Van den Berg, V. L.Walsh, C. M.Leclercq, Brigitte2015-08-112015-08-112015-02http://hdl.handle.net/11660/813English: CKD includes a variety of heterogeneous disorders which cause progressive structural or functional deterioration of the kidney (KDIGO, 2013). Renal replacement therapy (RRT), becomes necessary when accumulating waste products interfere with normal body functions, and physiologic changes can no longer be controlled by diet and medication alone (KDOQI, 2006; Schrier, 2009). Continuous ambulatory peritoneal dialysis (CAPD), uses the semi-permeable membrane of the peritoneum for dialysis, making it possible for patients to dialyse away from a dialysis unit (Wilkens, Juneja & Shanaman, 2012). No trial to date, has described the nutritional status of the CAPD population in the Eastern Cape, and the effect of protein supplementation in a South African CAPD population has not been investigated. A randomised controlled, open-label trial, was approved by the Ethics Committee of the Faculty of Health Sciences at the University of the Free State. Of the 28 patients receiving CAPD at Frere Hospital in 2012, 26 gave informed consent and were randomised into an experimental (n=13) and a control (n=13) group according to median age, gender, median serum albumin levels and median duration on CAPD. The intervention group were supplemented with a protein powder (Protifar) at 0.65g/kg actual body weight. Socio-demographics, medical histories, and CAPD regiments were recorded at baseline. Nutritional status assessed in terms of anthropometry, Subjective global assessment (SGA) nutrition assessment tool and biochemistry, was followed up monthly over the four month duration of the trial. Adequacy of dialysis was also assessed. Data was analysed with SAS statistical software and compared by 95% confidence intervals for median or percentage differences. The trial population were 76% female, 80% Black, 84% unemployed/receiving a grant; and 84% lived farther than 50 km away for Frere Hospital. Hypertension was the main cause of renal failure in 80%, and the main co-morbidity, in 92%. Most had been using CAPD for five to eight months, as four exchanges per day, and 69% also had a HD line. At baseline none were underweight based on body mass index (BMI) (calculated from dry weight); rather 35% were overweight/obese. Based on upper arm muscle area (AMA.) none were wasted. SGA nutrition assessment tool identified 23% as mildly to moderately malnourished, and only one participant as severely malnourished. Yet, most participants had inadequate intakes of energy (72%), protein (56%), HBV protein (64%), carbohydrate (52%) and fat (60%); and 92% had below normal serum albumin levels. Serum phosphate, urea and creatinine levels were elevated above normal in 44%, 96% and 100% of participants. Based on Kt/V and creatinine clearance, 90% and 100%, respectively, were inadequately dialysed. Protein supplementation did not statistically significantly impact on any parameter of nutritional status, although slight increases in the median dry weight, AMA and serum albumin levels, which may indicate some clinical benefit, was recorded. Compliance was generally good at above 82.% throughout the trial. As the first trial to describe the socio-demographic and nutritional status profile of patients receiving CAPD in the EC, a similar socio-demographic profile as described in other studies for the South African CAPD population in Johannesburg, Durban and Polokwane was found (Isla et al., 2014; Abdu et al., 2011; Naicker, 2002). The anthropometric profile was however found to be very different to that described for CAPD patients in developed countries, with a high prevalence of overweight/obesity. The causes of the overall inadequate dialysis reflected in highly elevated serum levels of waste products in this study population, needs to be investigate further. Although protein supplementation did not have a statistically significant impact on the nutritional status of CAPD patients in this trial, some non-significant improvements in anthropometry and biochemical indicators, suggest that studies of larger size with supplementation over a longer period of time are needed.Afrikaans: Kroniese niersiekte sluit 'n verskeidenheid van heterogeniese versteurings in wat progressiewe strukturele of funksionele agteruitgang van die nier veroorsaak (KDIGO, 2013). Nier vervangingsterapie (NVT) raak nodig wanneer afvalstowwe inmeng met normale liggaamsfunksie, en fisiologiese veranderinge nie meer deur dieet en medikasie alleen beheer kan word nie (KDOQI 2006; Schrier, 2009). Deurlopende ambulante peritoneale dialise (DAPD) maak gebruik van die semi-deurlaatbare membraan van die peritoneum vir dialise, en maak dit moontlik vir pasiënte om weg te wees van 'n dialise-eenheid (Wilkens, Juneja & Shanaman, 2012). Tot op datum het geen studie die voedingstatus van die DAPD bevolking in die Oos-Kaap beskryf, of die effek van proteïen-aanvullings in 'n Suid-Afrikaanse DAPD bevolking ondersoek nie. 'n Gerandomiseerde gekontroleerde, nie-blinde studie is deur die Etiekkomitee van die Fakulteit Gesondheidswetenskappe aan die Universiteit van die Vrystaat goedgekeur. Van die 28 pasiënte wat DAPD by die Frere-hospitaal ontvang het in 2012, het 26 ingeligte toestemming gegee en is in 'n eksperimentele- (n = 13) en 'n kontrole (n = 13) groep volgens ouderdom, geslag, serum albumienvlakke en tydperk reeds op DAPD, gerandomiseer. Die eksperimentele groep se dieet is aangevul met 'n proteïenpoeier (Protifar) teen 'n dosis van 0.65g / kg werklike liggaamsmassa. Sosio-demografiese inligting, mediese geskiedenis, en DAPD regimente is by basislyn aangeteken. Voedingstatus, in terme van antropometrie, subjektiewe globale assessering (SGA) en biochemie, is maandeliks oor die vier maande verloop van die studie bepaal. Toereikendheid van dialise is ook bepaal. Data is ontleed met SAS statistiese sagteware en vergelyk met 95% vertrouensintervalle vir mediaan of persentasie verskille. Die studie populasie was 76% vroulik, 80% Swart, 84% werkloos / op staatstoelaag; en 84% het verder as 50 km van Frere-hospitaal gewoon. Hipertensie was die hoofoorsaak van nierversaking in 80% van die deelnemers, en die vernaamste komorbiditeit in 92% van die deelnemers. Die meerderheid het al DAPD vir vyf tot agt maande gebruik, teen vier uitruile per dag, en 69% het ook 'n HD lyn gehad. Gebaseer op liggaamsmassa-indeks (LMI) (bereken met droë massa) was niemand in die studiepopuladie ondermassa by basislyn nie, en 35% was oorgewig / vetsugtig. Gebaseer op die bo-arm spierarea (BASA) was geen deelnemers ondervoed nie. SGA het 23% as effens tot matig ondervoed geklassifiseer, en slegs een deelnemer was as erg ondervoed geklassifiseer. Die meeste deelnemers het onvoldoende inname van energie (72%), proteïen (56%), HBV proteïen (64%), koolhidrate (52%) en vet (60%) gehad; en 92% se serum albumienvlakke was laer as normaal. Serum fosfaat-, ureum- en kreatinienvlakke was hoёr as normaal in 44%, 96% en 100% van die deelnemers. Gebaseer op Kt / V en kreatinienopruiming, was dialise onvoldoende in 90% en 100% onderskeidelik. Proteïen het nie ‘n statisties beduidende invloed op enige parameters van voedingstatus gehad nie, hoewel geringe toenames in die mediaan droë gewig, BASA en serum albumienvlakke wel waargneem is, wat moontlik op 'n kliniese voordeel dui Nakoming van die supplementasie was oor die algemeen goed: bo 82% deur die verloop van die studie. Daar is bevind dat DAPD pasiënte in die Ooskaap 'n soortgelyke sosio-demografiese profiel het as wat in Johannesburg, Durban en Polokwane, beskryf is in ander studies (Isla et al, 2014; Abdu et al, 2011; Naicker, 2002). Daar is egter bevind dat die antropometriese profiel baie verskil van wat beskryf word vir DAPD pasiënte in ontwikkelde lande, met 'n hoër voorkoms van oorgewig / vetsug. Die oorsake van die algemene onvoldoende dialise, soos weerspieël deur hoogs verhoogde serumvlakke van afvalprodukte in hierdie studie bevolking, moet verder ondersoek word. Alhoewel proteïenaanvulling nie 'n statisties beduidende impak op die voedingstatus van DAPD pasiënte in hierdie bevolking gehad het nie, dui nie-beduidende verbeterings in sommige antropometries- en biochemiese aanwysers dat aanvullingsstudies van groter omvang en langer tydsduur nodig is.en24-hour recallAlbuminChronic kidney diseaseContinuous ambulatory peritoneal dialysisDietary historyHemodialysisStandards of careArm muscle areaBody mass indexProtein energy wastingRenal replacement therapyDiabetes -- Nutritional aspectsChronic renal failure -- TreatmentDisseretation (M.Sc.Dietetics (Nutrition and Dietetics))--University of the Free State, 2015DissertationUniversity of the Free State