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

Abstract

BACKGROUND: Anorexia that results in inadequate nutrient intake is considered one of the most important causes of malnutrition in dialysis patients. OBJECTIVE: 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. DESIGN: 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. RESULTS: 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). CONCLUSION: An important yet unrecognized association was observed between a history of volume overload and dietary intake in peritoneal dialysis patients.