Nutritional Status In Peritoneal Dialysis Patients Research Articles

Efficacy and safety of keto-supplemented low-protein diet on nutritional status of peritoneal-dialysis patients: a systematic review and meta-analysis of randomized controlled trials.

The purpose of this meta-analysis is to evaluate the efficacy of a keto-supplemented low-protein diet (sLPD) in enhancing nutritional status among individuals undergoing peritoneal dialysis (PD) compared to a low-protein diet (LPD). Studies from PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched and reviewed up to January 2023. Randomized controlled trials (RCTs) were enrolled and analyzed using STATA MP 17. In this review, serum albumin (Alb), body mass index (BMI), and serum prealbumin (PA) were included for efficacy evaluation and serum calcium (CA) for safety evaluation. Potential heterogeneity was detected using subgroup analyses. 7 RCTs were included. Compared with LPD, sLPD can improve the Alb [Weighted Mean Difference (WMD)=4.16; 95% CI: 2.50, 5.83; p<0.0001), BMI [WMD=1.35; 95% CI: 0.59, 2.11; p<0.0001] and PA [WMD=0.07; 95% CI: 0.04, 0.10; p<0.0001] level of patients undergoing PD. Subgroup analyses showed that, although Alb had no difference with LPD within 12 months of PD duration, sLPD treatment could improve the levels of Alb and PA regardless of PD duration or course of treatment. sLPD can improve the BMI of patients with a PD duration of more than 24 months, regardless of the duration of treatment. A sLPD is an effective intervention for improving the nutritional status of PD patients. It is suggested that patients undergoing PD should initiate sLPD at the beginning of PD to ensure sufficient nutritional intake.

#5405 MALNUTRITION DIAGNOSIS IN CKD PATIENTS

Abstract Background and Aims Malnutrition is a prevalent condition in patients with chronic kidney disease (CKD) receiving replacement therapy by peritoneal dialysis (PD). Geriatric nutritional risk index (GNRI) is an effective tool for screening nutritional status in maintenance hemodialysis patients. The purpose of this study was to determine the information content of GNRI for the diagnosis of protein-energy malnutrition in patients with CKD receiving replacement therapy with PD when compared to malnutrition inflammation score (MIS) and 7-point subjective global assessment (7p-SGA). Method A prospective cohort study included 222 adults PD-patients (man 100, female 112, age 44±14). All patients received continuous ambulatory peritoneal dialysis. Median duration PD before inclusion in the study was 12 months, the observation period of patients was 36 months. Nutritional status assessment included anthropometric (body mass index, triceps skinfold thickness, midupper arm muscular area) and biochemical (albumin, C-reactive protein, total iron-binding capacity, total cholesterol, hemoglobin and others) examinations as well as bioelectrical impedance analysis (BIA – fat mass). GNRI calculated according to the formula GNRI = 1.489 × albumin (g/dL)] + [41.7 × (body wt/ideal body wt)], where the ideal body weight for women is: height (cm)–100–[(height–152) × 0.2], ideal body weight for men is equal to: height (cm) -100 - [(height - 152) × 0.4]. We used MIS and 7p-SGA as a reference standard, a score ≥6 and ≤5, respectively, defined malnutrition. The cutoff of GNRI the diagnosis of malnutrition were derived from these ROC-analysis. Results Most of the individual nutritional indexes, including the anthropometric, biochemical and BIA indexes, were significantly (P&amp;lt;0.001) lower in the patients with MIS score ≥6 and 7p-SGA score ≤5, thus both nutritional screening tools were considered reasonable as a reference standard to determine the information content GNRI in PD-patients. The GNRI fluctuated in the range 66–126 (median 99), MIS score – 2–24 (median 7) and 7p-SGA score – 2–7 (median 5). The GNRI showed a significantly negative correlation with MIS (r = -0,708, p&amp;lt;0.0001) and a significantly positive correlation with 7p-SGA (r = 0.636, p&amp;lt;0.0001) (Fig. 1). The most accurate GNRI cutoff to identify a malnourished patient according to the MIS was ≤99 (Fig. 2). The frequency of malnutrition among the observed patients was 52.3% when using GNRI≤99, 55.9% when using MIS≥6 and 51.4% when using 7p-SGA≤5 (n.s.). The values for sensitivity and specificity with a GNRI of ≤99 in predicting malnutrition based on the MIS were 77.4% (95%CI 69.0-84.4%) and 79.6% (95%CI 70.3-87.1%) respectively. Positive predictive value and negative predictive value also had high scores respectively 73.7% (95%CI 64.9-80.9%) and 72.2 (95%CI 63.1-79.8%). The application of the GNRI to the PD-patients found significant (p&amp;lt;0.001) differences in the various nutrition-related indexes (anthropometric, biochemical and BIA) between the group with a GNRI≤99 and that with GNRI&amp;gt;99. Mortality from all causes among patients with GNRI&amp;gt;99 was one case per 54.9 patient-years, among patients with GNRI≤99 was one case per 29.7 patient-years. Conclusion In PD-patients GNRI closely correlates with MIS and 7p-SGA, characterized by high sensitivity and specificity. GNRI can be used to determine the nutritional status of PD patients.

Relationship between gut microbiota and nutritional status in patients on peritoneal dialysis

Malnutrition is a common complication in the dialysis population, both hemodialysis and peritoneal dialysis (PD). We report our exploratory study on the characteristics of intestinal microbiota and nutritional status in PD patients. The nutritional status of our PD patients were evaluated, and their feces were collected for 16S rRNA gene V3-V4 regions amplification and high-throughput sequencing. The characteristics and differences of microbiota between the well-nourished (W) and malnourished (M) groups were compared. We studied the genera and the operational taxonomic units (OTUs) within the genus of our patients, initially comparing the malnourished and the well- nourished groups and later on reanalyzing the whole group using these OTUs. At the OTU level, 6 bacteria were significantly correlated with the serum albumin level. The abundances of 2 OTUs (OTU208 Lachnospiraceae_incertae_sedi and OTU4 Bacteroides) were more in W group. Meanwhile, 4 OTUs (OTU225 Akkermansia, OTU87 Megasphaera, OTU31 Peptostreptococcaceae_incertae_sedi and OTU168 Clostridium_sensu_strictu) displayed higher abundance among individuals in M group. Notably, the OTU168 Clostridium_sensu_stricto was the only bacteria that significantly correlated with serum albumin (r = − 0.356, P = 0.05), pre-albumin (r = − 0.399, P = 0.02), and SGA (r = 0.458, P = 0.01). The higher the OTU168 Clostridium_sensu_strictu, the lower serum albumin and pre-albumin and a higher score of SGA signifying a worse nutritional status. Our preliminary findings suggested a relationship between the nutrition status and microbiota in PD patients. Our results provide a basis for further exploration of the interactions between malnutrition and intestinal flora in PD patients with potential interventions using probiotics and prebiotics.

MO689: Relationship between Peritoneal/Renal Function and Nutritional Status in Peritoneal Dialysis Patients

Abstract BACKGROUND AND AIMS The positive impact of nutritional status on the health and treatment adequacy of peritoneal dialysis (PD) patients has been well established. There are several accepted strategies for stratifying malnutrition in PD, such as laboratory markers [serum albumin and normalized protein catabolic ratio (nPCR)] and the recent use of bioimpedance spectroscopy (BIS). The aim of this study was to assess the nutritional status of PD patients upon the start of the therapy. We also aimed to establish a potential relationship between peritoneal/renal function, obtained by a peritoneal equilibration test (PET), and nutritional markers. METHOD We studied a cohort of patients from a single PD unit between 1 July 2011 and 31 August 2021, who had one BIS measurement and a PET in the first 3 months after the beginning of PD. We also collect laboratory data within 6 months from the BIS reading (albumin, C-reactive protein and phosphorus). Demographic parameters (age, dialysis vintage, presence or absence of diabetes mellitus) and body mass index were also evaluated. RESULTS The study included 91 incident PD patients. The mean age of patients was 65.40 $ \pm $ 13.88 years, 59.3% were male and 28% had diabetes. Regarding baseline renal and peritoneal parameters, weekly total kt/v median was 1.99 (IQR 0.99–2.59) residual renal function (eGFR) median 3.2 (IQR 2.12–7.75) mL/min/1.73 m2 daily diuresis median 1500 (IQR 1000–2100), fluid removal (FR) median 2.23 (IQR 1.86–2.65) L/day and 41.8% had a dialysate/plasma (D/P) creatinine higher than 0.77. Lean tissue index was low in 36.3% and fat tissue index was high in 52.2%. Serum albumin median was 3.7 (IQR 3.3–4) g/dL and nPCR median 0.84 (IQR 0.72–1.04) g/kg/day. Hypervolemic patients had significantly lower lean tissue index (13.77 ± 3.25 versus 16.87 ± 3.82, P = 0.003). In a univariate analysis, patients with nPCR &amp;lt; 1.2 g/kg/day (79.1% from the complete cohort with no age difference) had lower baseline weekly total kt/v (2.17 ± 0.43 versus 6.62 ± 4.45, P &amp;lt; 0.001, lower daily diuresis (1261 ± 753 versus 1687 ± 958, P = 0.047), lower FR (2.05 ± 0.57 versus 2.40 ± 0.80, P = 0.043), and also significantly lower D/P creatinine (0.74 ± 0.1 versus 0.97 ± 0.27, P &amp;lt; 0.001). Furthermore, patients with serum albumin &amp;lt;3.8 g/dL had a lower ultrafiltration proof (326 ± 192 versus 511 ± 267, P = 0.028) and those with low lean tissue index had a lower daily diuresis (1405 ± 825 versus 1823 ± 1025, P = 0.045). In a multivariate analysis, patients with nPCR &amp;lt; 1.2 g/kg/day were older [exp (B) 0.19, 95% CI 0.8–0.9, P = 0.012] and had lower weekly total kt/v [exp (B) 0.18, 95% CI 0.6–0.9, P = 0.017]. CONCLUSION This study showed some relationships between kidney/peritoneal function parameters and body composition parameters. The level of nPCR, a measure of nutritional status, was significantly and positively associated with indicators of dialysis adequacy (kt/v), daily diuresis and, also with transport type. Further research regarding nutrition must be undertaken to help improve health outcomes in PD patients.

P1187THE NUTRITIONAL STATUS IN PERITONEAL DIALYSIS PATIENTS: HOSPITALIZATION AND MORTALITY

Abstract Background and Aims The worldwide medical public attention focuses on the problems associated with decreasing morbidity frequency and improving of survival of patients with the end stage renal disease (ESRD). Peritoneal dialysis (PD), including continuous ambulatory peritoneal dialysis (CAPD), one of the known modality of renal replacement therapy (RRT). Several studies demonstrated that namely nutritional. The aim of this study was to explore the relationship between the nutritional status in PD patients and their morbidity and mortality. Method This study was an observational, prospective, epidemiological tracking by clinical examination. The study included 105 patients with ESRD who started CAPD treated in single dialysis center of Ukraine (during 2012 - 2018). Fifty three (50.5%) patients were male, median age 60 (range 25–85 years) and the most common cause of ESRD was glomerulonephritis (63 patients, 60.0%). Median follow-up was 29 months (range 6- 132 months). Nutritional status (NS) indicators defined basing on the calculation of the subjective global assessment (SGA, points). Patients were classified into four groups according to their NS. Group 1 included 51 patients with normal NS, group 2- 30 patients with a light degree of malnutrition, group 3 (13 patients) and group 4 (11 patients) with moderate and severe degree of nutritional disorders, respectively. During follow-up, all hospital admissions and all causes of mortality were documented and compared for nutritional disorders versus normal NS. Results During follow up the 62 hospitalization cases (30 cardiovascular events, 15 PD-peritonitis, 13 other bacterial infections, 2 stroke and 2 - others) and 46 deaths among all patients were detected. The odds ratio for all-cause hospitalization in the group 3 (12/85.7% vs. 26/ 51.0%) were significantly higher than in the group 1 (OR = 5.7692, 95% CI: 1.1712 - 28.4178; р= 0.0312). A significant increasing of the hospitalization incidences both due infectious comorbidity (7/63.64% vs. 8/15.7%; χ²= 8.880, p = 0.003) among patients with severe degree of malnutrition compared with patients group 1. At the same time, cardiovascular (CVD) hospitalization rate was significantly higher in patients group 3 (8/57.1% vs. 10/ 19.6%; χ²= 5.968, p = 0.015) than in the group1. Mortality rate was significantly higher in patients group with moderate (11/84.6% vs 16/31.37%, χ²= 12.041, p &amp;lt;0.0001; OR =12.031; 95% CI: 2.3843 - 60.7105) and a light degree of nutritional disorders (11/84.6% vs 13/43.4%, χ²= 6.267, p= 0.013; OR = 7.1923; 95% CI: 1.352- 38.2367) than with normal NS. Similarly, patients with a severe degree of malnutrition (group 4) showed a higher mortality rate versus patients group1: 8/72.7%% vs. 16/31.37%,; χ²= 6.522, р= 0.011 (OR = 5.8333, 95% CI: 1.3645-24.9376). Cardiovascular disease was the leading cause of death (22/47.8%). Conclusion Thus, the obtained findings suggest that nutritional disorders at PD initiation have a significant negative effect on prognosis. The results of our study demonstrated the predictive role of assessing nutritional status in all-cause mortality and hospital admissions in ESRD population.

P1177THE INFLUENCE OF PERITONEAL GLUCOSE LOAD ON LEAN AND ADIPOSE TISSUE MASS IN PERITONEAL DIALYSIS PATIENTS USING A NOVEL AND QUANTITATIVE INDEX

Abstract Background and Aims There is now widespread consensus among nephrologists to increase the number of patients on peritoneal dialysis (PD). Most of the PD dialysis solutions are based on glucose as an osmotic agent. The peritoneal glucose load can damage the peritoneal membrane, increases its permeability to water, glucose and electrolytes leading to the development of fluid overload, hypertension, stimulation of the inflammatory process and metabolic disturbances. This study aims to verify the influence of glucose exposure load on lean and adipose tissue mass in PD patients using a novel and quantitative index. Method This is a retrospective and analytical study based on the medical records. The study examined the entire population of PD patients who were treated at the Peritoneal Dialysis Unit at the Galilee Medical Center in north of Israel during the last eight years (from January 1, 2010 through December 31, 2017). The clinical and laboratory data of these patients were collected from their medical records and analyzed. The main variables examined included peritoneal glucose load index (PGLI), lean tissue index (LTI) and Fat Tissue Index (FTI). LTI was calculated as the quotient of LTM/Height?(kg/m? and FTI was defined as the quotient of ATM/Height?(kg/m?. LTI and FTI were assessed using the Fresenius Medical Care Body Composition Monitor (BCM) device, based on Bio-impedance technology Results 187 assessments of the nutritional status in PD patients, using the BCM device, were evaluated. Among PD patients, 52.4% were men, 54% were treated with continuous ambulatory peritoneal dialysis (CAPD) and 46% had diabetes mellitus as primary renal disease. The average age was 57.8 ± 11.3 years, peritoneal dialysis vintage 31.36 ± 16.69 months, body mass index (BMI) 28.1 ± 4.4 kg/m2, daily urinary output 1040.0 ± 649.8 ml/day, hemoglobin 10.84 ± 1.02 g/dl, HbA1c 7.05 ± 1.09 %, Kt/V 1.89 ± 0.17, PGLI 3.11 ± 1.13 g/kg/day, residual renal function 6.68 ± 2.46 ml/min/1.73m2. A significant and positive correlation between the PGLI and FTI (r=0.28, p&amp;lt;0.001) and, a significant and negative association between PGLI and LTI (r=-0.24, p&amp;lt;0.001) were found. Conclusion Peritoneal glucose load may adversely influence the nutritional status of PD patients by increasing the adipose tissue mass and decreasing lean tissue mass.

Geriatric nutritional risk index is associated with mortality in peritoneal dialysis patients

Malnutrition is one of the most common complications among dialysis patients. The Geriatric Nutritional Risk Index (GNRI) is rarely used in dialysis patients, especially peritoneal dialysis (PD). To use the GNRI to evaluate the initial nutritional state of PD patients and to examine the association between the GNRI and mortality in chronic PD patients. We retrospectively examined the medical records at our centre to identify all adults (≥18 years) who had undergone PD for over 3 months before recruitment from January 2005 to December 2017. The correlation between the GNRI and mortality was examined by Kaplan-Meier and Cox proportional hazards analyses. A total of 1804 patients was enrolled in the study. Significant correlations were noted between the initial GNRI and Charlson index, uric acid, blood calcium, potassium, triglycerides, low-density lipoprotein cholesterol, haemoglobin and so on. Multivariate Cox proportional hazards analyses demonstrated that the GNRI was associated with all-cause mortality (hazard ratio = 0.96, P < 0.001, 95% confidence interval: 0.95-0.98) after adjustment. Compared with the lowest GNRI group, all-cause mortality decreased significantly for each level of GNRI after adjusting for various influencing factors, and the mortality risk of the highest GNRI grade decreased by 66%. The Kaplan-Meier analysis survival rate was significantly different among the four groups in terms of all-cause mortality and cardiovascular and cerebrovascular mortality (log-rank test, P < 0.05). These results demonstrated that the GNRI is significantly associated with mortality and can be a simple, clinically useful marker for the assessment of nutritional status in PD patients.

SUN-082 EFFECTS OF ORAL COLLAGEN PEPTIDES ON NUTRITIONAL STATUS OF PERITONEAL DIALYSIS PATIENTS

Protein energy malnutrition is common amongst end stage renal disease patients and it is associated with increased morbidity and mortality. It is more prevalent in peritoneal dialysis (PD) patients compared to hemodialysis (HD) patients. Dietetic counselling, oral supplementation, enteral feeding, and intradialytic parenteral nutrition are amongst the intervention employed to improve nutritional status of dialysis patients. The aim of our study is to evaluate the effect of oral collagen peptides on the nutritional status of PD patients.

Assessment of Nutritional Status and Metabolic Syndrome in Peritoneal Dialysis Patients: A Pilot Study

Aim : Nutritional deficiencies and metabolic syndrome (MS) is challenge in chronic kidney disease patients with peritoneal dialysis(PD). This study was planned in order to assess the nutritional status and metabolic syndrome in PD patients. Methods: This study was performed on clinically stable patients that were undergoing PD therapy. Energy and nutrient intakes were determined with consequently three days dietary record. The statement of MS was identified according to MS criteria adopted for PD patients. Results: The prevalence of MS was found 64.3%. The mean duration of PD in with-MS(35.4±25.23mo.) was lower than without-MS(44.3±30.99mo.) (p>0.05). Patients with MS had significantly greater systolic/diastolic blood pressure and lower high-density-lypoprotein cholesterol levels (HDL-C) (p<0.05). According to the body mass index (BMI), the 83.3% of patients’ with-MS and 30% without-MS were found overweight and body fat mass was significant higher in patients with-MS(p<0.05). The mean daily protein intakes per kilograms of body weight determined lower with-MS patients (0.8±0.25g/kg) than without-MS (0.9±0.29 g/kg). Conclusion: The prevalence of MS is remarkably high. The daily dietary energy and protein intakes were found under the recommended levels. Inadequate energy and protein intake increase loss of muscle mass and also excessive energy intake leads to obesity. Monitoring of nutritional status of PD patients is important both in prevention and progression of MS.

Comparison of Dual Energy X-ray Absorptiometry and Bioimpedance in Assessing Body Composition and Nutrition in Peritoneal Dialysis Patients

Peritoneal dialysis (PD) patients are characterized by protein malnutrition and muscle wasting. Reliable, easy, and cheap methods for evaluating nutrition are desirable. Three methods are commonly available: dual-energy X-ray absorptiometry (DXA), bioimpedance (BI), and subjective global assessment (SGA).The objective of the study was to compare the previously mentioned methods for assessment of body composition and nutritional status in PD patients. The study is cross-sectional and consisted of 72 PD patients from a single center PD ambulatorium. Participants were measured twice by DXA, twice by BI, and once by SGA. Measurements included lean tissue mass (LTM), fat tissue mass (FT) and, for BI, overhydration (OH), intracellular water (ICW), and extracellular water (ECW). LTM and FT were indexed to body area (Lean Tissue Index [LTI] and Fat Tissue Index [FTI], respectively), and ICW for height (ICW/ht). We assessed conventional biochemical and clinical variables, using values for normal individuals as a reference. There was good overall agreement between BI and DXA but considerable intra-individual variation (1 standard deviation: FT 5.7kg; LTM 5.6kg). Factors affecting the differences were FT, ICW, LTM, and ICW. Obesity (DXA 43%; BI 54%) and muscle wasting (BI 28%; SGA 53%) were common. Agreement between BI and SGA was poor. Thirty-eight percent of patients judged malnourished by SGA also had a low LTI; 23% with normal SGA had low LTI. SGA was closer related to LTI (BI) than LTI (DXA). Plasma albumin was correlated to LTI, FTI, and ICW/ht, and comorbidity to OH, clinical malnutrition, reduced FTI, but not LTI. Agreement between DXA and BI was high on a population basis but not at an individual level. Obesity and muscle wasting were common in this population. OH might reduce DXA accuracy in PD patients. LTI and ICW may be useful measures to supplement SGA in assessing nutrition.

Validity of nutrition risk index as a malnutrition screening tool compared with subjective global assessment in end-stage renal disease patients on peritoneal dialysis.

We undertook this study to compare subjective global assessment (SGA) and nutrition risk index (NRI) as malnutrition screening tools in peritoneal dialysis (PD) patients. Nutrition status of the patients was categorized into low, moderate and high risk of malnutrition based on both NRI and SGA. The sensitivity, specificity and predictive values of NRI were compared with SGA, an already validated tool of nutrition status assessment in PD patients. Two hundred and eighty-three end-stage renal disease patients (age 50.02 ± 13.76 years; 204 males, 150 diabetic) were included. Based on SGA, 71/283 (25.08%) had normal nutrition, 192/283 (67.84%) mild–moderate and 20/283 (7.07%) severe malnutrition. Based on NRI, 38/283 (13.43%) patients had normal nutritional status, 193/283 (68.20%) mild-moderate and 52/283 (18.37%) severe malnutrition. Twenty-three of 283 (8.1%) were correctly classified as normal by NRI (true negative) and 197/283 (69.6%) as malnourished (true positive), 15/283 (5.3%) as false negative, 48/283 (16.96%) were misclassified as malnourished (false positive). NRI has sensitivity of 92.9% and specificity of 32.39%. Positive predictive value and Negative predictive values (NPVs) of NRI are 80.41% and 60.53%, respectively. Accuracy of the test is 78%. The receiver operating characteristic curve of NRI is 0.63. To conclude, NRI carries high sensitivity but low specificity as compared to SGA. It can be used as screening tool but not as a diagnostic tool for assessment of nutritional status in PD patients because of its low specificity and NPV.

The effectiveness of oral essential aminoacids and aminoacids containing dialysate in peritoneal dialysis

Background/Aim: Oral essential amino acids (AAs) containing supplements (EAS) and AA containing dialysate (ACD) are frequently used in peritoneal dialysis (PD) patients with malnutrition. The present study was conducted to investigate two strategies and compare their effects on the malnutrition status of PD patients. Materials and Methods: A total of 31 EAS, 14 ACD patients were enrolled in this study. Serum albumin levels were lower than 3.5 g/dL in all subjects. EAS group patients took five pills containing AAs three times a day with meals. In the other, 2.000 cc of 1.1% ACD was given to patients daily during the study. Demographic and laboratory parameters were analyzed and compared at baseline and 6th month. Results: Significant increases in BMI, albumin, and protein in both groups. Mean albumin levels increased significantly by 0.54 g/dL in ACD group (p < 0.005) and 0.49 g/dL in EAS group (p < 0.001) following 6 months. Mean albumin and delta albumin levels did not differ between two groups. Conclusion: These strategies may play an important role in increasing albumin levels and improving the nutritional status of PD patients.

Assessment of Fluid and Nutritional Status Using Multifrequency Bioelectrical Impedance Analysis in Peritoneal Dialysis Patients

Background/Aims: The purpose of this study was to evaluate the clinical usefulness and relevance of bioelectrical impedance analysis (BIA) for assessing the fluid and nutritional status in peritoneal dialysis (PD) patients. Methods: Statistical analyses between various measures of fluid and nutritional status were performed in 106 cases of 64 patients. Results: Extracellular fluid/total body water (ECF/TBW) was correlated with systolic blood pressure, extremity edema, and antihypertensive medications (p = 0.042, p < 0.001, and p = 0.029, respectively). Body cell mass (BCM)/height² was correlated with SGA rating and PCR (p < 0.001 and p = 0.002, respectively). ECF/TBW and BCM/height² significantly predicted extremity edema (p < 0.001) and SGA rating (p = 0.001), respectively. ROC analysis yielded an ECF/TBW cut-off of 0.36 and a BCM/height² cut-off of 11.23. When the BCM/height² cut-off of 11.23 was applied to subclinical patients (SGA score ≥6), a significant difference in SGA rating was detected in subgroups (p = 0.010). Conclusion: BIA yields useful and relevant information about hydration and nutritional status in PD patients.

NUTRITION AND QUALITY OF LIFE OUTCOMES IN PERITONEAL DIALYSIS – A COMPARISON BETWEEN AUTOMATED AND CONTINUOUS AMBULATORYPERITONEAL DIALYSIS

Automated Peritoneal Dialysis (APD) has become the most popular form of peritoneal dialysis (PD) in Australia; however few studies on nutritional status in PD patients have separated APD from CAPD. Therefore the purpose was to assess the nutritional status, oral intake and self rated Quality of Life (QoL) in PD patients and compare between CAPD and APD. 10 adult CAPD and 37 APD patients on home-based peritoneal dialysis for ≥ 3 months had anthropometry measured, nutritional intake calculated from three day food diaries, and Patient Generated Subjective Global Assessment (PG-SGA) completed. QoL was assessed using the Medical Outcomes Study Short Form (SF-36) questionnaire. Overall 48.9% (n=23) were classified as well nourished, 44.7% (n=21) were mild or moderately undernourished, and 6.4% (n=3) were severely undernourished. The proportion of PD patients with energy and protein intake below evidence based guideline targets was 90.2% (n=37) and 70.7% (n=29), respectively. 25.5% (n=12) of patients lost weight and 59.6% (n=28) gained weight from initiation of therapy until date of assessment. Average quality of life score was 50.4±18.7. QoL was correlated with PG-SGA (R2=0.298, p<0.01) with adjustment for age, gender, and length of time on PD. No significant differences were seen between CAPD and APD for PG-SGA mean numerical score, PG-SGA category, or for energy, protein, phosphate and potassium intakes. QoL was not statistically significant between modalities for any of the eight dimensions or total score. In Conclusion, under-nutrition was highly prevalent in this small cohort of PD patients. Energy and protein intakes were below the current Australian recommendation for the majority of the sample. Nutritional status, dietary intakes and QoL outcomes did not differ between stable CAPD and APD patients.

Assessment of Body Composition in Peritoneal Dialysis Patients Using Bioelectrical Impedance and Dual-Energy X-Ray Absorptiometry

Introduction: Protein energy wasting is closely related to increased morbidity and mortality in peritoneal dialysis (PD) patients. Simple reliable and easily available methods of determining nutritional status and recognition of short-term changes in body composition are therefore important for clinical practice. Methods: We compared whole-body and segmental composition using multifrequency bioelectrical impedance analysis (MF-BIA) and dual-energy X-ray absorptiometry (DEXA) in 104 stable PD patients. Results: Assessment of whole-body composition showed that lean body mass (LBM) was highly correlated with good method agreement using DEXA as the reference test (r = 0.95, p < 0.0001; bias –0.88 kg, 95% CI –1.53 to 0.23 kg). Similarly, high correlation and good method agreement were found for fat mass (r = 0.93, p < 0.0001; bias 0.69 kg, 95% CI 0.03–1.36 kg). Segmental analysis of LBM revealed strong correlations between LBM for trunk, left and right arms and legs (r = 0.90, 0.84, 0.86, 0.89 and 0.90, respectively, p < 0.0001). Bone mineral content derived by MF-BIA overestimated that measured by DEXA (bias 0.740 kg, 95% CI 0.66–0.82 kg). Conclusion: MF-BIA may potentially be a useful tool for determining nutritional status in PD patients and serial estimations may help recognize short-term changes in body composition.

Geriatric Nutritional Risk Index as a Screening Tool for Malnutrition in Patients on Chronic Peritoneal Dialysis

Malnutrition is common among peritoneal dialysis (PD) patients. Recently, the Geriatric Nutrition Risk Index (GNRI) was found to be a reliable tool for screening malnutrition in hemodialysis patients. However, the GNRI has not been validated in PD patients. We studied 314 unselected, adult PD patients from a single dialysis unit. We compared their GNRI scores with their comprehensive Malnutrition-Inflammation Scores (MIS) and 7-point Subjective Global Assessment (SGA) scores. We randomly selected 106 patients for a repeated assessment, and the changes in their three indices were compared. Baseline GNRI was significantly correlated with MIS (r = -0.487, P < .0001) and SGA (r = 0.234, P < .0001). When MIS >or=6 was defined as malnutrition, the sensitivity and specificity of GNRI <or=93 in predicting malnutrition were 68.0% and 67.7%, respectively. When SGA <or=5 was used to define malnutrition, the sensitivity and specificity were 54.5% and 71.1%, respectively. The change in GNRI was correlated with the change in MIS (r = -0.244, P = .012) and overall SGA score (r = 0.266, P = .006), respectively. When an increase in MIS was defined as a worsening of nutrition, the sensitivity and specificity of GNRI were 45.7% and 81.7%, respectively. When a decrease in SGA was used to define a worsening of nutrition, the sensitivity and specificity were 42.3% and 87.0%, respectively. Although GNRI is significantly correlated with other nutritional indices, it is not sensitive for screening malnutrition in PD patients. Serial measurements of GNRI are also not sensitive in detecting a change in nutritional status. Further study is needed to identify a simple and reliable tool for the assessment and monitoring of nutritional status in PD patients.

Serial monitoring of nutritional status in Chinese peritoneal dialysis patients by Subjective Global Assessment and comprehensive Malnutrition Inflammation Score

The Malnutrition Inflammation Score (MIS) has been proposed for the assessment of nutritional status in peritoneal dialysis (PD) patients. The MIS and the Subjective Global Assessment (SGA) for serial monitoring of nutritional status in PD patients were compared. The change in the MIS and SGA overall score of 59 PD patients (28 male) over 12 months was studied. Clinical factors relating to the discrepancy between the two instruments were explored. The average patient age was 55.8+/-9.7 years. Thirty of the 59 patients (50.8%) had exact agreement in the changed MIS and SGA scores. Cohen's kappa score was 0.274, indicating a modest degree of agreement. For the detection of deterioration in nutritional status and using the MIS as the reference measure, the SGA had a sensitivity of 61.9% and specificity of 86.8%; serum ferritin level was substantially higher in the ones whose SGA did not detect a deterioration in nutrition (1464.1+/-873.3 vs 800.5+/-561.6 pmol/L, P=0.046). For the detection of improvement in nutritional status, the SGA had a sensitivity of 45.8% and specificity of 82.9%; patients whose SGA did not detect an improvement in nutrition were dialyzed longer (53.8+/-35.3 vs 27.6+/-18.9 months, P=0.038), had higher total iron binding capacity (TIBC) (45.6+/-5.5 vs 38.2+/-8.1 micromol/L, P=0.015), had higher total Kt/V (2.02+/-0.36 vs 1.75+/-0.23, P=0.048) and higher normalized protein nitrogen appearance (1.16+/-0.25 vs 0.95+/-0.23 g/kg per day, P=0.048). The longitudinal changes in the MIS and SGA score have modest agreement with each other. However, PD patients with a longer duration of dialysis, higher serum ferritin, TIBC, total Kt/V or normalized protein nitrogen appearance tend to have discrepancies between the longitudinal changes in the MIS and SGA overall score.

Biocompatibility of a bicarbonate-buffered amino-acid-based solution for peritoneal dialysis

Amino-acid-based peritoneal dialysis (PD) fluids have been developed to improve the nutritional status of PD patients. As they may potentially exacerbate acidosis, an amino-acid-containing solution buffered with bicarbonate (Aminobic) has been proposed to effectively maintain acid-base balance. The aim of this study was to evaluate the mesothelial biocompatibility profile of this solution in comparison with a conventional low-glucose-based fluid. Omentum-derived human peritoneal mesothelial cells (HPMC) were preexposed to test PD solutions for up to 120 min, then allowed to recover in control medium for 24 h, and assessed for heat-shock response, viability, and basal and stimulated cytokine [interleukin (IL)-6] and prostaglandin (PGE(2)) release. Acute exposure of HPMC to conventional low-glucose-based PD solution resulted in a time-dependent increase in heat-shock protein (HSP-72) expression, impaired viability, and reduced ability to release IL-6 in response to stimulation. In contrast, in cells treated with Aminobic, the expression of HSP-72 was significantly lower, and viability and cytokine-producing capacity were preserved and did not differ from those seen in control cells. In addition, exposure to Aminobic increased basal release of IL-6 and PGE(2). These data point to a favorable biocompatibility profile of the amino-acid-based bicarbonate-buffered PD solution toward HPMC.

Hyperleptinaemia and chronic inflammation after peritonitis predicts poor nutritional status and mortality in patients on peritoneal dialysis

The serum leptin level is elevated in patients undergoing peritoneal dialysis (PD) and associated with a loss of lean body mass. The nutritional status of PD patients may further be worsened following peritonitis. We investigated the association between hyperleptinaemia, inflammation and malnourishment in PD-related peritonitis. We conducted a prospective study on PD patients who developed peritonitis. Blood samples were obtained as baseline (D0) before the onset of peritonitis, and once peritonitis developed, leptin, adiponectin (ADPN) and other inflammatory markers were collected, on day 1 (D1), day 7 (D7) and day 42 (D42) of peritonitis. Patients were followed-up for any censor event or 1 year after peritonitis. Forty-two patients with a mean age of 62.9+/-13.2 years were recruited. Fourteen (33.3%) were diabetic. The serum leptin levels increased significantly from baseline to day 1 and 7, but fell back to the premorbid state at day 42. In contrast, the ADPN level decreased from a baseline value of 15.60+/-10.4 microg/ml to 13.01+/-8.1 microg/ml on day 1 (P=0.01) but rose to 14.39+/-8.9 microg/ml on day 7 (P=0.28) and 13.87+/-7.9 microg/ml on day 42 (P=0.21). High-sensitivity C-reactive protein (hs-CRP) increased significantly from baseline to day 1, 7 and even at day 42. The lean body mass (LBM) and nutritional markers decreased significantly after peritonitis. For patients with high hs-CRP (>3.0 mg/l) at day 42, there was a higher mortality rate than for those with lower hs-CRP (<3.0 mg/l, P=0.02), even if they were in clinical remission of peritonitis. Our study confirmed an increase in serum leptin during acute peritonitis and a prolonged course of systemic inflammation after apparent clinical remission of peritonitis. These factors related to the persistent chronic inflammation may contribute to the development of malnourishment and poor survival rate.

Comprehensive malnutrition inflammation score as a marker of nutritional status in Chinese peritoneal dialysis patients

Malnutrition is common among peritoneal dialysis (PD) patients. However, the ideal marker of nutritional status in PD patients remained controversial. We studied 165 unselected adult PD patients. We compared the comprehensive Malnutrition-Inflammation Score (MIS) and the 7-point Subjective Global Assessment (SGA) score. The mean age was 59.2 +/- 11.5 years. Seventy patients were male. MIS significantly correlated with the SGA score (r =-0.667, P < 0.001). Of the 165 patients, 132 (80.0%) had similar classification of nutritional status by SGA and MIS (Group I); 17 (10.3%) were classified as normal by SGA but moderately malnourished by MIS (Group II), while 16 (9.7%) were classified as normal by MIS but moderately malnourished by SGA (Group III). Group II had been dialysed longer than Group I (71.7 +/- 50.3 vs 40.7 +/- 37.5 months, P = 0.011). As compared with Group I, Group III was more likely to require helper for PD exchange (37.5%vs 9.7%, P = 0.004), marginally more likely to be diabetic (62.5%vs 35.6%, P = 0.085) and had a slightly higher Charlson's comorbidity score (6.13 +/- 1.78 vs 4.98 +/- 2.1, P = 0.085), although the latter two were not statistically significant. MIS has a reasonable correlation with the conventional SGA score in PD patients. Patients with limited self-care capability, diabetes and multiple comorbidities probably had worse score (i.e. worse nutrition) revealed by SGA than by MIS, while patients who had been dialysed longer had worse score revealed by MIS than by SGA.