A Study on Nutritional Status during Dialysis in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Ji-Yeon Seo; Nam-Ho Kim; Young-Ran Heo

doi:10.4163/kjn.2012.45.1.30

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Seo, Kim, and Heo: A Study on Nutritional Status during Dialysis in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Research Article

Korean Journal of Nutrition

Korean Journal of Nutrition 2012; 45(1): 30-43.

Published online: 29 February 2012

DOI: https://doi.org/10.4163/kjn.2012.45.1.30

A Study on Nutritional Status during Dialysis in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Ji-Yeon Seo¹, Nam-Ho Kim², Young-Ran Heo¹

¹Department of Food and Nutrition, Human Ecology Research Institute, Chonnam National University, Gwangju 500-757, Korea.

²Department of Internal Medicine, Chonnam National University, Gwangju 501-746, Korea.

To whom correspondence should be addressed. (yrhuh@jnu.ac.kr)

Received 19 December 2011 Revised 5 January 2012 Accepted 1 February 2012

Abstract

Patients undergoing peritoneal dialysis are at risk for protein-energy malnutrition because of nutrient losses during dialysis. This study determined the nutritional status of patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Forty-four patients receiving CAPD were divided into two groups according to dialysis period. We investigated the nutritional status of the patients by measuring anthropometric and biochemical parameters, as well as food intake, self-appetite, dietary habits, a subjective global assessment, and a total nutritional status assessment. Group I subjects (7 males, 13 females) had received dialysis for < 2 years, whereas the group II subjects (18 males, 6 females) received dialysis for ≥ 2 years. Energy intake with added dextrose in the dialysate per kg of body weight was 30.3 ± 5.8 kcal in group I and 29.0 ± 8.1 kcal in group II. The average protein intake per kg of weight was 1.0 ± 0.3 g in group I and 1.0 ± 0.4 g in group II, which were less than the recommended protein intake for patients undergoing CAPD (1.2-1.5 g/kg). Mean serum albumin level was significantly lower in group II than that in group I (p < 0.05). A recent self-appetite score was significantly higher in group II than that in group I (p < 0.01). The dietary habits score was significantly lower in group II than that in group I (p < 0.05). The subjective global assessment was significantly higher in group I (85.0%) than that in group II (54.2%) under normal nutrition status (p < 0.05). The dialysis period was significantly and negatively correlated with the subjective global assessment (r = -0.502, p < 0.01) and the total nutritional status assessment (r = -0.575, p < 0.01). These results demonstrated that patients undergoing CAPD for ≥ 2 years had worse nutritional status than those who had been undergoing dialysis for < 2 years. Good nutritional status can predict the long-term survival of patients undergoing peritoneal dialysis. Additionally, the exact evaluation of nutritional status before 2 years will be important to maintain long-term dialysis therapy in patients undergoing CAPD.

Keywords: peritoneal dialysis, nutritional status, dialysis period, nutrients intake

Figures and Tables

Fig. 1

Self-appetite score of subjects. ^*: p < 0.05 by t-test.

Table 1

General characteristics of subjects

1) Mean ± SD 2) N (%) 3) Comorbidity: diabetes mellitus and hypertension

^**: p < 0.01 by χ²-test or t-test

Table 2

Anthropometric measurement of subjects

1) Mean ± SD 2) N (%) 3) Obesity: > 25, Over weight: > 23, Normal weight: 18.5-22.9, Under weight: < 18.5

BMI: Body Mass Index, PIBW: Percent Ideal Body Weight, TBW: Total Body Water, LBM: Lean Body Mass, TSF: Triceps Skin Fold thickness, BSF: Biceps Skin Fold thickness, MAC: Mid-Arm Circumference, MAMC: Mid-Arm Muscle Circumference

^*: p < 0.05, ^**: p < 0.01 by χ²-test or t-test

Table 3

Daily mean energy and nutrient intakes of subjects

1) Mean ± SD 2) Protein ratio: Animal protein is more than 60% of total protein

No significant difference between the two groups by χ²-test or t-test

IBW: Ideal Body Weight

Table 4

Blood biochemical parameters of subjects

1) Mean ± SD

BUN: Blood urea nitrogen

^*: p < 0.05 by t-test

Table 5

Dietary habits of subjects

1) Mean ± SD

The question of 6 and 10 are back-calculated

^*: p < 0.05, ^**: p < 0.01 by t-test

Table 6

Subjective global assessment of subjects

1) Mean ± SD

^*: p < 0.05 by t-test or χ²-test

Table 7

Proportion of subjects met the nutritional standards

1) N(%)

BMI: Body Mass Index, LBM: Lean Body Mass, TSF: Triceps Skin Fold thickness, MAMC: Mid-Arm Muscle Circumference

^*: p < 0.05, ^**: p < 0.01 by χ²-test

Table 8

Pearson's correlation coefficients between nutritional status variables and dialysis duration of subjects

TSF: Triceps Skin Fold thickness, BSF: Biceps Skin Fold thickness, SGA : Subjective Global Assessments

^**: p < 0.01

References

1. The Korean Dietetic Association. Manual of medical nutrition therapy. 2008. 3rd ed. Seoul:

2. Avram MM, Bonomini LV, Sreedhara R, Mittman N. Predictive value of nutritional markers (albumin, creatinine, cholesterol, and hematocrit) for patients on dialysis for up to 30 years. Am J Kidney Dis. 1996. 28(6):910–917.

3. Park JK, Son SM. Nutritional status of continuous ambulatory peritoneal dialysis patients. Korean J Nutr. 2006. 39(7):624–640.

4. Gokal R, Oreopoulos DG. Is long-term technique survival on continuous ambulatory peritoneal dialysis possible? Perit Dial Int. 1996. 16(6):553–555.

5. Maiorca R, Cancarini GC, Zubani R, Camerini C, Manili L, Brunori G, Movilli E. CAPD viability: a long-term comparison with hemodialysis. Perit Dial Int. 1996. 16(3):276–287.

6. Roh HJ, Ryu DR, Yoo TH, Park HC, Shin SK, Kang SW, Choi KH, Lee HY, Han DS. Predictors and clinical features of long-term continuous ambulatory peritoneal dialysis (CAPD). Korean J Nephrol. 2001. 20(2):306–314.

7. Han SH, Lee SC, Goo YS, Kang E, Park HC, Roh HJ, Yoon SY, Choi SR, Yun DS, Kang SW, Choi KH, Han DS, Lee HY. Clinical factors affecting peritoneal membrane function in long-term continuous ambulatory peritoneal dialysis patients. Korean J Nephrol. 2002. 21(1):74–85.

8. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. J Am Soc Nephrol. 1996. 7(2):198–207.

9. Palop L, Martínez JA. Cross-sectional assessment of nutritional and immune status in renal patients undergoing continuous ambulatory peritoneal dialysis. Am J Clin Nutr. 1997. 66(2):498S–503S.

10. Park MJ, Lee KS, Cho MS, Kim JK, Park BS, Ma SK, Nah MY, Yeum CH, Gwon KJ, Kim SW, Kim NH, Choi KC. Dialysis adequacy and nutritional status in patients with continuous ambulatory peritoneal dialysis (CAPD). Korean J Nephrol. 2001. 20(4):654–662.

11. Lee YM. Evaluation of the effectiveness of nutrition education and counseling on the diet therapy practices of hemodialysis patients [master's thesis]. 2011. Daegu: Kyungbak National University.

12. Kim SM, Lee YS, Cho DK. Nutritional assessment of the continuous ambulatory peritoneal dialysis patients. Korean J Nutr. 1998. 31(9):1422–1432.

13. Seo HJ. A study on effect of nutrition education in hemodialysis patients [master's thesis]. 2002. Changwon: Changwon National University.

14. Kim SH, Kim SB. Characteristics in nutritional status of patients on hemodialysis and continuous ambulatory peritoneal patients in Chonbuk area. Korean J Nutr. 2003. 36(4):397–404.

15. World Health Organization, International Association for the Study of Obesity, International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. 2000. Sydney: Health Communications.

16. The Korean Dietetic Association. Samsung Medical Center. Crude amount of household unit with photograph-booklet. 1999. Seoul:

17. Kim YK, Choi KH, Kang SW, Lee HW, Lee SW, Lee HY, Han DS. Nutritional assessment of chronic. Korean J Nephrol. 1990. 9(1):58–66.

18. de Mutsert R, Grootendorst DC, Boeschoten EW, Brandts H, van Manen JG, Krediet RT, Dekker FW. Netherlands Cooperative Study on the Adequacy of Dialysis-2 Study Group. Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients. Am J Clin Nutr. 2009. 89(3):787–793.

19. Lee JW, Lee MS, Kim JH, Son SM, Lee BS. Kyomunsa. Nutrition assessment. Kyomunsa. 100–201.

20. NKF-DOQI clinical practice guidelines for peritoneal dialysis adequacy. National Kidney Foundation. Am J Kidney Dis. 1997. 30:3 Suppl 2. S67–S136.

21. Daugirdas JT, Blake PG, Ing TS. Handbook of dialysis. 2000. 3rd ed. Philadelphiadia: Lippincott Williams & Wilkins.

22. Young GA, Kopple JD, Lindholm B, Vonesh EF, De Vecchi A, Scalamogna A, Castelnova C, Oreopoulos DG, Anderson GH, Bergstrom J, Dichiro J, Prowant BF, Algrim CE, Martis L, Serkes KD. Nutritional assessment of continuous ambulatory peritoneal dialysis patients: an international study. Am J Kidney Dis. 1991. 17(4):462–471.

23. Kopple JD. McCollum Award Lecture, 1996: protein-energy malnutrition in maintenance dialysis patients. Am J Clin Nutr. 1997. 65(5):1544–1557.

24. Kang EW, Goo YS, Lee SC, Han SH, Yoon SY, Choi SR, Park HC, Kang SW, Choi KH, Lee HY, Han DS. Factors affecting malnutrition in continuous ambulatory peritoneal dialysis patients: a cross-sectional study. Korean J Nephrol. 2002. 21(6):943–955.

25. ESRD Registry Committee, Korean Society of Nephrology. Current renal replacement therapy in Korea 2007. Korean J Nephrol. 2006. 26:Suppl. S459–S481.

26. Bilbrey GL, Cohen TL. Identification and treatment of protein calorie malnutrition in chronic hemodialysis patients. Dial Transplant. 1989. 18:669–677.

27. Nelson EE, Hong CD, Pesce AL, Peterson DW, Singh S, Pollak VE. Anthropometric norms for the dialysis population. Am J Kidney Dis. 1990. 16(1):32–37.

28. Durnin JV, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr. 1974. 32(1):77–97.

29. Schoenfeld PY, Henry RR, Laird NM, Roxe DM. Assessment of nutritional status of the National Cooperative Dialysis Study population. Kidney Int Suppl. 1983. (13):S80–S88.

30. Kim HY, Kim B, Lee YH, Huh W, Kim DJ, Kim YG, Oh HY, Yom JI, Park KL, Cho YY. Dietary protein intake (DPI) and nutritional indices in predialysis patients with different stages of chronic renal insufficiency. Korean J Nephrol. 1998. 17(3):429–439.

31. Moncrief JW, Popovich RP. Continuous ambulatory peritoneal dialysis. Contrib Nephrol. 1979. 17:139–145.

32. Son JM, Park MS, Lee YH, Lee KE, Kim EM, Kim JY, Kim YS, Ahn KR, Han JS, Kim SK, Lee JS. A study of nutrient intakes and nutritional assessment of CAPD. Proceedings of fall symposium of the Korean Society of Nephrology. 1999. Seoul: 5163.

33. Rutherford WE, Bordier P, Marie P, Hruska K, Harter H, Greenwalt A, Blondin J, Haddad J, Bricker N, Slatopolsky E. Phosphate control and 25-hydroxycholecalciferol administration in preventing experimental renal osteodystrophy in the dog. J Clin Invest. 1977. 60(2):332–341.

34. Han DS. Dietary management of chronic renal failure. Korean J Intern Med. 1989. 37(1):1–11.

35. The Korean Dietetic Association. Food exchange table for renal disease-leaflet. 1997. Seoul:

36. Zeman FJ. Clinical nutrition and dietetics. 1991. 2nd ed. New York: Mac Millan Publishing Company;305–322.

37. Mo SM, Lee YS, Koo JO, Son SM, Seo JS, Yoon EY, Lee SK, Kim WK. Diet therapy. 2004. Kyomunsa.

38. Kim JK, Ahn SY, Moon MK, Kim MC, Park SJ, Yang SH, Park SE, Lee SR. A comparative study of anemia in hemodialysis patients and CAPD patients. Korean J Nephrol. 1991. 10(1):84–91.

39. Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis. 1990. 15(5):458–482.

40. Kwon KH, Noh HJ, Park HC, Lee IH, Kang SW, Choi KH, Lee HY, Han DS. Serum albumin as a predictor of morbidity and mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. Korean J Nephrol. 1997. 16(2):290–301.

41. Ohri-Vachaspati P, Sehgal AR. Correlates of poor appetite among hemodialysis patients. J Ren Nutr. 1999. 9(4):182–185.

42. Baker JP, Detsky AS, Wesson DE, Wolman SL, Stewart S, Whitewell J, Langer B, Jeejeebhoy KN. Nutritional assessment: a comparison of clinical judgement and objective measurements. N Engl J Med. 1982. 306(16):969–972.

43. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987. 11(1):8–13.

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