Effect of peritoneal dialysis prescription and peritoneal membrane transport characteristics on nutritional status.
These data suggest that dialysis dose is one of the major determinants of protein and energy intake in PD patients and that higher doses of dialysis tend to improve outcome. The data also suggest that with a long time on PD the peritoneal membrane probably has some underlying histological changes that preclude it from optimally responding to injury and may predispose it to irreversible damage. A possible early finding in this case is an increase in peritoneal transport in patients whose transport was initially stable. Peritoneal membrane transport properties are an important determinant of not only dialysis dose, but also nutritional status via both direct and indirect means. It is therefore important to identify the individual patient's peritoneal membrane transport characteristics. These transport characteristics may change over time. High transporters on CAPD represent a unique challenge. They have ultrafiltration problems and a tendency toward protein malnutrition presumably due to increased dialysate protein losses while on CAPD. One must consider that malnutrition in a rapid transporter may be due to the fact that the patient is on the wrong PD therapy. A change to NIPD may rectify some of the biochemical parameters, but these patients may not always improve. Reasons for this occasional lack of improvement are multifactorial, but emphasize our need to look at each patient as an individual and not focus only on laboratory parameters.
Burkart
J M
JM
Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA.
D001692:Biological Transport; D003404:Creatinine / Q000097:blood; D015314:Dialysis Solutions / Q000008:administration & dosage; D004044:Dietary Proteins / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D006801:Humans; D009752:Nutritional Status; D017063:Outcome Assessment, Health Care; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods; D010537:Peritoneum / Q000378:metabolism*; D010538:Peritonitis / Q000503:physiopathology; D012709:Serum Albumin / Q000032:analysis
D015314:Dialysis Solutions; D004044:Dietary Proteins; D012709:Serum Albumin; D003404:Creatinine