Nutritional status of patients undergoing continuous ambulatory peritoneal dialysis.

The study was conducted to determine the type and prevalence of malnutrition in 14 patients undergoing continuous ambulatory peritoneal dialysis. Height, weight, and anthropometric indicators were measured and venous blood samples were analyzed. A three-day dietary record was made. When ideal body weights were used as cut-off points,14% were underweight and 35.5% were obese. Fourteen percents had a body mass index (BMI) < 20 kg/m2 and 21.4% had BMI > 24.9 kg/m2. Seven and 14% of them had triceps skinfold thickness or mid arm muscle area below the 5th percentile and above the 95th percentile respectively. All of the patients were anemic. Lymphopenia, hypoalbuminemia, hypokalemia, hyperphosphatemia and hyperlipoproteinemia were present in 50%, 14%, 36%, 64% and 71% of the patients respectively. Sixty-two percent of them received >80% of their energy requirement. Protein intake was 0.97 + 0.39 gm/kg/day while protein loss was 6.5 + 1.4 gm/day into the dialysate and 0.3+ 0.04 gm/day in the urine. There were large variations in nutritional status in patients undergoing continuous peritoneal dialysis. The patients should have appropriate energy intake, taking into account the energy from glucose absorbed from the dialysate, and protein intake should be increased to cover the losses. Nutritional counseling should be made individually.

Urinary citrate excretion in normal adults.

For 60 healthy subjects, aged 18-48, the urinary citrate excretion was studied by enzymatic method of Toftegaard Nielsen. The mean values in 24hr. urine were 1.44+0.61 mmole/day, 1.33+0.54 mmole/l. and 1.80+1.06 mmole/gm Cr, respectively. In single voided urine specimens, urinary citrate concentrations were 1.44+0.74 mmole/l and 1.82+0.98 mmole/gm Cr. Females had a higher mean value than males. There was no significant difference in the concentration of citrated excreted in different periods of the day when the excretion was expreesed as mmole per gram of creatinine, but when expressed in mmole per litre, the 10 pm-6 am period was different from others. The concentration of excreted citrate in each period correlated well with the 24 hour excretion, especially when it was expressed as mmole per litre (corr. Coeff. 0.55-0.9). Therefore, a single voided specimen can be used in the evaluation of total daily citrate excretion.

Non-oliguric renal failure in aminoglycoside nephrotoxicity.

Clinical and laboratory data were reviewed on 35 patients with acute renal failure associated with aminoglycoside administration. The diagnosis of nephrotoxicity was based on azotaemia both with or without a decline in the volume of urine. Clinical nephrotoxicity in these cases most likely occurred in association with surgery, advanced age, diabetes mellitus, jaundice and recent exposure to aminoglycosides. Twenty one of the 35 patients were non-oliguric. The duration of established renal failure after administion of aminoglycosides varied from 4 to 16 days. The common causative drugs were gentamicin (1.5-5 mg/kg/day) and kanamycin (1 gm/day) respectively. The maximum creatinine was 15 mg/dl. Conservative management of renal failure included withdrawal of aminoglycosides or adjusting the dose according to renal function, treatment of underlying diseases and provision of adequate hydration. Sixteen patients improved with normal serum creatinine within 7 days to 2 months after the onset of renal failure. Non of non-oliguric patients required dialysis treatment. Five patients died from septicaemia.