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Part 4: Metabolic Syndrome and Nutrition in PD |
Departments of Nephrology and of Dietetics,1 Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Correspondence to: N. Prasad, Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014 India. narayan{at}sgpgi.ac.in
Background: Case-mix comorbidities and malnutrition
influence outcome in continuous ambulatory peritoneal dialysis (CAPD)
patients. In the present study, we analyzed the influence of stratified
comorbidities on nutrition indices and survival in CAPD patients. Patients and Methods: We categorized 373 CAPD patients
(197 with and 176 without diabetes) into three risk groups: low—age
under 70 years and no comorbid illness; medium— age 70 – 80 years,
or any age with 1 comorbid illness, or age under 70 years with diabetes;
high—age over 80 years, or any age with 2 comorbid illnesses. We then
compared nutrition indices and malnutrition by subjective global assessment
(SGA) between the three groups. Survival was compared using Kaplan–Meier
survival analysis. Results: Mean daily calorie and protein intakes in the
low-risk group (21 ± 6.7 Kcal/kg, 0.85 ± 0.28 g/kg) were
significantly higher than in the medium- (17.6 ± 5.2 Kcal/kg, 0.79
± 0.25 g/kg) and high-risk (17.5 ± 6.1 Kcal/kg, 0.78 ±
0.26 g/kg) groups (p = 0.001 and p = 0.04 respectively).
Relative risk (RR) of malnutrition was less in the low-risk group (103/147,
70.06%) than in the medium-risk group [135/162, 83.3%; RR: 2.0; 95% confidence
interval (CI): 2.1 to 3.4; p = 0.01] or the high-risk group (54/64,
84.4%; RR: 2.3; 95% CI: 2.1 to 4.9; p = 0.03). Mean survivals of
patients in the low-, medium-, and high-risk groups were 51
patient–months (95% CI: 45.6 to 56.4 patient–months), 43.3
patient–months (95% CI: 37.8 to 48.7 patient–months), and 29.7
patient–months (95% CI: 23 to 36.4 patient–months) respectively
(log-rank: 35.9 patient–months; p = 0.001). The 1-, 2-, 3-, 4-,
and 5-year patient survivals in the low-, medium-, and high-risk groups were
96%, 87%, 79%, 65%, and 56%; 89%, 67%, 54%, 43%, and 34%; and 76%, 48%, 31%,
30%, and 30% respectively. Conclusions: Intake of calories and protein was
significantly lower in the medium-risk and high-risk groups than in the
low-risk group. Survival was significantly better in low-risk patients than in
medium- and high-risk patients.
KEY WORDS: Comorbidities; stratification; survival.
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