Chapters authored
Diagnosis, Prevention, and Treatment of Protein-Energy Wasting in Peritoneal Dialysis
Protein-energy wasting (PEW) is highly prevalent in peritoneal dialysis (PD) patients and is associated with mortality. Reduced protein and energy intake, comorbidity conditions, endocrine disorders, increased inflammatory cytokines, uremic toxins, metabolic acidosis, oxidative stress, nutrient losses into dialysate, continuous absorption of glucose from PD solutions, abdominal fullness induced by the dialysate, and peritonitis contribute to PEW. Assessment of nutritional status for the detection and management of PEW includes the PEW definition criteria, subjective global assessment (SGA), malnutrition-inflammation score (MIS), and geriatric nutritional risk index (GNRI). Diverse factors can affect nutritional and metabolic status in these patients so multiple strategies may be required to prevent or reverse PEW. Preventive measures include continuous nutritional counseling, optimizing dietary nutrient intake, and managing comorbidities. To treat PEW, the following may be used: administration of oral, intraperitoneal, enteral, or parenteral nutritional supplementation and adjunct therapies such as anabolic agents, appetite stimulants, anti-inflammatory interventions, and exercise. Diagnosis, prevention, and treatment of PEW in PD patients may favorably impact the prognosis and course of the disease.
Part of the book: Evolving Strategies in Peritoneal Dialysis