Nutritional Management of the CAPO Patient *

Abstract

Malnutrition and wasting are common in patients undergoing maintenance dialysis. These problems may be more prevalent in patients undergoing peritoneal dialysis due to inadequate dialysis, poor protein intake, loss of nutrients in dialysate and tissue breakdown associated with intercurrent illnesses, particularly peritonitis. Periodic assessment of the nutritional status of these patients should be used as a guide to appropriate nutritional therapy. Protein and aminoacid loss <h1ring CAPD average only 8.0 and 3.0 g/day, respectively; with peritonitis, losses increase. Balance studies indicate that in a well-nourished patient 1.2 g protein/kg body weight is probably adequate; a malnourished patient should receive 1.4 –1.6 g/kg. Sufficient dialysis must be prescribed to enable ingestion of this diet; residual renal function makes a significant contribution to to∼al clearance. With CAPD, energy intake is supplemented by large amounts of glucose absorption; this is beneficial except for the obese or hyperlipoproteinemic patient. Nutritional support of the patient with intercurrent illness is crucial; nutrition administered via peripheral vein may be beneficial. Management of the nutritional needs of the diabetic presents additional problems which often test the skills of the clinician.