The following is a summary of “Weight loss and weight gains in patients starting peritoneal dialysis; the effect of peritonitis,” published in the May 2023 issue of Nephrology by Davenport.

Previous studies have indicated that peritoneal dialysis (PD) patients tend to gain fat mass after initiating dialysis. However, given changes in clinical practice and patient demographics, including earlier initiation of dialysis and an increase in elderly and co-morbid patients, researchers aimed to investigate changes in body composition in PD patients.

They conducted a comparative analysis of body composition changes using dual X-ray absorptiometry (DXA) in a cohort of 151 adult PD patients, including 81 males (54.6%) and 50 diabetic patients (30.1%). The mean age of the cohort was 60.5 ± 16.7 years. Measurements were taken shortly after starting PD and then again a median of 24 months later, allowing for the assessment of the initial impact of dialysis.

Overall, there was no significant change in weight (71.7 ± 15.4 kg vs. 71.9 ± 15.3 kg). However, on follow-up, there was a decrease in total weekly urea clearance from 2.29 (1.85–3.0) to 1.93 (1.63–2.4), an increase in peritoneal glucose absorption from 119 (46–217) to 321 (187–805) mmol/day (p < .001), and a decline in estimated dietary protein intake (nPNA) from 0.92 ± 0.23 to 0.86 ± 0.23 g/kg/day (P = .006). Among the patients, 69 (45.7%) experienced weight gain, and they exhibited a greater change in both lean and fat mass index compared to those who experienced weight loss (0.8 [−0.5 to 2.0] vs. −0.7 [−2.1 to 0.2] kg/m² and 0.9 [−0.1 to 2.3] vs. 0 [−2.6 to 0.8] kg/m, P < .001), respectively. Furthermore, patients who gained weight had fewer episodes of PD peritonitis compared to those who experienced weight loss (0 [0–1] vs. 1 [0–2], P = .019), while no significant differences were observed in hospital admissions.

The findings indicated a decline in dietary protein intake over time and a greater proportion of PD patients experiencing weight loss. The key differentiating factor between patients who gained and lost weight was the occurrence of peritonitis episodes. Increased attention to nutritional support may mitigate the loss of lean body mass in PD patients.

Source: onlinelibrary.wiley.com/doi/10.1111/nep.14161