IMPACT OF PERITONEAL ABSORPTION OF GLUCOSE ON APPETITE, PROTEIN CATABOLISM AND SURVIVAL IN CAPD PATIENTS

Dietary protein and calorie intake, protein catabolism and peritoneal kinetics were measured in 97 CAPD patients to establish the effect of peritoneal glucose absorption on appetite and survival. There was a la rge variability in the number of calories obtained from the dialysate, mean 5.89 cal/kg (median 5.43 cal/kg), with a skewed distribution, du e to the increased requirement for hypertonic solutions by patients wi th more rapid glucose absorption and poor ultrafiltration. On average calories derived from peritoneal absorption accounted for 19% of the t otal energy intake which in itself was well below that recommended. Pa tients with >6 cal/kg obtained from the dialysate (top 20th percentile , n = 19) were compared with those with <6 cal/kg, but no significant differences in oral protein or calorie intake, protein catabolism or t otal calorie intake were found. Age, body mass index (BMI) and KT/V we re also similar in both groups. Patients were followed-up prospectivel y for a minimum of 24 months and a comparison made of actuarial surviv al. Patients with high peritoneal calorie intake tended to survive lon ger but this was not significantly different (p = 0.25). This study su ggests that calories derived from the peritoneum in CAPD patients do n ot suppress appetite, provide a useful and significant proportion of t he total energy intake, that does not cause excessive obesity or have a negative effect on patient survival.