Abstract
To appraise energy and protein requirements in diabetic dialysis patients, changes in body weight and serum albumin level were studied for three months, and precise diet histories were taken in 20 hemodiysis patients (mean age 58.9±10.7 years) and 22 CAPD patients (mean age 62.3±9.0 years) with diabetes mellitus.
Most diabetic hemodiaysis patients whose daily energy intake was less than 27kcal/kg of standard body weight tended to have decreased body weight and serum albumin, while those whose intake was over 35kcal/kg showed increased body weight and tended to develop obesity. In diabetic CAPD patients whose daily energy intake (represented as dietary intake plus peritoneal absorption of glucose from CAPD dialysate) was less than 28-30kcal/kg, body weight and serum albumin level tended to decrease, while over 35kcal/kg, body weight gradually increased and obesity tended to develop in a short time.
Serum albumin levels and body weight were decreased in the diabetic dialysis patients whose daily protein intake was less than 0.9-1.1g/kg of standard body weight on hemodialysis and 0.7-1.2g/kg on CAPD. However, even in patients whose daily protein intake was over 1.4g/kg, serum albumin levels did not increase in hemodialysis or CAPD patients.
In patients with diabetic renal failure who had been well maintained and rehabilitated on dialysis therapy for over one year, the mean daily energy intake was 31±2.6kcal/kg on hemodialysis and 30±3.4kcal/kg (sum of diet and peritoneal glucose absorption) on CAPD. Mean daily protein intake in these patients was 1.23±0.14g/kg on hemodialysis and 1.18±0.20g/kg on CAPD.
These results suggest that in diabetic dialysis patients the optimal daily energy intake is 31-33kcal/kg of standard body weight on hemodialysis and 30-32kcal/kg (sum of diet and peritoneal glucose absorption) on CAPD, while optimal protein intake is 1.2-1.3g/kg of standard body weight on both hemodialysis and CAPD.
