Carbohydrate malabsorption in black and Hispanic dialysis patients

Patients on chronic hemodialysis have decreased food intake and decreased fat stores. Malabsorption of carbohydrates such as lactose, sorbitol, or fructose cause functional bowel symptoms. The aim of this study was to assess the role of carbohydrate malabsorption in the nutritional abnormalities of chronic hemodialysis (CHD). Eleven patients on dialysis (six Hispanic, five black Americans) were studied, compared to 11 healthy volunteers age-, race-, and sex-matched. Lactulose 10 g (transit time), lactose 12.5 g, sorbitol 5 g, and fructose 37.5 g were tested fasting. Breath [H2] was measured 4 h postprandially by gas chromatograph analysis. Positive test was defined as 20 ppm [H2] above baseline. Weight, height, and triceps skinfold were measured. One hundred percent of CHD patients were below the 50th percentile for triceps skinfold measurement and 55% were below the 10th percentile. No biochemical abnormalities were noted. Breath [H2] tests: lactulose: all patients in both groups responded with positive tests. No difference in transit time was noted. Lactose: 73% of CHD had positive test compared to 36% control. Sorbitol: 73% of CHD had positive test compared to 27% control (p less than 0.05). Fructose: 27% CHD compared to 0% control. This study confirmed that CHD patients have decreased fat stores. It demonstrates for the first time that CHD patients have increased incidence of malabsorption of sorbitol. This carbohydrate malabsorption may contribute to the nutritional abnormalities of CHD.