The Effect of Peritoneal Membrane Transport Characteristics on the Nutritional Status in Long-Term Continuous Ambulatory Peritoneal Dialysis(CAPD) Patients

Lee, Ho Yung; Lee, In Hee; Kwon, Keun Ho; Noh, Hyun Jin; Park, Hyeong Cheon; Kang, Shin Wook; Choi, Kyu Hun; Han, Dae Suk; Lee, Seong Woo; Shin, Min Jeong; Lee, Jong Ho

Abstract

Protein-calorie malnutrition is common in CAPD patients and is associated with increased morbidity and mortality. There are many causes of malnutrition in CAPD patients, and it is well known that a large amount of protein loss through the peritoneal membrane is one of them. To investigate the effect of the peritoneal membrane transport characteristics on the nutritional status in long-term CAPD patients, we conducted a cross-sectional study on clinically stable 110 patients who performed CAPD for more than 2 years, using PET and measuring nutritional status by subjective global assessment (SGA), biochemical, anthropometric and urea kinetic parameters. Following results were obtained. 1) The patients were divided into 4 groups according to the PET results: high transporter(n=17, 15.5%), high average transporter(n=32, 29.1%), low average transporter(n=52, 47.3%) and low transporter(n=9, 8.1%). 2) Serum albumin levels(g/dl) in high transporter, high average transporter, low average transporter and low transporter were 3.5+/-0.4, 3.8+/-0.4, 4.1+/-0.4 and 4.3+/-0.3, respectively, and there was a significant difference between high transporter and low transporter(p<0.05). High transporter had significantly lower serum creatinine level(11.5+/-1.8mg/dl) than in low transporter(16.3+/-5.0mg/dl)(p<0.05), prealbumin level(mg/dl) was significantly lower in high transporter(29.8+/-5.1) than low average transporter(41.1+/-9.6) and low transporter(41.4+/-3.6) (p< 0.05). But, there were no significant differences in Hct, BUN, total cholesterol, transferrin and IGF-1 among the 4 groups. 3) Albumin loss through dialysate (g/day) was significantly more in high transporter(5.36+/-1.44) than in low average transporter(4.17+/-1.09) and low transporter(3.88+/-1.35)(p<0.05), and SCCr(L/wk/ 1.73 m2) was higher in high transporter(67.08+/-10.60) than in the others(high average transporter, 63.75+/-17.72; low average transporter, 54.92+/-14.54; low transporter, 49.03+/-8.93) (p<0.05). 4) Malnourished patients assessed by SGA were more in high transporter group (6/17, 35.3%) than in low transporer group (1/9, 11.1%)(p<0.05). 5) There were no statistically significant differences in NPCR, Weekly Kt/Vurea, and anthropometric parameters among the 4 groups. In conclusion, CAPD patients in high transporter group are more malnourished despite of more adequate dialysis with higher SCCr compared to those in low transporter group, which is resulted from large amount of protein and albumin loss through dialysate. Strict management and protein replacement therapy will be indicated in high transport CAPD patients to prevent protein malnutrition related morbidity and mortality.