Nutritional parameters in diabetic patients on CAPD.
In diabetic patients treated with dialysis, morbidity and mortality are more elevated than in nondiabetic patients. For the high dropout of diabetic patients between the first and the second year of treatment not much data are available on their nutritional parameters. For this reason, after excluding patients who had not had a two-years follow-up, we compared two groups of patients, 8 diabetics and 10 nondiabetics, similar in age (66.0 +/- 8.1 vs 65.0 +/- 8.3 years) and weight (61.8 +/- 11.9 vs 62.1 +/- 5.5 kg), measuring their nutritional parameters [body mass index (BMI), normalized protein catabolic rate (PCRN), albumin, transferrin, cholesterol], dialytic dose (Kt/V), renal residual function (RRF) and peritoneal urea (Kdu) and creatinine clearances (Kdcr) after one and 24 months of continuous ambulatory peritoneal dialysis (CAPD). At the start of CAPD, diabetics had greater weekly Kt/V (2.77 +/- 0.68 vs 2.19 +/- 0.35, p < 0.03) for a better residual renal function (5.0 +/- 2.0 vs 2.6 +/- 1.6 mL/min, p < 0.01) and greater loss of proteins in dialysate (7.8 +/- 2.3 vs 5.2 +/- 2.1 g/day, p < 0.05). After 24 months diabetic patients showed a significant decrease in albumin (3.44 +/- 0.34 vs 2.92 +/- 0.33 g/dL, p > 0.01), PCRN (1.21 +/- 0.20 vs 0.92 +/- 0.10 g/kg/day, p < 0.02), and weekly Kt/V (2.77 +/- 0.68 vs 2.25 +/- 0.38, p < 0.05), and a reduction, even if not as significant as with nondiabetic patients, in residual renal function (5.0 +/- 2.0 vs 3.0 +/- 2.3, p = NS). BMI (p < 0.01) was significantly increased in both groups, and this increase is higher in diabetic patients, while transferrin and cholesterol had no significant variations in both groups of patients. Peritoneal clearances did not change in 24 months, whereas the daily protein loss into dialysate was constantly higher in diabetic patients. In conclusion, diabetic patients have, over time, a decrease of total (renal and peritoneal) clearances of urea and creatinine (primarily because of loss of residual renal function, a reduced protein intake (evaluated as PCRN), and an increased loss of proteins from the peritoneum, which bring about a decrease in albuminemia, a possible concomitant cause of the greater morbidity and mortality in diabetic patients.
Scanziani
R
R
Renal Unit, Desio Hospital, Milan, Italy.
Dozio
B
B
Bonforte
G
G
Surian
M
M
D000368:Aged; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D003404:Creatinine / Q000097:blood; D003925:Diabetic Angiopathies / Q000097:blood / Q000178:diet therapy*; D004044:Dietary Proteins / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000178:diet therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D010531:Peritoneal Dialysis, Continuous Ambulatory; D012709:Serum Albumin / Q000378:metabolism; D014508:Urea / Q000097:blood
D004044:Dietary Proteins; D012709:Serum Albumin; D014508:Urea; D003404:Creatinine