IMPROVED NUTRITION AFTER THE DETECTION AND TREATMENT OF OCCULT GASTROPARESIS IN NONDIABETIC DIALYSIS PATIENTS

Malnutrition in dialysis patients is of multifactorial etiology and is associated with greatly increased morbidity and mortality, A low seru m albumin level is one of the most powerful predictors of death and ma y persist despite optimization of the dialysis prescription, We retros pectively reviewed our experience in improving nutrition In nondiabeti c patients with unexplained hypoalbuminemia, Using radionuclide solid- phase gastric emptying scans, we identified 6 patients who had occult gastroparesis. These patients (one on hemodialysis and five on periton eal dialysis) were then treated with prokinetic medications (erythromy cin elixir or metoclopramide) selected on the basis of their effective ness in improving the scanning results after being given intravenously , Gastric emptying half-times improved from a median of 122 minutes (r ange, 95 to >300 minutes; normal, less than or equal to 90 minutes) to 12 +/- 2 minutes (mean +/- SEM), The serum albumin increased from 3.3 +/- 0.04 g/dL to 3.7 +/- 0.08 g/dL at 3 months, with every patient's value higher than 3.5 g/dL. This improvement was statistically signifi cant (P = 0.008) over the 5-month period of observation, which encompa ssed the 2 months before and 3 months after treatment, There was a lin ear improvement (P = 0.008) that showed a quadratic trend (P = 0.078) for a plateau at the final sampling point, The serum blood urea nitrog en, creatinine, and hematocrit levels remained unchanged (P > 0.1), We conclude that gastric emptying scans are valuable in identifying occu lt gastroparesis in high-risk patients and can guide the selection of prokinetic therapy, which may significantly increase serum albumin lev els. (C) 1998 by the National Kidney Foundation, Inc.