Evaluation of gastric emptying in patients with chronic renal failure on continuous ambulatory peritoneal dialysis using 99mTc-solid meal.
BACKGROUND
Continuous ambulatory peritoneal dialysis (CAPD) is an alternative to the hemodialysis mode of terminal renal failure treatment. Nutritional status impairment is common among patients with end-stage renal disease, and its laboratory surrogates predict increased morbidity and mortality risk in patients on chronic haemodialysis or peritoneal dialyses. The aetiology of malnutrition is multifactorial and delayed gastric emptying is also considered to be a significant factor. The aim of this study was to estimate the direct influence of indwelled dialysate in the peritoneal cavity on gastric emptying in patients treated with CAPD.


METHODS
the study group included 20 patients (9 males, 11 females) aged 50,1 +/- 11 years (range: 39-75 years) with chronic renal failure treated with CAPD for 18.4 +/- 14.7 months. All patients were non-diabetic and had no other than chronic uraemia co-morbidity known to influence autonomic nervous system function and gastric motility. The control group included 15 healthy volunteers matched by age, sex and body weight. Dialysis adequacy parameters were calculated based on 24-hour urine and dialysate collections. Gastric emptying was estimated with dynamic abdominal scintigraphy. We compared the results of gastric emptying tests performed in dialysed patients with and without dialysate liquid in the peritoneal cavity and related the values to those of the control subjects.


RESULTS
In the study group, weekly values of dialysis parameters were within the ranges considered satisfactory in terms of uraemia control. All parameters of gastric emptying were significantly delayed and prolonged in terminal renal failure patients, but the results have shown no significant differences between those with and without indwelling dialysate.


CONCLUSIONS
Based on the results we conclude that gastric emptying in subjects with chronic renal failure treated with CAPD is markedly delayed compared to healthy subjects. There was no significant effect of indwelling dialysate in the peritoneal cavity on gastric emptying rates found, based on the observation that its removal was not associated with any noticeable improvement of gastric emptying. The data strongly contraindicate the theory of peritoneal dialysate volume being the cause of this reversible disorder and indicate that the role of other possible factors leading to the development of gastropathy in those patients should be investigated.
Department of Endocrinology, Nuclear Medicine Unit, Jagiellonian University, Kraków, Poland. alahuh@endo.cm-uj.krakow.pl
Alicja
A
Hubalewska
Tomasz
T
Stompór
Ewa
E
Płaczkiewicz
Anna
A
Staszczak
Bohdan
B
Huszno
Władysław
W
Sułowicz
Zbigniew
Z
Szybiński
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000000981:diagnostic imaging* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013272:Stomach Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D013668:Technetium Tc 99m Aggregated Albumin / Q000008:administration & dosage*; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid