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Important factors other than dialysis adequacy associated with inadequate dietary protein and energy intakes in patients receiving maintenance peritoneal dialysis^1,2,3

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^{- 1}decrease 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