8% versus 73.9% +/- 6.8% (p = 0.048) in groups I and II respectively. Group I showed lower serum cholesterol than group II (179 +/- 33 mg/dL vs 231 +/- 41 mg/dL, p = 0.001) despite higher dietary intake of cholesterol (367 +/- 137 mg/day vs 251 +/- 97 mg/day, p = 0.016), correlating with DPI (r = +0.673, p = 0.023). Our results indicate that under conditions of similar CAPD adequacy, patients with a satisfactory course of CAPD therapy have higher dietary intake and are better nourished than those with a poor outcome. The changes in nutrition seem to be related to comorbid diseases and complications of CAPD therapy. Increased cholesterol level, associated with a diminished DPI, is prognostic of a poor outcome for CAPD patients.