Clinical Investigation

Kidney International (1982) 21, 849–861; doi:10.1038/ki.1982.109

Metabolic balance studies and dietary protein requirements in patients undergoing continuous ambulatory peritoneal dialysis

Michael J Blumenkrantz, Joel D Kopple, John K Moran and Jack W Coburn

The Medical and Research Services, Veterans Administration Wadsworth Medical Center, and Department of Medicine, University of California, Los Angeles, School of Medicine, Los Angeles, California

Correspondence: Dr J W Coburn, Veterans Administration Wadsworth Medical Center, Nephrology (691/111L), Wilshire and Sawtelle Boulevards, Los Angeles, California 90073, USA

Received 10 February 1981; Revised 23 November 1981.

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Abstract

Metabolic balance studies and dietary protein requirements in patients undergoing continuous ambulatory peritoneal dialysis. Balance studies for nitrogen, potassium, magnesium, phosphorus, and calcium were carried out in eight men undergoing continuous ambulatory peritoneal dialysis (CAPD) to determine dietary protein requirements and mineral balances. Patients were fed high energy diets for 14 to 33 days which provided either 0.98 (seven studies) or 1.44 g (six studies) of primarily high biological value protein/kg body wt/day. Mean nitrogen balance was neutral with the lower protein diet (+0.35 plusminus 0.83 SEM g/day) and strongly positive with the higher protein diet (+2.94 plusminus 0.54 g/day). With the higher protein diet the balances for potassium, magnesium, and phosphorus were strikingly positive, there was an increase in body weight in all patients, and a rise in mid-arm muscle circumference in five of the six patients. The relation between protein intake and nitrogen balance suggests that the daily protein requirement for clinically stable CAPD patients should be at least 1.1 g/kg/day; to account for variability among subjects 1.2 to 1.3 g protein/kg/day is probably preferable. Potassium balance correlated directly with nitrogen balance (r = 0.81). High fecal potassium losses (19 plusminus 1.2 mEq/day) in all patients probably helped maintain normal serum potassium concentrations. Mean serum magnesium was increased (3.1 plusminus 0.1 mg/dl), and magnesium balances were positive suggesting that the dialysate magnesium of 1.85 mg/dl is excessive. The net gain of calcium from dialysate was 84 plusminus 18 mg/day; this correlated inversely with serum calcium levels (r = -0.90).

Bilans métaboliques et besoins protéiques alimentaires de malades en dialyse péritonéale continue ambulatoire. Des études de bilan de l'azote, du potassium, du magnésium, du phosphore et du calcium, étaient fait en sept hommes en dialyse péritonéale continue ambulatoire (CAPD), pour déterminer leurs besoins protéiques alimentaires et leur bilan minéral. Les malades ont reçu pendant 14 à 33 jours des régimes hautement énergétiques, apportant soit 0,98 (sept études), soit 1,44 g (six études) de protéines de haute valeur biologique par kg de poids et par jour. Le bilan azoté moyen etait nul avec le régime comportant la plus faibie teneur protéique (+ 0,35 plusminus 0,88 g/j SEM) et était fortement positive avec le régime à plus forte teneur protéique (+2,94 plusminus 0,54 g/j). Avec le régime à haute teneur en protéine, les bilans potassique, magnésien et phosphoré étaient fortement positifs; le poids corporel s'est élevé chez tous les malades; la circonférence musculaire mesurée du milieu du bras a augmenté chez cinq sur six malades. La relation existant entre l'apport protéique et le bilan azoté suggère que les besoins journaliers en protéines pour des malades cliniquement stables en CAPD devraient être au moins de 1,1 g/kg/j; 1,2 à 1,3 g de protéines/kg/j sont sans doute préférables pour tenir compte de la variabilité entre les sujets. Le bilan potassique était directement corrélé avec la balance azotée (r = 0,81). De fortes pertes potassiques fécales (19 plusminus 1,2 mEq/j) chez tous les malades ont probablement contribué à maintenir normales les concentrations sériques du potassium. La magnésémie moyenne était élevée (3,1 plusminus 0,1 mg/dl), et les bilans magnésiens aient positifs suggérant que le magnésium du dialysat (1,85 18 mg/dl) était trop élevé. Le gain net en calcium à partir du dialysat était de 84 plusminus 18 mg/j; ce gain était inversement corrélé avec la calcémie (r = 0,90).

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