Nutritional predictors associated with malnutrition in continuous ambulatory peritoneal dialysis patients

Enhancing nutritional management in peritoneal dialysis patients through a generative pre-trained transformers-based recipe generation tool: a pilot study

Background

Patients undergoing peritoneal dialysis (PD) often face nutritional deficiencies due to inadequate intake, nutrient loss, insufficient dialysis, and a state of micro-inflammatory. Traditional nutritional management methods have not fully met personalized needs. Therefore, this study aimed to develop and evaluate an application for generating recipes based on Generative Pre-trained Transformers to improve the nutritional status of these patients.

Methods

This self-controlled prospective study included 35 patients undergoing PD from January to February 2024. The study was divided into two phases: the initial phase involved conventional dietary education under PD management, followed by a second phase where a new GPT-based dietary guidance tool was introduced. Patients adhered to the diets recommended by the tool. Nutritional intervention effects were assessed by comparing serum prealbumin, albumin, and phosphate levels before and after the intervention.

Results

After the intervention, the mean prealbumin levels significantly improved from 289.04 ± 74.60 mg/L to 326.72 ± 78.89 mg/L (p = 0.001). Although there was no statistical significance, the serum albumin levels in patients increased from 34.70 ± 5.94 g/L to 35.66 ± 5.14 g/L (p = 0.153). Serum phosphate levels remained stable and within safe limits (p = 0.241).

Conclusion

The AI-based recipe generation application significantly improved serum prealbumin levels in PD patients without causing adverse changes in phosphate levels, confirming its efficacy and safety in nutritional management for these patients. This study highlights the potential and practical value of AI technology in nutritional management for patients with chronic disease, providing important evidence for future clinical applications.

Association Between Peritoneal Glucose Absorption, Lipid Metabolism, and Cardiovascular Disease Risk in Nondiabetic Patients on Peritoneal Dialysis

BACKGROUND

Excessive sugar intake increases the energy metabolic burden and the risk of cardiovascular disease (CVD). Patients on peritoneal dialysis absorb much more glucose than the World Health Organization recommends, but the link to CVD is unclear.

OBJECTIVE

To identify the association between peritoneal glucose absorption, lipid metabolism, and CVD.

METHODS

We applied generalized additive mixed effects and mixed effects Cox proportional hazard models to evaluate the impact of peritoneal glucose absorption on lipid profiles and CVD risk. We performed subgroup analyses by using protein intake (normalized protein nitrogen appearance [nPNA] and normalized protein catabolic rate [nPCR] were used to assess protein intake) and high-sensitivity C-reactive protein (hs-CRP).

RESULTS

After multivariable adjustment, peritoneal glucose absorption per 10 g/d increase was associated with an increase in cholesterol of 0.145 (95% confidence interval [CI]: 0.086-0.204) mmol/L. No link with the total risk of CVD was observed; however, protein intake and hs-CRP levels affected the relationship between glucose absorption and CVD risk. Patients with values for nPNA and nPCR <1.0 g/(kg·d) were associated with a lower risk of CVD (hazard ratio [HR] 95% CI: 0.68 (0.46-0.98)) with glucose absorption per 10 g/d increase. While patients with hs-CRP levels ≥3 mg/d or values for nPNA or nPCR ≥1.0 g/(kg·d) were associated with a higher risk of CVD (HR 95% CI: 1.32 (1.07-1.63); 1.31 (1.02-1.68)) for glucose absorption per 10 g/d increase.

CONCLUSIONS

Our study found a positive correlation between peritoneal glucose absorption and lipid profiles. Increased glucose absorption was associated with a lower risk of CVD in lower protein intake patients and a higher risk of CVD in higher hs-CRP or protein intake levels in patients on peritoneal dialysis.

Longitudinal association between dietary protein intake and survival in peritoneal dialysis patients

BACKGROUND

Decreased dietary protein intake (DPI) may lead to protein-energy malnutrition and may be associated with increased mortality risk. We hypothesized that longitudinal changes in dietary protein intake have independent associations with survival in peritoneal dialysis (PD) patients.

METHODS

668 stable PD patients were selected in the study from January 2006 to January 2018 and were followed up until December 2019. Their three-day dietary records were collected at the baseline (the sixth month after PD) and thereafter every 3 months for two and a half years. The latent class mixed models (LCMM) were used to identify subgroups of PD patients with similar longitudinal trajectories of DPI. The relation between DPI (baseline and longitudinal data) and survival was examined using Cox model to estimate death hazard ratios. Meanwhile, different formulae were used to assess nitrogen balance.

RESULTS

The results showed that baseline DPI ≤ 0.60g/kg/day was associated with the worst outcome in PD patients. Patients with DPI 0.80-0.99g/kg/day and DPI ≥ 1.0g/kg/day both presented positive nitrogen balance; patients with DPI 0.61-0.79g/kg/day presented obviously negative nitrogen balance. Longitudinal association between time-dependent DPI and survival was found in PD patients. The consistently low DPI' (0.61-0.79g/kg/d) group was correlated with increased death risk as compared with the 'consistently median DPI' group (0.80-0.99g/kg/d, HR = 1.59, p = 0.008), whereas there was no difference in survival between 'consistently median DPI' group and 'high-level DPI' group (≥1.0 g/kg/d, p > 0.05).

CONCLUSION

Our study revealed that DPI ≥ 0.8 g/kg/day was beneficial to the long-term outcome for the PD population.

A 12-week personalised physical activity and dietary protein intervention for older adults undergoing peritoneal dialysis: A feasibility study

This single-arm observational study explored the feasibility and efficacy of a 12-week personalised physical activity and dietary protein intervention programme for older adults undergoing peritoneal dialysis. Older adults undergoing peritoneal dialysis received eight individualised nutrition and physical activity advice sessions provided by trained nurses. Protein intake and physical activity were regarded as primary outcomes. All data were collected at baseline and at week 12. The enrolment rate was 78.4%. Twenty-nine patients participated in the study. Of these, 86.2% (25/29) completed the intervention. There was a significant increase in protein intake (t = -4.453, P< 0.001) and physical activity levels (Z = -2.929, P = 0.004). Of the participants, 56.0% achieved the targeted protein goal, and 41.4% met the physical activity goal. The timed up-and-go performance (t = 4.135, P = 0.001) increased after intervention. Trained nurses can successfully implement personalised diet and physical activity advice, and achieve promising patient outcomes.