Cross-sectional assessment of nutritional and immune status in renal patients undergoing continuous ambulatory peritoneal dialysis.

Malnutrition prevalence and immunocompetence were assessed in uremic patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Forty-two males and twenty-four females with kidney disease treated with CAPD were distributed into three groups according to the length of time they had been undergoing dialysis. Group 0 included patients beginning dialysis; group 1, patients undergoing CAPD for < 30 mo; and group 2, patients undergoing CAPD for > 30 mo. Body weight and body mass index were greater in patients who had been undergoing CAPD for longer periods of time (approximately 11% in males and 14% in females), which was accompanied by higher fat stores and muscle mass when assessed through triceps skinfold thickness and arm muscle measurements. These differences were more apparent in females than in males. Immunoglobulin M values were lower in patients in groups 1 and 2 than in group 0, whereas retinol binding protein, fibronectin, and C4 were higher. Estimated protein intake was higher in predialysis patients (1.31 g.d-1.kg-1) than in the other groups (approximately 0.95 g.d-1.kg-1). The percentage of B cells decreased with time on dialysis. Although no changes in total or helper T cells were found, a significant rise was noted for the T cell subpopulation with assumed suppressor and cytotoxic activities and for natural killer cells in those patients undergoing longer periods of CAPD treatment. Alterations in immune cell numbers in immunoglobulins and complement proteins might be responsible for immunologic disturbances and infectious processes occurring in patients with chronic renal failure and undergoing CAPD.