Daily dietary energy and macronutrient intake and anthropometric measurements of the peritoneal dialysis patients

INTRODUCTION

This study was planned to investigate the relation between dietary macronutrient status and anthropometric measurements in peritoneal dialysis (PD) patients.

MATERIALS AND METHODS

A total of 28 clinically stable patients were enrolled in this study. All patients were taken a dietary therapy according to the guidelines of the American Journal of Kidney Foundation for 12 weeks. The anthropometric measurements were taken by bioelectrical impedance analyzer. The daily macronutrient intakes of the patients were calculated by the food consumption records.

RESULTS

The mean age was 48.3 ± 13.10 years [56.3 ± 7.41 years for males (n = 14) and 40.3 ± 12.84 years for females (n = 14)]. There were significant changes in fat percentage (%), total body water (TBW; %, L), extracellular water (ECW; %, L), basal metabolic rate over body weight (BMR/BW), and body fat mass index (BMFI) in males (p < 0.05), but there was no change in females (p > 0.05). The daily dietary energy and protein intakes were under the recommended level in the study period.

CONCLUSION

Patients undergoing PD frequently have low intakes of protein and energy. It is recommended that individuals undergoing PD periodically maintain 3-day dietary records followed by dietary interviews conducted by a dietitian.

Salt intake and hypervolemia in the development of hypertension in peritoneal dialysis patients

Peritoneal dialysis (PD) patients are often volume-expanded and have higher-than-normal blood pressure (BP) levels. In the present study, we aimed to investigate the role of fluid balance and salt intake for BP control in our PD patients. The study included 37 patients undergoing PD and having complete data for 3 consecutive months. Patients were allocated to one of two groups based on measured BP in the preceding 3 months: hypertensive patients (BP > 140/90 mmHg) and normotensive patients (did not meet the hypertensive BP criteria). Volume status was evaluated by bioimpedance analysis. The 37 patients (18 women, 19 men) had a mean age of 46.4 years. The hypertensive and normotensive groups included 17 and 20 patients respectively. Sex, age, and time on PD were similar between the groups. Weight (77.3 +/- 20.3 kg vs. 64.5 +/- 9.8 kg, p < 0.05), total sodium load (2649.2 +/- 621.9 mmol vs. 2272.4 +/- 511.9 mmol, p < 0.05), daily total sodium removal (160.5 +/- 74.4 mmol vs. 112.1 +/- 48.0 mmol, p < 0.05), extracellular water (19.4 +/- 4.3 L vs. 16.4 +/- 3.5 L, p < 0.05), and normalized extracellular water (11.6 +/- 1.9 L vs. 10.1 +/- 1.8 L, p < 0.05) were all significantly higher in the hypertensive group. Despite higher fluid and sodium removal, hypertensive patients were more hypervolemic than normotensive patients. Increasing fluid and salt removal by peritoneal ultrafiltration results in an increased financial burden and also causes serious clinical problems. Restricting fluid and salt intake is an alternative and safer strategy to maintain good fluid balance.

Cavernous sinus syndrome caused by metastatic colon carcinoma

Cranial metastasis has been reported as infrequent during colon cancers and usually occurs in the late stages with liver and/or lung metastasis. Metastasis to cavernous sinus is even rarer and only reported as case reports in the literature. In patients with cavernous sinus metastasis, the most common primary sites are the breast, lung, and genitourinary carcinomas, if head and neck tumors are excluded. A 34-year-old man underwent a right hemicolectomy for a mucinous adenocarcinoma of the right colon 14 months before presentation. Because metastatic implants on the omentum were detected during the operation, combination chemotherapy was begun. After 5 months of the last cycle of the chemotherapy, his left eyelid began to droop, left eye movements became limited, and he began experiencing numbness of his right forehead and cheek. Clinical and radiologic findings were discussed. Despite antiedematous treatment and radiation therapy, he did not experience marked improvement of his symptoms. He could not be given chemotherapy and died 2.5 months after the first symptom of cavernous sinus metastasis. Primary colon adenocarcinoma with cavernous sinus metastasis is very rare. It was hypothesized that the paravertebral plexus of Batson could permit the spread of tumor cells from pelvis toward the cranium. This could explain the metastases from pelvis to the cavernous sinus, such as in our case. Prognosis for the patients with cavernous sinus metastasis seems to be poor, and this might be the harbinger of rapid progression with widespread disease.

Membranous nephropathy associated with acute myeloid leukemia

Membranous nephropathy is the most common cause of adult-onset idiopathic nephrotic syndrome. Glomerular disease has been reported to occur in association with a wide variety of malignancies, particularly carcinomas and lymphomas. With the case reported here, we relate acute myeloid leukemia with membranous glomerulonephritis, depending on the previous literature reports about the association of malignancies and glomerulopathies.