Nutrition and Chronic Kidney Disease

Denis Fouque; Solenne Pelletier; Denise Mafra; Philippe Chauveau

Disclosures

Kidney Int. 2011;80(4):348-357. 

In This Article

What is the Optimal Protein Intake in Peritoneal Dialysis?

Data are more limited and still discussed regarding the optimal protein intake in peritoneal dialysis patients. Peritoneal dialysis is associated with albumin and amino-acid losses in the spent dialysate, which can reach 5–15 g/day, seven times per week as compared with hemodialysis losses that only happens three times weekly.[77,78] These losses may represent ~15% of the net daily protein intake. Interestingly, new dialysis regimen, such as automated peritoneal dialysis, does not appear to modify these losses.[78] Anorexia may occur in response to intraperitoneal glucose load and abdominal filling, and actual protein intakes of 1.0 g/kg/day or less are often reported.[79] Studies in metabolic ward in rather young adults have shown in the eighties that a protein intake of about 1.2 g protein/kg/day was associated with neutral or positive protein balance in all patients; however, most patients were already in balance for intakes equal or greater than 1.0 g protein/kg/day.[70,72] Current guidelines therefore mention that protein intake should be 1.0–1.2 g/kg/day[9,80,81] and not below 0.8 g/kg/day in any patient.[80] As most patients will not be able to reach 1.2 g protein/kg/day, an intake of 1.0 g/kg may be acceptable if the patient does not express a decline in nutritional status.[80]

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