Adaptation of CAPD patients to the continuous peritoneal energy uptake

Continuous ambulatory peritoneal dialysis (CAPD) treatment is the first continuously working detoxification procedure applied to uremic patients. However, the uninterrupted exposure of artificial fluids to the organism is accompanied by some side effects among which the continuous absorption of D-glucose from the dialysate is unequivocal: Figures presented in available literature report from approximately 50 to 200g per day [1–3]. Excess energy uptake is currently regarded to be one major risk factor for the development of atherosclerosis and diabetes mellitus. The continuing absorption of large amounts of D-glucose from the dialysate therefore would add to the already enlarged cardiovascular risk of patients on maintenance dialysis. However, in recent years clinical observations of CAPD patients have indicated that no seriously dangerous consequences in metabolism are initiated. The patients obviously develop a mechanism enabling them to compensate for the continuous peritoneal energy uptake.The aim of this investigation is to quantify mechanisms by which an adaptation to this mandatory energy uptake occurs. This was accomplished by determining the distribution of energy uptake fractions in nutrition and dialysate of CAPD patients with a free choice of food. In addition, the responses of insulin and growth hormone to an oral D-glucose tolerance test were evaluated. Furthermore, the course of lipid concentration in serum was studied over a period of approximately 2 years. The results show that a change in the nutritional habits is responsible for the adaptation to the peritoneal D-glucose uptake. Additionally, hormone abnormalities, specific for uremia, are improved in CAPD. However, a significant rise in cholesterol serum concentration must be noticed