Nutrition in diabetic patients undergoing continuous ambulatory peritoneal dialysis.

I n the pre-dialysis stage, the nutritional management of diabetic patients with chronic renal fail ure involves mainly caloric and protein intake and control of blood sugar. These aspects are very important because severity of hyperglycemia is correlated with the rate of progression of chronic renal failure, while strict glycemic control can markedly diminish the likelihood of nephropathy and retinopathy in patients with insulindependent diabetes (IDDM, type l) (1). Good glycemic control before starting dialysis has been shown to be an independent predictor of survival in patients with non insulin-dependent diabetes (NIDDM, type II) on continuous ambulatory peritoneal dialysis (CAPD); on the other hand, patients with poor glycemic control before dialysis have increased morbidity and shortened survival (2). Regarding protein restriction that may delay the progression of renal dis ease (3), one should avoid overzealous restriction, which would lead to protein malnutrition that may negatively affect outcome during subsequent dialysis. Adequate protein intake is important in end-stage renal disease (ESRD) in diabetic patients treated with either chronic hemodialysis or peritoneal dialysis, because mortality increases in a dose-dependent fashion with the degree of protein malnutrition. Protein-caloric malnutrition is a major complication of CAPD. An international cross-sectional study of 224 CAPD patients showed that 33% had mild malnutrition and 8% had severe malnutrition (4). In this study, female patients and diabetic patients were malnourished more frequently than male patients and non diabetic patients. Old age, long duration of CAPD, and minimal or absent residual renal function were factors predisposing to severe malnutrition.