Nutrition and Dialysis Adequacy of Korean Patients on Long-term CAPD

Kim, Sung Ho; Shin, Yong Bong; Cho, Young Jun; Kim, Yong Lim; Cho, Dong Kyu

Abstract

CAPD may have many negative impacts on nutritional status. Protein and caloric malnutrition are highly prevalent in chronic CAPD patients. In order to evaluate the relationship between nutritional and dialysis adequacy of long-term CAPD patients, twenty patients treated for aver 5 years on CAPD, with a mean age of 50.5+/-12.2 years and dialysis duration of 82.6+/-19.5 months(range 60-116) were studied. Fourteen of the twenty patients(70%) had no residual renal function(RRF). In these twenty patients the mean weekly Kt/Vurea and Ccr were 1.85+/-0.24 and 58.110.8L/week/1.73m2 with the median body surface area(BSA) of 1.61m2. Female(n=7) patients had lower BSA(1A7 vs 1.69m2), TBW(27.7 vs 35.6L), and higher serum albumin (4.01 vs 3.41g/dL), weekly Kt/Vurea(2.02 vs 1.76) than male(n=13) patients. Six patients had nPCR0.9 and nPCR was negatively correlated with age(r=-0.53, p<0.05), BSA(r=-0.54, p<0.05) and positively correlated with serum albumin(r=0.53, p<0.05). Serum albumin was not changed during 5 years of CAPD. Fourteen patients were well nourished and six patients were mild to moderately malnourished on SGA score. Fourteen of the twenty patients had normal serum albumin(> or =3.5g/dL) and 6 had hypoalbuminemia(<3.5g/dL). Serum albumin was positively correlated with nPCR(r=0.53, p<0.05) and negatively with BSA(r=-0.6S, p<0.001) and total body water (TBW)(r=-0.69, p<0.001). Hypoalbuminemia patients had high peritoneal membrane transport characteristics(24h D/Pcr 0.84 vs 0.74, p<0.05). Four patients had weekly Kt/Vurea>2.0 and Kt/Vurea was negatively correlated with BSA(r=-0.61, p<0.001). In conclusion, for Korean patients on long-term CAPD, small body size is the key for adequate dialysis and nutrition. Low serum albumin levels may be related with high peritoneal transport.