Body composition in patients treated with peritoneal dialysis.

Introduction Background. Malnutrition is a common complication in uremia and during maintenance dialysis. Several Malnutrition is a common complication in uremia and factors contribute to its development. DiVerent modes during maintenance dialysis [1‐3] which is associated of dialysis treatment may diVer in their eVects on with increased morbidity and mortality [4‐7]. Several nutritional status. factors contribute to the protein-energy malnutrition Methods. In order to analyse the nutritional con- in dialysis patients and various dialysis modalities may sequences of peritoneal dialysis (PD), body composi- diVer in their eVect on nutritional status [8]. tion analyses were performed in PD patients between Peritoneal dialysis (PD) may oVer potential nutriFebruary 1993 and March 1996. Body cell mass (BCM ) tional advantages compared with hemodialysis in that was estimated from measurements of total body potas- it provides a continuous energy supply, which may sium ( TBK ) in a whole-body counter. Total body have a protein-sparing eVect. In addition, the catabolic water ( TBW ) was determined by measurement of stimuli of hemodialysis, e.g. blood‐membrane intertritiated water. Body fat (BF ) was calculated from actions, are avoided. Protein losses in the peritoneal body weight (BW ), TBK and TBW. Observed values dialysate appear to be of the same magnitude as in were related to predicted (o/p) derived from local various hemodialysis modalities. However, increased population studies. abdominal filling and discomfort combined with supResults. Sixty patients were repeatedly investigated pressed appetite as a consequence of glucose uptake during the study period. Of these, 34 were investigated are factors that may negatively influence nutritional during the first year of PD. At the start of dialysis, status in PD patients [9]. TBK o/p was 0.94 and BF o/p 0.76. No change in The risk of malnutrition in PD is supported by the body composition was seen during the observation cross-sectional study of Young et al. which showed period in the group as a whole. However, within the that signs of malnutrition were present in a considergroup individual changes in BW were strongly correl- able proportion of patients who had been on PD for ated with individual changes in BF (r=0.66, P= more than 3 months [2]. In this multi-center study, 0.0001). Twenty-six patients were examined during the nutritional status was assessed by anthropometric and second and third year of PD. In this group, BW o/p biochemical methods. remained constant over time. However, there was a At the Department of Nephrology, Sahlgrenska small but significant decline of TBK o/p and a concom- University Hospital in Gothenburg, we used body itant increase of BF o/ p( P<0.05). No correlation was composition analyses to evaluate the nutritional eVects observed between changes in TBK and changes in of low protein diet in predialytic patients [10] as well serum albumin. as to study the nutritional status of patients on mainConclusions. The results of this study indicate, that tenance hemodialysis [11]. In 1993, body composition there may be a risk for further reduction of body cell analyses were included as a measure of nutritional mass during long-term PD treatment, while body status in the regular follow-up of PD patients. The energy stores are maintained or even increased. aim of the present study was to evaluate changes in