Joanna Bober, Olech Mazur, Edyta Gołembiewska, Anna Bogacka, Karina Sznabel, Dobrosława Stańkowska-Walczak, Joanna Kabat-Koperska, Ewa Stachowska


Introduction: The main causes of death in patients undergoing dialysis are cardiovascular diseases. Their presence is related to the nutritional status of patients treated with peritoneal dialysis, and has a predicted value in this kind of patient. Long-term therapy entails unfavourable changes, from which a clinically significant complication is protein-energy malnutrition and intensification of inflammatory processes. The aim of the study was to assess the nutritional status of patients with chronic kidney disease treated with peritoneal dialysis based on anthropometric, biochemical parameters analysis, a survey, as well as the determination of changes in measured parameters occurring over time.

Material and methods: The study involved 40 people undergoing peritoneal dialysis (PD) and 30 healthy people. For dialyzed patients testing material was collected twice, every 6 months. Proteins, albumins, prealbumins, C-reactive protein and glucose levels were measured. Anthropometric measurements included body height, body weight, triceps skinfold and subscapular skinfold thickness. Body mass index (BMI) value and exponent of tissue protein source were calculated. The examined patients completed the questionnaire, which included, among other factors, the daily intake of nutrients, and lifestyle information.

Results: During the 6 month observation of the PD group a statistically significant increase in the energy value of intake food and amount of calories intake from carbohydrates was found. Analysis of nutritional status dependent on the BMI showed that overweight and obese patients are characterized by higher concentrations of the C-reactive protein and glucose, as well as lower concentrations of prealbumin compared to patients with normal body weight. At the same time, the energy value of food and the amount of protein in the group with BMI > 25 were smaller than in the other groups. During the 6 month observation a decrease in the concentration of prealbumin and an increase in C-reactive protein in BMI > 25 group were observed.

Conclusions: The nutritional status of all patients undergoing peritoneal dialysis was abnormal, which was not reflected by BMI. In overweight and obese patients increased changes over time were observed. This suggests the occurrence of protein-energy malnutrition.


chronic kidney disease; malnutrition; body mass index; prealbumin; C-reactive protein

Full Text:

PDF (Język Polski)


Ahime R.S., Flier J.S.: Adipose tissue as an endocrine organ. Trends Endocrinol Metab. 2000, 11 (8), 327–332.

NKF KDOQI, National Kidney Foundation Kidney Disease Outcomes Quality Initiative. (5.05.2010).

Churchill D.N., Taylor D.W., Keshaviah P.R.: Adequacy of dialysis and nutrition in continuous peritoneal dialysis, association with clinical outcomes. J Am Soc Nephrol. 1996, 7 (2), 198–207.

Ateş K., Oztemel A., Nergizoğlu G., Ertürk S., Keven K., Akar H. et al.: Peritoneal protein losses do not have a significant impact on nutritional status in CAPD patients. Perit Dial Int. 2001, 21 (5), 519–522.

Lindholm B., Alvestrand A., Fürst P., Bergström J.: Plasma and muscle free amino acids during continuous ambulatory peritoneal dialysis. Kidney Int. 1989, 35 (5), 1219–1226.

Lin W.T., Tsai C.C., Chen C.Y., Lee W.J., Su C.C., Wu Y.J.: Proteomic analysis of peritoneal dialysate fluid in patients with dialysis-related peritonitis. Ren Fail. 2008, 30 (8), 772–777.

Raaijmakers R., Pluk W., Schröder C.H., Gloerich J., Cornelissen E.A., Wessels H.J. et al.: Proteomic profiling and identification in peritoneal fluid of children treated by peritoneal dialysis. Nephrol Dial Transplant. 2008, 23 (7), 2402–2405.

Pliakogiannis T., Trpeski L., Taskapan H., Shah H., Ahmad M., Fenton S. et al.: Reverse epidemiology in peritoneal dialysis patients, the Canadian experience and review of the literature. Int Urol Nephrol. 2007, 39 (1), 281–288.

Snyder J.J., Foley R.N., Gilbertson D.T., Vonesh E.F., Collins A.J.: Body size and outcomes on peritoneal dialysis in the United States. Kidney Int. 2003, 64 (5), 1838–1844.

Kiran V.R., Zhu T.Y., Yip T., Lui S.L., Lo W.K.: Body mass index and mortality risk in Asian peritoneal dialysis patients in Hong Kong-impact of diabetes and cardiovascular disease status. Perit Dial Int. 2014, 34 (4), 390–398.

Zhou H., Cui L., Zhu G., Jiang Y., Gao X., Zou Y. et al.: Survival advantage of normal weight in peritoneal dialysis patients. Ren Fail. 2011, 33 (10), 964–968.

Szponar L., Wolnicka K., Rychlik E.: Album fotografii produktów i potraw. IŻŻ, Warszawa 2000.

Young G.A., Kopple J.D., Lindholm B., Vonesh E.F., De Vecchi A., Scalamogna A. et al.: Nutritional assessment of continuous ambulatory peritoneal dialysis patients, an international study. Am J Kidney Dis. 1991, 17 (4), 462–471.

Martín-del-Campo F., Batis-Ruvalcaba C., González-Espinoza L., Rojas-Campos E., Angel J.R., Ruiz N. et al.: Dietary micronutrient intake in peritoneal dialysis patients: relationship with nutrition and inflammation status. Perit Dial Int. 2012, 32 (2), 183–191.

de Mutsert R., Grootendorst D.C., Axelsson J., Boeschoten E.W., Krediet R.T., Dekker F.W.: Excess mortality due to interaction between protein–energy wasting, inflammation and cardiovascular disease in chronic dialysis patients. Nephrol Dial Transplant. 2008, 23 (9), 2957–2964.

Kalantar-Zadeh K., Kopple J.D.: Trace elements and vitamins in maintenance dialysis patients. Adv Ren Replace Ther. 2003, 10 (3), 170–182.

Daugirdas J., Blake P., Ing T.: Podręcznik dializoterapii. Czelej, Lublin 2008.

Klahr S., Levey A.S., Beck G.J., Caggiula A.W., Hunsicker L., Kusek J.W. et al.: The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med. 1994, 330 (13), 877–884.

Mitch W.E.: Dietary therapy in uremia: the impact on nutrition and progressive renal failure. Kidney Int. 2000, 57, Suppl. 75, 38.

Locatelli F., Fouque D., Heimburget O., Drüeke T.B., Cannata-Andía J.B., Hörl W.H. et al.: Nutritional status in dialysis patients, European consensus. Nephrol Dial Transplant. 2002, 17 (4), 563–572.

Mak R.K., Cheung W.: Energy homeostasis and cachexia in chronic kidney disease. Pediatr Nephrol. 2006, 21 (12), 1807–1814.

Levey A.S., Adler S., Caggiula A.W., England B.K., Greene T., Hunsicker L.G. et al.: Effects of dietary protein restriction on the progression of advanced renal disease in the Modification of Diet in Renal Disease Study. Am J Kidney Dis. 1996, 27 (5), 652–663.

Kalantar-Zadeh K., Kopple J.D.: Relative contributions of nutrition and inflammation to clinical outcome in dialysis patients. Am J Kidney Dis. 2001, 38 (6), 1343–1350.

de Luis D., Bustamante J.: Nutritional aspects in renal failure. Nefrologia. 2008, 28 (3), 333–342.

Postorino M., Marino C., Tripepi G., Zoccali C.: Abdominal obesity and all-cause and cardiovascular mortality in end-stage renal disease. J Am Coll Cardiol. 2009, 53 (15), 1265–1272.

Praga M., Morales E.: Obesity, proteinuria and progression of renal failure. Curr Opin Nephrol Hypertens. 2006, 15 (5), 481–486.

Drechsler C., de Mutsert R., Grootendorst D.C., Boeschoten E.W., Krediet R.T., le Cessie S. et al.: Association of body mass index with decline in residual kidney function after initiation of dialysis. Am J Kidney Dis. 2009, 53 (6), 1014–1023.

Johnson D.W.: Dietary protein restriction as a treatment for slowing chronic kidney disease progression, the case against. Nephrology (Carlton). 2006, 11 (1), 58–62.

Kamimura M.A., Avesani C.M., Cendoroglo M., Canziani M.E., Draibe S.A., Cuppari L.: Comparison of skinfold thicknesses and bioelectrical impedance analysis with dual-energy X-ray absorptiometry for the assessment of body fat in patients on long-term haemodialysis therapy. Nephrol Dial Transplant. 2003, 18 (1), 101–105.

Schoenfeld P., Henry R., Laird N., Roxe D.M.: Assessment of nutritional status of the National Cooperative Dialysis Study population. Kidney Int. 1983, 23, S80–S85.

Stosovic M., Stanojevic M., Simic-Ogrizovic S., Jovanovic D., Djukanovic L.: The predictive value of anthropometric parameters on mortality in haemodialysis patients. Nephrol Dial Transplant. 2011, 26 (4), 1367–1374.

Stenvinkel P., Alvestrand A.: Inflammation in end-stage renal disease: sources, consequences, and therapy. Semin Dial. 2002, 15 (5), 329–337.

Lacson E. Jr, Levin N.W.: C-reactive protein and end-stage renal disease. Semin Dial. 2004, 17 (6), 438–448.

Zimmermann J., Herrlinger S., Pruy A., Metzger T., Wanner C.: Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int. 1999, 55 (2), 648–658.

Owen W.F., Lowrie E.G.: C-reactive protein as an outcome predictor for maintenance hemodialysis patients. Kidney Int. 1998, 54 (2), 627–636.

Yeun J.Y., Levine R.A., Mantadilok V., Kaysen G.A.: C-reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis. 2000, 35 (3), 469–476.

Avram M.M., Fein P.A., Paluch M.M., Schloth T., Chattopadhyay J.: Association between C-reactive protein and clinical outcomes in peritoneal dialysis patients. Adv Perit Dial. 2005, 21, 154–158.

Wang A.Y., Woo J., Lam C.W., Wang M., Sea M.M., Lui S.F. et al.: Is a single time point C-reactive protein predictive of outcome in peritoneal dialysis patients? J Am Soc Nephrol. 2003, 14 (7), 1871–1879.

Hakim R.M., Levin N.: Malnutrition in hemodialysis patients. Am J Kidney Dis. 1993, 21 (2), 125–137.

Mittman N., Avram M.M., Oo K.K., Chattopadhyay J.: Serum prealbumin predicts survival in hemodialysis and peritoneal dialysis, 10 years of prospective observation. Am J Kidney Dis. 2001, 38, 1358–1364.

Balafa O., Halbesma N., Struijk D.G., Dekker F.W., Krediet R.T.: Peritoneal albumin and protein losses do not predict outcome in peritoneal dialysis patients. Clin J Am Soc Nephrol. 2011, 6 (3), 561–566.

Chan M., Kelly J., Batterham M., Tapsell L.: Malnutrition (subjective global assessment) scores and serum albumin levels, but not body mass index values, at initiation of dialysis are independent predictors of mortality, a 10-year clinical cohort study. J Ren Nutr. 2012, 22 (6), 547–557.


Copyright (c) 2015 Joanna Bober, Olech Mazur, Edyta Gołembiewska, Anna Bogacka, Karina Sznabel, Dobrosława Stańkowska-Walczak, Joanna Kabat-Koperska, Ewa Stachowska

License URL: