Nutritional and metabolic response to catabolic stress in uremia

Metabolic balance studies were conducted in five nondialyzed chronically uremic patients and four patients undergoing maintenance hemodialysis or peritoneal dialysis who had sustained an acute intercurrent illness. Nitrogen balance became negative in all patients. In eight patients who did not have marked fluid removal, serum total protein, albumin and transferrin fell significantly. Negative nitrogen balance was caused by three factors: 1) decreased nitrogen intake, which wasn't always readily apparent 2) increased urea nitrogen appearance, and 3) in peritoneal dialysis patients with peritonitis, protein losses into dialysate. In the chronically uremic patients, urea nitrogen appearance correlated closely with total nitrogen output and appears to be a good predictor of total nitrogen losses.