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REVIEWS AND ORIGINAL ARTICLES |
From the Medical and Research Services of the V A Wadsworth and San Francisco V A Medical Centers and the UCLA and UCSF Schools of Medicine, Los Angeles and San Francisco, California Supported in part by USPHS, Contract AM-5-2218 from NIAMDD and VA Research Funds.
Malnutrition and wasting are common in patients undergoing maintenance
dialysis. These problems may be more prevalent in patients undergoing
peritoneal dialysis due to inadequate dialysis, poor protein intake, loss of
nutrients in dialysate and tissue breakdown associated with intercurrent
illnesses, particularly peritonitis. Periodic assessment of the nutritional
status of these patients should be used as a guide to appropriate nutritional
therapy. Protein and aminoacid loss <h1ring CAPD average only 8.0 and 3.0
g/day, respectively; with peritonitis, losses increase. Balance studies
indicate that in a well-nourished patient 1.2 g protein/kg body weight is
probably adequate; a malnourished patient should receive 1.4 -1.6 g/kg.
Sufficient dialysis must be prescribed to enable ingestion of this diet;
residual renal function makes a significant contribution to to
al
clearance. With CAPD, energy intake is supplemented by large amounts of
glucose absorption; this is beneficial except for the obese or
hyperlipoproteinemic patient. Nutritional support of the patient with
intercurrent illness is crucial; nutrition administered via
peripheral vein may be beneficial. Management of the nutritional needs of the
diabetic presents additional problems which often test the skills of the
clinician.
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