Johansson AC, Attman PO, Haraldsson B
The influence of peritoneal dialysis on nutritional status
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1450 1996
The authors measure body cell mass as estimated from total body potassium,
total body water as
measured by tritiated water, and body fat calculated from the previous two
indices plus body weight.
They make these measurements in 52 new PD patients and also have serial
measurements on 60 patients
for up to four years. They show that, as compared to normals, body water was
6% less than
predicted, body cell mass 8% less, and body fat 27% less at the time of
starting PD. In the
patients followed serially, there were no changes in body water or cell mass,
but body fat tended to
increase slightly with time. Interestingly, these changes did not correlate
with alterations in
serum albumin, dialysate protein losses, or residual renal or peritoneal
clearance. The authors
suggest that serum albumin is not a good marker of serial changes in body
protein mass.
Comment: This work suggests that body composition is better maintained
on CAPD than has been
suggested in other studies and concerns about long-term nutritional effects
of PD would not appear
to be borne out. Of particular interest is the finding that nutritional
compromise was present
right from the start of dialysis, suggesting again that the problem may not
just be how much or how
little dialysis we give but rather how late we start it. The lack of
association between muscle
mass and serum albumin is not surprising, considering that the latter has
previously been shown to
be more dependent on peritoneal transport status, presumably via dialysate
protein losses. Also,
evidence in hemodialysis suggests that serum albumin is very active as an
inverse acute phase
reactant in dialysis patients. These findings do not detract from the power
of the serum albumin in
predicting mortality and morbidity in dialysis patients. It is also worth
noting that there is
previous work from Oreopoulos's group suggesting that total body potassium
does decrease in
long-term PD patients. This study, therefore, needs to be repeated in other
populations to see how
well the findings stand up. (Peter G.
Blake, M.D., Victoria Hospital, London, Ontario)
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Am Soc Nephrol
CRF by organ system :
Nutrition