title: A partial explanation for the surprising ADEMEX result.
abstract: Among the many factors contributing to mortality and morbidity in dialysis patients, nutrition is one of the most important. The ADEMEX (Adequacy of Peritoneal Dialysis in Mexico) study suggests that increasing the amount of daily dialysis to compensate for loss of residual renal function (RRF) does not change mortality or morbidity in peritoneal dialysis (PD) patients. Our purpose in the present study was to determine whether a gradual increase in daily dialysis volume to compensate for loss of RRF interferes with the nutrition of patients. We studied the correlation between normalized protein catabolic rate (nPCR) and daily dialysis volume in 150 PD patients. The Student t-test was used to discover if the correlation was statistically significant. We found that, as the daily dialysis volume increases to replace lost RRF, nPCR declines significantly. This reverse relationship was statistically significant at a p value of 0.007. Replacement of lost RRF by an increase in daily dialysis volume in PD patients contributes significantly to their state of protein malnutrition. The large quantity of carbohydrate acquired through dialysis interferes with the patients' intake of protein. The resulting condition of malnutrition probably plays a significant role in mortality and morbidity in those patients.
authors.affiliation: Division of Nephrology, University of Ottawa, Ottawa Hospital-Riverside Campus, Ottawa, Ontario, Canada.
authors.forename: Denis E
authors.initials: DE
authors.lastname: Pagé
authors.forename: Greg
authors.initials: G
authors.lastname: Knoll
mesh_terms: D015314:Dialysis Solutions / Q000008:administration & dosage; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D011502:Protein-Energy Malnutrition / Q000209:etiology* / Q000503:physiopathology*; D011506:Proteins / Q000008:administration & dosage / Q000378:metabolism; D012709:Serum Albumin / Q000032:analysis
chemical_list: D015314:Dialysis Solutions; D011506:Proteins; D012709:Serum Albumin