Important factors other than dialysis adequacy associated with inadequate dietary protein and energy intakes in patients receiving maintenance peritoneal dialysis

Abstract

Anorexia that results in inadequate nutrient intake is considered one of the most important causes of malnutrition in dialysis patients. The objective was to determine factors other than dialysis adequacy that are associated with inadequate protein and energy intakes in patients receiving continuous ambulatory peritoneal dialysis. Dietary protein and energy intakes were assessed with a food-frequency questionnaire in 266 patients, and factors other than dialysis adequacy that are potentially associated with reductions in energy and protein intakes were examined. Only 39% of the patients had protein intakes > or = 1.2 g x kg(- 1) x d(- 1), and 26% had energy intakes > or = 126 kJ x kg(- 1) x d(- 1). Other than having a greater total urea clearance and glomerular filtration rate, patients with protein intakes > or = 1.2, as opposed to < 1.2, g x kg(- 1) x d(- 1) had lower high-sensitive C-reactive protein concentrations and fewer complications with volume overload (29% compared with 46%; P = 0.006). Patients with energy intakes > or = 126, as opposed to < 126, kJ x kg(- 1) x d(- 1) were younger, had lower high-sensitive C-reactive protein concentrations, and had a lower prevalence of diabetes (P = 0.006), atherosclerotic vascular disease (P = 0.020), and history of volume overload (P = 0.013). Multiple regression analysis showed that other than increasing age, diabetes, and total urea clearance, having a history of volume overload was independently associated with a 0.22-g x kg(- 1) x d(- 1)decrease in protein (P = 0.001) and a 13.07-kJ x kg(- 1) x d(- 1) decrease in energy intake (P = 0.006). An important yet unrecognized association was observed between a history of volume overload and dietary intake in peritoneal dialysis patients.