1996 Peritoneal Dialysis Core Indicators Study: report on nutritional indicators.

ABSTRACT

OBJECTIVE: The 1996 Peritoneal Dialysis Core Indicators Study illustrates the conduct of peritoneal dialysis in the United States during 1996. DESIGN AND PATIENT POPULATION The survey is a medical records audit of 1317 randomly selected adult U.S.A. Medicare patients using peritoneal dialysis during 1996. OUTCOME MEASURES: Abstracted data included basic demographic characteristics, dialysis prescription, delivered dialysis dose, residual renal function, serum albumin, hematocrit, anemia management, and patient status. RESULTS: The survey included 785 patients using continuous ambulatory peritoneal dialysis (CAPD) and 423 using automated peritoneal dialysis (APD) primarily in the form of continuous cycling peritoneal dialysis (CCPD). Except for the prescription mechanics and a greater likelihood that African-Americans would use CAPD, the groups did not differ substantially from one another. Evaluation of patient weight (W), body mass index (BMI), residual renal function, average serum albumin, protein equivalent of nitrogen appearance (nPNA), and dialysis efficiency as weekly fractional urea nitrogen removal (wKt/Vurea) and weekly creatinine clearance (wCrCl) revealed a picture of reasonable dialysis delivery and marginal protein nutrition. Additionally, there was little evidence that "dialysis efficiency," over the range assessed, had a major influence on nutritional status. Despite a tendency toward obesity (body weight = 76.6+/-20.0 kg and BMI = 27+/-7), 47% of patients had an average serum albumin below"normal" (3.5 g/dL by bromcresol green) and 70% had a nPNA below 1.0 g/kg/day. CONCLUSIONS: Peritoneal dialysis patients appear to have marginal protein reserves despite surfeit energy stores.