Does loss of residual renal function lead to malnutrition in peritoneal dialysis patients?
OBJECTIVE
It is usually believed that loss of residual renal function is associated with anorexia and the development of malnutrition. We conducted a retrospective study in our center to evaluate the effect of declining residual renal function on patients' nutritional status.


METHODS
All incident uremic patients (n = 46) who began peritoneal dialysis from January 1, 2003 June 1, 2003 in our center were closely followed for 1 year with focus on maintaining strict volume control with time on dialysis. Patient's residual renal function (RRF) was assessed by the average renal urea and creatinine clearances. Those patients who had more than 50% decrease in GFR were selected for the present analysis. Serum albumin (ALB), dietary protein intake (DPI) and subjective global assessment (SGA) were closely followed.


RESULTS
There were 16 patients (9 males and 7 females) included in the present analysis, among whom 31.3% were diabetics. Patients' GFR declined significantly (RRF were 4.32 +/- 2.69, 2.99 +/- 2.21 and 1.24 +/- 0.99 ml/min for Months 1, 6 and 12, respectively, p < 0.05), along with a significant decline in urine volume (985.62 +/- 543.29, 698.13 +/- 463.59 and 425.63 +/- 320.52 ml/d for Months 1, 6 and 12, respectively, p < 0.01). Although weekly peritoneal Kt/V did not increase significantly, peritoneal ultrafiltration increased significantly during this period (428.75 +/- 408.96, 534.38 +/- 296.39, 844.38 +/- 440.35 ml for Months 1, 6 and 12, respectively, p < 0.05). Serum ALB increased significantly (32.34 +/- 5.07, 34.74 +/- 4.89 and 36.21 +/- 3.98 g/l for Months 1, 6 and 12, respectively, p < 0.01). DPI also increased significantly. The prevalence of malnutrition (by SGA) decreased from 62.5% at the start of dialysis to 18.8% at the end of this study (p < 0.05).


CONCLUSIONS
Our study suggests that rapid decline of residual renal function in PD patients does not necessarily lead to decreased dietary protein intake and deteriorated nutritional status. Focus on incremental peritoneal fluid removal along with the decline in residual renal function and, thus, maintaining volume control may be one of the critical reasons for the success.
Cheng
L T
LT
Division of Nephrology, Peking University First Hospital, Beijing, China.
Chen
W
W
Tang
W
W
Wang
T
T
D000959:Antihypertensive Agents / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D003710:Demography; D004044:Dietary Proteins; D017097:Electric Impedance; D002149:Energy Intake / Q000187:drug effects; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D044342:Malnutrition / Q000209:etiology*; D008875:Middle Aged; D009752:Nutritional Status / Q000187:drug effects; D010530:Peritoneal Dialysis / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood
D000959:Antihypertensive Agents; D004044:Dietary Proteins; D012964:Sodium