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Original Research Communication |
1 From the Department of Medicine and Therapeutics (AY-MW, JS, MW, PK-TL, and S-FL), the Center for Nutritional Studies (MM-S and JW), and the Department of Chemical Pathology (CW-KL), Prince of Wales Hospital, Chinese University of Hong Kong, New Territories.
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
1.2 g kg- 1 d- 1, and 26% had energy intakes
126 kJ kg- 1 d- 1. Other than having a greater total urea clearance and glomerular filtration rate, patients with protein intakes
1.2, as opposed to < 1.2, g kg- 1 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
126, as opposed to < 126, kJ kg- 1 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 kg- 1 d- 1decrease in protein (P = 0.001) and a 13.07-kJ kg- 1 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.
Key Words: Protein intake energy intake volume overload malnutrition anorexia continuous ambulatory peritoneal dialysis
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