Nephrologie & therapeutique · 2026
[Nutritional monitoring in peritoneal dialysis: Biological and non-biological markers and dietary strategies].
СтатьяОбзорАннотация на английскомНазвание и аннотация: Перевод в очереди
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Trolonge Stanislas, Azar Raymond, Issad Belkacem
Аннотация
OBJECTIVE: To provide a practical overview of methods for assessing and monitoring nutritional status in patients undergoing PD, as well as the main dietary strategies aimed at preventing or correcting malnutrition.
METHODS: A literature search was conducted in the PubMed and Embase databases for publications published between 2000 and 2025. The search included the following keywords: peritoneal dialysis, nutrition, protein-energy wasting, nPNA, dietary management, and nutritional assessment. International guidelines from the Kidney Disease Outcomes Quality Initiative (KDOQI), the International Society of Renal Nutrition and Metabolism (ISRNM), and the French National Authority for Health (HAS), together with observational studies, clinical trials, and relevant reviews on nutritional monitoring in PD, were analyzed.
RESULTS: Nutritional assessment in PD relies on a multidimensional approach combining biological markers (albumin and prealbumin, interpreted in the context of inflammation); composite indices including the malnutrition-inflammation score (MIS), prognostic nutritional index (PNI), and subjective global assessment (SGA); evaluation of dietary intake; and functional tools such as handgrip strength and bioimpedance analysis. Calculation of normalized protein nitrogen appearance (nPNA) provides a useful indicator of protein intake and helps guide nutritional prescriptions. Current recommendations advocate a protein intake of approximately 1.2-1.3 g/kg/day, adjusted for dialysis-related protein losses and inflammatory status. Glucose absorption from the dialysate should also be taken into account when estimating energy intake. Management of sodium, phosphorus, potassium, and calcium intake is essential to limit metabolic and cardiovascular complications. Balanced dietary patterns, such as an adapted Mediterranean diet or well-designed plant-based approaches, may contribute to improving nutritional status.
CONCLUSION: Nutritional management of patients undergoing PD requires regular multidisciplinary assessment combining biological, clinical, and dietary indicators. An individualized approach that accounts for dialysis-related losses and patient-specific characteristics is essential to prevent malnutrition and improve long-term outcome.
METHODS: A literature search was conducted in the PubMed and Embase databases for publications published between 2000 and 2025. The search included the following keywords: peritoneal dialysis, nutrition, protein-energy wasting, nPNA, dietary management, and nutritional assessment. International guidelines from the Kidney Disease Outcomes Quality Initiative (KDOQI), the International Society of Renal Nutrition and Metabolism (ISRNM), and the French National Authority for Health (HAS), together with observational studies, clinical trials, and relevant reviews on nutritional monitoring in PD, were analyzed.
RESULTS: Nutritional assessment in PD relies on a multidimensional approach combining biological markers (albumin and prealbumin, interpreted in the context of inflammation); composite indices including the malnutrition-inflammation score (MIS), prognostic nutritional index (PNI), and subjective global assessment (SGA); evaluation of dietary intake; and functional tools such as handgrip strength and bioimpedance analysis. Calculation of normalized protein nitrogen appearance (nPNA) provides a useful indicator of protein intake and helps guide nutritional prescriptions. Current recommendations advocate a protein intake of approximately 1.2-1.3 g/kg/day, adjusted for dialysis-related protein losses and inflammatory status. Glucose absorption from the dialysate should also be taken into account when estimating energy intake. Management of sodium, phosphorus, potassium, and calcium intake is essential to limit metabolic and cardiovascular complications. Balanced dietary patterns, such as an adapted Mediterranean diet or well-designed plant-based approaches, may contribute to improving nutritional status.
CONCLUSION: Nutritional management of patients undergoing PD requires regular multidisciplinary assessment combining biological, clinical, and dietary indicators. An individualized approach that accounts for dialysis-related losses and patient-specific characteristics is essential to prevent malnutrition and improve long-term outcome.