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My wife, Linda, received a phone call from our IPN provider, Pentec Health. She was informed that we would receive a shipment of three of their protein-enhanced five-liter dialysis bags today/Tuesday, and four on Friday. Assuming Lowe’s delivers the refrigerator on Tuesday, we should be good. Also, we are to receive a phone call this afternoon at 1330 to bring us up to speed on the IPN gambit.

In doing research on IPN, a basic question arises. To wit, why do I need this? Why am I not getting enough protein via my diet, which lately has seen a large increase in protein-rich foods? What’s going on here?

I turned to Perplexity with the following Prompt and response:

Prompt: Is it possible that peritoneal dialysis reduces body protein to the extent that the patient is weak, gets winded after the slightest exertion, etc.

Peritoneal dialysis (PD) can contribute to significant protein loss, which may lead to muscle wasting, weakness, and fatigue. Here’s a detailed analysis:

Protein Loss in Peritoneal Dialysis

  • PD patients lose 5–7 grams of protein daily through dialysate, primarily albumin217.
  • This loss occurs because the peritoneum allows serum proteins to leak into the dialysis fluid during exchanges27.

Mechanisms Linking Protein Loss to Weakness

  1. Muscle Wasting (Sarcopenia)
    • Chronic protein loss exacerbates protein-energy wasting, reducing muscle mass and strength37.
    • Uremia, inflammation, and hormonal imbalances further accelerate muscle breakdown34.
  2. Fatigue and Exertional Limitations
    • Protein depletion impairs muscle repair and energy metabolism, causing fatigue and breathlessness during minimal exertion456.
    • Anemia (common in dialysis) reduces oxygen delivery, worsening fatigue6.
  3. Inflammation and Metabolic Dysfunction
    • Chronic inflammation from PD increases catabolism (muscle breakdown)37.
    • Acidosis and insulin resistance further disrupt protein synthesis34.

Contributing Factors

  • Fluid Overload: Exacerbates protein loss and inflammation7.
  • Inadequate Nutrition: PD patients require 1.3g/kg/day of protein to offset losses1. Failure to meet this accelerates muscle loss.
  • Physical Inactivity: A vicious cycle where fatigue reduces activity, further diminishing muscle mass45.

Management Strategies

  • Nutritional Intervention: High-protein diets (e.g., eggs, lean meats) to counter losses13.
  • Exercise: Resistance training preserves muscle mass and reduces fatigue56.
  • Volume Control: Optimizing fluid removal minimizes overhydration-related protein leakage7.

Conclusion

Yes, peritoneal dialysis can deplete body proteins sufficiently to cause weakness and exertional intolerance. This stems from direct protein loss, compounded by inflammation, metabolic dysregulation, and inadequate nutritional compensation. Addressing protein intake, volume status, and physical activity is crucial to mitigate these effects2137.

  1. https://www.dpcedcenter.org/wp-content/uploads/2021/02/Protein-and-Dialysis.pdf
  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC3082414/
  3. https://pmc.ncbi.nlm.nih.gov/articles/PMC12005912/
  4. https://pmc.ncbi.nlm.nih.gov/articles/PMC2582327/
  5. https://www.nhs.uk/tests-and-treatments/dialysis/side-effects/
  6. https://www.dpcedcenter.org/news-events/news/conquering-dialysis-fatigue/
  7. https://pmc.ncbi.nlm.nih.gov/articles/PMC9178188/
  8. https://www.sciencedirect.com/science/article/pii/S0085253815324741
  9. https://onlinelibrary.wiley.com/doi/10.1111/sdi.13194
  10. https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.653807/full
  11. https://www.mdpi.com/2077-0383/12/7/2670
  12. http://www.davita.com/treatment-services/peritoneal-dialysis/protein-and-your-peritoneal-dialysis-diet
  13. https://advancingdialysis.org/peritoneal-dialysis/nutritional-status-concerns-for-peritoneal-dialysis-patients/
  14. https://www.kidney.org/kidney-topics/getting-more-protein-while-dialysis
  15. https://homedialysis.org/news-and-research/blog/547-muscle-stiffness-in-dialysis-patients-tips-to-prevent-and-overcome
  16. https://onlinelibrary.wiley.com/doi/10.1155/2014/614846