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Energy intake in patients on continuous ambulatory peritoneal dialysis and haemodialysis
A Fernström1, B Hylander, S Rössner
1Department of Internal Medicine, Karolinska Hospital, Stockholm, Sweden.
Objectives:
To compare patients on continuous ambulatory peritoneal dialysis (CAPD) with those on haemodialysis (HD) regarding food composition and energy intake.
Design:
Prospective food recording during 5 consecutive days.
Setting:
Nephrology section at a University hospital.
Subjects:
Fifteen patients on CAPD and 15 patients on HD, matched for age, gender, duration of dialysis and body mass index (BMI).
Main Outcome Measures:
Percentage macronutrient energy composition, with and without inclusion of transperitoneal glucose uptake. Daily energy intake, both total and from the different macronutrients.
Results:
The percentage contribution of the dietary macronutrients to the energy intake was about the same in the two dialysis groups, although the actual energy intake in CAPD patients was lower from all three macronutrients (P = 0.02-0.04). The mean intraperitoneal glucose load in CAPD patients was 159 g day-1, which is approximately equivalent to 2700 kJ. Inclusion of this additional energy (estimated uptake: 70% of the intraperitoneal energy load = 19% of total energy intake) significantly increased the carbohydrate fraction and decreased the protein and fat fractions (P < 0.0001). Furthermore, this inclusion resulted in almost identical values for total energy intake in the two groups (approximately 144 kJ kg-1 day-1) and, in CAPD patients, a significantly higher actual energy contribution from carbohydrates (P = 0.04).
Conclusions:
Transperitoneal energy intake more than compensates for the lower oral dietary energy intake seen in CAPD patients. Nevertheless, the level of total energy intake places both patient groups in the risk zone for developing malnutrition.