Pathophysiology and Individualized Nutritional Intervention for Peritoneal Dialysis-Related Nutritional Metabolic Imbalance Syndrome: A Scoping Review.

BACKGROUND

This review introduces the concept of peritoneal dialysis-related nutritional metabolic imbalance syndrome (PD-NMIS), defines its diagnostic criteria and severity grading based on authoritative guidelines, elucidates its pathophysiology, and proposes a graded framework for individualized nutritional intervention.

OBJECTIVES

To construct a systematically literature-based conceptual framework for PD-NMIS.

METHODS

This scoping review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and Joanna Briggs Institute (JBI) methodology. Systematic searches were conducted in PubMed, Web of Science, EBSCO Academic Search Premier (EBSCO-ASP), China National Knowledge Infrastructure, and Wanfang Med Online (2010-2026), supplemented by searching 10 professional organization websites. From 1893 initial records, a staged exclusion process yielded 62 included studies, which underwent JBI quality assessment and narrative synthesis.

RESULTS

Diagnosis of PD-NMIS requires ≥1 criterion from category A (protein-energy wasting and inadequate energy intake) and ≥1 from category B (micronutrient deficiencies, fluid and electrolyte disorders, calcium-phosphorus metabolism disorders, and renal anemia). Nutritional interventions are graded by severity: targeted repletion (mild), multitarget combination (moderate), and intensive multimodal therapy (severe). Mild PD-NMIS: optimized protein and energy intake, dietary micronutrient correction, basic electrolyte and mineral management, regular exercise, and monitoring. Moderate PD-NMIS: increased protein and energy targets, oral nutritional supplements (ONSs), amino acid-based PD solution, stricter metabolic control, planned exercise, and multidisciplinary assessment. Severe PD-NMIS: hospitalization with high-dose enteral or parenteral nutrition, optimized dialysis adequacy, intensive etiological treatment, control of catabolic drivers, bed-based exercise, and daily multidisciplinary monitoring.

CONCLUSIONS

PD-NMIS is a literature-based proposed conceptual framework encompassing 6 core components of nutritional exhaustion and metabolic disorders. This review proposes its diagnostic criteria, severity grading, and a graded framework for individualized nutritional intervention, all of which warrant external validation in future studies.