Peritoneal Dialysis- What is the nutritional requirements?

Information Awareness.

 Malnutrition is a common complication on peritoneal dialysis (PD) patients and a risk factor for morbidity and mortality. The prevalence of severe malnutrition is 5% to 10%, whereas mild to moderate malnutrition occurs in 30% to 50%. Reasons for low nutritional intake and anorexia in continuous ambulatory peritoneal dialysis (CAPD) patients are summarized as follows:


Factors not associated with mode of dialysis:


-Insufficient removal of low-molecular-weight toxins due to under dialysis.
-Cumulation of middle molecules with central anorectic effects.
-Loss of metabolizing  renal tissue.
-Tastelessness of renal diet and altered taste perception.
-Metabolic Acidosis.
-Increased serum leptin levels.
-Endocrinologic levels.
-Gastroparesis and delayed gastric emptying
-Side effects of drugs.
-Infections(e.g. peritonitis)
-Comorbidity ( e.g.., Cardiovascular diseases)
-Psychosocial factors(e.g.., Depression)
-Low physical activity
-Advanced age
-Long duration of dialysis

-Late referral to dialysis.


Factors associated with the mode of dialysis


- Amino acid, vitamin, and protein losses.
-Glucose absorption
-Subjective feeling of fullness from the dialysate in the abdomen.
-High peritoneal transport rates.


Several studies showed increased weight gain  during the first 2 years of PD treatment. Reported weight gain may be cause by glucose absorption from the dialysate, representing additional energy intake. Longitudinal studies, however, this initial weight gain is followed by a progressive impairment of nutritional status over time. An increase in total body water also can cause weight gain despite reduced  daily protein  and energy intake. This is more frequent after loss of residual renal function. An increase in body fat is positively  correlated with the dialysate glucose concentration. Diabetic or female patients gain significantly more fat over time on PD than do non diabetic or male patients.


The required protein intake of PD patient is almost two fold higher than that of normal adults(1.2g/kg body weight in PD patients versus 0.6 to 0.7 g/kg body weight in normal adults). Metabolic balance studies showed that, with "unmeasured nitrogen losses" (e.g. sweat, skin desquamation, respiration) of 0.5g/day, the protein intake should be at least 1.1g/kg/day to avoid negative nitrogen balance. Consider the variability of each patients, a protein intake of 1.2g to 1.3g/kg/day is preferred.


Reference: Handbook of Nutrition and the Kidney; A Lippincott Williams & Wilkins Handbook.

                    Video 1. Example of a Renal Diet.

         Video 2. A video of a PD patient sharing her own Peritoneal dialysis diet.

-Other supplementary information to be followed soon.

Living with Kidney Disease - What you should know?

The following video credit and courtesy to KIDNEY RESEARCH UK. Living with Kidney Disease- What you should know?

Why Start PD?

                                     This is a video on how PD works.

            Our long-term goals in caring for patients with renal failure are to improve morbidity and mortality and preserve quality of life to the best possible degree.

            Many patients, especially younger patients, will likely need HD, PD, and renal transplantation at different times over their lifetime.

            Residual renal function is an important predictor of survival in the early years of RRT, and strategies to preserve residual renal function may add years of benefit to patients.

1. The preservation of residual renal function may in fact confer an important survival benefit in PD, as peritoneal dialysis patients have a slower rate of decline of residual renal function than do HD patients.

For example, Wang and colleagues reported that for every 1 mL/min/1.73 m2 increase in residual glomerular filtration rate (GFR), there was a 50% reduction in all-cause mortality and cardiovascular death among their cohort of PD patients.

2.Once there is no residual renal function, it is more difficult to achieve solute clearance with PD than with hemodialysis. Therefore, it makes much more sense to utilize peritoneal dialysis at the beginning of renal replacement therapy rather than as a last resort in the setting of vascular access failure. Using PD for dialysis initiation delays the use of hemodialysis and preserves upper extremities for vascular access.

              In addition to the benefits of preserving residual renal function and vascular access sites, numerous studies suggest that patient satisfaction is higher in patients on PD versus HD.

Among the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) cohort, patients who were receiving peritoneal dialysis were 1.5 times more likely to rate their dialysis care as excellent than were patients receiving HD.

3.PD patients in the CHOICE cohort were also more satisfied with the availability of their nephrologists than were hemodialysis patients, despite the fact that in-center HD patients are typically seen more frequently by their nephrologists.

(credit to Tucker, J Kevin MD; Denker, Bradley M. MD)

Fig. 1 Peritoneal Dialysis in a glance.