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B Lindholm

Publications and source records attributed to B Lindholm.

At least 109 records · Page 6Linked to original sources
PubMed1995

Albumin-based solutions for peritoneal dialysis: investigations with a rat model.

To evaluate albumin, an osmotic agent for peritoneal dialysis, the peritoneal fluid and solute transport were investigated during a 4-h single cycle peritoneal dialysis with albumin-based dialysis solutions. Two different albumin solutions were used in 15 normal Sprague-Dawley rats: isotonic 7.5% albumin solution (ADS 1, n = 7) and a combined 7.5% albumin and 1.35% glucose solution (ADS 2; n = 8). A standard 1.36% Dianeal solution was used to provide control values (n = 6). The rate of the intraperitoneal volume change (Qv) was positive during the initial 90 min with ADS 2 and during the initial 60 min with Dianeal 1.36% solution but negative with ADS 1. The peritoneal bulk flow reabsorption rate, Qa, was similar in all three groups. The estimated rate of transcapillary ultrafiltration (Qu = Qv + Qa) was positive with all three solutions throughout the dialysis. With ADS 1, Qu increased gradually during the initial 90 min and then remained stable, but it decreased with ADS 2 and Dianeal 1.36% solution. Qu with ADS 2 did not differ from that with Dianeal 1.36% solution during the initial 60 min, but it was significantly higher during the latter part of dialysis. The value of Qu during the last 2 h of dialysis was 0.026 +/- 0.010 and 0.025 +/- 0.009 ml/min with ADS 1 and ADS 2, respectively, and it was significantly higher than that with Dianeal 1.36% solution (0.005 +/- 0.007 ml/min; p < 0.017).(ABSTRACT TRUNCATED AT 250 WORDS)

Albumins↗
PubMed1994

Tryptophan and its metabolites in patients on continuous ambulatory peritoneal dialysis and following renal transplantation.

Plasma tryptophan (Trp) concentration in its total (TTrp) and non-protein-bound free form (FTrp) and its metabolite 5-hydroxyindole-3-acetic acid (5-HIAA) as well as muscle Trp contents (MTrp) were studied in 12 uraemic patients undergoing continuous ambulatory peritoneal dialysis (CAPD), 10 renal transplant patients, and 10 healthy control subjects. The CAPD patients exhibited signs of muscle weakness, as assessed by dynamometry, and signs of protein malnutrition with a decreased ratio of alkali-soluble protein relative to DNA in muscle as well as low serum albumin concentration. In the uraemic patients TTrp was markedly reduced, whereas in the transplant patients it did not differ from the controls. The FTrp, which was separated by the process of equilibrium dialysis, was less in the uraemic (P < 0.01) as well as transplant patients (P < 0.01) than in the controls. The plasma FTrp/TTrp ratio was increased in the uraemic patients (40 +/- 8%) but less in the transplant patients (16 +/- 4%), as compared to the controls (25 +/- 5%). The uraemic patients had increased plasma concentrations of 5-HIAA, whereas this metabolite could not be found in the plasma of renal transplant patients and healthy controls. MTrp was increased by an average of 33% in the uraemic patients whereas it did not differ between the transplant patients and the controls. The results indicate that the abnormal Trp metabolism in uraemic patients is to a large extent corrected by a successful renal transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Bidirectional solute transport in peritoneal dialysis.

OBJECTIVE: Three transport components are involved in solute transport in peritoneal dialysis: diffusion, convective transport, and peritoneal reabsorption of dialysate (fluid and solutes). The relative impact of these components on measureable transport characteristics (dialysate-to-plasma concentration ratio, diffusive mass transport coefficient, unidirectional clearances) may depend on the direction of solute transport, that is, from blood to dialysate or vice versa. The application of the bidirectional characteristics for the assessment of fluid and solute transport in peritoneal dialysis is reviewed and evaluated. DATA SOURCES: Theoretical analysis as well as computer simulations were applied to discuss available data from our own studies on peritoneal transport as well as from published clinical, experimental, and theoretical studies in the same field. STUDY SELECTION: Thirty-three relevant clinical and experimental studies as well as theoretical analyses derived from the literature were reviewed. DATA EXTRACTION: Data were extracted to highlight current controversies in the literature concerning the assessment of peritoneal reabsorption rate based on transport of macromolecules, middle molecules, and small solutes. RESULTS: Peritoneal reabsorption is the main component of the transport of macromolecules infused into the peritoneal cavity, and these solutes are currently being used for the assessment of the rate of reabsorption. In contrast, diffusive transport and peritoneal reabsorption cannot be experimentally discriminated for small solutes which exhibit negligible sieving through the membrane in convective transport (i.e., solutes with sieving coefficient equal to 1). For middle molecules each transport component may be of importance and may have an independent impact on bidirectional transport characteristics. CONCLUSIONS: Middle molecules, with sieving coefficients substantially less than 1, may be applied for estimation of peritoneal reabsorption rate using bidirectional transport characteristics, as apparent diffusive mass transport coefficients or unidirectional clearances. However, an independent measurement of sieving coefficient is necessary for this method.

Absorption↗
PubMed1994

Nutritional status, muscle composition and plasma and muscle free amino acids in renal transplant patients.

To investigate the effects of renal transplantation (Rtx) on the nutritional status, muscle composition and the plasma and muscle free amino acid (AA) pattern, three groups of altogether 30 renal transplant patients (group I n = 10; 46 +/- 14 [SD] days after Trx), (group II n = 10; 13 +/- 2 months after Rtx) and (group III n = 10; 9 +/- 2 years after Rtx) underwent anthropometric measurements, blood sampling and percutaneous muscle biopsy. The immunosuppressive therapy consisted of prednisolone, azathioprine and cyclosporine-A. The results were compared with data from age-matched healthy subjects. Renal function was impaired in groups I, II and III. Serum albumin was decreased in groups I and II. The patients of group II had an increased percentage of body fat, triceps and subscapular skin folds and total sum of skinfolds. In group I the ratio alkaline-soluble protein (ASP) to DNA, which is a sensitive index of protein depletion on the cellular level, was decreased. Muscle magnesium content was decreased whereas the muscle DNA, sodium and chloride contents were increased. The mean plasma concentration of most essential AA (EAA) was essentially normal except phenylalanine which was increased in groups I and II.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Albumin and amino acid levels as markers of adequacy in continuous ambulatory peritoneal dialysis.

Similar to previous findings in HD patients, a markedly decreased serum albumin level has been found to be a strong predictor of morbidity and mortality in CAPD patients. However, a slight decrease in serum albumin levels (to about 30 g/L if measured with nephelometry or the bromcresol purple method) does not always seem to reflect impaired nutritional status or to be associated with an increased morbidity or mortality in CAPD patients. A low serum albumin level among CAPD patients is related to dialysate albumin loss, comorbidity, age, and a low dietary protein intake. The possible relation between the dialysis dose (as assessed by small solute clearances) and serum albumin levels among CAPD patients is much less established and needs further study, although serum albumin tends to increase in prospective studies of increased peritoneal dialysis dose. Although the plasma levels of amino acids seem to be lower in CAPD patients compared to HD patients, this does not reflect the intracellular amino acid pattern in muscle which is less abnormal in CAPD patients, possibly because of the sustained hyperinsulinemia during CAPD, resulting in an increased intracellular to extracellular gradient. It is at present not established to what extent the amino acid abnormalities are related to the dialysis dose. Malnourished and hypoalbuminemic CAPD patients should be recommended to increase the protein intake, and if this is not effective, the dialysis dose should be increased. Furthermore, the use of amino acid-based peritoneal dialysis solutions is a promising new tool for the treatment of malnourished CAPD patients and may become an important component of CAPD therapy in the future. On the other hand, if the nutritional status deteriorates in spite of these efforts, the patient should be transferred to hemodialysis if possible.

Amino Acids↗
PubMed1994

Evaluation of an experimental rat model for peritoneal dialysis: fluid and solute transport characteristics.

The aim of this study was to develop a reference model of fluid and solute transport during experimental peritoneal dialysis in rats, which would simulate the conditions of clinical dialysis in CAPD patients as much as possible. For this purpose a 4-h dialysis study was performed in 13 normal Sprague-Dawley rats with conventional glucose solutions (Dianeal 1.36% solution, n = 6 and Dianeal 3.86% solution, n = 7) and a protocol and methods like those used in clinical dwell studies. The dilution of a marker, radioactive human serum albumin (RISA), was used to determine the intraperitoneal dialysate volume with corrections for the elimination of RISA from the peritoneal cavity and sample volumes. The isovolumetric method was employed to calculate the diffusive mass transport coefficients. To compare our data with reference values in CAPD patients, the data were scaled by a factor calculated as a ratio of the dialysate volume in CAPD to the dialysate volume in the rats. In a separate series of experiments the intraperitoneal hydrostatic pressure was monitored with increasing infusion volumes. The fluid transport characteristics, described as the percentage changes of the initial intraperitoneal volume, were essentially comparable to those in CAPD patients. However, the intraperitoneal volume curves were shifted more to the left than were the reported values in CAPD patients. The scaled diffusive mass transport coefficient for urea was similar to that in CAPD patients. However, the transport of other solutes, in particular glucose, was faster in the rats than in CAPD patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Dialysate to plasma solute concentration (D/P) versus peritoneal transport parameters in CAPD.

The relationship between dialysate to plasma solute equilibration ratio (D/P) and diffusive (diffusive mass transport coefficients, KBD) as well as convective (sieving coefficient, S, and net ultrafiltration) transport characteristics were studied in clinically stable CAPD patients and in patients with loss of ultrafiltration capacity (UFC). Forty-one 6-h single-dwell studies with standard glucose-based dialysis fluids containing 1.36% (n = 9), 2.27% (n = 9), and 3.86% (n = 23) anhydrous glucose were carried out in 33 clinically stable CAPD patients. Eleven patients with loss of UFC were studied with 3.86% glucose solution. Intraperitoneal dialysate volumes were calculated from the dilution of the tracer (131I-albumin) with a correction applied for its elimination from the peritoneal cavity. KBD and S were estimated using the Pyle-Popovich-Moncrief model with aqueous plasma concentrations. A theoretical D/P curve was derived with and without taking convective transport and peritoneal reabsorption into account. The three different glucose solutions yielded D/P curves which were similar for urea and potassium. For creatinine a slower equilibration and for glucose and sodium a faster decrease in dialysate concentration were observed with more hypertonic solutions. In general, there was a strong correlation which was best at 240 min between D/P (for glucose dialysate/initial dialysate concentration, D/Do) and KBD for all solutes (except sodium), whereas the correlation between D/P and convective transport parameters was much weaker. KBD for creatinine (with 3.86% glucose solution) could be estimated (r = 0.98) from aqueous D/P using the experimental formula: creatinine KBD = -1.8 - ln (1 - D240/P)/0.1. Patients with loss of UFC due to increased diffusive transport (n = 8) could be discriminated from the clinically stable patients using KBD and D/P (or D/D0) for creatinine and glucose or D/P for sodium. However, patients with loss of UFC associated with increased peritoneal reabsorption (n = 2) could not be identified using these parameters. Theoretically derived D/P curves were in excellent agreement with measured D/P for 1.36% glucose solution and simulations were satisfactory also for the 2.27% and 3.86% solutions provided that the effect of convective transport was taken into account. The standardized peritoneal equilibration tests (PET) as proposed by Twardowski et al. [17] seems to be appropriately designed as regards duration of the dwell and the choice of glucose and creatinine as investigated solutes. Thus, PET can be recommended as a sensitive routine investigation for the monitoring of normal/abnormal peritoneal transport behaviour in peritoneal dialysis patients.

Biological Transport↗
PubMed1994

Methods for estimation of peritoneal dialysate volume and reabsorption rate using macromolecular markers.

Reabsorption of fluid and solutes from the peritoneal cavity poses several problems for the correct estimation of peritoneal dialysate volume and ultrafiltration rate with macromolecular volume markers. Although physiological mechanisms of peritoneal reabsorption (direct lymphatic absorption vs reabsorption to the peritoneal tissue) are being currently discussed, many experimental and clinical studies have demonstrated that peritoneal reabsorption of the marker is mainly a bulk "backflow" out of the peritoneal cavity. Theoretical bases for the estimation of peritoneal dialysate volume and cumulative ultrafiltration of fluid including the correction for peritoneal reabsorption are reviewed. A widely applied simplified method which, however, neglects the impact of ultrafiltration on marker concentration is also discussed. The systematic errors involved in the application of the simplified method are usually less than 10% in the standard conditions; however, in specific cases they may be much higher. Therefore, the correct method is suggested for practical applications.

Absorption↗
PubMed1993

Protein and energy intake, nitrogen balance and nitrogen losses in patients treated with continuous ambulatory peritoneal dialysis.

The aim of this investigation was to analyze factors which influence the dietary protein intake (DPI), the energy intake and the utilization of ingested protein, and to determine the relationship between various types of nitrogen losses in stable continuous ambulatory peritoneal dialysis (CAPD) patients. We performed 23 nitrogen balance (NB) studies of 6 to 11 days duration in 12 CAPD patients. One study was performed in all patients 3.4 +/- 1.2 months after starting CAPD (early studies). The study was then repeated in nine patients after 12.1 +/- 2.6 months, and two of these patients were studied again after 16 and 24 months, respectively (late studies). Before each NB study, the dietary intakes prior to the study were assessed in diaries and interviews. During a few days preceding the NB periods and during the NB periods each patient received an individualized diet composed so as to resemble the patients' spontaneously chosen diet regarding DPI and dietary energy intake (DEI). Total nitrogen, protein, urea and creatinine were analyzed in the dialysate and urine collected daily. Total nitrogen was also analyzed in the feces, collected over the whole NB period. Total nitrogen appearance (TNA), non-protein nitrogen appearance (NPNA) and urea nitrogen appearance (UNA) were calculated by correcting total nitrogen output, non-protein nitrogen output, that is, TNA minus the total protein losses (PL) and urea nitrogen output for changes in total body urea nitrogen. Glucose was determined in the collected dialysate and the daily glucose absorption was calculated. DPI varied between 0.62 and 2.09 g/kg/day, DEI between 21 and 42 kcal/kg/day and the peritoneal energy (glucose) intake (PEI) between 4 and 13 kcal/kg/day. DPI (but not DEI) correlated with Kt/V(urea) and Kt/VCr and with total and renal clearances for urea and creatinine. NB (not corrected for "unmeasured" nitrogen losses) was positive in most studies, and it correlated with DPI and the total energy intake (TEI) in the early studies, but only with TEI in the late studies. DPI correlated with TNA, NPNA, UNA, non-protein-non-urea nitrogen loss and fecal nitrogen loss. UNA was highly correlated with TNA and NPNA (r = 0.95). We used data from 33 NB studies in CAPD patients (our present data combined with data from the literature) to calculate regression equations describing the relationship between TNA and NPNA, respectively, and UNA.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

Effect of alternative osmotic agents on peritoneal transport.

To investigate the impact of osmotic agents on solute transport in continuous ambulatory peritoneal dialysis single 6-hour dwell studies were performed in nondiabetic patients using different osmotic agents: glucose 3.86%, amino acids 2.70, and glycerol 2.50%. Diffusive mass transport coefficient (KBD) and sieving coefficient (S) were assessed for urea, creatinine, glucose, glycerol, potassium, sodium, and total protein using the Babb-Randerson-Farrell model. The estimated KBD values for small solutes were higher in peritoneal dialysis fluid based on amino acids than in both glucose- and glycerol-based dialysis solutions. S values for small solutes were higher in glucose-based peritoneal dialysis fluid than in dialysis solutions based on amino acids and glycerol. Moreover, nonphysical, i.e., out of the range 0-1, S values were obtained for urea and potassium in glucose-based peritoneal dialysis fluid and for glucose and glycerol applied as osmotic agents. No difference in the transport parameters for total protein was found between the three investigated dialysis fluids. We conclude that the composition of dialysis fluid (osmotic agent, buffer solute, pH) can change the transport characteristics of the peritoneum. Furthermore, other physiological processes besides the diffusive and convective transport can contribute to the net peritoneal transport of some solutes.

Adult↗
PubMed1993

Supplemented dialysis: amino acid-based solutions in peritoneal dialysis.

Peritoneal dialysis is associated with several metabolic and nutritional abnormalities, some of which are related to the use of glucose-based solutions. Furthermore, the catabolic effects of uremia per se, protein and amino acid losses into the dialysate, peritonitis and poor appetite contribute to amino acid abnormalities, negative nitrogen balance and a high prevalence of malnutrition in peritoneal dialysis patients. To overcome these problems the use of amino acid instead of glucose as an osmotic agent has been proposed. Short-term studies have shown that amino acid-based solutions in peritoneal dialysis may supplement in excess the daily losses of amino acids during dialysis with glucose-based solutions. The amino acid solutions produce similar ultrafiltration and solute transport as the standard glucose solutions although the period of effective ultrafiltration is rather short. However, it should be noted that some studies have reported that the transport of small and large solutes may increase in patients using amino acid solutions. During the early 1980s several investigators have developed and tested different amino acid solutions for peritoneal dialysis. The initial clinical experience from Toronto with amino acid solutions containing large amounts of non-essential amino acids and inadequate amount of buffer were in general discouraging. The patients, who were not always malnourished and tended to have a low energy intake, developed increased BUN levels, acidosis, no improvement in nutritional status or amino acid abnormalities and, in some cases, anorexia. In 1985 a new 1% amino acid solution, containing an increased buffer amount and amino acids (mainly essential) in proportions which take the amino acid abnormalities in uremic patients into account, became available. The use of this solution resulted in some improvement in amino acid pattern and nutritional parameters, but acidosis and increased BUN levels remained problems. The experiences from these and previous studies showed that: (1) the improvement of the composition of amino acid solutions was beneficial; (2) a further increase of the buffer amount was needed; (3) patients included should have signs of protein malnutrition combined with low dietary protein intake to benefit from intraperitoneal amino acid supply, and (4) energy intake should be sufficient to prevent amino acids to end up as energy source. For this purpose a new improved 1.1% amino acid solution has been developed containing a further increase of some essential amino acids and an increased amount of lactate (40 mmol/l). This solution has been tested in malnourished patients eating 0.8 g protein/kg/day and 25-30 kcal/kg/day.(ABSTRACT TRUNCATED AT 400 WORDS)

Absorption↗
PubMed1993

Peritoneal transport during dialysis with amino acid-based solutions.

OBJECTIVE: To evaluate the potential clinical role of amino acids as an osmotic agent. DESIGN: The peritoneal transport of fluid, amino acids, and other solutes was investigated during a 6-hour single-cycle peritoneal dialysis with PDA 1% versus 1.36% glucose (n = 6) or PDA 2.7% versus 3.86% glucose solution (n = 9). PATIENTS: Fifteen stable nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients. RESULTS: The fractional absorption of the osmotic agents at 6 hours was higher with PDA 2.7% versus glucose 3.86% (p < 0.005). The diffusive mass transport coefficient, KBD, calculated for a period of dialysate isovolemia was higher with PDA 2.7% versus PDA 1% for essential, nonessential (p < 0.005), and total (p < 0.05) amino acids. The intraperitoneal volume-over-time curves and KBD values for urea, creatinine, glucose, albumin, beta 2-microglobulin, and total protein did not differ between the amino acid solutions and the corresponding glucose solutions. KBD for urea was significantly higher during the dwell with PDA 2.7% versus PDA 1% (p < 0.05). Plasma amino acid concentrations increased substantially during the first 1-2 hours and then decreased gradually. Valine and methionine rose to 792% and 1119% of baseline values, respectively. CONCLUSIONS: We conclude that the peritoneal transport of fluid and investigated solutes, except amino acids, was not different with the amino acid solutions compared with the corresponding equimolar glucose solutions. However, ultrafiltration tended to be lower with amino acid solutions. Furthermore, the fractional absorption of amino acids and KBD values for amino acids was higher with PDA 2.7% versus PDA 1%, suggesting an effect of the hypertonic amino acid solution on the peritoneal membrane transport properties. Also, the hypertonic PDA 2.7% solution yielded nonphysiologically high plasma levels of several amino acids. We therefore consider this solution not to be safe enough for long-term clinical use.

Absorption↗
PubMed1992

A quantitative description of solute and fluid transport during peritoneal dialysis.

To investigate the relationship between dialysate glucose concentration and peritoneal fluid and solute transport parameters, 41 six-hour single dwell studies with standard glucose-based dialysis fluids containing 1.36% (N = 9), 2.27% (N = 9) and 3.86% (N = 23) anhydrous glucose were carried out in 33 clinically-stable continuous ambulatory peritoneal dialysis (CAPD) patients. Intraperitoneal dialysate volumes (VD) were determined from the dilution of 131I-albumin with a correction applied for its elimination from the peritoneal cavity (KE, ml/min). Diffusive mass transport coefficients (KBD) were calculated from aqueous solute concentrations (with a correction applied for the plasma protein concentration and, for electrolytes, also for the Donnan factor) during a period of dialysate isovolemia. The intraperitoneal amount calculated to be transported by diffusion was subtracted from the measured total amount of solutes in the dialysate, yielding an estimate of non-diffusive solute transport. The intraperitoneal dialysate volume over time curve was characterized by: initial net ultrafiltration (lasting on average 92 min, 160 min and 197 min and with maximum mean net ultrafiltration rates 6 ml/min, 8 ml/min and 14 ml/min, respectively, for the 1.36%, 2.27% and 3.86% solutions); dialysate isovolemia (lasting about 120 min for all three solutions) and fluid reabsorption (rate about 1 ml/min for all three solutions). KBD for glucose, potassium, creatinine, urea and total protein did not differ between the three solutions and the fractional absorption of glucose was almost identical for the three glucose solutions, indicating that the diffusive transport properties of the peritoneum is not influenced by the initial concentration of glucose or the ultrafiltration flow rate. About 50% of the total absorption of glucose occurred during the first 90 minutes of the dwell. The mean percentage of the initial amount of glucose which had been absorbed (%GA) at time t during the dwell could be described (r = 0.999) for all three solutions using the experimental formula %GA = 85 - 75.7 * e-0.005*t. After 360 minutes, about 75% of the initial intraperitoneal glucose amount had been absorbed corresponding to a mean (+/- SD) energy supply of 75 +/- 6 kcal, 131 +/- 18 kcal and 211 +/- 26 kcal for the three solutions. Non-diffusive (that is, mainly convective) transport was almost negligible for the less hypertonic solutions while it was estimated to account for 30 to 40% of the total peritoneal transport of urea, creatinine and potassium during the first 60 minutes of the 3.86% exchange.

Absorption↗
PubMed1992

Aqueous solute concentrations and evaluation of mass transport coefficients in peritoneal dialysis.

The quantitative description of diffusive and convective mass transport of small solutes in peritoneal dialysis is dependent on accurate determination and appropriate expression of the concentration of investigated substances. For small solutes which easily equilibrate between dialysate and plasma the solute concentration in plasma should be expressed per volume of plasma water (aqueous concentration) and not per volume of whole plasma. Furthermore, the Donnan effect should be taken into account for electrolytes if measured by flame photometry. The common practice of expressing solute concentration per volume of whole plasma (plasma concentration) may result in substantial errors in calculated values of peritoneal transport parameters. To quantify these errors we compared plasma versus aqueous dialysate to plasma ratios (D/P), diffusive mass transport coefficients (KBD), and sieving coefficients (S) for 28 6-h single-dwell studies using glucose 3.86% dialysis fluid. For all substances except glucose non-corrected plasma D/P overestimated corrected aqueous D/P at 360 min by 2% (potassium and sodium) to 8% (creatinine) and, as assessed by the Pyle-Popovich model, non-corrected KBD overestimated true KBD by 12% (potassium) to 41% (urea). Similar results were also obtained for KBD estimation using the Garred model and KBD estimated during dialysate isovolaemia. The use of aqueous instead of plasma concentrations resulted in a substantial change of S for urea but not for the other investigated solutes. These results emphasise the importance of expressing small solute concentrations per volume of plasma water and not per volume of whole plasma in calculations of D/P ratios and mass transport coefficients.

Biological Transport, Active↗
PubMed1992

Nutritional aspects on peritoneal dialysis.

Peritoneal dialysis is associated with metabolic and nutritional abnormalities due to the combined effects of uremia per se, glucose absorption from the dialysate and a variety of catabolic factors, such as protein and amino acid losses into the dialysate, poor appetite possibly reflecting insufficient removal of small solutes, and recurrent episodes of peritonitis. Signs of protein-energy malnutrition are common, especially in patients with minimal or no residual renal function. Variables that best correlate with the degree of malnutrition include serum albumin, midarm muscle circumference, clinical signs of muscle wasting and loss of subcutaneous fat, and a history of anorexia. The incidence of malnutrition is higher in females than in males and in diabetics than in non-diabetics. CAPD patients generally have a lower protein intake than HD patients, but may have a lower average protein requirement than HD patients. Progression of malnutrition may occur in CAPD patients due to the synergistic effects of loss of residual renal function, underdialysis, anorexia and inadequate dietary intake. In underdialyzed CAPD patients, the amount of dialysis should be increased and measures should be taken to increase the supply of energy and protein. The use of amino acid-based dialysis fluid may provide new opportunities for compensation of dialytic losses of protein and amino acids, normalization of essential amino acids, supplementation of inadequate dietary protein intake, and improvement of the nutritional status in CAPD patients.

Amino Acids↗