Managing the nutritional concerns of the patient undergoing peritoneal dialysis

Although less obvious and dramatic than other aspects of the uremic syndrome, chronic malnutrition and wasting are serious problems for patients with renal failure [1–5]. The malnutrition syndromes observed resemble both adult Marasmus (caloric malnutrition) and/or adult Kwashiorkor (protein-calorie malnutrition) [6]. For patients undergoing maintenance hemodialysis or peritoneal dialysis therapy, recognition of the signs and symptoms of malnutrition is often difficult because they so closely resemble signs and symptoms of uremia and inadequate dietary intake. Loss of essential nutrients into the dialysate produce abnormalities which are superimposed upon and often resemble the metabolic abnormalities of uremia. The result is often a complex of signs and symptoms that suggest the patient is ‘failing to thrive’ but which is generally neither interpreted correctly nor dealt with. These problems have appeared more likely to occur in patients undergoing intermittent peritoneal dialysis [7, 8] and may also be significant in patients undergoing CAPD or CCPD [9]. It is not clear how and to what extent malnutrition contributes to the overall morbidity and mortality of patients with end-stage renal disease, but the fact that malnutrition adversely influences the outcome of many other acute and chronic illnesses, suggests that careful attention must be paid to the nutritional management of the peritoneal dialysis patient.