Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Nutritional status and protein intake in peritoneal dialysis patients

John M Burkart, MD
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD


Moderate to severe malnutrition (also called protein-energy wasting) is associated with an increased risk of death in patients on both hemodialysis and peritoneal dialysis. The early identification and treatment of malnutrition may improve nutritional status and patient outcome.

This topic reviews malnutrition among patients treated with peritoneal dialysis. Malnutrition among hemodialysis patients and among patients with chronic kidney disease who are not on dialysis is discussed elsewhere. (See "Patient survival and maintenance dialysis", section on 'Malnutrition' and "Overview of the management of chronic kidney disease in adults", section on 'Malnutrition'.)

Malnutrition among older patients in the general population is discussed elsewhere. (See "Hospital management of older adults", section on 'Malnutrition'.)


The diagnosis of malnutrition (protein-energy wasting) is based upon biochemical measures, anthropomorphic parameters, and history of dietary intake. In 2008, the International Society for Renal Nutrition and Metabolism (ISRNM) published standardized criteria for the diagnosis [1].

Four categories of criteria are recognized:


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Feb 4, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int 2008; 73:391.
  2. Marckmann P. Nutritional status of patients on hemodialysis and peritoneal dialysis. Clin Nephrol 1988; 29:75.
  3. Young GA, Kopple JD, Lindholm B, et al. Nutritional assessment of continuous ambulatory peritoneal dialysis patients: an international study. Am J Kidney Dis 1991; 17:462.
  4. Teehan BP, Schleifer CR, Brown JM, et al. Urea kinetic analysis and clinical outcome on CAPD. A five year longitudinal study. Adv Perit Dial 1990; 6:181.
  5. Rocco MV, Jordan JR, Burkart JM. The efficacy number as a predictor of morbidity and mortality in peritoneal dialysis patients. J Am Soc Nephrol 1993; 4:1184.
  6. Keshaviah PR, Nolph KD, Moore HL, et al. Lean body mass estimation by creatinine kinetics. J Am Soc Nephrol 1994; 4:1475.
  7. Flanigan MJ, Bailie GR, Frankenfield DL, et al. 1996 Peritoneal Dialysis Core Indicators Study: report on nutritional indicators. Perit Dial Int 1998; 18:489.
  8. Centers for Medicare and Medicaid Services, Kinney R. 2005 Annual Report: ESRD Clinical Performance Measures Project. Am J Kidney Dis 2006; 48:S1.
  9. Mehrotra R, Duong U, Jiwakanon S, et al. Serum albumin as a predictor of mortality in peritoneal dialysis: comparisons with hemodialysis. Am J Kidney Dis 2011; 58:418.
  10. Prasad N, Gupta A, Sinha A, et al. Changes in nutritional status on follow-up of an incident cohort of continuous ambulatory peritoneal dialysis patients. J Ren Nutr 2008; 18:195.
  11. Nolph KD, Moore HL, Prowant B, et al. Continuous ambulatory peritoneal dialysis with a high flux membrane. ASAIO J 1993; 39:904.
  12. Burkart JM, Jordan J, Rocco MV. Cross sectional analysis of D/P creatinine ratios versus serum albumin values in NIPD patients. Perit Dial Int 1994; 14(Suppl 1):S18.
  13. Nolph KD, Moore HL, Prowant B, et al. Cross sectional assessment of weekly urea and creatinine clearances and indices of nutrition in continuous ambulatory peritoneal dialysis patients. Perit Dial Int 1993; 13:178.
  14. Hylander BI, Dalton CB, Castell DO, et al. Effect of intraperitoneal fluid volume changes on esophageal pressures: studies in patients on continuous ambulatory peritoneal dialysis. Am J Kidney Dis 1991; 17:307.
  15. Hylander B, Barkeling B, Rössner S. Eating behavior in continuous ambulatory peritoneal dialysis and hemodialysis patients. Am J Kidney Dis 1992; 20:592.
  16. Bouma SF, Dwyer JT. Glucose absorption and weight change in 18 months of continuous ambulatory peritoneal dialysis. J Am Diet Assoc 1984; 84:194.
  17. Kang SH, Cho KH, Park JW, et al. Impact of heavy proteinuria on clinical outcomes in patients on incident peritoneal dialysis. BMC Nephrol 2012; 13:171.
  18. Dombros N, Dratwa M, Feriani M, et al. European best practice guidelines for peritoneal dialysis. 2 The initiation of dialysis. Nephrol Dial Transplant 2005; 20 Suppl 9:ix3.
  19. Blumenkrantz MJ, Kopple JD, Moran JK, Coburn JW. Metabolic balance studies and dietary protein requirements in patients undergoing continuous ambulatory peritoneal dialysis. Kidney Int 1982; 21:849.
  20. Diamond SM, Henrich WL. Nutrition and peritoneal dialysis. In: Nutrition and the Kidney, Mitch WE, Klahr S (Eds), Little, Brown, Boston 1988. p.198.
  21. Bergström J, Lindholm B. Nutrition and adequacy of dialysis. How do hemodialysis and CAPD compare? Kidney Int Suppl 1993; 40:S39.
  22. Nolph KD. What's new in peritoneal dialysis--an overview. Kidney Int Suppl 1992; 38:S148.
  23. Mehrotra R, Chiu YW, Kalantar-Zadeh K, et al. Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med 2011; 171:110.
  24. http://www.usrds.org/2013/view/Default.aspx (Accessed on June 02, 2014).
  25. Lindsay RM, Spanner E, Heidenheim RP, et al. Which comes first, Kt/V or PCR--chicken or egg? Kidney Int Suppl 1992; 38:S32.
  26. McCusker FX, Teehan BP, Thorpe KE, et al. How much peritoneal dialysis is required for the maintenance of a good nutritional state? Canada-USA (CANUSA) Peritoneal Dialysis Study Group. Kidney Int Suppl 1996; 56:S56.
  27. Lindsay RM, Nesrallah G, Suri R, et al. Is more frequent hemodialysis beneficial and what is the evidence? Curr Opin Nephrol Hypertens 2004; 13:631.
  28. Li PK, Culleton BF, Ariza A, et al. Randomized, controlled trial of glucose-sparing peritoneal dialysis in diabetic patients. J Am Soc Nephrol 2013; 24:1889.
  29. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 1996; 7:198.
  30. Misra M, Nolph KD, Khanna R, et al. Retrospective evaluation of renal kt/V(urea) at the initiation of long-term peritoneal dialysis at the University of Missouri: relationships to longitudinal nutritional status on peritoneal dialysis. ASAIO J 2003; 49:91.
  31. Heaf JG, Sarac S, Afzal S. A high peritoneal large pore fluid flux causes hypoalbuminaemia and is a risk factor for death in peritoneal dialysis patients. Nephrol Dial Transplant 2005; 20:2194.
  32. Stenvinkel P, Heimbürger O, Paultre F, et al. Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 1999; 55:1899.
  33. de Mutsert R, Grootendorst DC, Axelsson J, et al. Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients. Nephrol Dial Transplant 2008; 23:2957.