The effect of comorbidity and frailty on dietary intake and protein losses in end-stage kidney disease patients undergoing peritoneal dialysis

Abstract

Abstract End-stage kidney disease (ESKD) patients are advised to follow restricted diets, increasing their risk of malnutrition. We aimed to determine whether co-morbidity and frailty affected dietary intake or protein losses in ESKD patients treated with peritoneal dialysis (PD). We assessed 42 PD patients (mean age 62 ± 16 years) for malnutrition, using the Global Leadership Initiative in Malnutrition (GLIM) criteria, 24-hour dietary recall, bioimpedance, and hand grip strength (HGS), and measured effluent dialysate nitrogen losses. The malnutrition rate was 43%, significantly associated with heart failure (HF) odds ratio (OR) 22.6 (95% Confidence Interval (CI):2.0–259.5, p  = 0.012) and low appendicular lean mass index (ALMI) OR 0.13 (95% CI:0.03–0.55, p  = 0.006). Sarcopenia was associated with lower dietary protein intake (DPI) ( p  < 0.05), and decreased protein losses ( p  < 0.05), whereas Frailty was associated with older age ( p  < 0.001), greater malnutrition risk ( p  < 0.05) and reduced HGS ( p  < 0.05). Diabetic patients also had higher malnutrition risk ( p  < 0.01). HF was associated with male gender ( p  < 0.05), and lower body fat ( p  < 0.05). Increasing numbers of older more co-morbid ESKD patients are being treated with PD, and those with sarcopenia, frailty, diabetes, and HF are at an increased risk of malnutrition. These findings highlight the need for more individualized nutritional assessments.