Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Advanced wasting in peritoneal dialysis patients
Zhi Xu, Glen H Murata, Robert H Glew, Yijuan Sun, Darlene Vigil, Karen S Servilla, Antonios H Tzamaloukas
Zhi Xu, Nephrology Division, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
Glen H Murata, Research Service, Raymond G. Murphy Veterans Affairs Medical Center, Albuquerque, NM 87108, United States
Robert H Glew, Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
Yijuan Sun, Darlene Vigil, Karen S Servilla, Renal Section, Medicine Service, Raymond G. Murphy VA Medical Center, Albuquerque, NM 87108, United States
Yijuan Sun, Darlene Vigil, Karen S Servilla, Antonios H Tzamaloukas, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
Antonios H Tzamaloukas, Research Service and Renal Section, Raymond G. Murphy VA Medical Center, Albuquerque, NM 87108, United States
Author contributions: Xu Z composed the first draft of this report; Murata GH made the statistical analysis and critical changes in the report; Glew RH made critical changes in the report; Sun Y assisted in the collection of data and made critical changes in the report; Vigil D assisted in the collection of data and made critical changes in the report; Servilla KS assisted in the collection of data and made critical changes in the report; Tzamaloukas AH designed the study and assisted in the collection of the data and the writing of the report.
Institutional review board statement: This study was reviewed and approved by the Human Research Committee of the Raymond G. Murphy VA Medical Center.
Informed consent statement: Patients were not required to give informed consent to the study because the study used anonymous clinical data that were obtained to evaluate nutrition and adequacy of dialytic treatment to which each patient had agreed.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonios H Tzamaloukas, MD, MACP, Emeritus Professor of Medicine, University of New Mexico School of Medicine, Physician (Raymond G. Murphy VA Medical Center), Renal Section (111C), Raymond G. Murphy VA Medical Center, 1501 San Pedro, SE, Albuquerque, NM 87108, United States.
antonios.tzamaloukas@va.gov
Telephone: +1-505-2651711-4733 Fax: +1-505-2566441
Received: November 8, 2016
Peer-review started: November 10, 2016
First decision: December 1, 2016
Revised: February 17, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: May 6, 2017
Processing time: 177 Days and 4.1 Hours
AIM
To identify patients with end-stage renal disease treated by peritoneal dialysis (PD) who had zero body fat (BF) as determined by analysis of body composition using anthropometric formulas estimating body water (V) and to compare nutritional parameters between these patients and PD patients whose BF was above zero.
METHODS
Body weight (W) consists of fat-free mass (FFM) and BF. Anthropometric formulas for calculating V allow the calculation of FFM as V/0.73, where 0.73 is the water fraction of FFM at normal hydration. Wasting from loss of BF has adverse survival outcomes in PD. Advanced wasting was defined as zero BF when V/0.73 is equal to or exceeds W. This study, which analyzed 439 PD patients at their first clearance study, used the Watson formulas estimating V to identify patients with VWatson/0.73 ≥ W and compared their nutritional indices with those of PD patients with VWatson/0.73 < W.
RESULTS
The study identified at the first clearance study two male patients with VWatson/0.73 ≥ W among 439 patients on PD. Compared to 260 other male patients on PD, the two subjects with advanced wasting had exceptionally low body mass index and serum albumin concentration. The first of the two subjects also had very low values for serum creatinine concentration and total (in urine and spent peritoneal dialysate) creatinine excretion rate while the second subject had an elevated serum creatinine concentration and high creatinine excretion rate due, most probably, to non-compliance with the PD prescription.
CONCLUSION
Advanced wasting (zero BF) in PD patients, identified by the anthropometric formulas that estimate V, while rare, is associated with indices of poor somatic and visceral nutrition.
Core tip: This retrospective study of patients with end-stage renal disease treated by peritoneal dialysis (PD) analyzed the relationship between advanced wasting and other indicators of nutritional status, including body weight and serum albumin concentration. Advanced wasting was defined as zero body fat based on estimates of body water obtained from formulas based on gender, age, height and weight. Only two male patients, both young, were identified as having advanced wasting among the 439 patients (262 men and 177 women) on PD we studied. Both of these patients with advanced wasting had poor nutrition as evidenced by their remarkably low body weights and serum albumin levels. We conclude that advanced wasting, as defined in this study, is rare in patients on PD, but when present is strongly indicative of an exceedingly poor overall state of nutrition.
