Gastrointestinal and pancreatic function in peritoneal dialysis patients: their relationship with malnutrition and peritoneal membrane abnormalities.
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.
Aguilera
Abelardo
A
Servicio de Nefrologa, Gastroenterologa y Laboratorio de Gastroenterologa, Hospitales Universitario de la Princesa y La Paz, Madrid, Spain.
Bajo
M Auxiliadora
MA
Espinoza
Mauricio
M
Olveira
Antonio
A
Paiva
Ana M
AM
Codoceo
Rosa
R
Garca
Pilar
P
Sánchez
Sonia
S
Celadilla
Olga
O
Castro
Maria Jose
MJ
Selgas
Rafael
R
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
D015415:Biomarkers; D005768:Gastrointestinal Hormones; D008055:Lipids; D014409:Tumor Necrosis Factor-alpha