title: Gastrointestinal and pancreatic function in peritoneal dialysis patients: their relationship with malnutrition and peritoneal membrane abnormalities.
abstract: BACKGROUND
  Malnutrition is frequent in peritoneal dialysis (PD) patients, but the contribution of gastrointestinal (GI) dysfunction has not been well established.
  
  
  METHODS
  We studied GI function in 49 stable PD patients to ascertain its relationship with malnutrition. After an overload fat diet, fecal fat, sugar, starch and nitrogen, intestinal protein permeability (alpha(1)-antitrypsin fecal clearance [C-alpha(1)-AT]), fecal chymotrypsin (CT), GI hormones and gastrin, pepsinogen I and II, cholecystokinin (CCK), gastrin releasing peptide (GRP), and neuropeptide Y (NPY) were measured. Vasoactive intestinal polypeptide (VIP), substance P (SP), and tumor necrosis factor (TNF-alpha) and biochemical nutritional markers were evaluated.
  
  
  RESULTS
  All patients showed high fecal sugar. Elevated fecal nitrogen was found in 21 patients, 6 with high C-alpha(1)-AT. High fecal starch levels appeared in 21, fat in 20, and low fecal CT in 39 patients. These determinations showed inverse relation with nutritional markers. Increased fecal C-alpha(1)-AT values were associated with lower serum albumin. Fecal CT values showed a negative linear correlation with serum albumin and were inversely associated with retinol-binding protein, normalized protein nitrogen appearance, and serum iron. High plasma levels of pancreatic stimulating hormones were found: gastrin, CCK, and VIP. These levels were higher in patients with a worse pancreatic exocrine function. Higher values of other GI hormones, gastrin, pepsinogen I and II, CCK, GRP, and TNF-alpha. Normal concentrations of NPY, VIP, and PS were observed.
  
  
  CONCLUSIONS
  GI abnormalities (malabsorption, maldigestion, pancreatic dysfunction, and protein losing enteropathy) are present in an important number of PD patients. These features are negatively associated to nutrition.
authors.affiliation: Servicio de Nefrologa, Gastroenterologa y Laboratorio de Gastroenterologa, Hospitales Universitario de la Princesa y La Paz, Madrid, Spain.
authors.forename: Abelardo
authors.initials: A
authors.lastname: Aguilera
authors.forename: M Auxiliadora
authors.initials: MA
authors.lastname: Bajo
authors.forename: Mauricio
authors.initials: M
authors.lastname: Espinoza
authors.forename: Antonio
authors.initials: A
authors.lastname: Olveira
authors.forename: Ana M
authors.initials: AM
authors.lastname: Paiva
authors.forename: Rosa
authors.initials: R
authors.lastname: Codoceo
authors.forename: Pilar
authors.initials: P
authors.lastname: Garca
authors.forename: Sonia
authors.initials: S
authors.lastname: Sánchez
authors.forename: Olga
authors.initials: O
authors.lastname: Celadilla
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Castro
authors.forename: Rafael
authors.initials: R
authors.lastname: Selgas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D004063:Digestion; D010188:Exocrine Pancreatic Insufficiency / Q000150:complications* / Q000503:physiopathology; D005243:Feces / Q000737:chemistry; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000503:physiopathology; D005768:Gastrointestinal Hormones / Q000097:blood*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007408:Intestinal Absorption; D007515:Islets of Langerhans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008055:Lipids / Q000032:analysis; D008297:Male; D044342:Malnutrition / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000503:physiopathology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D015415:Biomarkers; D005768:Gastrointestinal Hormones; D008055:Lipids; D014409:Tumor Necrosis Factor-alpha