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Perit Dial Int 27(2): 192-195 2007
© 2007 International Society for Peritoneal Dialysis
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Clinical

DIETARY PROTEIN REQUIREMENTS AND DIALYSATE PROTEIN LOSSES IN CHRONIC PERITONEAL DIALYSIS PATIENTS

Wytske M. Westra1,4, Joel D. Kopple1,2,3, Raymond T. Krediet4, Marilyn Appell1 and Rajnish Mehrotra1,2

1 Division of Nephrology & Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance;2 David Geffen School of Medicine at UCLA;3 UCLA School of Public Health, Los Angeles, California, USA; 4 Division of Nephrology, Department of Medicine, Academic Medical Center, Amsterdam, The Netherlands

Correspondence to: R. Mehrotra, Division of Nephrology & Hypertension, Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, California 90502 USA. rmehrotra{at}labiomed.org

{diamondsuit} Background: Recommended dietary protein allowances for chronic peritoneal dialysis (PD) patients are approximately 60% higher than the dietary protein allowances for healthy adults. The relative contribution of dialysate protein and amino acid losses to these high protein requirements or total nitrogen losses is uncertain.

{diamondsuit} Methods: Following a peritoneal equilibration test, two 24-hour dialysate collections (24-1 and 24-2) were performed in 9 stable patients undergoing automated PD [4 males, 3 diabetics, age 43 ± 5 years (mean ± SEM), dialysis vintage 42 ± 6 months, dialysate-to-plasma ratio of creatinine 0.61 ± 0.04]. Dialysate effluent from nighttime cycling was collected separately from the daytime dwells.

{diamondsuit} Results: The measured 24-hour protein losses were 9.4 ± 0.6 (24-1) and 10.8 ± 0.8 (24-2) g/day. Even though day dwells accounted for 27% of daily dialysate volume, they accounted for 40% of daily protein and amino acid losses. The frequency of nighttime cycling and duration of dwell were significant predictors of peritoneal protein losses. Dialysate protein and amino acid losses constituted 24% ± 2% and 3.1% ± 0.3% of dialysate nitrogen and 14% ± 1% and 1.7% ± 0.1% of dietary nitrogen intake respectively.

{diamondsuit} Conclusions: Treatment with automated PD is associated with somewhat higher 24-hour dialysate protein losses compared to previous reports among continuous ambulatory PD patients. Dialysate protein and amino acid losses constitute a small, albeit significant, proportion of total nitrogen appearance and thus may contribute to the increased dietary protein requirements of chronic PD patients.

KEY WORDS: KEY WORDS:; Nutrition; end-stage renal disease; dialysate protein loss; nitrogen appearance; dietary protein intake; chronic kidney disease.

Received 8 March 2006; accepted 30 August 2006.






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