Adaptation of CAPD patients to the continuous peritoneal energy uptake

Baeyer, Hans von; Gahl, Gerhard M.; Riedinger, Hans; Borowzak, Ruth; Averdunk, R.; Schurig, R; Kessel, Michael

doi:10.1038/ki.1983.6

Cited by 68 publications

(19 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A high proportion (39-41%) failed to achieve sug gested adequacy targets for weekly total creatinine clear ance and KT/V(urea). This can in part be explained by the low average daily ultrafiltrate of 560 ml resulting from a policy of caution against the use of excessive hypertonic exchanges, for the fear of causing peritoneal damage and exacerbating lipid abnormalities [36].…”

Section: Discussionmentioning

confidence: 99%

Limitations of Kinetic Models as Predictors of Nutritional and Dialysis Adequacy in Continuous Ambulatory Peritoneal Dialysis Patients

et al. 1993

View full text Add to dashboard Cite

Nutrition has been shown to predict clinical outcome in continuous ambulatory peritoneal dialysis (CAPD) patients. However, despite the positive relationship between KT/V (urea) and the normalised protein catabolic rate, the ability of urea kinetic modelling to predict clinical outcome or nutrition remains inconclusive. We have evaluated the relationship between nutrition and achieved dialysis in a cross-sectional study of 147 stable CAPD patients on dialysis for a mean period of 22 months. Protein-energy malnutrition was present in 22-32% of the study population. 39 and 41% of the population failed to achieve suggested adequacy targets of 50 litres/week for total creatinine clearance and a weekly KT/V(urea) of 1.7, respectively. Severely malnourished patients had significantly greater normalised clearance and adequacy values than well-nourished patients. Intrinsic actual peritoneal clearance bore no relation to patient size. The subsequent normalisation of this value by a component of patient mass results in a mathematical bias against well-nourished or obese patients. This may explain the failure of such adequacy values to reflect outcome and argues against accepting such values as measures of dialysis well-being.

show abstract

Section: Discussionmentioning

confidence: 99%

Limitations of Kinetic Models as Predictors of Nutritional and Dialysis Adequacy in Continuous Ambulatory Peritoneal Dialysis Patients

et al. 1993

View full text Add to dashboard Cite

show abstract

“…Food intake can be significantly suppressed by large filling volumes (≥10% of body weight), especially if the total osmolality of the dialysate is high (31). In addition, the continuous absorption of glucose from the dialysate may cause loss of appetite in some patients (32).…”

Section: Dialysate Absorptionmentioning

confidence: 99%

Impact of End‐Stage Renal Disease and Dialysis on Glycemic Control

Mak

2000

Seminars in Dialysis

100

View full text Add to dashboard Cite

“…Other contributors to the seemingly improved hyperglycemia in peritoneal dialysis patients include diminished appetite related to continuous glucose absorption [17] or due to the mechanical effects of large filling peritoneal dialysis volumes. [18] Lowered patient energy expenditure, [19] limited amino acid losses and effect of peritoneal glucose absorption to stimulate insulin secretion may be other mechanisms to this end. [20]…”

Section: Dose Ckd Confound the Natural Course Of Dm?mentioning

confidence: 99%

Burnt-Out Diabetes: Impact of Chronic Kidney Disease Progression on the Natural Course of Diabetes Mellitus

Kalantar-Zadeh

Derose

Nicholas

et al. 2009

Journal of Renal Nutrition

View full text Add to dashboard Cite

Many individuals with diabetic nephropathy, the leading cause of chronic kidney disease (CKD) in the United States, progress to stage 5 of CKD and undergo maintenance dialysis treatment. Recent data indicate that in up to one-third of the diabetic dialysis patients with the presumptive diagnosis of diabetic nephropathy, glycemic control improves spontaneously with the progression of CKD, loss of residual renal function and the initiation of dialysis therapy, leading to normal to low hemoglobin A1c (<6%) and glucose levels, requiring cessation of insulin or other diabetic medications. Potential contributors to this so-called "burnt-out diabetes" include decreased renal and hepatic insulin clearance, decline in renal gluconeogenesis, deficient catecholamine release, diminished food intake due to anorexia and/or diabetic gastroparesis, protein-energy wasting with resultant weight and body fat loss, and hypoglycemic effect of dialysis treatment. Although the concept of "burnt-out diabetes" appears in sharp contradistinction to the natural history of diabetes mellitus, studying this condition and its potential causes and consequences including the role of genetic factors may lead to better understanding of the pathophysiology of metabolic syndrome and diabetes mellitus in the CKD population and in many other individuals with chronic disease states associated with wasting syndrome that can confound the natural history of diabetes. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Brief Case ReportMr. H. is a 54-year-old Filipino man who has been undergoing maintenance hemodialysis for 3 years. He was first diagnosed with diabetes mellitus (DM) type 2 approx. 25 years ago and initially treated with oral hypoglycemic agents. Several years later the patient required insulin injections for refractory hyperglycemia (>350 mg/dl), high hemoglobin A1c levels (>8%) and polyuria due to osmotic glucosuria. His BMI was 35 kg/m2 then. In addition to insulin, he also received anti-hypertensive medications including ACEI-inhibitors for hypertension, statins for LDL-hypercholesterolemia (>160 mg/dL), and pain medications for diabetic neuropathy with severe burning pain in his feet. In-between he underwent quadruple bypass surgery for extensive coronary artery disease and laser treatment for diabetic proliferative retinopathy. The patient required progressively higher doses of insulin until 5 years ago, when he presented to emergency room with hypoglycemic episode, which led to lowering his insulin dose for the first time. At that time, his serum creatinine was 1.7 mg/d...

show abstract

Adaptation of CAPD patients to the continuous peritoneal energy uptake

Cited by 68 publications

References 15 publications

Limitations of Kinetic Models as Predictors of Nutritional and Dialysis Adequacy in Continuous Ambulatory Peritoneal Dialysis Patients

Limitations of Kinetic Models as Predictors of Nutritional and Dialysis Adequacy in Continuous Ambulatory Peritoneal Dialysis Patients

Impact of End‐Stage Renal Disease and Dialysis on Glycemic Control

Burnt-Out Diabetes: Impact of Chronic Kidney Disease Progression on the Natural Course of Diabetes Mellitus

Contact Info

Product

Resources

About