Nephrology Dialysis Transplantation, Vol 14, Issue 7 1715-1722, Copyright © 1999 by Oxford University Press
D Kang, K Yoon, K Choi, , H Lee, D Han, E Cho and J Lee
Background: The study was carried out to evaluate the
role of individual peritoneal membrane transport characteristics in the
nutritional status expressed as the composite nutritional index (CNI).
Methods: Cross-sectional analyses of the overall
nutritional status of 147 continuous ambulatory peritoneal dialysis (CAPD)
patients were performed using the CNI. CNIs based on a scoring system of 10
nutritional indices including subjective global assessment, biochemical
parameters and anthropometry were compared according to the results of a
standard peritoneal equilibration test (PET). Results:
Patients were classified as low (n=17, 10.9%), low average (n=59, 40.2%)
high average (n=54, 36.7%) and high (n=18, 12.2%) transporters based on the
D/PCr after 4 h dwells. The mean 4 h D/;Cr was 0.65±0.12
(0.34-0.95), and there was no significant correlation between D/PCr and
other demographic parameters such as age, duration of peritoneal dialysis
and body surface area. D/PCr was correlated with dialytic albumin loss
(r=0.47, P<0.001), serum albumin (r=-0.46, P<0.001), serum
creatinine (r=-0.38, P<0.001), serum IGF-1 (r=-0.37, P<0.01)
and LBMCr (r=-0.26, P<0.05). In high transporters the serum albumin
was significantly lower while dialysate protein and albumin losses were
significantly greater compared with low transporters. Serum creatinine and
IGF-1 concentrations as well as LBMCr were also decreased in higher
transporters. The mean CNI score was 8.1±4.9, with a range of
0-24. CNI was positively correlated with age, duration of peritoneal
dialysis, incidence of peritonitis, CRP and dialytic protein loss, whereas
it was inversely correlated with ultrafiltration volume, haemoglobin and
NPNA. The CNI score was significantly higher in high transporters compared
with low transporters (11.7±4.3 vs
5.9±1.6, P<0.01). There was also a significant
correlation between D/PCr and CNI (r=0.29, P<0.05). Multiple
regression analysis revealed that the incidence of peritonitis, duration of
CAPD, CRP and D/PCr were the independent factors affecting the CNI.
Conclusion: Peritoneal membrane transport
characteristics correlate with the overall nutritional status of peritoneal
dialysis patients assessed by the scoring system of the CNI, although it is
associated with a different impact on the individual nutritional indices.
The results of this cross-sectional study also suggest that a high
permeability state is a risk factor for malnutrition in CAPD patients.
Prospective studies evaluating the changes in nutritional parameters among
patients with different membrane transport rates are needed to understand
better the relationship of peritoneal membrane characteristics to the
nutritional status of CAPD patients. Key words:
composite nutritional index; peritoneal transport characteristics
ORIGINAL ARTICLES
Relationship of peritoneal membrane transport characteristics to the nutritional status in CAPD patients
Department of Internal Medicine, Medical Research Center, College of Medicine, Ewha Women's University, Seoul, Korea; Department of Medicine, College of Medicine and Department of Food and Nutrition, College of Human Ecology, Yonsei University, Seoul, Korea; Corresponding author at: Department of Internal Medicine, Yonsei University College of Medicine, CPO Box 8044, Seoul 120-754, Korea
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