Nutrition and Delayed Hypersensitivity during Continuous Ambulatory Peritoneal Dialysis in Relation to Peritonitis

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Abstract
Anthropometric measurements, sixteen specific plasma proteins, triglycerides, cholesterol, urea and creatinine were measured at 4-monthly intervals for 1 year in 15 patients on CAPD. Delayed hypersensitivity skin tests were performed on 11 patients at the start and after 4 and 12 months. Body weight increased due mainly to a mean increase in ‘calculated’ body fat of 2.0 kg with increases in cholesterol, triglycerides and apolipoprotein B. Gain in fat correlated with the daily supply of dextrose in the dialysis fluid. Albumin, transferrin, prealbumin and retinol-binding protein decreased in 8 patients who intermittently ate less than 1.3 g protein/kg/day. A high concentration of dextrose in the dialysis fluid probably caused loss of appetite. Peritonitis resulted in increases in acute phase proteins although other plasma proteins decreased. Skin test responses indicated improvement in cell-mediated immunity during continuous ambulatory peritoneal dialysis (CAPD). The incidence of peritonitis and length of stay in hospital were greater in the patients who were hypoalbuminaemic probably due to impairment of the humoral mechanism. Dextrose in dialysis fluid may contribute to hyperlipidaemia and malnutrition with impairment of immunocompetence.