ABSTRACT
We measured mortality and morbidity among 114 patients assigned randomly to home hemodialysis (HD) and home intermittent peritoneal dialysis (IPD). Data were collected during the time of home training and for 12 months after initiation of home dialysis. Training time was shorter for the IPD than for the HD patients (P less than 0.001) with median time 1.8 months for IPD and 3.9 months for HD. Switching to the alternative mode of treatment was more frequent for the IPD group (29/59 vs. 5/55, P less than 0.001). Survival time was not different, perhaps because of the modality change. More IPD patients were hospitalized in the first 6 months (20 for IPD vs. 9 for HD, P = 0.02), but they had fewer troublesome cardiovascular events in the first year (0 vs. 12, P less than 0.001). The HD patients maintained better nutritional status as reflected in body weight and arm muscle circumference and possibly in urea appearance rate. Thus, these data suggest that for most patients, IPD is a less satisfactory form of therapy than HD, but certain advantages of IPD did emerge. Applications of this information to the currently more popular mode of CAPD await further study.
Subject(s)
Hemodialysis, Home , Kidney Failure, Chronic/therapy , Peritoneal Dialysis , Clinical Trials as Topic , Follow-Up Studies , Health Status Indicators , Humans , Kidney Failure, Chronic/mortality , Male , Middle Aged , Random AllocationABSTRACT
Since wasting and malnutrition are common problems in patients with renal failure, it is important to develop techniques for the longitudinal assessment of nutritional status. This paper reviews available methods for assessing the nutritional status; their possible limitations when applied to uremic patients are discussed. If carefully done, dietary intake can be estimated by recall interviews augmented with dietary diaries. Also, in a stable patient with chronic renal failure, the serum urea nitrogen (N)/creatinine ratio and the rate of urea N appearance reflect dietary protein intake. A comparison of N intake and urea N appearance will give an estimate of N balance. Anthropometric parameters such as the relationship between height and weight, thickness of subcutaneous skinfolds, and midarm muscle circumference are simple methods for evaluating body composition. Other methods for assessing body composition, such as densitometry and total body potassium, may not be readily applicable in patients with renal failure. More traditional biochemical estimates of nutritional status such as serum protein, albumin, transferrin, and selected serum complement determinations show that abnormalities are common among uremic patients. Certain anthropometric and biochemical measurements of nutritional status are abnormal in chronically uremic patients who appear to be particularly robust; thus, factors other than altered nutritional intake may lead to abnormal parameters in such patients. Serial monitoring of selected nutritional parameters in the same individual may improve the sensitivity of these measurements to detect changes. Standards for measuring nutritional status are needed for patients with renal failure so that realistic goals can be established optimal body nutriture.
Subject(s)
Kidney Failure, Chronic/physiopathology , Nutritional Physiological Phenomena , Adipose Tissue/physiology , Amino Acids/blood , Blood Proteins/analysis , Blood Urea Nitrogen , Body Composition , Body Weight , Creatinine/blood , Diet , Dietary Proteins , Humans , Male , Middle Aged , Minerals , Muscles/physiology , Physical Examination , Skinfold Thickness , Urea/blood , Uremia/physiopathologyABSTRACT
The conventional dialysate of 2.5 gm% dextrose, and 132 mEq/L sodium may result in mild postdialysis hypernatremia, thirst and excessive interdialytic weight gain. A reduction of dialysate sodium to 118--120 mEq/L is recommended.
