Impact of nutritional status on peritonitis in CAPD patients

To determine the impact of nutritional status on peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in a developing country. 56 patients with end-stage renal disease on CAPD were randomly selected for this study. These patients were assessed for nutritional status and perito...

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Bibliographic Details
Published in:Peritoneal dialysis international 2007, Vol.27 (1), p.42-47
Main Authors: PRASAD, Narayan, GUPTA, Amit, SHARMA, Raj K, SINHA, Archna, KUMAR, Ramesh
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Biological and medical sciences
Body Mass Index
Emergency and intensive care: renal failure. Dialysis management
Female
Follow-Up Studies
Glomerulonephritis
Humans
Intensive care medicine
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - metabolism
Kidney Failure, Chronic - therapy
Male
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Nephropathies. Renovascular diseases. Renal failure
Nutritional Status - physiology
Peritoneal Dialysis, Continuous Ambulatory - adverse effects
Peritonitis - etiology
Peritonitis - metabolism
Pharmacology. Drug treatments
Prognosis
Proportional Hazards Models
Retrospective Studies
Serum Albumin - metabolism
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Summary:To determine the impact of nutritional status on peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in a developing country. 56 patients with end-stage renal disease on CAPD were randomly selected for this study. These patients were assessed for nutritional status and peritonitis episodes. Nutritional parameters were assessed by anthropometry, diet, body mass index (BMI), Nutritional Risk Index (NRI), serum albumin level, and Subjective Global Assessment (SGA). Based on SGA, patients were categorized into either group 1 (malnutrition, n = 31) or group 2 (normal nutritional status, n = 25). Peritonitis was considered the primary outcome and was compared between the two groups. Demographic profiles, Kt/V, creatinine clearance, and mean follow-up of the two groups were similar. Number of peritonitis episodes was significantly higher in patients with malnutrition (25/31) compared to patients with normal nutritional status (4/25) (p = 0.001). Mean peritonitis rate per patient per year was also significantly higher in patients with malnutrition (0.99 +/- 1.07) compared to patients with normal nutritional status (0.18 +/- 0.42) (p = 0.007). On univariate analysis, malnutrition based on SGA (p = 0.009), NRI (p = 0.02), serum albumin level (p = 0.005), and calorie intake (p = 0.006) was a significant predictor of peritonitis. On multivariate Cox regression analysis, only SGA (p = 0.001, odds ratio 0.08, 95% confidence interval 0.02-0.36) was found to be a significant predictor of peritonitis. On general linear model, the observed power of prediction of peritonitis was 0.96 based on SGA. On Kaplan-Meier survival analysis, peritonitis-free survival in patients with normal nutrition (42 months) was significantly higher compared to patients with malnutrition (21 months) based on SGA (log rank p = 0.003). We conclude that peritonitis rate is high in patients with malnutrition and that malnutrition indices, especially SGA, can predict the peritonitis rate in CAPD patients.
ISSN:0896-8608
1718-4304
DOI:10.1177/089686080702700110