Manual of Clinical Nutrition

Medical Nutrition Therapy for Chronic Kidney Disease

Manual of Clinical Nutrition Management G- 16 Copyright © 20 13 Compass Group, Inc.

Estimates of Calories Absorbed in Peritoneal Dialysis

Energy requirements and nutrient intake calculations for patients who receive peritoneal dialysis should
include carbohydrate absorption from the dialysate. The most accurate method of determining the energy
load is to measure the grams of glucose in the effluent and compare that with the grams of glucose infused (2).

Simple estimate of glucose absorption in peritoneal dialysis: The following quick estimate does not
consider the peritoneal equilibration test (2)
For CCPD: [(dextrose % x L) x 3.4] x 40% = energy (kcal)(2)

For CAPD: [(dextrose % x L) x 3.4] x 60% = energy (kcal)(2)

Glucose absorbed (kcal)(2) = Glucose infused (mL) x 40% APD* or Glucose infused (mL) x 60% absorption

(CAPD). For a 1-L volume of dialysate in CAPD:

1.5% = 15 g x 3.4 kcal/g = 51 kcal x 60% = 31 kcal/L

2.5% = 25 g x 3.4 kcal/g = 85 kcal x 60%= 51 kcal/L

4.25% = 42.5 g x 3.4 kcal/g = 144.5 kcal x 60% = 86.7 kcal/L

*APD-automated peritoneal dialysis

Example (2): A patient on CAPD uses 4 L of 1.5% solution and 4 L of 4.25% solution.

4L, 1.5% = 124 kcal

4L, 4.25% = 346 kcal

Total = 470 kcal

*The Academy of Nutrition and Dietetics has assigned grades, ranging from Grade I (good/strong) to Grade V (insufficient evidence), to
evidence and conclusion statements. The grading system is described in Section III: Clinical Nutrition Management A Reference Guide,
page III-1.

References

1. Chronic Kidney Disease Evidence-Based Nutrition Practice Guideline. Academy of Nutrition and Dietetics Evidence Analysis Library.
   Academy of Nutrition and Dietetics; 2010. Available at: http://www.andevidencelibrary.com. Accessed February 4, 2013.


2. McCann L, ed. Pocket Guide to Nutrition Assessment of the Patient with Chronic Kidney Disease. 4th ed. New York, NY: National Kidney
   Foundation; 2009. Available at http://www.kidney.org/professionals/crn/pocketGuide/index.cfm.


3. Wolk R, Moore E, Foulks C. Renal disease. In: Mueller CM, ed. The A.S.P.E.N. Adult Nutrition Support Core Curriculum: A Case-Based
   Approach—The Adult Patient. Silver Spring, Md: American Society For Parenteral and Enteral Nutrition; 2012:492-510.


4. Kopple JD, Massry SG, eds. Nutrition Management of Renal Disease. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2004.


5. Chronic kidney disease. In: The Nutrition Care Manual. Updated annually. The Academy of Nutrition and Dietetics. Available at:
   http://www.nutritioncaremanual.org. February 4, 2013..


6. Renal Practice Group of the American Dietetic Association. National Renal Diet: Professional Guide. 2nd ed. Chicago, Ill: American
   Dietetic Association; 2002.


7. Caggiula AW, Levey AS. MDRD Study data suggest benefits of low-protein diets. J Am Diet Assoc. 1995;95:1289.


8. National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic
   Kidney Disease. Am J Kidney Dis. 2007;49(suppl 2): S12-S154.


9. National Kidney Foundation. KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. Am J
   Kidney Dis. 2003;42(suppl 3): S1-S201.


10. Hsu CH. Are we mismanaging calcium and phosphate metabolism in renal failure? Am J Kidney Dis. 1997;29:641-649.


11. Malluche HH, Monier-Faugere MC. Hyperphosphatemia: pharmacologic intervention yesterday, today and tomorrow. Clin Nephrol.
    2000;54:309-317.


12. Renagel [package insert]. Cambridge, Mass: Genzyme Corp; 2001.


13. Slatopolsky E., Martin KJ, Sherrard DJ. Should vitamin D analogs be the therapy of preference for ESRD patients with secondary
    hyperparathyroidism? Dial Transplantation. 2001;30:190-195.


14. Wiggins KL, ed. Guidelines for Nutrition Care of Renal Patients. 3rd ed. Chicago, Ill: American Dietetic Association; 2002.

Bibliography
Centers for Medicare & Medicaid Services. End Stage Renal Disease (ESRD) Program Interpretive Guidance Version 1.1. October 2008
update. Baltimore Md: Dept of Health and Human Services; 2008. Ref: S&C- 09 - 01.
National Kidney Foundation. KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and
Stratification. Am J Kidney Dis. 2002;39(suppl 1):S1-S266.